Background: In the current COVID-19 pandemic, some risk factors for severe disease and death have been identified, including age, male gender, diabetes mellitus, cardiovascular and lung diseases, chronic kidney disease and cancer Although still scarce, current data does not support an increased risk for severe COVID-19 on PLWH [1,2] Our aim was to describe clinical characteristics and outcomes of PLWH with COVID-19 followed in our hospital, a reference centre for emerging infectious diseases in Portugal Materials and methods: Retrospective analysis on cases of PLWH with a confirmed COVID-19 diagnosis between 2 March and 14 July 2020 The data showcased in Table 1 was collected from patient records Proven COVID-19 required a positive SARS-CoV-2 nucleic acid amplification test on respiratory samples Results: We followed 2092 patients with COVID-19, eight of whom were PLWH (six males, mean age 48 ± 15 years) on ART at the time of diagnosis, which included protease inhibitors (PI) in two and tenofovir alafenamide in two Median CD4 + T cell count was 626 (range 14 to 1337) cells/mm3 Seven were virally suppressed and had a CD4 + T cell count =350 cells/mm3, and six had at least one comorbidity other than HIV Two patients received treatment with hydroxychloroquine, both of whom were hospitalised: one with concomitant ankylosing spondylitis on methotrexate and the other diagnosed with SARS-CoV-2 pneumonia while hospitalised for candidaemia The latter was a 67-year-old HIV-2 infected patient on a failing ART regimen without immune recovery and with detectable HIV viraemia, and the only casualty in our cohort He had multiple comorbid conditions and required treatment with supplemental oxygen therapy Seven patients were classified as having mild disease, six of whom currently considered fully recovered with a median 40 5 days (range 21 to 74 days) until two consecutive negative SARS-CoV-2 PCR tests Conclusions: PLWH accounted for \u003c 0 4% of patients with COVID-19 in our centre PLWH may still get infected during PI-and/or tenofovir-based ART A severe clinical picture among those with viral suppression on ART was not seen thereby adding to the growing body of evidence supporting the notion that adequately controlled HIV does not by itself place one at increased risk for severe disease or excess mortality

Objectives A few molecularly proven SARS-CoV-2 cases of symptomatic reinfection are currently known worldwide, with a resolved first infection followed by a second infection after a 48 to 142-day intervening period. We report a multiple-component study of a clinically severe and prolonged viral shedding COVID-19 case in a teenager Portuguese female. She had two hospitalisations, a total of 19 RT-PCR tests, mostly positive, and criteria for releasing from home isolation at the end of 97 days. Methods The viral genome was sequenced in seven serial samples and in the diagnostic sample from an infected close relative. A human genome-wide array (>900K) was screened on the seven samples, and in vitro culture was conducted on isolates from three late samples. Results The patient had co-infection by two SARS-CoV-2 strains, affiliated in distinct clades and diverging by six variants. The 20A lineage was absolute at the diagnosis (shared with a cohabitating relative), but nine days later the 20B lineage had 3% frequency, and two months later the 20B lineage had 100% frequency. The 900K profiles confirmed the identity of the patient in the serial samples, and allowed us to infer that she had polygenic risk scores for hospitalization and severe respiratory disease within the normal distributions for a Portuguese population cohort. Conclusions The early-on dynamic co-infection was the probable cause for the severity of COVID-19 in this otherwise healthy young patient, and for her prolonged SARS-CoV-2 shedding profile.

The use of mycobacterial blood cultures (MBC) for the diagnosis of tuberculosis (TB) is advised in immunosuppressed patients to increase the diagnostic recovery [[1]Lange C. Mori T. Advances in the diagnosis of tuberculosis.Respirology. 2010; 15: 220-240Crossref PubMed Scopus (120) Google Scholar]. In human immunodeficiency virus (HIV) -infected individuals it is not clear if MBC provide additional value over a well-directed study and other properly collected samples for microbiological investigation. Also, the number of MBC that should be processed is not defined. We performed an assessment of the overall sensitivity of MBC for the diagnosis of TB in HIV-infected adult individuals requiring acute hospital admission, at Centro Hospitalar São João, Porto/Portugal, between 2008 and 2014. TB was classified as probable (clinical criteria and one positive acid-fast bacilli (AFB) smear or granuloma in biopsy or positive nucleic acid amplification test (NAAT)) and definitive (clinical criteria and positive culture or two positive AFB smears or a positive AFB smear and positive NAAT). Disseminated TB was defined as TB in two non-contiguous locations. We included 139 HIV-infected individuals. In our sample, 111 (79.9%) were male, mean age was 44.8 years (±12.7). Median CD4+ count at the time of TB diagnosis was 86/mm3 (interquartile range 30–177). In 51 (37%) of the patients, TB and HIV were diagnosed simultaneously. The majority of patients had lung disease (n = 115; 82.7%), of which 52 (45.2%) also had extrapulmonary manifestations. Forty-six patients (33.1%) had disseminated disease. A total of 218 MBC were drawn to 121 patients (87.1%), with 56 patients (46.2%) having collected at least two MBC, and 25 (20.7%) having at least three. Eleven patients (9.1%) had more than three MBC collected. All samples were collected on separate days. From the 81 patients with a definitive or probable diagnosis, a total of 144 MBC were collected. Of those, 15 (12.4%) patients had a positive MBC result, of which 12 (80%) were positive in the first MBC drawn. Hence, the overall sensitivity of one MBC in the diagnosis of TB was 14.8%. Three of 56 patients had a second positive MBC sample, which increased the sensitivity to 27.5%. Adding a third MBC sample did not increase the overall sensitivity of the test. The sensitivity of MBC was higher in patients with CD4+ <50/mm3 (the estimated sensitivity of MBC was 27.3% and 33.3%, for one or two samples, respectively) and patients with extrapulmonary commitment had a significantly higher proportion of positive MBC samples (80% versus 20%; p 0.006). Of the 15 patients with a positive MBC, three had only pulmonary manifestations (20%), ten had pulmonary and extrapulmonary disease (66.7%) and two had strictly extrapulmonary commitment, with lymphatic disease. All patients with a positive MBC for Mycobacterium tuberculosis complex had a positive culture in at least one other biological sample, and all but one had either a positive AFB smear or NAAT. Indeed, 80% of MBC-positive individuals had a positive AFB smear. In our analysis, we included respiratory specimens collected from invasive procedures (e.g. bronchoscopy) and auramine staining was performed in all samples. As in some previous studies [2Barr D.A. Kerkhoff A.D. Schutz C. Ward A.M. Davies G.R. Wilkinson R.J. et al.HIV-associated Mycobacterium tuberculosis bloodstream infection is underdiagnosed by single blood culture.J Clin Microbiol. 2018; 56Crossref PubMed Scopus (9) Google Scholar, 3Liu X. Bian S. Zhang Y. Zhang L. Yang Q. Wang P. et al.The characteristics of patients with mycobacterium tuberculosis blood stream infections in Beijing, China: a retrospective study.BMC Infect Dis. 2016; 16: 750Crossref PubMed Scopus (4) Google Scholar, 4Gopinath K. Kumar S. Singh S. Prevalence of mycobacteremia in Indian HIV-infected patients detected by the MB/BacT automated culture system.Eur J Clin Microbiol Infect Dis. 2008; 27: 423-431Crossref PubMed Scopus (18) Google Scholar, 5von Gottberg A. Sacks L. Machala S. Blumberg L. Utility of blood cultures and incidence of mycobacteremia in patients with suspected tuberculosis in a South African infectious disease referral hospital.Int J Tuberc Lung Dis. 2001; 5: 80-86PubMed Google Scholar] MBC showed low sensitivity and overall low diagnostic yield in the diagnosis of TB, namely among HIV-infected patients. In our study, we included severely immunosuppressed patients requiring acute hospital admission. We found that the overall sensitivity of one MBC was 14.8%. Having two blood samples for culture increased sensitivity to a maximum of 33.3% in those <50/mm3. A third sample had no additional value in any strata. When comparing patients with positive and negative MBC, patients with positive MBC had more advanced HIV disease, as shown by a higher mean viral load and lower CD4+ count, and a higher rate of extrapulmonary reflecting failure of the severely impaired immune system at controlling TB infection. In all MBC-positive cases, M. tuberculosis was also isolated in samples collected from other sites and all but one patient had either a positive AFB smear or NAAT. The mean time to positivity of MBC, when using standard media, is between 2–6 weeks, considerably longer than both AFB smear and NAAT. Moreover, only a small percentage of patients with evidence of TB had a positive MBC. Although current guidelines and standards recommend performing MBC in HIV-infected patients with suspected TB, we found no added value of MBC in the diagnosis of TB in a setting where invasive biological samples and microbiological tests (including molecular studies and culture with automated techniques) are performed. We do not know if the results are different for mycobacterial infections other than M. tuberculosis that are often considered in the differential diagnosis. More studies, including cost analysis, are needed to better define the role of MBC in the diagnosis of mycobacterial infections. The authors have no conflicts of interest to declare. This work was supported by contributions from Iceland, Liechtenstein and Norway through the European Economic Area Grants under the Public Health Initiatives Programme (PT 06, grant number 138DT1). We would like to thank Dr Margarida Tavares for their extraordinary support in this study.

Dual human immunodeficiency virus (HIV) 1 and HIV-2 super-infections are rare but challenging. A HIV-1-infected patient receiving effective antiretroviral therapy was investigated for a severe CD4+ cell count decline. HIV-2 superinfection was diagnosed and genotypic test revealed mutations conferring resistance to most drug class, limiting options for treatment.

P001 - Sepsis impairs the capillary response within hypoxic capillaries and decreases erythrocyte oxygen-dependent ATP efflux

Journal of the European Academy of Dermatology and VenereologyVolume 31, Issue 4 p. e196-e197 Letter to the Editor Europe importation of Panton–Valentine leukocidin-positive Staphylococcus aureus: a case report of recurrent furunculosis J. Vide, Corresponding Author J. Vide juliavide@gmail.com Department of Dermatology and Venereology, Centro Hospitalar de São João EPE, Porto, PortugalCorrespondence: J. Vide. E-mail: juliavide@gmail.comSearch for more papers by this authorM. Costa-Silva, M. Costa-Silva Department of Dermatology and Venereology, Centro Hospitalar de São João EPE, Porto, PortugalSearch for more papers by this authorJ. Sobrinho-Simões, J. Sobrinho-Simões Laboratório de Biologia Celular e Molecular, Centro Hospitalar de São João, Porto, PortugalSearch for more papers by this authorF. Ceia, F. Ceia Department of Infectious Diseases, Centro Hospitalar de São João EPE, Porto, PortugalSearch for more papers by this authorA. Pinto, A. Pinto Department of Infectious Diseases, Centro Hospitalar de São João EPE, Porto, PortugalSearch for more papers by this authorA.C. Carvalho, A.C. Carvalho Department of Infectious Diseases, Centro Hospitalar de São João EPE, Porto, Portugal Faculty of Medicine, University of Porto, Porto, PortugalSearch for more papers by this authorA. Sarmento, A. Sarmento Department of Infectious Diseases, Centro Hospitalar de São João EPE, Porto, Portugal Faculty of Medicine, University of Porto, Porto, PortugalSearch for more papers by this authorC. Lisboa, C. Lisboa Department of Dermatology and Venereology, Centro Hospitalar de São João EPE, Porto, Portugal Faculty of Medicine, University of Porto, Porto, PortugalSearch for more papers by this authorF. Azevedo, F. Azevedo Department of Dermatology and Venereology, Centro Hospitalar de São João EPE, Porto, PortugalSearch for more papers by this author J. Vide, Corresponding Author J. Vide juliavide@gmail.com Department of Dermatology and Venereology, Centro Hospitalar de São João EPE, Porto, PortugalCorrespondence: J. Vide. E-mail: juliavide@gmail.comSearch for more papers by this authorM. Costa-Silva, M. Costa-Silva Department of Dermatology and Venereology, Centro Hospitalar de São João EPE, Porto, PortugalSearch for more papers by this authorJ. Sobrinho-Simões, J. Sobrinho-Simões Laboratório de Biologia Celular e Molecular, Centro Hospitalar de São João, Porto, PortugalSearch for more papers by this authorF. Ceia, F. Ceia Department of Infectious Diseases, Centro Hospitalar de São João EPE, Porto, PortugalSearch for more papers by this authorA. Pinto, A. Pinto Department of Infectious Diseases, Centro Hospitalar de São João EPE, Porto, PortugalSearch for more papers by this authorA.C. Carvalho, A.C. Carvalho Department of Infectious Diseases, Centro Hospitalar de São João EPE, Porto, Portugal Faculty of Medicine, University of Porto, Porto, PortugalSearch for more papers by this authorA. Sarmento, A. Sarmento Department of Infectious Diseases, Centro Hospitalar de São João EPE, Porto, Portugal Faculty of Medicine, University of Porto, Porto, PortugalSearch for more papers by this authorC. Lisboa, C. Lisboa Department of Dermatology and Venereology, Centro Hospitalar de São João EPE, Porto, Portugal Faculty of Medicine, University of Porto, Porto, PortugalSearch for more papers by this authorF. Azevedo, F. Azevedo Department of Dermatology and Venereology, Centro Hospitalar de São João EPE, Porto, PortugalSearch for more papers by this author First published: 23 August 2016 https://doi.org/10.1111/jdv.13938Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume31, Issue4April 2017Pages e196-e197 RelatedInformation

Unfortunately, the original version of this supplement [1] contained errors in two of the abstracts; P037 and P127. Please see details below.

Thyroid diseases have well known, proper clinical presentations. In elderly inpatients of internal medicine wards, the clinical picture is masked by acute diseases and comorbidities, making it hard to reach the diagnosis and decisions regarding therapy. Objectives: Compare the characteristics of patients (pts) with hyper and hypothyroidism. Methods: Prospective study of patients admitted to an internal medicine ward consecutively during one year, with hyper and hypothyroidism (non-controlled clinical and subclinical forms). We compared the clinical presentation, comorbidities, season of admittance, clinical characteristics and mortality during hospital stay and upon follow-up (322 ± 227 days). Results: A total of 130 patients with thyroid dysfunction were included (prevalence: 31.6%), hypothyroidism (n = 62) vs hyperthyroidism (n = 68), age = 77.9 ± 12.6 vs 78.2 ± 14.3 years (ns); male 37.1 vs 41.2% (ns); Comorbidities in hypo versus hyperthyroidism: atrial fibrillation 48.4 vs 38.2% (ns); anemia 56.5 vs 48.5% (ns); heart failure 46.8 vs 47.1% (ns); arterial hypertension 71 vs 73.5% (ns); dementia 19.4 vs 4.4% (p = 0,008); and chronic renal disease 45.2 vs 52.9% (ns). Previous amiodarone treatment is 11.5 vs 24.2% (p = 0.062). Prevalence during winter months is (November to April) 51.6% vs 32.4% (p = 0.026). Physical exam: body mass index 27.2 ± 6.9 vs 25.8 ± 5.3 kg/m2 (ns); systolic arterial pressure 126.9 ± 29.2 vs 139.0 ± 30.3 mm Hg (p = 0,022); dyastolic arterial pressure 69.1 ± 16.2 vs 73.4 ± 19.4; and heart rate 82.5 ± 23.2 vs 87.4 ± 25 bpm (ns). Conclusion: The authors did not find the typical syndromes or clinical differences between hypo- and hyperthyroidism, except for the presence of dementia which was more frequent in pts with hypothyroidism and higher systolic arterial pressure in pts with hyperthyroidism. The prevalence of atrial fibrillation and the heart rate, contrary to what one would expect, were similar in both groups. In advanced age, the presence of multiple comorbidities and ploymedication of pts in internal medicine wards are associated with more frequent thyroid dysfunction, although with uncharacteristic presentation.

Celiac disease (CD) is a chronic immune-mediated enteropathy, associated with the ingestion of gluten- containing foods. The form of presentation is variable, may be clinically sparse with a late diagnosis. Diarrhea, weight loss and anemia are common, the diagnosis is supported by serological markers and duodenal biopsies. Clinical case: Woman, 70 years old, history of arterial hypertension and dyslipidemia, with chronic diarrhea, persistent vomiting and weight loss since 2011. She had low weight (BMI 15.7), mild anemia and hypoalbuminemia, positive fecal fat, bacteriological and parasitological examination negative (including Giardia); serology for Yesinia, Campylobacter and HIV negative, positive ANA (1/320), anti-DNA, ANCA and ASCA negative, anti transglutaminase and gliadin IgA negatives. Upper endoscopy 2011 — erosive gastritis and duodenitis; Helicobacter pylori negative; colonoscopy without lesions, biopsies of the cecum: colitis with mild activity; admitted with the diagnosis of inflammatory bowel disease, she was treated with mesalazine without clinical improvement. Repeated colonoscopy and biopsy: nonspecific inflammatory changes. For the possibility of irritable bowel syndrome/nervous anorexia, she was evaluated and medicated by Psychiatry, without improvement. Repeated upper endoscopy to exclude Whipple's disease — Tropheryma whippelii negative; but duodenum presented a mosaic pattern and biopsies with marked atrophy of the villi, crypt hyperplasia, fibrosis and inflammatory infiltration of lymphocytes compatible with CD (Marsh IIIB); serology for celiac disease remained negative. She was hospitalized, submitted to transitory parenteral feeding, starting gluten free diet with improvement and weight gain. Conclusion: The CD is an increasingly common disease in adults whose diagnosis is not always easy, and whose treatment requires adherence to a gluten-free diet indefinitely.

Introduction: Diabetes mellitus (DM) is an independent predictor of mortality in hospitalized patients (pts). Prospective observational studies have reported a greater association between hyperglycaemia and increased mortality in non-diabetic pts compared with diabetics. Objectives: To compare the clinical characteristics and prognosis of non-diabetic vs. diabetic pts with hyperglycaemia in an internal medicine ward. Methods: Prospective study of consecutively admitted pts with a diagnosis of type 2 DM — Group A — vs. non-diabetic pts with hyperglycaemia (at least one occasional glucose ≥200 mg/dl or fasting glucose ≥126 mg/dl in the acute phase) — Group B. We compared prevalence, clinical characteristics and in-hospital and long-term mortality (277.6 ± 186.5 days). Results: 306 pts were included. Group A (175, 57.2%) vs. Group B (131, 42.8%); prevalence 30.8% vs. 23.8%, men 46.9 vs. 42.7% (ns); age 75.1 ± 11.6 vs. 77.2 ± 13.4 years old (ns), and BMI 27.9 ± 5.9 vs. 25.1 ± 4.8 kg/m2 (p = 0.001). Comorbidities A vs. B: hypertension 86.9 vs. 74.0% (p = 0.007); coronary disease 35.4 vs. 19.8% (p = 0.004), heart failure 65.1 vs. 39.7% (p = 0.001), peripheral artery disease 11.4 vs. 9.4% (ns), cerebrovascular disease 19.4 vs. 25.2% (ns), chronic kidney disease 51.4 vs. 40.5% (ns), and Charlson index 8.0 ± 2.6 vs. 6.6 ± 3.0 (p = 0.001). In-hospital mortality A vs. B: 3.4 vs. 12.2% (p = 0.007); long-term mortality A vs. B: 23.5 vs. 36.6% (p = 0.03). 14.7% of pts with hyperglycaemia met criteria for type 2 DM. Conclusion: Hyperglycaemia occurred in almost a quarter of acutely ill pts admitted in an internal medicine ward. Although significantly less obese and with fewer comorbidities, non-diabetic pts with hyperglycaemia had a significantly worse short and long-term prognosis than diabetics. This important issue and the potential benefit of correction of glycaemia in these patients deserve assessment in large, randomized, and multicentre studies.

Introduction: Subclinical hyperthyroidism is a relatively common condition, especially in the elderly, and is associated with major cardiovascular risk factors. There are no clear recommendations for its management. Objectives: To determine how doctors in an internal medicine ward manage subclinical hyperthyroidism, its consequences and short and long-term prognosis. Methods: Prospective study of patients (pts) consecutively admitted over one year. We compared clinical characteristics, in-hospital and long-term mortality (322 ± 227 days) of pts with subclinical hyperthyroidism (normal free T4 and decreased TSH) and without thyroid dysfunction. We assessed outpatient prescription (surveillance vs. radioactive iodine or antithyroid drugs) and thyroid function evolvement. Results: 475 pts were included; 71 (14.9%) had subclinical disease. Subclinical hyperthyroidism (n = 38) vs. pts without thyroid dysfunction (n = 404): men 39.5% vs. 46.5% (ns), age 79 ± 14.8 vs. 73 ± 14.9 years old (p = 0.022), and atrial fibrillation (AF) 26.3% vs 28.9% (ns); HR at admission 85.4 ± 20.2 vs. 84.4 ± 22.9 ppm (ns), systolic arterial pressure 143.5 ± 31.5 vs. 135.1 ± 29.2 mm Hg (p = 0.098), and BMI 26.1 ± 4.8 vs. 26.6 ± 5.6 (ns). 27.8% of pts with subclinical hyperthyroidism were on prior therapy with amiodarone. In-hospital mortality is 18.4 vs. 4.9% (p = 0.001) and long-term mortality is 16.1 vs. 14.6% (ns). On follow-up, from the 31 pts with hyperthyroidism, 80.6% evolved to euthyroidism, 12.9% to subclinical hyperthyroidism and 6.5% to clinical hyperthyroidism. At discharge, only one patient, who evolved to euthyroidism, was prescribed an antithyroid drug. Conclusion: Patients with hyperthyroidism are significantly older and have significantly higher in-hospital mortality than pts without thyroid dysfunction. Even without directed therapy, most evolved to normal thyroid function. The favorable long-term prognosis supports our conservative attitude.

Sarcoidosis is a systemic granulomatous of unknown etiology which affects mostly young adults. The clinical presentation is variable but nearly 90% have pulmonary involvement. Diagnosis is based on clinical and radiological presentation, confirmed by the presence of noncaseating granulomas and the exclusion of other granulomatous diseases. Evolution is also variable, from acute outset with spontaneous resolution to cronical disease, namely pulmonary fibrosis. Clinical case: Man, 64 years old, smoker in the past, with severe coronary artery disease, heart failure, type 2 diabetes mellitus, arterial hypertension, dyslipidemia. Hospitalized for recurrent atypical chest pain. Chest radiography — bilateral diffuse micronodular pattern. CT scan: micronodular pattern in upper lung fields, mediastinal and hilar lymphadenopathy; clinical analysis with no significant changes, serum calcium and urinary ACE and ADA normal; HIV negative. Intradermal reaction anergic, fiberoptic bronchoscopy without lesions, sputum and bronchoalveolar lavage (BAL): bacteriological and mycobacteriological (direct and culture) negative; BAL: CD4/CD8 lymphocyte ratio: 2.3; cytology negative for neoplastic cells, bronchial biopsies with nonspecific alterations. Normal spirometry and plethysmography; slight decrease in diffusion capacity of carbon monoxide. Transbronchial biopsies: aggregates of histiocytic cell type granuloma, giant cells multinucleated, compatible with sarcoidosis. Ophthalmic examination without significant changes. Started corticosteroid therapy with good clinical response. Comments: The diagnosis of Sarcoidosis remains a challenge for the doctor, being fundamental the exclusion of other diseases, including tuberculosis. The treatment is based on corticosteroid therapy in selected patients depending on the organ involvement, with difficult monitoring and uncertain prognosis.

ABSTRACT Cancer patients receiving chemotherapy are at increased risk of venous thromboembolism (VTE). The presence of cancer and anticoagulant use are risk factors for bleeding, yet data on bleeding risk are limited in these patients. This analysis evaluated the risk of major bleeding in cancer patients receiving chemotherapy using a US claims database. This retrospective cohort study used the MarketScan® databases, a nationwide database containing data from about 100 payers and covering > 30 million patients annually. Adult cancer patients receiving chemotherapy within 6 months of cancer diagnosis between January 2004 and December 2010 were included. Cancers of interest were: lung, colon/rectum, pancreas, bladder, stomach, and ovary. The index date was the first date of chemotherapy. Patients were followed until the earliest of: 1) first diagnosis of major bleeding; 2) termination of enrolment in the health plan; 3) end of study. The primary outcome was the first occurrence of major bleeding, based on selected ICD-9-CM/CPT codes, following chemotherapy initiation. Of 74,575 patients identified, exclusion of those with prior history of bleeding at baseline (∼5%) resulted in 70,822 patients included in the analysis. Mean age was 62 years, 37% were ≥ 65 years, and 52% were male. Average time of follow up and chemotherapy were 14.3 and 8.6 months, respectively; 6% had a history of VTE within 6 months prior to the index date. Major bleeding occurred in 5.8% of patients and the incidence rate for all cancers combined was 4.9 per 100 person-year (PY) and 10.5, 9.3, 6.2, 4.3, 3.6, and 3.3/100 PY for pancreatic, stomach, lung, bladder, colon/rectum, and ovarian cancer, respectively. Approximately 14% of patients (N = 10,456) developed VTE after chemotherapy initiation (> half in the first 3 months of chemotherapy treatment). Of these, 7.8% experienced major bleeding with incidence rates ranging from 5.9-17.7/100 PY after VTE. Major bleeding incidence in cancer patients receiving chemotherapy varies by cancer type with the highest rates in patients with upper gastrointestinal cancer. Compared to the overall cohort, major bleeding risk was higher in cancer patients who developed VTE. Disclosure J.H. Zong: Employee of Sanofi. L. Eckert: Employee of Sanofi. L. Zhang: Employee of Sanofi. W.S. Dai: Employee of Sanofi. A.T. Cohen: Consult: Astellas, AZ, Bayer, BI, BMS, Daiichi, GSK, JJ ResFund: AZ, Bayer, BI, BMS, Daiichi, GSK, JJ BoardSpeakerAdvis comm: Bayer, BI, BMS, Daiichi, GSK, J&J, Mitsubishi, Pfizer, Sanofi. All other authors have declared no conflicts of interest.

Neoplastic diseases (ND) and chronic kidney disease (CKD) are strongly related. Side effects of neoplastic treatments can cause CKD and the latter can be a risk factor for ND. Even in early stages of CKD, the risk of developing ND increases, the latter being drastically increased in patients (pts) treated with hemodialysis.

Background: The prevalence of atrial fibrillation increases substantially with age. As atrial fibrillation carries a higher risk of thromboembolic events, several scores have been developed to estimate thromboembolic and bleeding risk in order to help with the prophylactic decision.Objective: To determine thromboembolic and bleeding risk of elderly with atrial fibrillation according to CHADS(2), CHA(2)DS(2)-VASc and HASSLED and its repercussions on thromboembolic prophylaxis.Methods: Retrospective, observational study including 142 consecutively hospitalized patients over 65 years old, with non-valvular atrial fibrillation/flutter. CHADS(2) and CHA(2)DS(2)-VASc were applied and compared and HASBLED score was used to estimate haemorrhagic risk. The adequacy of prescribed antithrombotic therapy was evaluated. Long-term follow-up of thromboembolic and haemorrhagic events was carried out.Results: None of the elderly patients were allocated to the low-risk category according to CHADS(2) and CHA(2)DS(2)-VASc risk stratification. CHADS(2) classified 32 (22.5%) patients at moderate risk, while CHA(2)DS(2)-VASc score classified all patients at high risk. Applying the HASBLED score, 57(40.1%) had high haemorrhagic risk. Although by CHA(2)DS(2)-VASc all patients had a formal indication for anticoagulation, only 77 (54.2%) were anticoagulated. Age was found to be a common criteria for withholding oral anticoagulation. The thromboembolic event rate was 2.6% for anticoagulated patients and 11.5% for not anticoagulated ones, while major haemorrhages occurred in 6.5% anticoagulated and 1.5% not anticoagulated patients.Conclusions: All elderly with atrial fibrillation had high thromboembolic risk, better predicted by CHA(2)DS(2)-VASc. Anticoagulation, the only factor that can alter prognosis, was underused despite the evidence of the scores. Paradoxically, age alone was frequently considered a contra-indication for anticoagulation. (C) 2012 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.