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BackgroundElevated low-density lipoprotein cholesterol (LDL-C) is a major risk factor for the development of cardiovascular diseases (CVDs), however a significant gap exists between the recommended guideline goals and the achievement of these goals in clinical practice. In addition, there remains suboptimal utilization of lipid-lowering therapies (LLT) (1,2). This study examines the prescribed LLT and the level of LDL-C goal achievements among Irish adults in a primary care setting. In addition, it identifies the patient factors associated with prescribing of LLT and LDL-C goal achievements.MethodsThis study is a cross-sectional analysis of the rescreen data of the Mitchelstown Cohort Study that occurred in 2015. Demographic, medication and diagnosis data were obtained from participant electronic health records. CVD risk was assessed using the SCORE tool. LDL-C goal achievements were determined using the LDL-C goals set out in the 2011 ESC/EAS guidelines for the management of dyslipidemia. A multivariate regression analysis was conducted.ResultsAmong 1,183 participants, 48.5% were prescribed LLT, 42% of whom attained their LDL-C goals. Among very high-risk and high-risk participants, 20.8% were prescribed high-intensity statin and 32.6% of these achieved their LDL-C goal. Combination therapy was prescribed to 9.3% of participants. In multivariate analysis diabetes, polypharmacy and hyper-polypharmacy were associated with prescribing LLT. Being male or ≤59 years was associated with lower likelihood of LLT prescription. Target LDL-C goal achievement was associated with male sex and age ≤64 or ≥70 years while BMI 25–29kg/m2 was associated with lower LDL-C goal achievement.ConclusionDyslipidaemia is undertreated in this Irish primary care population with limited use of high-intensity statins. This study highlights the gap between guideline recommendations for LLT prescription and LDL-C target goals and real-world implementation of guidelines.

Application for ESRA Abstract Prizes:Background and AimsThe impact of substance abuse on traumatic injuries is of serious concern in today’s world. Data from the Australian registry shares substance use in major trauma to be higher than in the general population Nearly 40% of deaths due to trauma had positive alcohol or toxicology screens. We share a case presenting with acute cocaine, marijuana, polypharmacy toxicity requiring emergency surgery for fracture femur.MethodsA 60 yr old male, presented after a fall from a height. In discussion he shared use of Cocaine, Marijuana & polypharmacy, prior to and after sustaining the injury. Plan was ORIF to fix the Left subtrochanteric femoral fracture. On anaesthetic review, the patient was noted to be extremely drowsy, unresponsive at times, slurring speech. His heart rate was 60b/min with a BP of 172/94 mmHg, normal QTc, apyrexial. CT brain revealed right caudate nucleus, corona radiata ischemic infarct. We debated the possibility of the CVA leading to the fall. On assessment as the pupils were pin point a trial of naloxone was performed eliciting reversal and GCS of 15/15 with normal neurology.ResultsTaking into account acute cocaine, marijuana and possible drug use, a spinal anaesthetic was determined to be appropriate. The patient had an ORIF with cerclage and TFNA nail which was uneventful and was discharged a week later.ConclusionsSubstance misuse is associated with higher odds of inpatient medical adverse events, prolonged hospital stay and non-routine discharge after orthopaedic trauma Emphasis on appropriate investigations, associated diagnosis, prompt recognition and proactive treatment measures may support effective trauma management.

There is a rising prevalence of multimorbidity, particularly in older patients, and a need for evidence-based medicines management interventions for this population. The Supporting Prescribing in Older Adults with Multimorbidity in Irish Primary Care (SPPiRE) trial aimed to investigate the effect of a general practitioner (GP)-delivered, individualised medication review in reducing polypharmacy and potentially inappropriate prescriptions (PIPs) in community-dwelling older patients with multimorbidity in primary care. We conducted a cluster randomised controlled trial (RCT) set in 51 GP practices throughout the Republic of Ireland. A total of 404 patients, aged ≥65 years with complex multimorbidity, defined as being prescribed ≥15 regular medicines, were recruited from April 2017 and followed up until October 2020. Furthermore, 26 intervention GP practices received access to the SPPiRE website where they completed an educational module and used a template for an individualised patient medication review that identified PIP, opportunities for deprescribing, and patient priorities for care. A total of 25 control GP practices delivered usual care. An independent blinded pharmacist assessed primary outcome measures that were the number of medicines and the proportion of patients with any PIP (from a predefined list of 34 indicators based predominantly on the STOPP/START version 2 criteria). We performed an intention-to-treat analysis using multilevel modelling. Recruited participants had substantial disease and treatment burden at baseline with a mean of 17.37 (standard deviation [SD] 3.50) medicines. At 6-month follow-up, both intervention and control groups had reductions in the numbers of medicines with a small but significantly greater reduction in the intervention group (incidence rate ratio [IRR] 0.95, 95% confidence interval [CI]: 0.899 to 0.999, p = 0.045). There was no significant effect on the odds of having at least 1 PIP in the intervention versus control group (odds ratio [OR] 0.39, 95% CI: 0.140 to 1.064, p = 0.066). Adverse events recorded included mortality, emergency department (ED) presentations, and adverse drug withdrawal events (ADWEs), and there was no evidence of harm. Less than 2% of drug withdrawals in the intervention group led to a reported ADWE. Due to the inability to electronically extract data, primary outcomes were measured at just 2 time points, and this is the main limitation of this work. The SPPiRE intervention resulted in a small but significant reduction in the number of medicines but no evidence of a clear effect on PIP. This reduction in significant polypharmacy may have more of an impact at a population rather than individual patient level. ISRCTN Registry ISRCTN12752680.

IntroductionBRONCHUK is a multicentre, prospective, observational cohort study enrolling adults with radiologically confirmed bronchiectasis across secondary centres in the UK. The objectives of the study are to develop a multicentre bronchiectasis registry incorporating baseline data collection with annual follow-up data for at least 5 years and to describe treatment patterns across the UK.Polypharmacy is defined as the concurrent use of ≥5 medications and has been rarely documented in literature for bronchiectasis patients. Polypharmacy has been associated with increased risk of adverse drug reactions and increased treatment burden. The current BTS guidelines have not detailed the impact of polypharmacy in bronchiectasis patients.MethodsAdult patients with a clinical diagnosis of bronchiectasis supported by CT Thorax were recruited in the study across multiple centres in the UK. Patient data collected at baseline included demographics, aetiology testing, comorbidities, lung function, radiology, treatments, microbiology and quality of life. Both respiratory and non-respiratory medications were included in the database but are not exhaustive.Results1626 patients were included in the analysis [1000 females (61.5%); 626 males (38.5%)] with a mean age of 64.4±13.4 years. 611 (37.6%) patients had documented asthma, 255 (15.7%) COPD and 58 (3.6%) ABPA.The mean BSI score was 7.3±3.5.376 patients (23.1%) had ≥5 respiratory-related medications prescribed. 643 patients (39.5%) had documented polypharmacy (including non-respiratory medications).321 (36%) patients without co-existing asthma/COPD were prescribed ICS.A weak positive relationship was established between age and number of medications prescribed (r=0.126;p<0.001). Higher rates of polypharmacy were seen in male cohort (45.5% as compared to 37.1% in female cohort) (χ2 =11.360;p<0.001).A logistic regression analysis showed that with each 1-point increase in BSI score the odds of polypharmacy increased by 20% (OR = 1.197, p <.001).Abstract S39 Figure 1[Image Omitted. See PDF.]ConclusionPolypharmacy is a growing concern due to risks of cumulative harm. Since this database didn’t collect all medications prescribed to patients, the current polypharmacy rates are underreported. Polypharmacy was associated with gender and disease severity. LABA and ICS were the most frequently prescribed medications. As new therapies and precision medicine emerge in bronchiectasis minimising polypharmacy should be considered.

BackgroundDelayed hypoxic leukoencephalopathy (DHL) is a rare demyelinating syndrome characterized by acute neurological deterioration following an initial recovery from a hypoxic insult. Presentation can vary but usually includes cognitive decline, akinetic mutism or parkinsonism. Gradual recovery occurs but neurological deficits usually persist.CaseA 52-year-old man with schizoaffective disorder and a history of polysubstance misuse was found unresponsive with pinpoint pupils and vomitus, having last been seen well two days prior. He was hypoxic but normotensive. Urine drug screening was positive for amphetamines, benzodiazepines, methadone, and opiates. A diagnosis was made of acute respiratory failure with multiorgan dysfunction secondary to polypharmacy overdose. He was intubated and managed in the Intensive Care Unit. He was extubated 5 days later and was alert, orientated and mobile. He was transferred to the mental health unit as he remained thought disordered. Two weeks later, there was deterioration in his cognitive function, coupled with the development of akinetic mutism, severe rigidity and tremor. Serum and CSF infectious, metabolic, autoimmune and paraneoplastic panels were unremarkable, and EEG was normal. MRI brain demonstrated diffuse subcortical white matter hyperintensities on T2 based sequences, consistent with DHL. The patient was transferred back to the medical ward for supportive care and later inpatient rehabilitation. Over four months, he showed gradual neurological improvement and was discharged home with NDIS support.ConclusionThis case highlights the biphasic nature of DHL and the importance of recognizing delayed neurological deterioration after hypoxic injury. Early identification, supportive care, and rehabilitation can facilitate functional recovery.

Abstract Objectives In Africa, antipsychotic polypharmacy (APP) is increasing due to a high antipsychotic dose prescribing, repeated psychiatric hospitalization, uncontrolled psychotic symptoms, and greater side effect burden. Therefore, the aim of this review and meta-analysis is to assess the prevalence and correlates of APP among patients with schizophrenia in Africa. Methods A systematic search was performed from August 1 to 31, 2020, on PubMed, MEDLINE, Google Scholar, and Science Direct databases to select articles based on the inclusion criteria. Meta-Analysis of Observational studies in Epidemiology guidelines were employed. Cross-sectional observational studies that reported APP and/or its correlates in schizophrenia patients in English language published in peer-reviewed journals without time limits were included in the review. The quality of included articles was assessed using Newcastle-Ottawa quality assessment tool. Prevalence and correlates of APP were the outcome measures of this review and meta-analysis. Open Meta Analyst and RevMan version 5.3 software were used for meta-analysis. A random effect model was used to synthesize data based on the heterogeneity test. Results Six studies that involved 2154 schizophrenia patients met the inclusion criteria in this review and meta-analysis. The quality of included studies ranges from 6.5 to 10 based on the Newcastle-Ottawa quality assessment tool. The pooled prevalence of APP among patients with schizophrenia was 40.6% with 95% confidence interval: 27.6% to 53.7%. Depot first-generation antipsychotics and oral first-generation antipsychotics were the most commonly prescribed APP combinations. Socio-demographic, clinical, and antipsychotic treatment characteristics were significantly associated with APP. There was a wide variation in the correlates of APP assessed by studies and the way that association/correlations was determined and reported. Conclusions APP is common and highly prevalent. Advanced age, male gender, longer duration of schizophrenia, hospital admission, and longer antipsychotic treatment were correlates of APP in Africa.

BackgroundAs recent evidence has emerged indicating the efficacy of sodium-glucose-co-transporter-2 inhibitors (SGLT2i) in reducing all-cause mortality as well as hospitalisations in patients with HFrEF, it has been widely and quickly adapted into Cardiology practice. However, given the comorbidities and polypharmacy associated with this patient cohort, the real-world initiation and monitoring can be challenging.AimTo assess the renal biochemical effects of SGLT2i initiation, as well as effects on hospitalisation and side effects in a cohort of patients commenced on SGLT2i at Beaumont Hospital HF unit.MethodsThis is a retrospective observational study carried out through Heart Support Unit outpatient department. Demographic data available such as age, comorbidities, and concurrent medical therapies for HFrEF was obtained from PIPE and medical records [table 1]. Follow up biochemical markers of renal function and nt-Pro-BNP levels were obtained as well as data on any hospitalisations in the intervening period and changes in concomitant medications. Analysis was carried out to assess for any significant changes in renal function, electrolytes, nt-pro-BNP.Results86 patients were identified for SGLT2i (78 dapagliflozin and 8 empagliflozin), having started SGLT2i between July 2020 and March 2021. Of these 77 patients were available for analysis (59 male, 18 female). 9 patients were excluded due to contraindications, or lack of follow up data. Therapy was predominantly commenced at 10mg OD (96%). Mean follow up was 97 days post commencement of SGLT2i. Mean age was 68 (40-94). The treatment was well tolerated as a whole, 1 patient was discontinued due to hyponatremia (na 128). Mean creatinine prior to starting SGLT2 was 111.9 ±28, mean eGFR 60.9ml/min/kg2 (male 63.5, female 51.8). Mean creat was 112.7 following observation. This was consistent even in patients with stage III and IV CKD, average creatinine rose just 1mmol in this patient cohort. No statistically significant difference (using paired t-tests) was noted in creat, Na, K, Mg or nt-pro-BNP. No clinically significant electrolyte abnormalities were identified at any follow up measurement. There were 9 cardiac hospitalisations during the study duration (11.5%). There were 7 non-cardiac admissions (9%). There was 1 death, caused by low output HF with euglycemic ketoacidosis.Abstract 42 Table 1Demographic dataAbstract 42 Table 2ConclusionConsistent with published data, the introduction of SGLT2i was well tolerated in this cohort. There was no significant change in renal function. No clinically significant electrolyte disturbance was observed. Loop diuretic therapy was reduced or stopped in 23%. While a modest reduction in average nt-pro-BNP was seen, this was not statistically significant. The data is reassuring and consistent with literature, that these agents do not result in deterioration in renal function in these patients on complex polypharmacy regimens and there is no need to check renal profile unless clinically indicated.

BackgroundPeople with HIV (PWH) are aging and may have a long history of HIV infection, long exposure to antivirals, increasing comorbidities and polypharmacy. We aim to assess the use of two drug regimens (2DR) in geriatric population of PWH.MaterialsThis is a cross-sectional study in PWH older than 64 years and currently followed up in 3 HIV centers in northern Italy. Data were collected from medical reports or electronic database in February 2025 and subjects with the last visit within 9 months and currently receiving ARVs were included. Polypharmacy (PP) was defined as 5 or more non-HIV drugs. The primary endpoint was the use of 2DR, secondary end-points were prevalence and characterization of comorbidities, polypharmacy and viroimmunological status. Multiple cox regression model was used to assess factors associated to 2DR treatmentsResults655 PWH were included (80%, males, median (IQR) age was 70 (66–75), 54% heterosex, 23% MSM, 13% past-IVUs, 95% were Caucasians. A total of 315 (48%), 243 (37%) and 42 (6.4%) subjects had received <3, 3–6 and more than 6 lines of HIV therapy, respectively. Median (IQR) duration of HIV infection was 25 (19–33) years, median (IQR) nadir and current CD4 count were 146 (3–50) and 689 (504–926) cells/mL, respectively, while 611 (93%) subjects had plasma HIV RNA <50 copies/ml. A total of 18 (3%), 212 (36%), 304 (53%) and 43 (7.5%) individuals had 0, 1–2, 3–5 and ≥6 comorbidities, respectively. A total of 266/525 (50.6%) had polypharmacy, while 21/570 (3.7%) were HBsAg positive. Overall, primary RAMs were documented in 159 subjects in NRTI- (124), NNRTI- (103), PI- (68) and INI- (10) regions, respectively.A total of 329 (50.2%) and 322 (49%) were on 2DR and ≥3DR, respectively; 4 were on DRV-monotherapy. 2DRs were as follows: DTG/3TC (175/329, 53.2%), boosted PI+X (57, 17%), DTG/RPV (53, 16%), CAB/RPV (17, 5%), DTG/DOR (13, 4%) and others (15, 4.5%). The most used 3DRs were BIC/F/TAF (160/322, 49.6%), RPV/F/TAF (65, 20.2%) and DTG/ABC/3TC (22, 6.8%) and DRVc/F/TAF (20, 6.2%). Overall, boosted PIs were used in 100 (15.2%) individuals, in different combinations. At Cox regression analysis, factors associated with a higher probability of being on 2DR were the number of comorbidities (HR of ≥ 6 comorbidities compared to 0–2: 0.52, 95% CI 0.3–0.9, global p <0.001), the presence of major mutations (HR = 0.67, 95%CI 0.48–0.94; p = 0.02) and the value of nadir CD4+ count (increase of 50, HR = 1.08, 95%CI 1.02–1.15; p = 0.015) (table 1).Abstract P106 Table 1Conclusions2DRs, INSTI-based and in different combinations, are used in up to half of geriatric PWH, with DTG/3TC being the most frequent, while CAB/RPV LA underused.

Introduction: Many commonly prescribed medications are associated with a variety of gastrointestinal (GI) side effects. Functional GI disorders are characterized by a variety of symptoms that could arise due to, or be confused with, medication side effects. We aimed to examine the prevalence of polypharmacy and certain medications in patients referred to a tertiary gastroenterology practice, and the association between the medications and GI complaints. Methods: We performed a retrospective review of consecutive outpatient gastroenterology consultations in 988 unique patients. Information regarding patient demographics, presenting GI symptoms, and detailed individual medication histories. Medications were categorized based on their mechanism of action and were not limited to only those directed at treating GI conditions. Continuous variables were summarized with the sample median and range. Categorical variables were summarized with number and percentage of patients. Spearman's test of correlation was used to assess associations. Results: The most common presenting GI symptoms were abdominal pain (72%), nausea (57%), and constipation (53%). The prevalence of polypharmacy (five or more medication) is 10%. Eighty percent of patients were taking at least one medication and 60% were taking two or more. The most frequently used medication group was PPIs (43%), followed by benzodiazepines (30%), selective serotonin-reuptake or norepinephrine-re uptake inhibitors (SSRIs/SNRIs) (28%), non-steroidal anti-inflammatory drugs (27%), opioids (21%), and anti-epileptics (10%). Diabetes medications, magnesium-containing medications, and other classes were each used by less than 10% of the patients. There is a significant positive correlation between the total number of presenting symptoms and the total number of different medications the patients were currently taking (Spearman's r: 0.09, P=0.006). Conclusion: Although there is a higher use of prescription medicines in our study population (80%) compared to the general population (70%), the prevalence of polypharmacy (5 or more medications) is lower (10%) compared to the general population (21%). There is a higher use of antidepressant (33%) compared to the general population (10%). Though the correlation between the number of different medications and number of presenting symptoms is weak, it suggests that the medications may contribute to the symptoms leading to their GI consultation.