Evaluation of the antimicrobial activity of Eucalyptus radiata essential oil against Escherichia coli strains isolated from meat products

The present study sought to evaluate the antimicrobial and anti-adherent potential of Eucalyptus radiata essential oil against food-borne strains of Escherichia coli. The study was performed using the Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC). In addition, the disk diffusion technique was used to evaluate the association of Eucalyptus radiata essential oil with synthetic antimicrobials. The Minimum Inhibitory Adherence Concentration (MIC) was also performed. The results revealed that E. radiata showed antimicrobial activity against the E. coli strains tested, with MIC values ranging from 500 μg/mL to 1000 μg/mL and MBC values ranging from 500 μg/mL to 1,024 μg/mL. As for the associations, it was observed that E. radiata oil exhibited a synergistic effect for some antibiotics, especially Ceftriaxone, with greater interference from the essential oil. Furthermore, it was effective in inhibiting the adherence of bacterial strains of E. coli, showing a more significant antibiofilm effect than the antibacterial agent 0.12% chlorhexidine digluconate. In summary, the essential oil of E. radiata showed antimicrobial potential against strains of E. coli of food origin, and can therefore, through in-depth studies, be used alone or in association with synthetic antimicrobials to combat infections caused by this pathogen.

Antibacterial activity of Thymus vulgaris (thyme) essential oil against strains of Pseudomonas aeruginosa, Klebsiella pneumoniae and Staphylococcus saprophyticus isolated from meat product

Meat products represent an important component of the human diet and are a good source of nutrients. Food-borne microorganisms are the main pathogens that cause human diseases as a result of food consumption, especially products of animal origin. The objective of the present research was to verify the antibacterial activity of the essential oil of Thymus vulgaris against strains of Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus saprophyticus isolated from meat products. For this, the analyses of Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) were performed in microdilution plates. The association of the product with antimicrobials was also studied using disk diffusion. And the anti-adherent activity, which was determined in the presence of sucrose, in glass tubes. Thyme oil showed a strong inhibitory activity against K. pneumoniae, P. aeruginosa and S. saprophyticus, with the MIC values ranging from 64 to 512 μg/mL, and bactericidal effect for most strains, with MBC values ranging from 256 to 1,024 μg/mL. T. vulgaris oil exhibited varied interactions in association with the antimicrobials, with synergistic (41.67%), indifferent (50%) and antagonistic (8.33%) effects. Regarding the anti-adherent activity, the test product was effective in inhibiting the adherence of all bacterial strains under study. Therefore, thyme oil presents itself as an antibacterial and anti-adherent agent against K. pneumoniae, P. aeruginosa and S. saprophyticus, being a natural product that can represent an interesting alternative in the efforts to combat foodborne diseases.

Evaluation of the antibacterial activity of trans-anethole against Enterococcus cloacae and Enterococcus faecalis strains of food origin

The present study sought to evaluate the antibacterial activity of trans-anethole against food-borne strains of Enterobacter cloacae and Enterococcus faecalis. The study was performed using Minimum Inhibitory Concentration (MIC), and Minimum Bactericidal Concentration (MBC) methods, in addition, disc diffusion technique was used to evaluate the association of trans-anethole with synthetic antimicrobials. Minimum Inhibitory Concentration for Adherence (MICA) testing was also performed. The results revealed that trans-anethole presents no antibacterial activity at any of the concentrations used against the E. cloacae strains tested. However, trans-anethole presented antibacterial effect against five of the six E. faecalis bacterial strains tested, with MIC values ranging from 500 μg/mL to 1000 μg/mL. Further, when analyzing the MBC results against E. faecalis, it was observed that the compound presented values ranging from 500 μg/mL to 1000 μg/mL. As for the associations, it was observed that trans-anethole when combined with the antimicrobials ampicillin, gentamicin, ciprofloxacin, and ceftriaxone presented synergistic effect against most strains of E. faecalis. However, both trans-anethole and the control chlorhexidine (0.12%) presented no antibiofilm effects against strains of E. faecalis. In short, trans-anethole presented potential antibacterial against E. faecalis strains of food origin, and may upon further study, it may be used alone or in association with synthetic antimicrobials to combat infections caused by this bacterium.

Age-at-death assessed with Lamendin's original and population-specific models in a modern Brazilian osteological collection

BACKGROUND

Estimating the age at death is a common procedure in the fields of forensic human identification and anthropological/archaeological investigations. Root translucency and periodontosis are regressive parameters used to estimate the age of adults, more specifically in Lamendin's method - established in 1992 in a French population. This study aimed to test the applicability and validity of Lamendin's method in a Brazilian osteological collection.

METHODS

The sample consisted of 74 single-rooted teeth obtained from 50 skeletal remains (mean age: 53.20 ± 16.17 years) from Southeast Brazil. Lamendin's method was applied to enable a comparison between chronological (CA) and estimated ages (EA). A new population-specific equation was designed for the studied sample and the outcomes were compared with those obtained with Lamendin's original equation.

RESULTS

The original methods led to a general underestimation of 11.32 years (8.83 years in males and 15.91 years in females). The method had a better performance among individuals between 40 and 59 years (mean differences between CA and EA: 4.8 years). The population-specific equation led to a mean overestimation of -2.04 years in males, and a mean underestimation of 3.77 years in females. Underestimations were considerably higher in other age groups.

CONCLUSION

Despite the apparent improvements, both the original and the population-specific equations revealed coefficients of concordance that were constantly low between CA and EA. These outcomes suggest restrictions to the application of Lamendin's method in the forensic field, especially for human identification. The method, however, seems to be applicable for anthropological/archaeological applications.

Access to cardiac rehabilitation programs in patients with acute coronary syndrome: can referral be a step towards improvement? Insights from a multicentre national registry

 

The burden of cardiovascular disease remains on top of society's health problems, and acute coronary syndromes are undoubtedly a major cause. Cardiac rehabilitation programs (CRP) have been demonstrated to be a cost-effective strategy in reducing morbimortality and improving quality of life after an acute event. Despite this evidence and clinical recommendations, CRP are still globally underused. The lack of referral patients to CRP has been appointed as an important impediment to patients' participation.

This study aimed to clarify the main features of referred patients to CRP vs non-referred patients after an acute coronary syndrome (ACS).

The authors performed a retrospective analysis of adult patients with information about CRP destination, included in the Portuguese Registry on Acute Coronary Syndromes (ProACS) between October 2010 and December 2021. Comparison tests for parametric and non-parametric variables were performed. Logistic regression was applied for multivariate analysis. A p-value less than 0.05 was considered statistically significant.

A total of 28809 patients admitted for ACS were analysed, 22896 (79.5%) not referred for CRP (group 1) and 5913 (20.5%) were referred or even had a planned CRP. Table 1 shows the most important baseline characteristics and differences between groups. Table 2 demonstrate the group differences regarding admission diagnosis, complementary study results and in-hospital complications. Multivariate analysis established the following variables as independent factors for non-referral for CRP: age greater than 75 years (OR 0.80, 95% CI [0.72, 0.89]), history of valvular disease (OR 0.76, 95% CI [0.59, 0.97]), history of kidney disease (OR 0.65, 95% CI [0.54, 0.79]), admission diagnosis of unstable angina (UA) (OR 0.37, 95% CI [0.27, 0.50]), multivessel disease (OR 0.73, 95% CI [0.67, 0.80]), left ventricular ejection fraction less than 50% (OR 0.76, 95% CI [0.68, 0.84]), mechanical complication of myocardial infarction (OR 0.26, 95% CI [0.10, 0.67]) and acute heart failure during hospitalization (OR 0.67, 95% CI [0.58, 0.77]).

In conclusion, contrary to international results, women and patients with non-ST-segment elevation myocardial infarction were not negative predictors for referral to CRP. However, we observed that in our country, older patients, those with UA as an admission diagnosis, comorbidities and/or reduced systolic function are less referred to CRP by physicians. Paradoxically, these patients often have greater disease management complexity and poor outcomes. Besides that, the beneficial effects of cardiac rehabilitation in these groups have been demonstrated. Thus, it is extremely important to understand the limitations of referral in our country and implement strategies to overcome them.

Funding Acknowledgement

Type of funding sources: None.

AB0749 Anti-PM/Scl 75 and Anti-PM/Scl 100 antibodies: does the number matter?

Background

Anti-polymyositis/Scl (PM/Scl) antibodies have been associated to systemic sclerosis (SSc), PM and PM-SSc overlap syndrome. Although not specific and with some uncertainty about their true prevalence, they have been linked to the clinical presentation and prognosis of SSc rather than traditionally related impact of the extent of the cutaneous involvement12.

Objectives

The aim of this study is to describe the demographic, clinical and laboratorial data associated with the presence of anti-PM/Scl and to compare the differences against the two major antigenic components: 100 and 75 kDa proteins (anti-PM/Scl-75 and anti-PM/Scl-100).

Methods

A retrospective study including patients with positive anti-PM/Scl antibody followed in rheumatology department from January 2017 to December 2021 were analyzed. Demographic, clinical, immunological and nailfold capillaroscopy data at presentation and during follow-up were collected. Descriptive, Student’s t and Fisher test were estimated.

Results

Fifty six patients were positive for anti-PM/Scl antibodies. Of these, 38 (68%) were female with a median age at presentation of symptoms was 47 ± 16 years. Asymptomatic carrier of anti-PM/Scl75 and anti-PM/Scl100 were present in 15 (27%) and 7 (13%) of the patients, respectively. SSc and PM were the diagnosis most found, 34% and 9%, respectively. Arthralgias/Arthritis and Raynaud phenomenon (RP) were the first clinical features most presented followed by respiratory symptoms and constitutional symptoms. Relating to cumulative organ complications, peripheral vascular involvement was the most affected (RP, 30%) followed by musculoskeletal (MSK) and lung (interstitial lung disease - ILD, 21%) and skin involvement (limited cutaneous form, 20%). All patients were positive to antinuclear antibodies by indirect immunofluorescence.

Comparing patients with positive anti-PM-Scl75 and anti-PM-Scl100 showed a statistically significant difference at the presence of RP (as first or cumulative manifestation) and early pattern on nailfold capillaroscopy (p= 0.049 and p=0.039, respectively). A statistically significant difference was also found in an asymptomatic patient (p<0.001) – Table 1.

Conclusion

Anti-PM/Scl antibodies are frequently associated to MSK and RP symptoms as first and cumulative clinical manifestations followed by ILD and limited cutaneous form of SSc. Between anti-PM/Scl 75 and 100 serological profile, anti-PM/Scl100 is more associated to RP and abnormal nailfold capillaroscopy pattern.

References

[1]Wielosz E, Dryglewska M, Majdan M. The prevalence and significance of anti-PM/Scl antibodies in systemic sclerosis. Ann Agric Environ Med. 2021 Mar 18;28(1):189-192.

[2]Iniesta Arandia N, Espinosa G, Guillén Del Castillo A et al. Anti-Polymyositis/Scl Antibodies in Systemic Sclerosis: Clinical Associations in a Multicentric Spanish Cohort and Review of the Literature. J Clin Rheumatol. 2022 Jan 1;28(1):e180-e188.

Disclosure of Interests

None declared

POS0891 REUMA.pt/MYOSITIS – THE PORTUGUESE REGISTRY OF INFLAMMATORY MYOPATHIES

Background

The idiopathic inflammatory myopathies (IMM) module of the Rheumatic Diseases Portuguese Register (Reuma.pt/Myositis) is a tool used to systematically evaluate IIM patients.

Objectives

To clinically characterise the Reuma.pt/Myositis cohort.

Methods

Multicentre open cohort study, including IIM patients registered in Reuma.pt up to January 2022. Data collected included demographic, clinical, and treatment data and patient-reported outcomes. Data were presented as frequencies and median (interquartile range) for categorical and continuous variables, respectively.

Results

280 patients were included, 71.4% female, 89.4% Caucasian, with a median age at diagnosis and disease duration of 48.9 (33.6-59.3) and 5.3 (3.0-9.8) years, respectively. Patients were classified as having definite (N=57/118, 48.3%; N=35/224, 15.6%), likely (N=23/118, 19.5%; N=50/224, 22.3%), or possible (N=2/118, 1.7%; N=46/224, 20.5%) IIM by 2017 EULAR/ACR and Bohan-Peter criteria, respectively. Disease subtypes included dermatomyositis (DM, N=122/280, 43.6%), polymyositis (N=59/280, 21.1%), myositis in overlap syndromes (N=41/280, 14.6%), clinically amyopathic DM (N=17/280, 6.1%), nonspecific myositis (N=13/280, 4.6%), mixed connective tissue disease (N=12/280, 4.3%), immune-mediated necrotizing myositis (N=9/280, 3.2%), and inclusion bodies myopathy (N=7/280, 2.5%). Over the course of the disease, the most common symptoms were proximal muscle weakness (N=180/215, 83.7%), arthralgia (N=127/249, 52.9%), erythema (N=63/166, 38.0%), fatigue (N=47/127, 37.0%), Raynaud’s phenomenon (N=76/234, 32.5%), and dysphagia (N=33/121, 27.3%), and the most common clinical signs were Gottron’s sign (N=75/184, 40.8%), heliotrope rash (N=101/252, 40.1%), Gottron’s papules (N=93/237, 39.2%), and arthritis (N=38/98, 38.8%). Organ involvement included lung (N=78/230, 33.9%), oesophageal (N=40/221, 18.1%), and heart (N=11/229, 4.8%) involvements. Most patients expressed myositis-specific (MSA, N=158/242, 65.3%) and/or myositis-associated (MAA, 112/242, 46.3%) antibodies. The most frequent antibodies were anti-SSA/SSB (N=70/231, 30.3%), anti-Jo1 (N=56/236, 23.7%), and anti-Mi2 (N=31/212, 14.6%). Most patients had a myopathic pattern on electromyogram (N=101/138, 73.2%), muscle oedema in magnetic resonance (N=33/62, 53.2%), and high CK (N=154/200, 55.0%) and aldolase levels (N=74/135, 54.8%) at diagnosis, with median highest CK levels of 1308 (518-3172) and aldolase of 42 (12-121) mg/dL. Neoplasia was found in 11/127 patients (8.7%), most commonly breast (N=3/11, 27.3%), non-melanoma skin (N=2/11, 18.2%), and colorectal (N=2/11, 18.2%) cancer (Table 1). Most patients with cancer-associated myositis had DM (N=8/11, 72.7%) and expressed MSA (N=6/11) and/or MAA (N=3/11). The most used drugs over the course of disease were glucocorticoids (N=201/280, 71.8%), methotrexate (N=117/280, 41.8%), hydroxychloroquine (N=87/280, 31.1%), azathioprine (N=85/280, 30.4%), mycophenolate mofetil (N=56/280, 20.0%), intravenous immunoglobulin (N=55/280, 19.6%), and rituximab (N=45/280, 16.1%). At the last follow-up, there was a median MMT8 of 150 (142-150), modified DAS skin of 0 (0-1), global VAS of 10 (0-50) mm, and HAQ of 0.125 (0.000-1.125).

Table 1.

Autoantibodies in cancer-associated myositis

CancerIIMAutoantibodiesBreastDM (3)Mi2, SRP (+ SSA/SSB), Pm/SclSkin (non-melanoma)Clinically amyopathic DM, PMJo1, SAE1 (+SSA/SSB)ColorectalDM (2)Mi2 (2)KidneyDM-LungDM-LymphomaInclusion bodies myopathy-UnknownDM-

Conclusion

Reuma.pt/Myositis adequately captures the main features of inflammatory myopathies’ patients, depicting in this first report a heterogeneous population, with frequent muscle, joint, skin and lung involvements. Of interest, most patients reached low disease activity at the last follow-up appointment.

Disclosure of Interests

None declared

POS0861 ANTI-Ku ANTIBODY SYNDROME: IS IT A DISTINCT CLINICAL ENTITY? A CLUSTER ANALYSIS OF 75 PATIENTS

Background

Anti-Ku antibodies are rare among patients with Connective Tissue Diseases (CTD) (1). Their potential role as a disease biomarker is not well established.

Objectives

To identify subgroups of anti-Ku positive patients according to their spectrum of anti-nuclear antibody (ANA) specificities and analyze their clinical and analytical features.

Methods

Multicenter, cross-sectional study of anti-Ku positive patients, irrespective of their diagnosis, followed at eight Rheumatology outpatient clinics. Patients were spontaneously identified according to the local work-out for suspected autoimmune diseases. Anti-Ku and other ANA specificities were determined at each hospital’s Immunology lab according to the local methodology and strategy to decide on which auto-antibodies to check when faced with a positive ANA immunofluorescence. Clinical, analytical and treatment cumulative features were identified following a dedicated structured questionnaire. Hierarchical cluster analysis (method: between-groups linkage, squared Euclidian distance) for ANA specificity variables was performed to identify subgroups.

Results

Seventy-five anti-Ku positive patients were included (female: 73.3%, mean age at diagnosis: 50.5±17.9 years, mean disease duration: 4.7±5.4 years). Their clinical diagnosis were undifferentiated connective tissue disease (UCTD) (21.3%), systemic lupus erythematosus (17.3%), Sjögren’s syndrome (16.0%), inflammatory myositis (14.7%), systemic sclerosis (10.7%), overlap CTD syndrome (8.0%), other connective tissue diseases (17.3%), healthy anti-Ku carrier (17.3%).

Six autoantibody clusters were identified and included most patients (Figure 1): Cluster 1 - anti-Ku without any other ANA specificities (36.0%); cluster 2 - Anti-nor90 and anti-fibrillarin (8.0%); cluster 3 - anti-Jo1, PL-7, PL-12, and PM-Scl100 (9.3%); cluster 4 - anti-Scl70 (4.0%); cluster 5 - anti-Sm, anti-ribosome, and anti-dsDNA (13.3%); cluster 6 - anti-centromere, Th/To, PM-Scl75 (8.0%). The remaining patients were outliers (21.3%) not fitting in any cluster.

Figure 1.

Hierarchical cluster analysis of ANA specificities in anti-Ku+ patients

Detailed clinical analysis of patients in cluster 1, the most numerous, presenting anti-Ku antibodies without any other ANA specificities, the most frequent clinical manifestations were: Raynaud’s phenomenon (40.7%), arthritis (25.9%), sicca syndrome (25.9%), myositis (14.8%), and interstitial lung disease (ILD) (14.8%); 25.9% were healthy anti-Ku carriers. Patients from cluster 1 were most frequently treated with low dose glucocorticoids (51.9%), hydroxychloroquine (37.0%), or methotrexate (18.5%).

Among the whole study population (n=75), major organ involvement was present in 18.7%, with ILD in 10.7% and renal involvement in 8.0%. None of the patients in cluster 1 presented nephritis.

Conclusion

Anti-Ku positive patients without any other ANA specificities is the largest subset and may represent a distinct entity among the differentiated CTD (2). Patients with this anti-Ku syndrome may develop ILD. In addition, anti-Ku antibodies can be found in patients with a diversity of other ANA specificities and heterogeneous CTD diagnosis.

References

[1]Lakota K, et al. International cohort study of 73 anti-Ku-positive patients: association of p70/p80 anti-Ku antibodies with joint/bone features and differentiation of disease populations by using principal-components analysis. Arthritis Res Ther. 2012 Jan 6;14(1):R2. doi: 10.1186/ar3550. PMID: 22226402; PMCID: PMC3392788.

[2]Spielmann L, et al. Anti-Ku syndrome with elevated CK and anti-Ku syndrome with anti-dsDNA are two distinct entities with different outcomes. Ann Rheum Dis. 2019 Aug;78(8):1101-1106. doi: 10.1136/annrheumdis-2018-214439. Epub 2019 May 24. PMID: 31126956.

Disclosure of Interests

None declared

POS1282 PEDIATRIC INFLAMMATORY MULTISYSTEM SYNDROME TEMPORALLY-ASSOCIATED WITH SARS-CoV-2 – A PORTUGUESE SINGLE CENTRE CASE SERIES

Background

Across the globe, coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 appears to affect paediatric population in a milder and nonthreatening way, when compared to adults. However, since April 2020 case reports of previously healthy children presenting with unremitting fever, biologic inflammatory syndrome and cardiac dysfunction have been emerging. This syndrome, which has been termed Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 infection (PIMS-TS), represents a rare complication of COVID-19 in children1.

Objectives

To describe the clinical, laboratory and imaging characteristics, course, management and outcomes of hospitalized children diagnosed with PIMS-TS in a Portuguese tertiary care hospital.

Methods

A retrospective study including children (< 18 years) that attended our hospital from April 2020 to December 2021 was performed. All the children included fulfilled the case definition of PIMS-TS published by the Centre for Disease Control and Prevention. Sociodemographic and clinical data, laboratory markers and imaging findings were collected.

Results

A total of 19 children met the criteria for PIMS-TS, 68% male with a mean age at diagnosis of 8 years old (IQR 5.8-15). They were all caucasian, except for a mixed-race patient, and all previously healthy, except one patient who was obese. Twelve had recent infection by SARS-CoV-2 detected by reverse transcriptase (RT) PCR and 18 had positive IgG serology.

All had fever at diagnosis, with a median duration of 6 days (IQR 5-6) and 89.5% had mucocutaneous, gastrointestinal and hematological attainment, respectively. Other affected systems were respiratory (73.7%), cardiovascular (63%), lymphoid organs (52.6%), musculoskeletal (47%), genito-urinary (31.6%) and neurological (26.3%). Laboratory findings can be found in Table 1.

Thirty-six percent were admitted in intensive care unit for a median duration of 8 days (IQR 4-9). 42.1% needed respiratory support, 87.5% with supplemental oxygen therapy, 62.5% with mechanical ventilation and 12.5% with non-invasive ventilation. All patients received intravenous (IV) immunoglobulin, 52.6% IV corticosteroid (CS) pulses and 78.9% IV and oral CS. Other treatments included acetylsalicylic acid (n=18), heparin (n=8) and antibiotic therapy (n=19) - Table 3. Seventeen fully recovered and 2 had sequalae: one of them with coronary artery aneurysms and other exertional dyspnea.

Conclusion

In this case series, there was a broad spectrum of clinical symptoms and disease severity, ranging from fever and systemic inflammation to critical care admission with myocardial injury, shock, and development of coronary artery aneurysms.

Despite short-term morbidity, there were no mortality cases, with most of them recovering without sequelae. All physicians providing clinical care to children should consider this rare but severe delayed syndrome in paediatric population.

References

[1]Ramcharan T, Nolan O, Lai CY et al. Paediatric Inflammatory Multisystem Syndrome: Temporally Associated with SARS-CoV-2 (PIMS-TS): Cardiac Features, Management and Short-Term Outcomes at a UK Tertiary Paediatric Hospital. Pediatr Cardiol. 2020 Oct;41(7):1391-1401.

Characters from table content including title and footnotes: 710

Disclosure of Interests

None declared

Morphology, molecular phylogeny and biomass evaluation of Desmodesmus abundans (Scenedesmaceae-Chlorophyceae) from Brazil

Abstract The biotechnological potential of microalgae has been the target of a range of research aimed at using its potential to produce macromolecules with high added value. Particular focus has been given to biofuels' production, such as biohydrogen, biodiesel, and bioethanol from lipids and carbohydrates extracted from microalgal biomass. Bioprospecting and accurate identification of microalgae from the environment are important in the search for strains with better performance. Methodologies that combine morphology and molecular techniques allow more precise knowledge of species. Thereby, this work aimed to identify the new strain LGMM0013 collected at Iraí Reservoir, located in Paraná state, Brazil, and to evaluate the production of biomass, carbohydrates, and lipids from this new microalgal strain. Based on morphology and phylogenetic tree from internal transcribed spacer (ITS), strain LGMM0013 was identified as Desmodesmus abundans. D. abundans accumulated 1500 mg L-1 of dried biomass after 22 days of cultivation in autotrophic conditions, 50% higher than Tetradesmus obliquus (LGMM0001) (Scenedesmaceae-Chlorophyceae), usually grown in photobioreactors located at NPDEAS at the Federal University of Paraná (UFPR) to produce biomass. Analysis of the D. abundans biomass from showed an accumulation of 673.39 mg L-1 of carbohydrates, 130% higher than T. obliquus (LGMM0001). Lipid production was 259.7 mg L-1, equivalent to that of T. obliquus. Nitrogen deprivation increased the production of biomass and carbohydrates in D. abundans LGMM0013, indicating this new strain greater biomass production capacity.

Is there a real difference in approach between women and men with non-ST-segment elevation myocardial infarction? Insights from a multicentre national registry

 

In patients with non-ST-elevation myocardial infarction (NSTEMI), the early invasive strategy has shown benefit in morbidity and mortality, especially in intermediate-to-high risk patients. However, women still seem to have a lower revascularization rate, regardless of the risk.

The aim of this study is to describe our clinical practice reality about the performance of the invasive strategy between genders among NSTEMI patients, in Portugal.

The authors performed a retrospective analysis of patients admitted with NSTEMI included in the Portuguese Registry on Acute Coronary Syndromes (ProACS) between October 2010 and February 2021. A propensity score matching included baseline characteristics and previous history was applied. Comparison tests and log-rank test were performed. A p-value less than 0.05 was considered statistically significant.

A total of 11858 patients with NSTEMI were included, of which 71.3% (n=8450) were men. After the propensity score performing, 4458 patients were analysed, 50.0% (n=2229) men. Table 1 shows the most important baseline characteristics.

The authors found a significant delay in hospital admission after the onset of symptoms in women (median of 6 hours and 48 minutes) compared to men (median of 5 hours) (p&lt;0.01). Grace score was higher in males (mean 153 points) than in females (mean 145 points) (p&lt;0.01).

The cardiac catheterization was performed in 82.9% (n=3695) of the patients, with no difference between genders (p-value=0.19), as shown in table 2. Among those who underwent cardiac catheterisation, the presence of significant stenosis and coronary occlusion was greater in males, for almost all localizations. The absence of obstructive coronary lesions was more common in females (p-value&lt;0.01).

During hospitalization, sustained ventricular tachycardia was more prevalent in males (p-value =0.01), with no significant difference for other complications or in-hospital mortality.

A 1-year follow-up of 2351 patients (1184 men and 1163 women) was analysed, with survival of 91.2% (n=1080) in men and 91.0% (n=1056) in women, with no significant difference (p-value=0.80).

In conclusion, we observed that women are admitted to the hospital later than men and have a lower Grace score at admission. However, the standardized analysis of the groups allows us to infer that the invasive strategy does not seem to be less frequent or late in women, as observed in other populations. A more recent analysis, including risk groups, would be interesting to clarify the results.

Funding Acknowledgement

Type of funding sources: None.

[Prognosis of in hospital nonagenarians with acute kidney injury]

BACKGROUND

There has been little in the way of study of nonagenarians with acute kidney injury (AKI, defined in lines with KDIGO guidelines), but the rise in their life expectancy makes further study of this population necessary. The aim of this study is to assess mortality in nonagenarians with AKI during hospitalization.

METHODS

In this retrospective study, patients with AKI during hospitalization between 2013-2014 were included. At baseline, epidemiological variables, comorbidities and treatments were collected. Analytics and mortality were studied during hospitalisation. Univariate analysis was carried out to evaluate mortality-associated variables. A logistic regres-sion analysis was carried out to demonstrate independent predictors for mortality.

RESULTS

Two hundred and sixty-four nonagenarian patients were included. Mean age was 93±3 years, 73 (27.7?%) of whom were men. During hospitalization, 79 patients (29.9?%) died. Comorbidities related to mortality were history of heart failure (p?=?0.018), diastolic dysfunction (p?<?0.042) and higher dependence according to the modified Barthel index (p?=?0.003). The clinical variables related to mortality at hospital admission were lower systolic (p?=?0.016) and diastolic blood pressure (p?=?0.013), higher white blood cell count (p?=?0.003), greater severity of AKI (p?=?0.003) and L-?lactic (p?=?0.005). In an adjusted multivariate analysis, history of heart failure (OR?=?2.31, 95%CI: 1.07-5.00, p?=?0.036), depend-ence according to the Barthel index (OR?=?0.80, 95%CI: 0.67-0.97, p?=?0.016) and L-?lactic acid (OR?=?1.31, 95%IC: 1.06-1.61, p?=?0.005) were independent predictors of mortality.

CONCLUSION

Heart failure, dependence according to the Barthel index and L-?lactic acid at admission are independent predictors of mortality in nonagenarians hospitalized with AKI.

POS1083 PSORIATIC DISEASE – A HETEROGENOUS DISEASE WHO NEEDS A MULTIDISCIPLINARY CARE!

Background:

Rheumatologists and Dermatologists usually manage Psoriatic Arthritis (PsA) and Psoriasis (PsO) separately, but early diagnosis and integrated management could achieve better outcomes with gains in quality of life of the patients. A multidisciplinary care is essential to achieve these goals.

Objectives:

The aim of this study is to describe a model of integrated multidisciplinary approach for early diagnosis of PsA and the multidisciplinary management of PsA patients.

Methods:

A retrospective study including patients that attended the multidisciplinary clinical from January 2019 to December 2020 was performed. Patients with PsO complaining articular symptoms and patients with articular symptoms with cutaneous lesions suspected to be PsO was referred to this clinical. Demographic, clinical data and disease activity measures were collected. Descriptive, Student’s t and Fisher test and Odds Ratio were estimated.

Results:

A total of 50 patients were referred to multidisciplinary clinical. Of these, 40 patients met criteria for psoriatic arthritis according to CASPAR criteria: 22 (55%) were male and median age was 49.5 ± 11.5 years. Family history of psoriasis was present in 19 (47.5%) and 7 (17.5%) had spondyloarthritis family history. Obesity and overweight were the comorbidities most found, 42.9% and 37.1%, respectively, followed by hypertension 25%, dyslipidaemia and depression 22.5% and metabolic syndrome 15%. Thirty-three patients (84.6%) were under topical treatment, 23 (59%) were under csDMARDs and 13 (32.5%) were under bDMARDs. After multidisciplinary clinical evaluation, treatment change was made - switch to another bDMARDs in 5 patients and bDMARD was started in 7 patients. All patients had a previous evaluation for infection risk assessment and 11 patients performed 9 months isoniazid for latent tuberculosis treatment.

Eleven patients (28.9%) presenting moderate to severe PASI. Thirty-one patients presenting prolonged disease duration (> 10 years) with cutaneous (74.2%) and articular (61.3%) involvement. Peripheral disease without axial involvement was present in 28 patients (90%) while the others (10%) had both axial and peripheral involvement. Severe or moderate articular disease activity (DAS28) was present in 52.6% of the patients. The most frequent extra-articular manifestation was dactylitis (23.3%) and enthesitis (19.4%). The average number of multidisciplinary clinical consultations for these patients was 2.

There was a statistically significant difference at the mean age, gender and disease duration > 10 years between patients with psoriatic disease with and without arthritis (p= 0.047; p=0.01 and p=0.03, respectively); there was no statistically significant differences in family history of psoriasis (p=0.711) and spondyloarthritis (p=0.174), nutritional status (p=0.732) and comorbidities such as diabetes mellitus (p=0.545), hypertension (p=0.404), dyslipidaemia (p=0.394) and depression (p=0.089).

In the remaining 10 patients screened, the osteoarthritis and/or tendonitis were responsible for the articular complaints in 6 patients and scalp seborrhoea and eczema were responsible for the cutaneous complaints in the rest.

Conclusion:

Despite the small number of patients observed in our multidisciplinary clinical, we found that this kind of clinical care may facilitate the diagnosis of joint disease and offers a more comprehensive treatment approach for patients with both psoriasis and PsA.

References:

[1]Luchetti MM, Benfaremo D, Campanati A, Molinelli E, Ciferri M, Cataldi S, Capeci W, Di Carlo M, Offidani AM, Salaffi F, Gabrielli A. Clinical outcomes and feasibility of the multidisciplinary management of patients with psoriatic arthritis: two-year clinical experience of a dermo-rheumatologic clinic. Clin Rheumatol. 2018 Oct;37(10):2741-2749. doi: 10.1007/s10067-018-4238-4

[2]Theodorakopoulou E, Dalamaga M, Katsimbri P, Boumpas DT, Papadavid E. How does the joint dermatology-rheumatology clinic benefit both patients and dermatologists? Dermatol Ther. 2020 May;33(3):e13283. doi: 10.1111/dth.13283

Disclosure of Interests:

None declared.

An outbreak of infective endocarditis during the COVID-19 pandemic? - an observational retrospective single centre study

Funding Acknowledgements

Type of funding sources: None.

Infective endocarditis (IE) is described as an uncommon and challenging infective disease, due to its presentation variability. Its mortality remains high besides the better disease knowledge and therapeutic progress.

The aim of this study was to describe the clinical features and the incidence of IE. Furthermore, we try to identify the risk factors associated with early mortality.

A retrospective study was conducted and all patients diagnosed with definite or possible IE between January 2015 and June 2020, according to the modified Duke criteria, were included. Patient selection and information collection were obtained through medical records. Outcomes were in-hospital and 3 months after discharge mortality.

Group comparisons and multivariate logistic regression analysis were performed. A p-value less than 0.05 is statistically significant.

We analysed 51 patients, which 41 were admitted between 2015 and 2019 with a mean incidence of 8.2 cases per year. In 2020, 10 cases were diagnosed, corresponding to a percentual increase of 143.9%.

Of the 51 patients, 70.6% were male. The mean age was 65 years. Fever was the main presentation feature at admission. We counted 33.3% prosthetic valve endocarditis (PVE) and 5.9% IE device-related. The most common pathogens were Streptococcus gallolyticus (13.7%) and Streptococcus oralis (13.7%). 35 patients (68.6%) had local complications and 26 patients (51%) had systemic complications. One-third of the patients was referenced to surgical treatment. Overall in-hospital mortality was 19.6% and early mortality at 3 months was 27.5%.

In the univariate analysis, early mortality was higher in diabetes mellitus (DM) patients (p < 0.01) and in those who developed sepsis during hospitalization (p = 0.04). In multivariate logistic regression, only DM (OR = 15.8, 95% CI [3.2, 79.0]) was shown to be an independent factor of mortality.

The incidence of IE increased during the first semester of 2020, possibly due to the increased attention given to patients with fever. Diabetes mellitus was found to be the only independent predictor of mortality. More national multicentre studies are needed.

Plasma and Peritoneal Ceftriaxone Concentrations After Intraperitoneal Administration in Horses With Septic Peritonitis

Intraperitoneal ceftriaxone administration in healthy horses results in high and prolonged peritoneal concentrations. Recent findings suggest that intraperitoneal ceftriaxone might increase survival rates in horses affected by peritonitis. The present study aimed to evaluate plasma and peritoneal concentrations of ceftriaxone after intraperitoneal administration in horses with septic peritonitis. Twenty-six horses presenting clinical, laboratorial, and sonographic findings compatible with the disease were included. All horses received daily intraperitoneal ceftriaxone (25 mg/kg bwt) in addition or not with other antibiotics and support therapies. High-performance liquid chromatography was used to determine plasma and peritoneal ceftriaxone concentrations before and after 12 and 24 hours of ceftriaxone administration. Mean plasma concentrations 12 and 24 hours after administration were, respectively, 1.84 ± 0.43 and 0.37 ± 0.07 μg/mL, and mean peritoneal concentrations were 5.7 ± 2.84 and 0.42 ± 0.13 μg/mL. Ceftriaxone concentration was lower in comparison with previous studies in healthy horses and presented under the minimal inhibitory concentration for enterobacteria (≤1 μg/mL) and for gram-positive isolates (≤0.5 μg/mL) at 24 hours. The variation of the results obtained between healthy horses and with septic peritonitis demonstrated that pharmacokinetics/dynamics are different between these patients and suggests the use of an interval of dose of 12 hours.

P1393Prolonged atrial electrical conduction as a predictor of atrial fibrillation after atrioventricular nodal reentrant tachycardia ablation

BACKGROUND

Patients (pts) with atrioventricular nodal reentrant tachycardia (AVNRT) have a higher incidence of atrial fibrillation (AF) during follow-up. Conventional risk factors can play a role in AF development, however atrial electrical conduction properties may be implicated in AF pathogenesis.

AIMS

to evaluate atrial conduction times and assess its effect on AF development during follow-up.

METHODS

We studied AVNRT pts who performed EPS and catheter ablation of the slow pathway between 2013 and 2016 in a single center. Pts with AF or valvular disease were excluded. We evaluated duration of symptoms due to AVNRT, conventional risk factors for AF (age, gender, obesity, hypertension, diabetes and structural heart disease (SHD)), left atrium (LA) enlargement and electrophysiologic study (EPS) time intervals related with atrial electrical conduction properties. We measured the time interval between: (1) the beginning of the P wave on the ECG to the A deflection in His-bundle electrogram (P-AHis); (2) the beginning of the P wave to the mid-distal coronary sinus (CS) atrial electrogram (P-CS) and (3) the beginning of the P wave to the H deflection in His-bundle electrogram (P-HHis).

RESULTS

Fifty-two pts were evaluated during a median follow-up of 63 months (IQR 51-69): 22% male, median age 55 years (IQR 42-67). AF occurred in 9 patients (17%) (39 cases per 1000 person-years). Patients with AF were older (67 vs 53 years, p= 0.005) and had more frequently LA enlargement (33% vs 7%, p= 0.024) but they did not differ in hypertension, obesity, diabetes, SHD and duration of symptoms. EPS measured intervals P-AHis and P-HHis interval were not different between the groups (26.0 vs 22.8 ms, p = 0.89 and 151 vs 106 ms, p= 0.56, respectively) but P-CS were prolonged in patients with AF (70 vs 55 ms, p = 0.02) (figure 1). Univariate logistic analysis for AF is presented in table 1. There was no interaction between P-CS and LA enlargement (p = 0.87). In multiavariate analysis, only P-CS was independently associated with AF (table).

CONCLUSIONS

In this group of patients with AVNRT, P-CS, but not other atrial conduction intervals, was independently associated with AF development. The possible role of LA electrical conduction impairment in AVNRT pts for AF development needs further studies.

Univariate and multivariate analysis Univariate analysis Multivariate analysis OR 95% CI p-value OR 95% CI p-value Age (years) 1.10 1.02-1.19 0.016 1.10 1.00-1.21 0.051 LA enlargement 7.00 1.10-44.71 0.040 3.42 0.41-28.03 0.255 P-CS 1.07 1.021.14 0.013 1.06 1.01-1.12 0.044 OR Odds ratio. CI: confidence interval

Abstract Figure. Box-plot for the studied intervals

FRI0165 RISK OF CKD IN MEMBRANOUS AND PROLIFERATIVE LUPUS NEPHRITIS - ANALYSIS OF A NATIONWIDE MULTICENTRE COHORT

Background:

Lupus nephritis (LN) is one of the most severe manifestations of Systemic Lupus Erythematosus.

Objectives:

1) To compare proliferative (PLN), membranous (MLN) and mixed LN regarding clinical and laboratory presentation. 2) To investigate predictors of progression to chronic kidney disease (CKD).

Methods:

Multicentre observational study, with retrospective analysis of a prospective cohort, using data from the Portuguese registry of rheumatic diseases – Reuma.pt. Patients with biopsy-proven PLN, MLN and mixed LN were included. Groups were compared using Pearson’s Chi-Square for categorical variables and One-Way ANOVA or Kruskal-Wallis for numerical variables. COX regression analysis was used to investigate predictors of CKD (defined as estimated glomerular filtration rate [eGFR] lower than 60 mL/min/1.73m2for at least 3 months) and Kaplan-Meier curves were drawn.

Results:

236 patients were included. Median follow-up was 8 years (IQR 11; maximum 35 years). As seen in table 1, the level of proteinuria did not differ between groups; however, MLN patients presented with significantly lower serum creatinine. Levels of complement C3 and C4 were reduced in PLN but normal in MLN patients, and there were fewer patients with positive anti-dsDNA antibodies in the MLN group (p<0.001). On univariable COX regression, mixed histology was associated with progression to CKD (HR 26 [95% CI 3 - 255], p 0.005) (figure 1), however, it lost significance after adjusting for eGFR. In fact, eGFR≤75 at one year after the renal biopsy (HR 21 [95% CI 7 - 65], p<0.001) was the strongest predictor of CKD, even after adjusting for hypertension or histology.

Table 1.

Comparative description of the Reuma.pt cohort of patients with proliferative, membranous and mixed LN

PLNMLNMixedPTotal, N186428Females, N (%)157 (85)39 (95)4 (50)0.004EthnicityWhite European, N (%)163 (90)31 (78)7 (88)0.115Other, N (%)19 (10)9 (23)1 (13)Age LN diagnosis(y), median (IQR)30 (20)34 (16)42 (25)0.409SLEDAI at LN diagnosis, median (IQR)16 (9)10 (10)21 (17)0.006*uPCR at LN diagnosis, median (IQR)1675 (2598)1698 (2153)2160 (3320)0.629Creatinine at LN diagnosis, median (IQR)0.80 (0.32)0.70 (0.20)1.00 (0.95)0.006*eGFR at LN diagnosis, mean ± SD98 ± 33112 ± 1782 ± 450.019*Albumin at LN diagnosis, mean ± SD34 ± 734 ± 730 ± 60.390C3 at LN diagnosis, mean ± SD0.65 ± 0.260.90 ± 0.350.53 ± 0.30<0.001*Positive anti-dsDNA LN diagnosis, N (%)115 (91)11 (48)6 (86)<0.001*Use of antimalarials, N (%)166 (94)36 (92)8 (100)0.688Use of immunosuppressants, N (%)163 (94)33 (87)8 (100)0.245Use of corticosteroids, N (%)145 (84)33 (85)7 (100)0.511CKD after LN diagnosis, N (%)27 (15)1 (3)3 (38)0.018*ESRD, N (%)7 (4)1 (3)2 (25)0.016Deaths, N (%)14 (8)2 (5)00.610

uPCR: urinary protein-creatinine ratio, mg/g; y: years; Creatinine presented in mg/dL, eGFR in mL/min/1.73m2,albumin in g/L and C3 in g/L

Note: Baseline data (LN diagnosis) in grey; other data refer to the course of disease

*Significant difference between the proliferative and membranous groups

Figure 1.

Kaplan-Meir curves showing cumulative survival free of CKD in patients with PLN, MLN and mixed LN

Conclusion:

Our results support previous findings from single-centre studies suggesting that MLN has a different serological profile than PLN, possibly reflecting different pathogenesis. Renal function at one year predicts long-term outcome in LN.

Disclosure of Interests:

Filipa Farinha: None declared, Sofia C Barreira: None declared, Maura Couto: None declared, Margarida Cunha: None declared, Diogo Fonseca: None declared, Raquel Freitas: None declared, Luís Inês: None declared, Mariana Luis: None declared, Carla Macieira: None declared, Ana Rita Prata: None declared, Joana Rodrigues: None declared, Bernardo Santos: None declared, Rita Pinheiro Torres: None declared, Ruth J. Pepper: None declared, Anisur Rahman: None declared, Maria Jose Santos Speakers bureau: Novartis and Pfizer

Adjuvant intraperitoneal ceftriaxone in the treatment of septic peritonitis in horses

BACKGROUND

Intraperitoneal administration of ceftriaxone maintains therapeutic abdominal concentrations for 24 hours in healthy horses. Therefore, it is a possible treatment for septic peritonitis. The aim of this study was to evaluate the efficacy of ceftriaxone as an adjuvant treatment in horses with septic peritonitis.

METHODS

Twenty-six horses with clinical signs, sonography and/or laboratory findings of septic peritonitis were included. Peritoneal fluid was collected for microbiological culture and in vitro microbial sensitivity profile assessment. Daily intraperitoneal administration of ceftriaxone (25 mg/kg) was initiated with supportive and systemic antimicrobial treatment. The animals were divided into three groups: group 1-gastrointestinal tract injuries and abdominal surgery (excluding perforations/ruptures); group 2-not related to changes in the gastrointestinal tract; group 3-secondary to intestinal rupture and/or faeces contamination.

RESULTS

The mean success rate of the treatment was 77 per cent (20/26 animals), with success rates of 84.6 per cent in group 1; 87.5 per cent, group 2; and 40 per cent, group 3.

CONCLUSIONS

This is the first study to report adjuvant intraperitoneal treatment ceftriaxone for septic peritonitis in horses and indicates that this treatment can successfully treat septic peritonitis in horses.

Systemic absortion and adverse effects of topical ocular use of ketorolac tromethamine and sodium diclofenac in New Zealand rabbits for 90 days

ABSTRACT The effect of the systemic absorption of 0.1% diclofenac sodium (DS) eyedrop was compared to that of 0.5% ketorolac tromethamine (KT) in female New Zealand white rabbits treated on both eyes three times a day for 90 days. The rabbits were divided in three groups of six animals (n= 18): KT group, DS group, and control (Co) group, in which saline (0.9% NaCl) solution was instilled. Water and food consumption were measured daily, clinical examination was performed weekly, and blood samples were collected every 30 days for laboratory examination. The plasma was analyzed for the presence of KT and DS by solid-phase extraction (SPE) associated with mass spectrometry (MS). Systemic absorption of these drugs was confirmed by SPE-MS, allowing their separation and identification in the plasma. At the end of the treatment, the animals were euthanized and necropsied, and no macroscopic or microscopic changes were found. This observation confirmed the laboratory results, which were within normal reference standards for the species. According to the results obtained, it can be concluded that treatment with eyedrops containing KT and DS for 90 days in healthy rabbits does not cause adverse systemic effects.

P3795Should we also screen for obstructive sleep apnea in patients presenting with excessive supraventricular ectopic activity?

Background

It is recommended to consider obstructive sleep apnoea (OSA) screening in atrial fibrillation (AF) patients with risk factors, due to the strong evidence of an association between these two entities. Excessive supraventricular ectopic activity (ESVEA) has been proposed to be a risk factor for AF. However, strong evidence between ESVEA and OSA has not been established.

Objective

We aimed to determine if ESVEA is associated with moderate to severe OSA since its treatment may prevent AF.

Methods

We studied patients who performed polysomnography and 24-hour Holter monitoring. Patients with atrial fibrillation were excluded. ESVEA was defined as more than 30 PACs per hour (frequent PACs) or runs of >4 consecutive PACs. The circadian pattern of PACs was also evaluated. Sleeping hours were used to define “nocturnal”. Moderate to severe OSA was defined when polyssonography demonstrated a apnoea/hypopnoea index (AHI) >15. We examined the association between ESVEA and moderate to severe OSA during wakefulness and sleep.

Results

We studied 290 patients [median age 65 (55–72) years, 62% males, body mass index (BMI) 30 (27–34)]. 112 (38%) had moderate to severe OSA. Median AHI was 11 (5–24) and mean oxygen saturation was 94% (92–95). Median PACs was 35 (9–117) and 29 patients (10%) had frequent PACs. Runs of >4PACs occurred in 114 patients (39%). Forty-three patients (15%) had predominant nocturnal PACs and 42 (14%) had nocturnal runs of PACs. Multivariate logistic regression analysis demonstrated only nocturnal PACs were associated with moderate to severe OSA (p=0.027) (table 1).

Multivariate logistic regression Odds Ratio 95% Confidence Interval p-value Male gender 4.49 2.48–8.17 <0.001 Body mass index (kg/m2) 1.09 1.03–1.15 0.002 Nocturnal PACs 4.12 1.17–14.46 0.027 Variables not included in the model: age, number of PACs/h, frequent PACs (>30 PAcs/hour), runs of PACs (>4 consecutive PACs), nocturnal frequent PACs and nocturnal runs of PACs.

Conclusion

OSA screening in patients presenting with nocturnal PACs should be routinely considered, especially in male and obese. Treating moderate to severe OSA patients with CPAP has a potential benefit in preventing ESVEA and consequently AF.

Comparação dos parâmetros bioquímicos entre gestação única e gemelar de ovelhas da raça Dorper durante gestação, parto e pós-parto

RESUMO Nas ovelhas, a demanda de nutrientes aumenta durante a gestação, especialmente nas últimas seis semanas, quando ocorre maior desenvolvimento do feto. Os objetivos deste trabalho foram estudar o perfil bioquímico de ovelhas durante a gestação e no periparto imediato, comparando-se gestação única com gemelar. Foram utilizadas 60 ovelhas, Dorper, divididas em dois grupos experimentais com base no diagnóstico de gestação ultrassonográfico: grupo 1: 30 ovelhas com feto único; grupo 2: 30 ovelhas com gestação gemelar. Em nove momentos de coleta, foram mensurados no soro sanguíneo: ureia, creatinina, proteína total (PT), albumina, globulina, aspartato aminotransferase (AST), gamaglutamiltransferase, fosfatase alcalina, colesterol e triglicérides. O peso vivo das ovelhas do G2 foi maior que do G1 em todos os momentos, inclusive quando estavam vazias. Houve diferença entre as ovelhas do G1 e do G2 nos valores de PT, albumina, AST e triglicérides. A partir de 120 dias de gestação, o perfil proteico se modificou, com menores níveis de ureia, PT, albumina e globulina, mostrando que a demanda metabólica se intensificou no último mês da gestação. Os níveis de colesterol e triglicérides diminuíram de 140 dias de gestação para o parto. Este trabalho mostrou que a gestação proporcionou mudanças significativas no metabolismo da ovelha, principalmente no terço final da gestação, quando há maior necessidade de acompanhamento para evitar a incidência de doenças metabólicas.

Bone remodelling of the humerus after a resurfacing and a stemless shoulder arthroplasty

BACKGROUND

New implant designs, such as resurfacing and stemless implants, have been developed to improve the long-term outcomes of the shoulder arthroplasty. However, it is not yet fully understood if their influence on the bone load distribution can compromise the long-term stability of the implant due to bone mass changes. Using three-dimensional finite element models, the aim of the present study was to analyse the bone remodelling process of the humerus after the introduction of resurfacing and stemless implants based on the Global C.A.P. and Sidus Stem-Free designs, respectively.

METHODS

The 3D geometric model of the humerus was generated from the CT data of the Visible Human Project and the resurfacing and stemless implants were modelled in Solidworks. Considering a native humerus model, a humerus model with the resurfacing implant, and a humerus model with the stemless implant, three finite element models were developed in Abaqus. Bone remodelling simulations were performed considering healthy and poor bone quality conditions. The loading condition considered comprised 6 load cases of standard shoulder movements, including muscle and joint reaction forces estimated by a multibody model of the upper limb.

FINDINGS

The results showed similar levels of bone resorption for the resurfacing and stemless implants for common humeral regions. The regions underneath the head of the resurfacing implant, unique to this design, showed the largest bone loss. For both implants, bone resorption was more pronounced for the poor bone quality condition than for the healthy bone quality condition.

INTERPRETATION

The stemless implant lost less density at the fixation site, which might suggest that these implants may be better supported in the long-term than the resurfacing implants. However, further investigation is necessary to allow definite recommendations.

The upgraded JET gamma-ray cameras based on high resolution/high count rate compact spectrometers

The JET gamma-ray cameras have been recently upgraded within the gamma-ray camera upgrade project in support of development of JET high performance deuterium plasma scenarios and in preparation of deuterium-tritium experiments. New, dedicated detectors based on a LaBr₃ crystal and silicon photo-multipliers have been developed and replaced pre-existing CsI detectors in all 19 channels. The new instrument gives opportunity of making two-dimensional gamma-ray measurements with a counting rate capability exceeding 1 MCounts/s (MCps) and energy resolution better than 5% at 1.1 MeV. The upgrade is of relevance for fast ion and runaway electron physics studies in high performance deuterium discharges and also in plasmas with tritium at neutron yields in the range up to about 5 × 10¹⁷ n/s.

An update on a systematic review of the use of geriatric assessment for older adults in oncology

BACKGROUND

Our previous systematic review of geriatric assessment (GA) in oncology included a literature search up to November 2010. However, the quickly evolving field warranted an update. Aims of this review: (i) provide an overview of all GA instruments developed and/or in use in the oncology setting; (ii) evaluate effectiveness of GA in predicting/modifying outcomes (e.g. treatment decision impact, treatment toxicity, mortality, use of care).

MATERIALS AND METHODS

Systematic review of literature published between November 2010 and 10 August 2012. English, Dutch, French and German-language articles reporting cross-sectional or longitudinal, intervention or observational studies of GA instruments were included.

DATA SOURCES

MEDLINE, EMBASE, PsycINFO, CINAHL and Cochrane Library. Two researchers independently reviewed abstracts, abstracted data and assessed the quality using standardized forms. A meta-analysis method of combining proportions was used for the outcome impact of GA on treatment modification with studies included in this update combined with those included in our previous systematic review on the use of GA.

RESULTS

Thirty-five manuscripts reporting 34 studies were identified. Quality of most studies was moderate to good. Eighteen studies were prospective, 11 cross-sectional and 5 retrospective. Three studies examined treatment decision-making impact and found decisions changed for fewer than half of assessed patients (weighted percent modification is 23.2% with 95% confidence interval (20.3% to 26.1%). Seven studies reported conflicting findings regarding predictive ability of GA for treatment toxicity/complications. Eleven studies examined GA predictions of mortality, and reported that instrumental activities of daily living, poor performance status and more numerous GA deficits were associated with increased mortality risk. Other outcomes could not be meta-analyzed.

CONCLUSION

Consistent with our previous review, several domains of GA are associated with adverse outcomes. However, further research examining effectiveness of GA on treatment decisions and oncologic outcomes is needed.