[Health status and quality of life in β-thalassemia adults in Marseille, France]

INTRODUCTION

The life expectancy of β-thalassemia patients has increased over the last 20 years. In this study, we evaluated the current health status and quality of life of these patients managed in a reference center in Marseille.

METHODS

This is a single-center, descriptive study conducted between June and August 2019 in patients over 18 years of age with β-thalassemia major or intermedia. Clinical and paraclinical data were collected retrospectively and the SF-36 health survey questionnaire was proposed to each patient.

RESULTS

43 of 64 selected patients were included and divided into 2 groups: 35 patients with transfusion-dependent β-thalassemia and 8 patients with non-transfusion-dependent β-thalassemia. Liver iron overload is the most frequent complication, present in 80% of transfusion-dependent and 62.5% of non-transfusion-dependent patients. Cardiac iron overload is present only in the transfusion dependent β-thalassemia group (20%). Hypogonadotropic hypogonadism remains the most common endocrine disorder (41.9%) followed by osteoporosis (37.2%). Among the 31 patients who completed the SF-36 questionnaire, physical and mental quality of life scores were lowered in transfusion dependent (respectively 42.7 and 46.8) as in non-transfusion-dependent patients (respectively 43.8 and 28.9).

CONCLUSION

Despite an improvement in medical care, our patients with β-thalassemia show an alteration in their quality of life that will need to be characterized in the entire French cohort.

Adolescents' Utilization of a Tertiary-Level Pediatric Emergency Department in Italy

Aim

Describe the use of the emergency department of a tertiary-level children's hospital in Italy by adolescents.

Methods

This retrospective study was based on the medical records of patients aged 13 to 17 years, who accessed the emergency department of the Institute for Maternal and Child Health of Trieste, from 1 January to 31 December 2018. The primary outcome was to describe the leading causes of access, diagnoses, rate of hospitalization, and ward of destination among adolescent patients.

Results

During the study period, 24,599 patients accessed the department. Among them, 3,062 were adolescents, for a total of 3,895 unscheduled visits. The principal causes of access were trauma (45.3%) and organic diseases (38.8%). Two hundred and forty nine adolescents (6.4%) had mental health problems. One hundred and forty two adolescents (3.6%) Were Admitted to the Hospital, 54 of Whom (38%) to the Neuropsychiatric Ward, for Mental Health Problems.

Conclusions

Among adolescents seen in this Italian tertiary-level children's hospital, mental health problems represented a small proportion of emergency department visits but were the leading cause of urgent hospitalization.

Does a standard triage tool adequately detect the needs of children and adolescents admitted for mental health problem?

BACKGROUND

the visits to the paediatric emergency department for mental problems are increasing exponentially, but the emergency department team in not ready enough to manage them, due to the lack of adequate training. This study aimed to evaluate how the Italian Society of Paediatric Emergency Medicine and Urgency triage system was able to estimate urgency in patients accessing the paediatric emergency department for a mental health problem.

METHODS

We conducted a retrospective study at the emergency department of the Institute for Maternal and Child Health, IRCCS Burlo garofolo of Trieste (Italy), from December 2015 to April 2017. During the study period, we identified all the patients undergoing an urgent psychiatric consultation. We collected demographic variables, triage code, diagnosis, and outcomes of each patient. Subsequently, we have assigned a degree of psychiatric urgency, based on Gail and Rosenn's classificationwhich is a specific tool to evaluate psychiatric urgency. The primary study outcome was the comparison between the degree of urgency assigned using the triage system and the Gail and Rosenn's classification.

RESULTS

In this series, 567 patients underwent an urgent psychiatric consultation, and 280 of them received a diagnosis of a mental health problem. The degree of urgency assigned at the triage was: emergency for 5 cases (2%), urgency for 96 (34%) and non-urgency for 179 (64%). Instead, the degree assigned with GRC was: emergency for 95 cases (34%), urgency for 112 (42%) and non-urgency for 73 (26%). The number of patients, detected as emergency and urgency by the two tools, was significantly different (p = 0.0001).

CONCLUSIONS

In this study, we demonstrated that the Italian Society of Paediatric Emergency Medicine and Urgency triage system underestimated the urgency of patients with mental health problems compared to a specific tool to assess the degree of psychiatric urgency.

FRI0060 EVALUATION OF THE CARDIOVASCULAR RISK IN WOMEN WITH RHEUMATOID ARTHRITIS WITH DUPLEX STUDY OF THE CAROTID AND FEMORAL ARTERIES

Background:

The increasing of the cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) is well know, even with the absence of traditional coronary risk factors. The ultrasound – duplex scan (USD) is a non invasive technique able to early detect atherosclerotic changes in the blood vessel, that gives the possibly to retard the development of symptomatic CVD.

Objectives:

To evaluate the cardiovascular (CVS) risk in patients with RA classificated as low risk by Framingham Score (FS), before and after the EULAR 1.5 multiplication factor and stratify with the carotid and femoral USD (intima-media thickness - IMT and atherosclerotic plaques - AP)

Methods:

Thirty-five female patients with RA and low CVS risk by FS and 35 healthy women with low CVS risk by FS (control group) were enrolled for the study. All of them submitted to carotid and femoral USD

Results:

The groups were homogenous by age and CVS comorbidities -Table 1. Mean age in the diagnosis was 44.57 years, mean disease duration was 12.11 years and mean disease activity was Disease Activity Score 28: 1,91 and Clinical Disease Activity Score: 6.176. In the RA patients group 46% showed changes in the carotid and/or femoral USD compared with 14% of the control group (p = 0,004) –Graphic 1. The USD with abnormalities in RA group 31% of the carotid USD and 81% of the femoral USD (p= 0,005) showed IMT and/or AP. After EULAR 1.5 multiplication factor, 66% remained low CVS risk. Where 35% of the RA patients showed changes in the carotid and/or femoral USD compared with 14% of the control group (p=0,07)

Conclusion:

The USD is able to early detect the CVD, special attention should be given to the femoral arteries, that are frequently affected. The Eular criteria is also effective and should be used in the clinical practice

References:

[1]Mota LMH, Cruz BA, Brenol CV, et al. Diretrizes para o diagnóstico da artrite reumatoide.Rev. Bras. Reumatol 2013;53(2)

[2]Charles-SchoemanC. Cardiovascular disease and Rheumatoid Arthritis: an update. CurrRheumatol Rep 2012;14(5): 455-62

[3]Purcarea A, Sovaila S, Gheorghe A, et al. Cardiovascular disease risk scores in the current practice which to use in rheumatoid arthritis?Journal of Medicine and Life 2014;7(4):461-67

[4]Agca R, Heslinga SC, Rollefstad S, etal.EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update.AnnRheumDis 2016

[5]Abu-Shakra M, Polychuck I, Szendro G, et al. Duplex Study of the Carotidand Femoral Arteries of Patients with Rheumatoid Arthritis: A Controlled Study.Seminars in Arthritis and Rheumatism 2005;35(1):18-23

[6]Freire CMV, Alcantara ML, Santos SN, etal. Recomendação para a Quantificação pelo Ultrassom da Doença Aterosclerótica das Artérias Carótidas e Vertebrais: Grupo de Trabalho do Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia.ArqBrasCardiol: Imagem cardiovasc. 2015;28:e1- e64

[7]Helck A, Bianda N, Canton G et al. Intra-individual comparison of carotid and femoral atherosclerotic plaque features with in vivo MR plaque imaging.Int J Cardiovasc Imaging 2015;31(8):1611-8

[8]Lucatelli P, Fagnani C, Tarnoki AD, et al, Genetic influence on femoral plaque and its relationship with carotid plaque an international study.Int J Cardiovasc Imaging 2018;34(4):531-41

[9]Cournot M, Bura A, Cambou JP, et al. Arterial Ultrasound Screening as a Tool for Coronary Risk Assessmente in Asymptomatic Men and Women.Angiology 2012;63(4):282-88

[10]Peters MJ, Symmons DP, McCarey D, et al.Eular evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 2010;69:325-3

Figure 1.

Graphic 1: USD abnormalities

IMT - intima-media thickness; AP atherosclerotic plaques

Disclosure of Interests:

None declared

SAT0086 THE PRESENCE OF COMORBIDITIES IN PATIENTS WITH RHEUMATOID ARTHRITIS IS ASSOCIATED WITH BAD PATIENT-REPORTED OUTCOMES (PROS)

Background:

Patients with rheumatoid arthritis have more cardiovascular comorbidities which contributes to hospitalization and mortality.

Objectives:

.This study aims to investigate whether there is an association between cardiovascular comorbidities in RA with subgroup of patients and clinical findings of the disease

Methods:

This study is a cross-sectional part of Rheumatoid Arthritis in Real Life (REAL), which is a multicenter prospective study conducted in Brazil, involving 13 centers specialized in the care of patients with RA. All subjects met the ARA (1987) or ACR/EULAR (2010) RA classification criteria. Subjects were submitted to clinical interview with physical exam and review of medical records. A sample of 1116 patients was selected for convenience. The association between cardiovascular comorbidities (systemic arterial hypertension (HA), diabetes mellitus (DM) type2, dyslipidemia, stroke and heart failure), the clinical characteristics and laboratory parameters of RA was evaluated through chi-square hypothesis tests, Student`s t-test, Fischer exact test, correlations test and ANOVA. Also, correction Bonferoni test was used for multiple comparisons. Differences were considered statistically significant only when p ≤ 0.05.

Results:

89% of the patients were female, with a mean age of 58 years. 62% of patients with RA had comorbidities, with HA the most prevalent. There were statistically significant association between cardiovascular comorbidities with age (61.71±9.69years old vs 53.03±12.10) (p <0.001), lower educational level (n=282±66.5vs 143±33,5) (p <0.001), lower physical activity (n=132±73.3 vs 48±26.7) (p <0.001), disease duration (18.5±9.75 years vs 14.4±8.61) (p <0.001), positive anti-CCP test (60.5% vs 39.5%) (p = 0.027), high clinical disease activity index CDAI) (65.9%vs 34.1%) (p <0.001), DAS28VHS (3.72±1.46 vs 3.45±1.58) (p = 0.008) and HAQ score (1.00±0.76) vs 0.83±0.77 (p <0.001).

Conclusion:

The frequency of cardiovascular comorbidities is high in RA patients and is associated with age, disease duration and positive anti-CCP test. It is also important to see that these comorbidities are more common in patients with lower frequency of physical activity and lower functional capacity, higher disease activity score and lower level of education. Better control of disease activity and extensive information to patients about the importance of exercise should be parallel objectives in RA.

Disclosure of Interests:

Ivanio Pereira Grant/research support from: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Consultant of: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Paid instructor for: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Speakers bureau: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Thayse Coan: None declared, G Castro: None declared, Geraldo Castelar Grant/research support from:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Consultant of:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Paid instructor for:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Speakers bureau:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Ana Beatriz Vargas-Santos Grant/research support from: Has received supporting for international medical events from AbbVie and Janssen, Cleandro Albuquerque Grant/research support from: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Consultant of: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Paid instructor for: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Speakers bureau: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Ana Paula Gomides Consultant of: Abvvie, Manoel Bertolo Grant/research support from: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Paid instructor for: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Speakers bureau: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Paulo Louzada Jr Grant/research support from: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Paid instructor for: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Speakers bureau: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Rina Giorgi: None declared, Sebastião Radominsky Grant/research support from: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Consultant of: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Paid instructor for: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Speakers bureau: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Maria Fernanda Guimarães: None declared, Karina Bonfiglioli Consultant of: Roche, Abbvie, Pfizer, Janssen and BMS, Maria de Fátima Sauma: None declared, Claiton Brenol: None declared, Evandro Coutinho: None declared, Licia Mota Grant/research support from: Has received personal or institutional support from AbbVie, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer, Roche and UCB., Speakers bureau: Has received personal or institutional support from AbbVie, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer, Roche and UCB.

AB0191 DECREASING DELAY TO DIAGNOSIS AND TREATMENT OF RHEUMATOID ARTHRITIS: STILL DIFFICULT TO TREAT WITHIN THE WINDOW OF OPPORTUNITY

Background:

The need for early rheumatoid arthritis (RA) treatment for better outcomes is widely accepted. Is that goal being achieved in real-life settings?

Objectives:

To evaluate changes in the delay to RA diagnosis and treatment, and in the proportions of patients being treated early along the last decades in Brazil.

Methods:

This study was drawn from the REAL cohort, designed to assess RA management under real-life conditions. Patients ≥ 18 years old attending public hospitals in Brazil and meeting RA classification criteria were included. Subjects were stratified according to the year their symptoms began. Delays from symptoms onset to RA diagnosis and treatment were inquired. Early RA diagnosis and treatment was assessed using three different cut points: ≤3, ≤6 and ≤12 months of symptoms onset. Mann-Kendall’s trend test, chi-square tests, Welch’s ANOVA and Games-Howell’s post-hoc tests were used to test hypotheses, at 0.05 significance level.

Results:

1116 RA patients were included; 89.4% female; 56.8% white; mean (SD) age 57.1 (11.5) years. A downward trend was found in the delay to RA diagnosis (tau = -0.677, p < 0.001) and treatment (tau = -0.695, p < 0.001) from 1990 to 2015 (Figures 1 and 2). The year of symptoms onset was associated with the frequency of early treatment for all defined cut points: ≤3 months (χ2= 11.25, p = 0.001), ≤6 months (χ2= 34.84, p < 0.001), and ≤12 months (χ2= 64.79, p<0.001). The more recent the year of symptoms onset, the higher the proportions of individuals treated early (Table 1). Groups stratified according to successive periods of symptoms onset differed in the mean delay to RA treatment [F(5, 372.8) = 41.9; p < 0.001]. Patients with symptoms initiated more recently (2011-2015) had significantly lower delays compared to all other groups. Nonetheless, only 36.3% of these patients with more recent disease started treatment within 6 months of symptoms onset, and 17.2% within 3 months.

Table 1.

Proportions of individuals with RA receiving the first DMARD within different time intervals from symptoms onset, according to the year their symptoms began.

Symptoms beginning (year)Interval from symptoms onset to first DMARDN≤ 3 months≤ 6 months≤ 12 months≤ 1990 8.5%14.9%33.3%1411991 – 1995 5.3%15.8%34.7% 951996 – 200012.3%24.7%44.5%1462001 – 200511.5%26.3%49.8%2172006 – 201017.2%38.9%61.1%2392011 – 201517.2%36.3%72.0%157Figure 1.

Rheumatoid arthritis diagnostic delay according to the year of symptoms beginning, from 1990 to 2015 in Brazil

Figure 2.

Rheumatoid arthritis treatment delay according to the year of symptoms beginning, from 1990 to 2015 in Brazil.

Conclusion:

Delays to RA diagnosis and treatment have decreased, and more patients have been treated within defined windows for early RA management in the last decades in Brazil. Despite all improvements, it was still difficult to attain early RA treatment. Additional efforts are warranted in pursuit of that goal.

Disclosure of Interests:

Cleandro Albuquerque Grant/research support from: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Consultant of: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Paid instructor for: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Speakers bureau: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Ana Paula Gomides Consultant of: Abvvie, Ana Beatriz Vargas-Santos Grant/research support from: Has received supporting for international medical events from AbbVie and Janssen, Claiton Brenol: None declared, Ivanio Pereira Grant/research support from: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Consultant of: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Paid instructor for: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Speakers bureau: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Karina Bonfiglioli Consultant of: Roche, Abbvie, Pfizer, Janssen and BMS, Manoel Bertolo Grant/research support from: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Paid instructor for: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Speakers bureau: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Maria Fernanda Guimarães: None declared, Maria Sauma: None declared, Paulo Louzada Jr Grant/research support from: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Paid instructor for: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Speakers bureau: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Rina Giorgi Grant/research support from: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, Bristol-Myers Squibb, UCB, Eli-Lilly, AbbVie, Abbott and EMS, Consultant of: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, Bristol-Myers Squibb, UCB, Eli-Lilly, AbbVie, Abbott and EMS, Paid instructor for: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, Bristol-Myers Squibb, UCB, Eli-Lilly, AbbVie, Abbott and EMS, Speakers bureau: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, Bristol-Myers Squibb, UCB, Eli-Lilly, AbbVie, Abbott and EMS, Sebastião Radominsky Grant/research support from: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Consultant of: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Paid instructor for: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Speakers bureau: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Licia Mota Grant/research support from: Has received personal or institutional support from AbbVie, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer, Roche and UCB., Speakers bureau: Has received personal or institutional support from AbbVie, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer, Roche and UCB., Geraldo Castelar Grant/research support from:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Consultant of:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Paid instructor for:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Speakers bureau:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche

THU0333 CARDIOVASCULAR COMORBIDITIES ARE COMMON IN RHEUMATOID ARTHRITIS PATIENTS WHO PRACTICE LESS PHYSICAL ACTIVITY AND WHO HAVE WORSE FUNCTIONAL CAPACITY

Background:

Patients with rheumatoid arthritis have more cardiovascular comorbidities which contributes to hospitalization and mortality.

Objectives:

This study aims to investigate whether there is an association between cardiovascular comorbidities in RA with subgroup of patients and clinical findings of the disease

Methods:

This study is a cross-sectional part of Rheumatoid Arthritis in Real Life (REAL), which is a multicenter prospective study conducted in Brazil, involving 13 centers specialized in the care of patients with RA. All subjects met the ARA (1987) or ACR/EULAR (2010) RA classification criteria. Subjects were submitted to clinical interview with physical exam and review of medical records. A sample of 1116 patients was selected for convenience. The association between cardiovascular comorbidities (systemic arterial hypertension (HA), diabetes mellitus (DM) type2, dyslipidemia, stroke and heart failure), the clinical characteristics and laboratory parameters of RA was evaluated through chi-square hypothesis tests, Student`s t-test, Fischer exact test, correlations test and ANOVA. Also, correction Bonferoni test was used for multiple comparisons. Differences were considered statistically significant only when p ≤ 0.05.

Results:

89% of the patients were female, with a mean age of 58 years. 62% of patients with RA had comorbidities, with HA the most prevalent. There were statistically significant association between cardiovascular comorbidities with age (61.71±9.69years old vs 53.03±12.10) (p <0.001), lower educational level (n=282±66.5vs 143±33,5) (p <0.001), lower physical activity (n=132±73.3 vs 48±26.7) (p <0.001), disease duration (18.5±9.75 years vs 14.4±8.61) (p <0.001), positive anti-CCP test (60.5% vs 39.5%) (p = 0.027), high clinical disease activity index CDAI) (65.9%vs 34.1%) (p <0.001), DAS28VHS (3.72±1.46 vs 3.45±1.58) (p = 0.008) and HAQ score (1.00±0.76) vs 0.83±0.77 (p <0.001).

Conclusion:

The frequency of cardiovascular comorbidities is high in RA patients and is associated with age, disease duration and positive anti-CCP test. It is also important to see that these comorbidities are more common in patients with lower frequency of physical activity and lower functional capacity, higher disease activity score and lower level of education. Better control of disease activity and extensive information to patients about the importance of exercise should be parallel objectives in RA.

Disclosure of Interests:

Ivanio Pereira Grant/research support from: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Consultant of: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Paid instructor for: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Speakers bureau: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Gabriela Ribas: None declared, G Castro: None declared, Geraldo Castelar Grant/research support from:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Consultant of:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Paid instructor for:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Speakers bureau:: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Ana Beatriz Vargas-Santos Grant/research support from: Has received supporting for international medical events from AbbVie and Janssen, Cleandro Albuquerque Grant/research support from: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Consultant of: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Paid instructor for: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Speakers bureau: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Ana Paula Gomides Consultant of: Abvvie, Manoel Bertolo Grant/research support from: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Paid instructor for: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Speakers bureau: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Paulo Louzada Jr Grant/research support from: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Paid instructor for: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Speakers bureau: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Rina Giorgi: None declared, Maria Fernanda Guimarães: None declared, Sebastião Radominsky Grant/research support from: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Consultant of: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Paid instructor for: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Speakers bureau: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Karina Bonfiglioli Consultant of: Roche, Abbvie, Pfizer, Janssen and BMS, Maria de Fátima Sauma: None declared, Claiton Brenol: None declared, Evandro Coutinho: None declared, Licia Mota Grant/research support from: Has received personal or institutional support from AbbVie, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer, Roche and UCB., Speakers bureau: Has received personal or institutional support from AbbVie, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer, Roche and UCB.

AB0190 DO IT FAST! EARLY ASSESSMENT BY A RHEUMATOLOGIST INCREASES THE CHANCES OF RHEUMATOID ARTHRITIS BEING TREATED WITHIN THE “WINDOW OF OPPORTUNITY”

Background:

The current concept of treating rheumatoid arthritis RA patients emphasizes the importance of early diagnosis and early initiation of disease-modifying drugs (DMARD) for a better prognosis of these patients.

Objectives:

To evaluate the impact of rheumatologic evaluation on the diagnosis of RA patients, as well as on the initiation of DMARD and on the clinical control of disease activity of these patients under real-life conditions.

Methods:

The REAL study included RA patients attending eleven public hospitals, from different regions of Brazil. All subjects met the ARA (1987) or ACR/EULAR (2010) RA classification criteria. Subjects were submitted to clinical interview with physical exam and review of medical records. Specialized assessment was defined as sequentially “early”, when the rheumatologist was the 1stor 2ndconsulted physician, and sequentially “late”, when the rheumatologist was consulted after two or more other doctors. Welch’st, Mann-Whitney’s U, chi-square and Spearman’s rho tests were used to test hypotheses, at significance level of 0.05. The study was approved by local ethics committees and all participants granted informed consent.

Results:

1057 RA patients were assessed; 89.4% (n=945) female; 56.5% (n=597) white; mean (SD) age of 56.9 (11.5) years; mean (SD) disease duration of 173.1 (114.5) months. Median [IQR] delay from symptoms onset to RA diagnosis and to the first DMARD both equaled 12 [6, 36] months. Only 28.7% received a DMARD within 6 months of symptoms onset, and 13.1% within 3 months. Most patients (64.6%) sought a general practitioner first, but 80.7% were finally diagnosed only upon rheumatologist consultation. For 28.8%, the rheumatologist was consulted after two or more other doctors. Early specialized assessment resulted in higher chances of receiving a DMARD within 6 months (OR 2.77; 95%CI [1.93, 3.97]) and within 3 months (OR 2.57; 95%CI [1.54, 4.27]) of RA onset. Late assessment was associated with lower chances of being in remission or low disease activity upon study inclusion (OR 0.53; 95%CI [0.39, 0.72]). Patients assessed early by the rheumatologist, compared to those assessed late, showed lower (mean [SD]) HAQ scores (0.877 [0.715] vs. 1.074 [0.857]; p<0.001) and DAS28-CRP scores (3.20 [1.32] vs. 3.45 [1.48]; p=0.02), and shorter delays to RA diagnosis (26.9 [46.7] vs. 44.6 [60.1] months; p<0.001) and to use the first DMARD (32.5 [58.5] vs. 50.6 [69.9] months; p<0.001). The delay to initiate a DMARD was strongly correlated to that of diagnosing RA (rho 0.816; p < 0.001).

Conclusion:

Most RA patients missed the window of opportunity to early treatment. Treatment delay strongly correlated with delay in diagnosis, which critically depended on the input from the rheumatologist. Late rheumatologist assessment was associated with lower chances of early RA treatment and with worse outcomes. Failure in direct transition from primary to specialized care was a common problem that needs to be solved.

Disclosure of Interests:

Cleandro Albuquerque Grant/research support from: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Consultant of: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Paid instructor for: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Speakers bureau: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Ana Paula Gomides Consultant of: Abvvie, Ana Beatriz Vargas-Santos Grant/research support from: Has received supporting for international medical events from AbbVie and Janssen, Claiton Brenol: None declared, Ivanio Pereira Grant/research support from: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Consultant of: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Paid instructor for: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Speakers bureau: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Karina Bonfiglioli Consultant of: Roche, Abbvie, Pfizer, Janssen and BMS, Manoel Bertolo Grant/research support from: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Consultant of: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Paid instructor for: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Speakers bureau: Has participated in clinical and/or experimental studies related to this work and sponsored by Roche; has delivered speeches at events related to this work and sponsored by AbbVie and Pfizer, Maria Fernanda Guimarães: None declared, Maria Sauma: None declared, Paulo Louzada Jr Grant/research support from: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Paid instructor for: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Speakers bureau: Has received supporting for internationals congresses from Bristol-Myers Squibb, UCB and consulting fees from Pfizer, Rina Giorgi Grant/research support from: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, Bristol-Myers Squibb, UCB, Eli-Lilly, AbbVie, Abbott and EMS, Consultant of: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, Bristol-Myers Squibb, UCB, Eli-Lilly, AbbVie, Abbott and EMS, Paid instructor for: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, Bristol-Myers Squibb, UCB, Eli-Lilly, AbbVie, Abbott and EMS, Speakers bureau: Has received consulting fees, speaking fees and supporting for internationals congresses from Roche, Pfizer, Bristol-Myers Squibb, UCB, Eli-Lilly, AbbVie, Abbott and EMS, Sebastião Radominsky Grant/research support from: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Consultant of: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Paid instructor for: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Speakers bureau: Has received consulting and speaking fees from Abbvie, Janssen, Pfizer, Roche and UCB, Licia Mota Grant/research support from: Has received personal or institutional support from AbbVie, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer, Roche and UCB., Speakers bureau: Has received personal or institutional support from AbbVie, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer, Roche and UCB., Geraldo Castelar-Pinheiro Grant/research support from: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Consultant of: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche, Speakers bureau: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche

[Same-eye comparison of pupillary dilation with an intraoperative standardized intracameral combination of mydriatics (Mydrane®) versus a preoperative ophthalmic (Mydriasert®) in standard cataract surgery in non-diabetic patients (French translation of the article)]

INTRODUCTION

Cataract surgery is the most commonly performed surgery in the world, and its success depends in part on the quality of mydriasis.

PURPOSE

To compare, for the same eye, the pupillary dilation obtained with Mydrane® (standardized intracameral solution of 0.02% tropicamide, combined with 0.31% phenylephrine and 1% lidocaine) intraoperatively versus Mydriasert® (0.28mg tropicamide insert and 5.4mg phenylephrine) with a contact time between 45 and 60 minutes in the preoperative period.

METHODS

Single center prospective study from November 2016 to January 2018 at the Laveran Army Instructional Hospital in Marseille. Patients referred for surgery were dilated at the preoperative consultation with Mydriasert®. The pupillary diameter after 45-60 minutes of contact with the insert was manually measured, by two different examiners, through the "iris image" tab of the Pentacam® elevation topography. Patients were dilated on the day of their cataract surgery with 0.2cc of Mydrane® injected in the anterior chamber through a paracentesis. Thirty seconds later, prior to injection of viscoelastic, an eye photograph was taken by screen capture. The pupillary diameter was evaluated by two different examiners with to the Piximeter 5.9 metrology software. The difference in pupil dilation between Mydriasert® and Mydrane® was tested with the paired series Student t-test.

RESULTS

In total, 111 eyes of 82 patients were included. Mydriasert® achieved a mean pupillary dilation of 7.21±0.79mm. The mydriasis obtained with Mydrane® averaged 6.35±0.8mm. This difference of 0.86mm was statistically significant (P<0.001) with a confidence interval of 95% [-0.97; -0.74].

CONCLUSION

On average, Mydrane® dilates the pupil less than Mydriasert®. However, the mydriasis obtained with Mydrane® remains comfortable for the performance of the capsulorhexis. It helps save preoperative time and affords additional anesthetic to the cataract surgery. Nevertheless, the use of Mydriasert® is beneficial when extra mydriasis is required.

Goftte: A R package for assessing goodness-of-fit in proportional (sub) distributions hazards regression models

BACKGROUND AND OBJECTIVE

In this paper, we introduce a new R package goftte for goodness-of-fit assessment based on cumulative sums of model residuals useful for checking key assumptions in the Cox regression and Fine and Gray regression models.

METHODS

Monte-Carlo methods are used to approximate the null distribution of cumulative sums of model residuals. To limit the computational burden, the main routines used to approximate the null distributions are implemented in a parallel C++ programming environment. Numerical studies are carried out to evaluate the empirical type I error rates of the different testing procedures. The package and the documentation are available to users from CRAN R repositories.

RESULTS

Results from simulation studies suggested that all statistical tests implemented in goftte yielded excellent control of the type I error rate even with modest sample sizes with high censoring rates.

CONCLUSIONS

As compared to other R packages goftte provides new useful method for testing functionals, such as Anderson-Darling type test statistics for checking assumptions about proportional (sub-) distribution hazards. Approximations for the null distributions of test statistics have been validated through simulation experiments. Future releases will provide similar tools for checking model assumptions in multiplicative intensity models for recurrent data. The package may help to spread the use of recent advocated goodness-of-fit techniques in semiparametric regression for time-to-event data.

The carbonation kinetics of calcium hydroxide nanoparticles: A Boundary Nucleation and Growth description

HYPOTHESIS

The reaction of Ca(OH)₂ with CO₂ to form CaCO₃ (carbonation process) is of high interest for construction materials, environmental applications and art preservation. Here, the "Boundary Nucleation and Growth" model (BNGM) was adopted for the first time to consider the effect of the surface area of Ca(OH)₂ nanoparticles on the carbonation kinetics.

EXPERIMENTS

The carbonation of commercial and laboratory-prepared particles' dispersions was monitored by Fourier Transform Infrared Spectroscopy, and the BNGM was used to analyze the data. The contributions of nucleation and growth of CaCO₃ were evaluated separately.

FINDINGS

During carbonation the boundary regions of the Ca(OH)₂ particles are densely populated with CaCO₃ nuclei, and transform early with subsequent thickening of slab-like regions centered on the original boundaries. A BNGM limiting case equation was thus used to fit the kinetics, where the transformation rate decreases exponentially with time. The carbonation rate constants, activation energies, and linear growth rate were calculated. Particles with larger size and lower surface area show a decrease of the rate at which the non-nucleated grains between the boundaries transform, and an increase of the ending time of Ca(OH)₂ transformation. The effect of temperature on the carbonation kinetics and on the CaCO₃ polymorphs formation was evaluated.

More accurate cancer-related excess mortality through correcting background mortality for extra variables

Relative survival methods used to estimate the excess mortality of cancer patients rely on the background (or expected) mortality derived from general population life tables. These methods are based on splitting the observed mortality into the excess mortality and the background mortality. By assuming a regression model for the excess mortality, usually a Cox-type model, one may investigate the effects of certain covariates on the excess mortality. Some covariates are cancer-specific whereas others are variables that may influence the background mortality as well. The latter should be taken into account in the background mortality to avoid biases in estimating their effects on the excess mortality. Unfortunately, the available life table might not include such variables and, consequently, might provide inaccurate values of the background mortality. We propose a model that uses multiplicative parameters to correct potentially inaccurate background mortality. The model can be seen as an extension of the frequently used Estève model because we assume a Cox-type model for the excess mortality with a piecewise constant baseline function and introduce additional parameters that multiply the background mortality. The original and the extended model are compared, first in a simulation study, then in an application to colon cancer registry data.

Elaboration and Formalization of Current Scientific Knowledge of Risks and Preventive Measures Illustrated by Colorectal Cancer

Objectives: Present the method used to elaborate and formalize current scientific knowledge to provide physicians with tools available on the Internet, that enable them to evaluate individual patient risk, give personalized preventive recommendations or early screening measures.

Methods: The approach suggested in this article is in line with medical procedures based on levels of evidence (Evidence-based Medicine). A cyclical process for developing recommendations allows us to quickly incorporate current scientific information. At each phase, the analysis is reevaluated by experts in the field collaborating on the project. The information is formalized through the use of levels of evidence and grades of recommendations. GLIF model is used to implement recommendations for clinical practice guidelines.

Results: The most current scientific evidence incorporated in a cyclical process includes several steps: critical analysis according to the Evidence-based Medicine method; identification of predictive factors; setting-up of risk levels; identification of prevention measures; elaboration of personalized recommendation. The information technology implementation of the clinical practice guideline enables physicians to quickly obtain personalized information for their patients. Cases of colorectal prevention illustrate our approach.

Conclusions: Integration of current scientific knowledge is an important process. The delay between the moment new information arrives and the moment the practitioner applies it, is thus reduced.

Laparoscopic pancreaticoduodenectomy for tumors of the head of pancreas; 10 cases for a single center experience

OBJECTIVE

The tumors of the head of the pancreas are one of the leading causes of cancer-related death in Western countries. The current gold standard for these tumors is a Whipple procedure. This procedure did not change in its surgical steps since when it was initially introduced in 1935. More recently, a laparoscopic approach with similar outcomes has been described. The aim of this paper is to describe the laparoscopic surgical technique performed in our unit, reporting single center postoperative outcomes.

PATIENTS AND METHODS

From the 1st January 2013 to the 31st December 2015 a database was created. Data about patients who underwent a laparoscopic pancreaticoduodenectomy (LPD) were collected prospectively. All patients were preoperatively assessed with blood samples, tumor markers, CT chest abdomen and pelvis and/or MRI pancreas. Only patients with specific characteristics were considered eligible for an LPD: performance status 0, body mass index (BMI) less than 30 kg/m2, a small neoplastic lesion (< 3.5 cm) confined to the pancreas, the absence of infiltrated organs and/or blood vessels (T1 or T2). Postoperative data and complications were recorded and described according to the Clavien-Dindo classification and the international study group of pancreatic surgery definitions.

RESULTS

In a time interval of 36 months, 31 patients with an initially considered resectable pancreatic cancer were referred. 11 patients were found to have metastasis during the preoperative workout. Only 10 patients were considered eligible for a LPD. Six of them were men (60%). The mean BMI was 25.01 kg/m2 (19.6-29.8). 5 patients, who underwent to LPD did not have any comorbidities. An overall 50% of all patients were jaundice at the time of diagnosis with a mean bilirubin level of 181.3 µmol/L (119.7-307.8). All patients with a direct bilirubin greater than 250 µmol/L underwent a preoperative percutaneous biliary drainage. In the majority of the LPD performed (50%), the histology reported a pancreatic adenocarcinoma. Other postoperative histology described were: IPMN (20%), ampullar neoplasia (20%) and neuroendocrine tumor (10%). Neo-adjuvant chemotherapy was never considered indicated. The reported postoperative complications were: 1 anastomotic bleeding, 2 pancreatic fistula, 1 infected intra-abdominal collection and 1 delay gastric emptying. The pancreatic fistulas were considered grade A and grade B. One fatality after LPD occurred because of an uncontrollable, diffuse severe hemorrhagic gastritis associated with a GJ anastomosis bleeding in the POD 25. The mean hospital stay was 12.3 days (8-25). The mean operative time was 224 min (170-310). There were no intraoperative complications. The main intraoperative blood loss was 220 ml (180-400) and intraoperative blood transfusions were not required. The resection margins were negative (R0) in 100% of cases and the mean lymph nodes harvested were 24 (18-40). The LPD is still a not common practice. Our results are comparable with those reported in literature about the open technique. These remarkable surgical outcomes are probably related to the extremely careful preoperative patient selection performed. The indication for a laparoscopic vs. an open pancreaticoduodenectomy was based on a CT scan pancreas performed less than 30 days before the planned date of surgery and a careful preoperative assessment. A low complication rate and a relative short stay in hospital were associated to a good quality of life in the early postoperative period and an early referral for postoperative chemotherapy. Good clinical outcomes were associated with outstanding oncological results.

CONCLUSIONS

Laparoscopic pancreaticoduodenectomy is a feasible surgical procedure. Remarkable oncological and surgical outcomes can be achieved with a morbidity and mortality rate in line with the data reported by the large series of open procedures.

Upper aerodigestive tract cancer and oral health status before radiotherapy: A cross-sectional study of 154 patients

OBJECTIVES

We aimed to determine primarily the oral health status of patients with upper aerodigestive tract cancer before radiotherapy, and secondarily the prevalence of risk factors for poor oral status.

METHODS

A cross-sectional study was conducted in Marseille University hospital. Assessment criteria were the Decay, Missing and Filled (DMF) Index and periodontal status.

RESULTS

One hundred and fifty-four patients, mean age 60.9years, were included. The most common sites of primary tumors were the larynx (28.6%) and oral cavity (26.6%). Current or past smokers accounted for 80.5% of patients and 67% were alcohol abusers. Most patients (83.8%) did not have xerostomia. They ate three meals a day (61%), with sugar consumption in 40%. The median number of daily tooth brushings was 2, with a manual toothbrush (81.2%). Few patients used dental floss or interproximal brushes. Individual DMF index was 17.6 (D=2.3, M=9.3, F=6.0) and was higher in patients with xerostomia and alcohol abusers (P=0.01). Osseous level was 62.3% and 57.8% of patients had osseous infections, which were more common with poor hygiene (P=0.04). Most patients (85.7%) had periodontal disease, but incidence did not significantly differ according to risk factors.

DISCUSSION

The DMF index was higher in presence of periodontal disease and osseous infections. Alcohol and xerostomia were associated with a high individual DMF index and osseous infections were more frequent in patients with poor hygiene. Patients with upper aerodigestive tract cancer are at high risk of osteoradionecrosis if they do not receive dental treatment before radiotherapy.

Evaluation of hand hygiene compliance and associated factors with a radio-frequency-identification-based real-time continuous automated monitoring system

BACKGROUND

Hand hygiene is a major means for preventing healthcare-associated infections. One critical point in understanding poor compliance is the lack of relevant markers used to monitor practices systematically.

METHODS

This study analysed hand hygiene compliance and associated factors with a radio-frequency-identification-based real-time continuous automated monitoring system in an infectious disease ward with 17 single bedrooms. Healthcare workers (HCWs) were tracked while performing routine care over 171 days. A multi-level multi-variate logistics model was used for data analysis. The main outcome measures were hand disinfection before entering the bedroom (outside use) and before entering the patient care zone, defined as the zone surrounding the patient's bed (inside/bedside use). Variables analysed included HCWs' characteristics and behaviour, patients, room layouts, path chains and duration of HCWs' paths.

FINDINGS

In total, 4629 paths with initial hand hygiene opportunities when entering the patient care zone were selected, of which 763 (16.5%), 285 (6.1%) and 3581 (77.4%) were associated with outside use, inside/bedside use and no use, respectively. Hand hygiene is caregiver-dependent. The shorter the duration of the HCW's path, the worse the bedside hand hygiene. Bedside hand hygiene is improved when one or two extra HCWs are present in the room.

INTERPRETATION

Hand hygiene compliance at the bedside, as analysed using the continuous monitoring system, depended upon the HCW's occupation and personal behaviour, number of HCWs, time spent in the room and (potentially) dispenser location. Meal tray distribution was a possible factor in the case of failure to disinfect hands.

[Oncological results of active surveillance in prostate cancer: A retrospective multicentric cohort]

PURPOSE

To report oncological outcomes of patients with prostate cancer undergoing active surveillance according to SURACAP criteria.

METHODS

This multicentric study included patients who were initially treated with active surveillance for localized prostate cancer according to the SURACAP criteria. The duration of active surveillance as well as the causes of discontinuing the protocol and the definitive pathological results of patients who further underwent radical prostatectomy were retrospectively evaluated. The predictors of discontinuing active surveillance were assessed using a univariable Cox Model. In addition, the predictive value of initial MRI was assessed for patients who performed such imagery.

RESULTS

Between 2007 and 2013, 80 patients were included, with a median age of 64 years [47-74]. Median follow-up was 52.9 months [24-108]. At 5 years follow-up, 43.4% patients were still under surveillance. Among patients that underwent surgery, 17.8% had an extra-capsular extension. The risk of discontinuing was not significantly greater for patients with tumor size of 2 or 3mm versus 1mm (HR=0.9 [0.46-1.75], P=0.763), 2 positives cores versus 1 (HR=0.98 [0.48-2.02], P=0.967), T2a vs. T1c stage (HR=2.18 [0.77-6.18], P=0.133), increased PSA level (HR=1 [0.96-1.15], P=0.975) or the patient's age (HR=1 [0.93-1.16], P=0.966). Among the 50 patients who performed initial MRI, the results of such imagery was not significantly associated to the risk of discontinuing active surveillance MRI (HR=1.49 [0.63-3.52], P=0.36).

CONCLUSION

Although this study reveals a high rate of release from active surveillance at 5 years, the rate of extra-capsular tumors reported in the group of patients that underwent surgery is among the lowest in literature.

LEVEL OF EVIDENCE

4.

Intranasal Dexmedetomidine Sedation as Adjuvant Therapy in Acute Asthma Exacerbation With Marked Anxiety and Agitation

We describe 2 patients with acute asthma exacerbation who were admitted to the emergency department (ED) with severe agitation and restlessness as a prominent finding, for which bedside asthma treatment sedation with intranasal dexmedetomidine was performed. In both cases, dexmedetomidine allowed the patients to rest and improved tolerance to treatment. Dexmedetomidine is a unique sedative with an excellent safety profile and minimal effect on respiratory function. These properties render it particularly promising for the management of severe agitation in children admitted to the ED with acute asthma exacerbation.

A quasi randomized-controlled trial to evaluate the effectiveness of clowntherapy on children's anxiety and pain levels in emergency department

The aim of the study is to investigate if the presence of medical clowns during painful procedures in the emergency department (ED) affects children's anxiety and pain. Forty children (4-11 years) admitted to the ED with the need of painful procedures were prospectively enrolled. They were randomly assigned to the clown group, where children interacted with clowns or to the control group in which they were entertained by parents and ED nurses. The children's anxiety was assessed by the Children's Anxiety and Pain Scales; pain was evaluated with the Numerical Rating Scale and Wong-Backer Scale, according to the children's age. Staff and clown's opinions were evaluated by means of dedicated questionnaires. Children's anxiety levels in the clown group were significantly lower than those compared with the control group, while children's pain levels did not change between the two groups.

CONCLUSION

The presence of clowns in the ED before and during painful procedures was effective in reducing children's anxiety.

WHAT IS KNOWN

• Anxiety and fear caused by medical procedures exacerbate children's pain and may interfere with the procedure. • To reduce anxiety, fear, and pain and to facilitate patient's evaluation, different non-pharmacological approaches have been proposed and positive effects of laughter and humor have been reported. What is New: • The presence of clowns in the waiting room and in the ED during medical evaluation and painful procedures helps to reduce children's anxiety.

Antibacterial activity of silver nanoparticles grafted on stone surface

Microbial colonization has a relevant impact on the deterioration of stone materials with consequences ranging from esthetic to physical and chemical changes. Avoiding microbial growth on cultural stones therefore represents a crucial aspect for their long-term conservation. The antimicrobial properties of silver nanoparticles (AgNPs) have been extensively investigated in recent years, showing that they could be successfully applied as bactericidal coatings on surfaces of different materials. In this work, we investigated the ability of AgNPs grafted to Serena stone surfaces to inhibit bacterial viability. A silane derivative, which is commonly used for stone consolidation, and Bacillus subtilis were chosen as the grafting agent and the target bacterium, respectively. Results show that functionalized AgNPs bind to stone surface exhibiting a cluster disposition that is not affected by washing treatments. The antibacterial tests on stone samples revealed a 50 to 80 % reduction in cell viability, with the most effective AgNP concentration of 6.7 μg/cm(2). To our knowledge, this is the first report on antimicrobial activity of AgNPs applied to a stone surface. The results suggest that AgNPs could be successfully used in the inhibition of microbial colonization of stone artworks.

A comparison of three scales for measuring pain in children with cognitive impairment

AIM

Pain is a neglected problem in children with cognitive impairments, and few studies compare the clinical use of specific pain scales. We compared the Non-Communicating Children's Pain Checklist Postoperative Version (NCCPC-PV), the Echelle Douleur Enfant San Salvador (DESS) and the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). The first two were developed for children with cognitive impairment, and the third is a more general pain scale.

METHODS

Two external observers and the child's caregiver assessed 40 children with cognitive impairment for pain levels. We assessed inter-rater agreement, correlation, dependence on knowledge of the child's behaviour, simplicity and adequacy in pain rating according to the caregiver for all three scales.

RESULTS

The correlation between the NCCPC-PV and the DESS was strong (Spearman correlation coefficient = 0.76) and better than between each scale and the CHEOPS. Although the DESS showed better inter-rater agreement, it was more dependent on familiarity with the child and was judged more difficult to use by all observers. The NCCPC-PV was the easiest use and the most appropriate for rating the child's pain.

CONCLUSION

The NCCPC-PV was the easiest to use for pain assessment in cognitively impaired children and should be adopted in clinical settings.