In patients with renal dysfunction and non-ST-segment elevation ACS, bleeding complications are more frequent and outcomes appear worse in individuals treated with UFH compared with LMWH. Combination therapy with LMWH and GP IIb/IIIa inhibitors appears to be better tolerated than with UFH and GP IIb/IIIa inhibitors.

In spite of emerging evidence of therapeutic benefit from non-invasive positive pressure ventilation (NPPV), only a minority of ALS patients use this therapy. We examined factors which correlate with use of NPPV in ALS patients. Data were analyzed from the ALS CARE Database on the use of NPPV in patients with FVC less than 50% of predicted and probable or definite ALS based on modified El Escorial criteria. Of the 403 eligible patients, 146 (36%) used NPPV. NPPV compliance was strongly correlated with symptoms of dyspnea and orthopnea as well as with the use of other therapies including PEG tubes, augmentative speech devices, and riluzole. Male gender and household income >$80,000 were also associated with higher NPPV use. There was no correlation between age, race, type of insurance, forced vital capacity, duration of symptoms, ALSFRS-R, caregiver burden or quality of life with the use of NPPV. These data suggest that the factors which are most closely associated with NPPV utilization are symptomatic orthopnea and dyspnea. The findings may be useful in designing prospective studies to examine the factors which might explain the underutilization of NPPV and the optimal use of this treatment.

NIPPV is used more than seven times as frequently as invasive ventilation in ALS patients. Patients who use NIPPV have more severe disease than those who do not use any respiratory intervention. Patients with lower income are less likely to use NIPPV, which raises concerns about disparities in the care of patients with ALS.

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BackgroundCaring for a child with juvenile idiopathic arthritis (JIA) negatively impacts caregivers. There are no studies on caregiver burden in JIA from South Asia.ObjectivesTo assess the caregiver burden in children with JIA from India.MethodsWe conducted this observational study in a Tertiary care center in North India. We translated and culturally adapted the CAREGIVER QUESTIONNAIRE[1]into Hindi and administered it to 145 caregivers of JIA patients age ≤ 18 years from November 2021 to December 2022. We collected their socio-economic data, clinically examined the child and reviewed their clinic records for disease characteristics including activity and damage. The Juvenile Arthritis Multidimensional Assessment Report was used to assess the physical function and health related quality of life. The CAREGIVER QUESTIONNAIRE was scored[2]to determine impact in various domains.ResultsOne hundred and forty-five caregivers participated with median age of 39 (32-45) years. This included 68 (47.9%) fathers, 34 (23.4%) mothers, 22 (15.2%) brothers, 18 (12.4 %) uncles and 1 (0.7%) sister, grandfather and grandmother. The JIA patients had median age of 15 (12-17) years and the male: female ratio 2.4:1. Enthesitis related arthritis was the predominant subtype (65.5%) followed by systemic onset JIA (11.7%), RF+ polyarthritis (9.0%), RF- polyarthritis (6.9%), oligoarticular JIA (6.2%) and extended oligoarticular (0.7%). Majority (69.7%) expressed sadness at diagnosis, and one fourth (28.3%) continued to express sadness. Half (53.4%) of the caregivers neglected their health and one tenth (9.7%) became sick. Two thirds (64.8%) had to borrow money to meet the expenses.Emotional impact scored 12.9 ± 2.3 (range 4-18). Social impact scored 6.1 ± 1.9 (range 2-9), economic impact 2.6 ± 1.0 (range 0-5), labour impact 7.0 ± 4.2 (range 0-15), family impact 6.8 ± 1.6 (range 4-16) relationship impact 0.6 ± 0.5 (range 0-0.8). Impact on spirituality was 0.9 ± 0.6 (range 0-5) and impact of social networks was 0.8 ± 0.8 (min= 0, max=8). Total score was 37.8 ± 9.2 (range 10-84).ConclusionJIA has significant emotional, social, economic and labor impact on caregivers. Social support needs to be given to caregivers for caring for children with JIA.References[1]Torres-Made MD, et. al. Development and validation of the CAREGIVERS questionnaire: multi-assessing the impact of juvenile idiopathic arthritis on caregivers. Pediatr Rheumatol Online J. 2020 Jan 14;18(1):3.[2]Fortuna-Reyna BJ, et. al. Psychosocial and economic impact of rheumatic diseases on caregivers of Mexican children. Pediatr Rheumatol Online J. 2021 Mar 17;19(1):30.Table 1.Characteristics of 145 children with juvenile idiopathic arthritisCharacteristicN= 145Age in years15 (12-17)Sex M:F103 (71.0): 42 (29.0)Duration of illness in years3 (2-6)Height of patients in cms158 (142- 166)Weight of patients in kgs43 (31-51)Children with JIA siblings5 (3.4)Children with at least 1 school year lost51 (35.2)Children with hospitalization in past51 (35.2)Time required to reach hospital in hours6 (4-8)Income in last 12 months100000 (48000-150000)Disease associated direct costs in last 12 months, in INR26375 (10800-50100)Disease associated indirect costs in last 12 months, in INR11250 (6000-24000)Juvenile arthritis disease activity score-279 (3-17)Children with Juvenile arthritis damage index- articular ≥ 123 (15.9)Children with Juvenile arthritis damage index- extraarticular ≥ 131 (21.4)Juvenile arthritis functionality scale3 (0.75-6.625)Paediatric Rheumatology Quality of Life Scale7 (2-14)Frequency represented as n(n%). Continuous variables expressed as median(interquartile range)Figure 1.Acknowledgements:NIL.Disclosure of InterestsNone Declared.