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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.

Purpose:To assess the prevalence of phosphodiesterase 5 (PDE5) inhibitor use and associated factors among University of Gondar undergraduate students. Materials and Methods:An institution-based, cross-sectional study, using a survey questionnaire, was conducted from October to December 2015 to assess PDE5 inhibitor use and associated factors among male students at the University of Gondar. A Self-Esteem and Relationship questionnaire (14 items), an International Index of Erectile Function questionnaire (15 items) and a questionnaire on PDE5 inhibitor use (14 items) were included in the survey.Results: Across all respondents (age, 21.9±1.88 years), more than half (55.7%, n=233) had heard about PDE5 inhibitors, but only 23 men (5.5%) reported trying a PDE5 inhibitor drug at least once. Older students were more likely to use PDE5 inhibitors compared to younger students (adjusted odds ratio [AOR], 1.40; 95% confidence interval [CI], 1.109∼1.768). Those students who were smokers were 5.15 times more likely to use PDE5 inhibitors as compared to their non-smoking counterparts (AOR, 5.15; 95% CI, 2.096∼12.687). In addition, multivariate logistic regression showed that being in a relationship, alcohol use, greater number of cigarettes smoked per day, and more sexual partners were significantly associated with PDE5 inhibitor use. Conclusions:The prevalence of PDE5 inhibitor use among undergraduate students was 5.5%. Cigarette smoking and other substance use, older age, and greater number of sexual partners were significantly associated factors for PDE5 inhibitor use. These findings suggest that restricting access to PDE5 inhibitor drugs is essential to curtailing misuse among university students.