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Background. There was limited published data on target organ damage (TOD) and the effect of nonadherence to practice guidelines in Ethiopia. This study determined TOD and the long term effect of nonadherence to clinical guidelines on hypertensive patients.Methods. An open level retrospective cohort study has been employed at cardiac clinic of Gondar university hospital for a mean follow-up period of 78 months. Multivariate Cox regression was conducted to test associating factors of TOD. Results. Of the total number of 612 patients examined, the overall prevalence of hypertensive TOD was 40.3%. The presence of comorbidities, COR = 1.073 [1.01-1.437], AOR = 1.196 [1.174-1.637], and nonadherence to clinical practice guidelines, COR = 1.537 [1.167-2.024], AOR = 1.636 [1.189-2.251], were found to be predicting factors for TOD. According to Kaplan-Meier analysis patients who were initiated on appropriate medication tended to develop TOD very late: Log Rank [11.975 ( = 0.01)]. Conclusion. More than forty percent of patients acquired TOD which is more significant. Presence of comorbidities and nonadherence to practice guidelines were correlated with the incidence of TOD. Appropriate management of hypertension and modification of triggering factors are essential to prevent complications.

A519 days; In KPI5 58% of patients received adjuvant chemotherapy within 60 days after surgery; In KPI6 57% of patients performed radiotherapy within 90 days after surgery (who did not receive adjuvant chemotherapy) and 69% within 180 days after surgery (who received adjuvant chemotherapy); In KPI7 74% of the patients with tumor stage I and II performed one diagnostic examinations within 365 months after surgery. ConClusions: This study sustains the replicability of E.Pic.A. in different realities, the use of the KPIs to measure the performance is a way to guarantee a homogenous level of care regardless where the treatment is performed. Potentially, the improvement of these KPIs could lead to cost savings coming from inefficiencies that could be relocated to higher-value interventions for patients. References: 1. Massa et al., The Breast 34 (2017) 103-107. Disease-specific stuDies inDiviDual's HealtH-clinical Outcomes studies piH1 cOmparing tHe effect Of prOgressive relaxatiOn anD perineal strengHtening interval exercises amOng WOmen WitH primaer DysmenOrrHOea tO reDuce menstrual cramps

Objectives: PARADIGM-HF, a phase III trial conducted in patients with heart failure and reduced ejection fraction (HFrEF), showed that sacubitril/valsartan, a first-inclass angiotensin receptor-neprilysin inhibitor, provided incremental cardiovascular and overall survival benefit compared to enalapril. This analysis aimed to quantify the number of potential all-cause deaths that could be avoided with optimal usage of sacubitril/valsartan for the treatment of HFrEF in Costa Rica. MethOds: Data from Instituto Nacional de Estadística y Censos was used to identify patients with HFrEF for whom sacubitril/valsartan could be indicated. A literature review was conducted to determine the prevalence of HF, and the proportion of HFrEF patients classified as NYHA Class II-IV, in Latin America. The number needed to treat (NNT) to avoid one all-cause death, standardized to 12 months, was derived from the PARADIGM-HF trial. The potential number of all-cause deaths prevented or postponed with sacubitril/valsartan treatment was estimated using multi-way sensitivity analysis. The main outcome measure was all-cause mortality. Results: The entire 2017 population (≥ 20 years) was estimated at 3,435,930 and the estimated prevalence of HF was 1.0%. Physician interviews indicated that 60% of patients with chronic HF are diagnosed, yielding approximately 20,616 patients. Half of diagnosed patients had HFrEF, 80% of whom were classified as NYHA Class II-IV, equating to 8,246 patients with HFrEF NYHA II-IV. The absolute reduction in all-cause mortality in PARADIGM-HF was 2.8% over an average follow-up of 27 months with a NNT of 80.3, standardized to 12 months. Thus, optimal usage of sacubitril/valsartan therapy was estimated to prevent 103 deaths each year. cOnclusiOns: This analysis suggests that a significant number of all-cause deaths could potentially be prevented with optimal implementation of sacubitril/valsartan therapy into routine clinical practice in Costa Rica. However, one limitation of this analysis is the lack of current epidemiology data available specific to HF prevalence in Costa Rica.

Background: Adverse drug reactions (ADRs) to antiretroviral medications remained important reasons of concern that may compromise the effectiveness of the ART programs. In health communication, pictograms has a comprehensive place to aid attention, memory recall and promote adherence. In this study, we sought to assess whether this intervention would help to identify and improve ADR reporting in an ART clinic serving HIV patients in Northwest Ethiopia. Methods & Materials: A cross-sectional study on ART-naïve HIV-positive patients was conducted from July 15, 2015 to January 15, 2016. The patients were randomly categorized into two groups. The first group (group A) were subjected to receive pictorial medication information and pictograms-enhanced tool to identify and report ADRs, while the second group (group B) did not receive any pictogram-enhanced tool to identify the medications and to report ADRs. Results: Bivariate analysis showed that sociodemographic characteristics, age, sex, education, employment, and marital status were predictors of identifying and reporting ADRs. Males were twice more likely to identify ADRs than females. Univariate analysis revealed, intervention group showed a statistically significant association with the ability to identify ART medications using pictograms. Intervention group patients were more likely to identify 3TC [OR (95% CI) = 7.536 (4.042-14.021), p = 0.000], TDF [(OR (95% CI) = 6.250 (2.855-13.682), p = 0.000], NVP [(OR (95% CI) = 5.320 (1.954-14.484), p = 0.001], EFV [(OR (95% CI) = 3.929 (1.876-8.228), p = 0.000], and AZT [(OR (95% CI) = 3.570 (1.602-7.960), p = 0.002] using pictograms. Compared to group B, group A showed 4.3 times more likely to identify diarrhea as an ADR using pictogram. Conclusion: It was found that the use of pictogram-based intervention for ART medications resulted in increased identification of ADRs and improved ADR reporting among naïve HIV-positive patients with limited literacy in Northwest Ethiopia. This intervention provided promising innovation with the potential implications to improve ADR reporting and promote patients safety, particularly for HIV-positive patients with limited educational levels.