Hippocampus, amygdala, and insula activation in response to romantic relationship dissolution stimuli: A case-case-control fMRI study on emerging adult students

BACKGROUND

Romantic relationship dissolutions (RRD) are associated with posttraumatic stress symptoms (PTSS). Functional magnetic resonance imaging in RRD studies indicates overlapping neural activation similar to posttraumatic stress disorder. These studies combine real and hypothetical rejection, and lack contextual information and control groups exposed to non-RRD or DSM-5 defined traumatic events.

AIM

We investigated blood oxygen level dependent (BOLD) activation in the hippocampus, amygdala, and insula of participants with RRDs compared with other traumatic or non-trauma stressors.

METHODS

Emerging adults (mean age = 21.54 years; female = 74.7 %) who experienced an RRD (n = 36), DSM-5 defined trauma (physical and/or sexual assault: n = 15), or a non-traumatic stressor (n = 28) completed PTSS, depression, childhood trauma, lifetime trauma exposure, and attachment measures. We used a general and customised version of the International Affective Picture System to investigate responses to index-trauma-related stimuli. We used mixed linear models to assess between-group differences, and ANOVAs and Spearman's correlations to analyse factors associated with BOLD activation.

RESULTS

BOLD activity increased between index-trauma stimuli as compared to neutral stimuli in the hippocampus and amygdala, with no significant difference between the DSM-5 Trauma and RRD groups. Childhood adversity, sexual orientation, and attachment style were associated with BOLD activation changes. Breakup characteristics (e.g., initiator status) were associated with increased BOLD activation in the hippocampus and amygdala, in the RRD group.

CONCLUSION

RRDs should be considered as potentially traumatic events. Breakup characteristics are risk factors for experiencing RRDs as traumatic.

LIMITATION

Future studies should consider more diverse representation across sex, ethnicity, and sexual orientation.

Phosphine-incorporated Metal-Organic Framework for Palladium Catalyzed Heck Coupling Reaction

As an emerging material with the potential to combine the high efficiency of homogeneous catalysts and high stability and recyclability of heterogeneous catalysts, metal-organic frameworks (MOFs) have been viewed as one of the candidates to produce catalysts of the next generation. Herein, we heterogenized the highly active mono(phosphine)-Pd complex on surface of UiO-66 MOF, as a catalyst for Suzuki and Heck cross coupling reactions. The successful immobilization of these Pd-monophosphine complexes on MOF surface to form UiO-66-PPh2-Pd was characterized and confirmed via comprehensive set of analytical methods. UiO-66-PPh2-Pd showed high activity and selectivity for both Suzuki and Heck Cross Coupling Reactions. This strategy enabled facile access to mono(phosphine) complexes which are challenging to design and require multistep synthesis in homogeneous systems, paving the way for future MOF catalysts applications by similar systems.

Toxicity Evaluation, Oxidative, and Immune Responses of Mercury on Nile Tilapia: Modulatory Role of Dietary Nannochloropsis oculata

The current study evaluated the potential ameliorative effect of a dietary immune modulator, Nannochloropsis oculata microalga, on the mercuric chloride (HgCl2)-induced toxicity of Nile tilapia. Nile tilapia (45-50 g) were fed a control diet or exposed to ¼ LC50 of HgCl2 (0.3 mg/L) and fed on a medicated feed supplemented with N. oculata (5% and 10% (50 or 100 g/kg dry feed)) for 21 days. Growth and somatic indices, Hg2+ bioaccumulation in muscles, and serum acetylcholinesterase (AChE) activity were investigated. Antioxidant and stress-related gene expression analyses were carried out in gills and intestines. Histopathological examinations of gills and intestines were performed to monitor the traits associated with Hg2+ toxicity or refer to detoxification. Hg2+ toxicity led to significant musculature bioaccumulation, inhibited AChE activity, downregulated genes related to antioxidants and stress, and elicited histopathological changes in the gills and intestine. Supplementation with N. oculata at 10% was able to upregulate the anti-oxidative-related genes while downregulated the stress apoptotic genes in gills and intestines compared to the unexposed group. In addition, minor to no histopathological traits were detected in the gills and intestines of the N. oculata-supplemented diets. Our data showed the benefit of dietary N. oculata in suppressing Hg2+ toxicity, which might support its efficacy as therapeutic/preventive agent to overcome environmental heavy metal pollution in aquatic habitats.

Dietary microalgal-fabricated selenium nanoparticles improve Nile tilapia biochemical indices, immune-related gene expression, and intestinal immunity

BACKGROUND

Feed supplements, including essential trace elements are believed to play an important role in augmenting fish immune response. In this context, selenium nanoparticles (SeNPs) in fish diets via a green biosynthesis strategy have attracted considerable interest. In this investigation, selenium nanoparticles (SeNPs, 79.26 nm) synthesized from the green microalga Pediastrum boryanum were incorporated into Nile tilapia diets to explore its beneficial effects on the immune defense and intestinal integrity, in comparison with control basal diets containing inorganic Se source. Nile tilapia (No. 180, 54-57 g) were fed on three formulated diets at concentrations of 0, 0.75, and 1.5 mg/kg of SeNPs for 8 weeks. After the trial completion, tissue bioaccumulation, biochemical indices, antioxidant and pro-inflammatory cytokine-related genes, and intestinal histological examination were analyzed.

RESULTS

Our finding revealed that dietary SeNPs significantly decreased (P < 0.05) serum alkaline phosphatase (ALP), lactate dehydrogenase (LDH), and cholesterol, while increasing (P < 0.05) high-density lipoproteins (HDL). The Se concentration in the muscle tissues showed a dose-dependent increase. SeNPs at a dose of 1.5 mg/kg significantly upregulated intestinal interleukin 8 (IL-8) and interleukin 1 beta (IL-1β) gene transcription compared with the control diet. Glutathione reductase (GSR) and glutathione synthetase (GSS) genes were significantly upregulated in both SeNPs-supplemented groups compared with the control. No apoptotic changes or cell damages were observed as indicated by proliferating cell nuclear antigen (PCNA) and caspase-3 gene expression and evidenced histopathologically. SeNPs supplementation positively affects mucin-producing goblet cells (GCs), particularly at dose of 1.5 mg/kg.

CONCLUSION

Therefore, these results suggest that Green synthesized SeNPs supplementation has promising effects on enhancing Nile tilapia immunity and maintaining their intestinal health.

Self-assembling Organogels Loaded with Tenoxicam for Local Intensive Pain and Inflammation Cure: In Vitro and In Vivo Correlation

Due to tenoxicam (TX)'s poor aqueous solubility (0.072 mg/ml), it is poorly absorbable in the GIT, and the long-term oral administration of TX may cause severe GIT disturbances. Topical administration of TX can help in bypassing the GIT adverse effects. Therefore, in the present work, we constructed different pluronic/lecithin organogels (PLOs) for topical delivery of TX. PLO was constructed simply via direct mixing of an aqueous pluronic solution with lecithin solution. The prepared PLO formulations were characterized for their physicochemical properties including pH, drug content, visual inspection, viscosity, and spreadability. Also, the in vitro release and kinetic studies were carried out to investigate the mechanism of drug release. Moreover, the in vivo studies were carried out by investigating the anti-inflammatory and analgesic activities using albino male rats. The results showed that the modified PLOs have good physicochemical properties. The viscosity of the modified gels is a direct proportionality with both lecithin and pluronic concentrations. Also, subsequently, the drug release rate is directly proportional to gel viscosity. Moreover, the in vivo studies showed that the modified PLOs (F19) showed a significant ( < 0.05%) paw edema inhibition and pain analgesia compared with other investigated groups. Also, the results indicated that the increase in dose is accompanied by higher activity and a longer duration of action which extended to 12 h. Hence, the modified PLOs are promising safe candidates or vehicles for effective TX loading with sustained delivery behavior.

Frequency of Post Endoscopic Retrograde Cholangiopancreatography Acute Pancreatitis in an Academic Hospital of Bangladesh

Post-ERCP acute pancreatitis (PEP) is a common and serious complication with high morbidity and mortality rates. There is a paucity of data on the frequency of PEP in a resource constraint setting like Bangladesh. Hence we have conducted a prospective study to determine the frequency of PEP and the factors associated with its occurrence. This prospective, observational study was carried out in Gastroenterology Department of Dhaka Medical College & Hospital, Dhaka, Bangladesh from April 2018 to December 2018 on the consecutive patients who underwent ERCP. PEP and its severity were diagnosed according to consensus definition. Serum lipase was done in all patients before procedure and 24 hours after procedure or if patient develops abdominal pain after the procedure which became earlier. Total 168 patients were included (mean age 46.97±14.35 years; male 72(43.0%). The most common indication of ERCP was choledocholithiasis 97(58.0%) followed by malignant biliary obstruction 45(27.0%), recurrent pyogenic cholangitis 8(5.0%), chronic pancreatitis 4(2.3%), biliary ascariasis 4(2.3%) and others 10(6.0%). Overall post ERCP complication rate was 46(27.3%) including cholangitis 29(17.3%), pancreatitis 16(9.5%), bleeding 12(7.1%), aspiration pneumonia 4(2.4%) and death 3(1.8%). Regarding the severity of PEP, 50.0%, 43.7% and 6.3% patients developed mild, moderate and severe pancreatitis respectively. Number of cannulation attempts >5 times [22(48%) vs. 17(14%); p=0.001], cannulation attempts duration more than 10 minutes [25(55%) vs. 27(22%); p=0.001], unintentional passage of guide wire into the pancreatic duct [8(17%) vs. 18(15%); p=0.001], pancreatic duct contrast injection [12(26%) vs. 2(1.6%); p=0.001] and pre-cut sphincterotomy [16(35%) vs. 6(4.9%); p=0.001] were significantly different between the patients who developed PEP compared to those who did not. In multiple logistic regressions analysis, pancreatic duct contrast injection was significantly associated with PEP [OR 25.523 with 95% CI (4.049- 100.0%)]. Around ten percent patients had developed PEP. Regarding the severity half of them were mild, 44.0% patients had moderate and 6.0% patient had severe type of pancreatitis. Difficult cannulation, unintentional passage of guide wire into the pancreas, pancreatic duct contrast injection and pre-cut sphincterotomy were associated with PEP. Among them pancreatic duct contrast injection had independent significance in the causation of PEP.

Influence of various intermittent fasting regimens on body weight and glycemic control in streptozotocin-induced diabetic rats

OBJECTIVE

This study aims to compare the effects of various intermittent fasting (IF) regimens, i.e., time-restricted fasting (TRF), alternate day fasting (ADF), and periodic fasting (PF) on body weight, glycemic control and associated metabolic parameters in streptozotocin-induced diabetic rats.

MATERIALS AND METHODS

Sixty male Sprague-Dawley rats (aged 3 months) were randomly assigned to the normal control (NC), diabetic control (DC), TRF, ADF, and PF groups. Type 2 diabetes was induced in all groups, except for the NC group, by intramuscular administration of streptozotocin (55 mg/kg). The IF interventions were administered for 6 weeks.

RESULTS

The rats in all the groups, except for the NC group, exhibited significant weight loss (31.4%, 46.4%, 31.0%, and 33.9% in the DC, TRF, ADF, and PF groups, respectively). The fasting blood glucose levels decreased to varying degrees, with the PF group showing the most significant decrease (77.0%), followed by the ADF (55.0%) and TRF (32.2%) groups. The plasma insulin levels were significantly lower in the experimental groups than in the NC group, but no significant effects were observed on the lipid profile.

CONCLUSIONS

The study findings indicate that while the IF protocols led to body weight loss, they exhibited varying effects on glycemic control and other metabolic parameters.

Hearing the voices of adolescents: Evaluating the quality of care for young adults with chronic illnesses in the UAE

BACKGROUND

Quality care for adolescents and young adults with chronic illnesses has been under-explored in the United Arab Emirates (UAE) and internationally, especially from patients' perspectives. Most available international studies focused on quality of life and the transition to adulthood rather than service quality.

AIM

This research assesses care quality for adolescents with chronic illnesses in the UAE, aiming to understand their perspectives, appraise current practices, and identify service gaps.

METHODS

A cross-sectional survey employed a validated questionnaire examining 33 essential care components. Participants comprised 576 adolescents and young adults with chronic conditions from five UAE Emirates.

RESULTS

Participant's reports indicated that none of the 33 care elements were received consistently. Most participants (80.6%) reported crucial care aspects were absent, and across most investigated items, 19.4%-46.5% of participants reported receiving the services they were supposed to receive only some or many of the times, indicating significant areas for improvement.

CONCLUSIONS

Findings demonstrate significant care quality gaps for UAE's adolescents and young adults with chronic illnesses. These may critically affect their ability to manage their conditions and ensure holistic growth. These insights can guide healthcare enhancements tailored to this demographic.

PRACTICE IMPLICATIONS

There is an urgency for enhanced patient-centered care in UAE healthcare, emphasizing clinicians' roles in supporting adolescents with chronic illnesses, especially during transitions. Healthcare managers should prioritize standardized care policies, improved communication, and training that emphasizes consistent patient feedback and transition readiness. Further research into care gaps and tailored interventions within the region's distinct sociocultural setting is essential.

Relationship between Clinical Profile, Severity and Outcome of Community Acquired Pneumonia with Hyponatremia in Children Aged 2-60 Months

Hyponatremia is the most common electrolyte imbalance seen in clinical practice and a common laboratory findings in children with community acquired pneumonia. This study aimed to find out relationship between clinical profile, severity and outcome of community acquired pneumonia with hyponatremia in children aged 2-60 months. This descriptive cross-sectional study was done in pediatrics department of Mymensingh Medical College Hospital, Bangladesh. Study period was 6 month from November 2016 to April 2017. Data were collected from 2 months to 60 months old children who fulfill the selection criteria. In this study sampling technique was purposive. Detailed history was taken, and meticulous examinations and relevant investigations were performed. 100 patients with community acquired pneumonia were enrolled, 34.0% patient had hyponatremia and 66.0% patients had no hyponatremia. Hyponatremia is more marked (45.5%) in severe pneumonia followed by moderate pneumonia (33.3%) and no hyponatremia found in mild pneumonia. Mean temperature, respiratory rate, heart rate, head nodding, nasal flaring, grunting, stridor, cyanosis, convulsion, feeding problem, Poor air entry were significantly higher in patient of pneumonia with hyponatremia when compared to patient of pneumonia without hyponatremia. Mean duration of symptoms and mean duration of hospital stay were also significantly higher in patient of pneumonia with hyponatremia. The mean serum sodium concentration was 132.18±1.51mmol/L in hyponatremic patients and 137.91±1.94mmol/L in normonatremic patients. Mean values of total leucocyte count, ESR, and C-reactive protein were significantly higher in patient of pneumonia with hyponatremia. Serum hemoglobin was significantly lower in hyponatremic patients than normonatremic patients. Maximum (55.9%) patients of community acquired pneumonia (CAP) with hyponatremia had patchy opacity, 26.5% had consolidation, 11.8% had interstitial opacity and 5.9% had pneumatocele. All the patients were treated with appropriate antibiotics and fluid and discharged after complete recovery without any complication. There was no death in the study population. From this study we can conclude that, hyponatremia is directly related with the severity of community acquired pneumonia (CAP). The intensity of clinical profile and investigation findings are also directly related with the severity of pneumonia.

Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve: A Case Report

Among other valvular heart disease Aortic stenosis (AS) is the most common in the developed world. Transcatheter Aortic Valve Replacement (TAVR) is most acceptable treatment option for patient with severely calcified aortic stenosis with high and intermediate risk group. Among several challenges, one of the main challenges is to deal with bicuspid aortic valve (BAV). Non-circular annulus, bulky leaflets leading to perivalvular leaks and risk for rupture and often very severe calcification may contribute to periprocedural strokes leading to poor clinical outcome. This case, a 68-year-old woman with a history of type 2 diabetes mellitus (DM), hypothyroidism, bicuspid aortic valve and severe aortic stenosis, bronchial asthma, who had repeatedly refused any suggestion for open heart surgery, was our volunteer candidate for TAVR. After successful TAVR the peak pressure gradient decreased from 100mmHg to 17mmHg. So, TAVR could be a viable option for highly selected patients with severe aortic stenosis and bicuspid aortic valve who have favourable anatomy.

Strain gauge analysis and fracture resistance of implant-supported PEKK hybrid abutments restored with two crown materials: An in vitro study

BACKGROUND

Polyetherketoneketone (PEKK) was recently introduced as an alternative to titanium and ceramic implant abutments due to its apparent ability to dissipate excessive strain around dental implants. However, the biomechanical behaviors of implant abutment crown systems may change depending on the crown and abutment material combinations used.

OBJECTIVES

This study aimed to assess how the crown material affects strain generation and fracture resistance of PEKK hybrid abutment crowns.

MATERIAL AND METHODS

Sixteen dummy implants (Ø 3.7 x 11 mm), simulating maxillary first premolars, were restored with 16 milled PEKK hybrid abutments and randomly categorized into two groups according to the crown material (n = 8): Group C, milled composite crowns cemented on PEKK hybrid abutments; and Group Z, ultra-translucent zirconia crowns cemented on PEKK hybrid abutments. Before thermocycling, a cyanoacrylate-base adhesive was used to position two strain gauges on buccal and lingual crestal bone surfaces, and a vertical load (100 N) was applied to the central fossa to record the strain generated. Then, all samples were thermocycled between 5°C and 55°C before being loaded to fracture on a universal testing machine. Modes of failure were observed under an optical microscope, and representative samples were examined using a scanning electron microscope. Independent t-tests were used for intergroup comparisons. The significance level was set at (p < 0.05) for all tests..

RESULTS

The results showed a significant difference between both groups. The zirconia group recorded significantly higher strain and fracture resistance values than the composite group (p < 0.001). There was a positive correlation between the strain developed in peri-implant crestal bone and fracture resistance of the abutment crown complex.

CONCLUSIONS

Strains developed in both groups were within the acceptable clinical range. The crown material substantially impacted the strain and fracture of the PEKK hybrid abutment crown system.

Recent Advances in the Pharmaceutical and Biomedical Applications of Cyclodextrin-Capped Gold Nanoparticles

The real problem in pharmaceutical preparation is drugs' poor aqueous solubility, low permeability through biological membranes, and short biological t_1/2. Conventional drug delivery systems are not able to overcome these problems. However, cyclodextrins (CDs) and their derivatives can solve these challenges. This article aims to summarize and review the history, properties, and different applications of cyclodextrins, especially the ability of inclusion complex formation. It also refers to the effects of cyclodextrin on drug solubility, bioavailability, and stability. Moreover, it focuses on preparing and applying gold nanoparticles (AuNPs) as novel drug delivery systems. It also studies the uses and effects of cyclodextrins in this field as novel drug carriers and targeting devices. The system formulated from AuNPs linked with CD molecules combines the advantages of both CD and AuNPs. Cyclodextrins benefit in increasing aqueous drug solubility, loading capacity, stability, and size control of gold NPs. Also, AuNPs are applied as diagnostic and therapeutic agents because of their unique chemical properties. Plus, AuNPs possess several advantages such as ease of detection, targeted and selective drug delivery, greater surface area, high loading efficiency, and higher stability than microparticles. In the present article, we tried to present the potential pharmaceutical applications of CD-derived AuNPs in biomedical applications including antibacterial, anticancer, gene-drug delivery, and various targeted drug delivery applications. Also, the article highlighted the role of CDs in the preparation and improvement of catalytic enzymes, the formation of self-assembling molecular print boards, the fabrication of supramolecular functionalized electrodes, and biosensors formation.

The relationship between parental adverse childhood experiences and the health, well-being and development outcomes of their children: a systematic review

OBJECTIVES

A growing body of research is emerging regarding the relationship between parental adverse childhood experiences (ACEs) and negative health, well-being and developmental outcomes in their children. This systematic review seeks to understand the relationship between parental ACEs and the health, well-being and developmental outcomes of their children and whether the relationships differ according to the number and type of parental ACEs.

STUDY DESIGN

Systematic review.

METHOD

The review includes articles published between 2000 and 2021 from studies using quantitative longitudinal methods and multivariate analysis to investigate the relationship between parental ACEs and their offspring's outcomes. Relevant studies were identified through a systematic search of five databases and findings synthesised using a narrative synthesis. This review was registered on PROSPERO (CRD42021274068).

RESULTS

Nineteen studies met the inclusion criteria and were included in the review. This resulted in a combined population sample of 124,043 parents and 128,400 children. Diversity in measurement of parental ACE exposure and in the type of ACEs measured within the studies precluded a meta-analysis. Offspring of parents exposed to ACEs had a higher risk of a range of negative health, well-being and developmental outcomes. This relationship differs according to the number and type of parental ACEs, with a positive relationship observed between the number of parental ACEs and the risk of negative health, well-being and development outcomes in their children.

CONCLUSIONS

These findings indicate that screening for parental ACEs by health visitors, midwives and other health or social care staff may identify an at-risk population of infants, children and adolescents and improve child outcomes.

Nutritional and immunological evaluation of Nannochloropsis oculata as a potential Nile tilapia-aquafeed supplement

Nannochloropsis oculata (N. oculata) is a marine microalga containing bioactive compounds and a high omega-3 polyunsaturated fatty acid (ω-3 PUFAs). Therefore, it is very promising for nutraceutical and the functional food industry applications. Three groups of Nile tilapia (forty-five fish/group) were fed on basal diets or diets containing 5% (N5) or 10% (N10) of the microalga N. oculata for seven weeks. Fish growth performance, proximate composition, and lipid (fatty acids/ FAs and lipoproteins) profile were estimated. In addition, the expression pattern of some lipid metabolism and immune-relevant genes were assessed. An enhancement in whole body crude protein and growth indices of Nile tilapia was observed on both the supplemented groups N5 and N10. Higher levels of high-density lipoproteins (HDL); and lower levels of the low-density lipoproteins (LDL) were evident in both supplemented groups, while the cholesterol and triglycerides (TG) levels were similar among groups. Ω-3 PUFAs were the significant FAs profile of tilapia fed on N. oculata-supplemented diets in terms of eicosapentaenoic acid, docosahexaenoic acid, and n3/n6 ratio. Concerning the gene expression pattern, heat-shock protein70, glutathione-S-transferase, glutathione peroxidase, and interleukin-1β (IL-1β) were elevated significantly in both supplemented groups. IL-10 is only upregulated in the N10 group. The lipid metabolism-related gene expression showed downregulation of only fatty acid synthase (FAS) in both supplemented groups, with no statistical changes in Peroxisome proliferator-activated receptor alpha (PPARα). Tumor necrosis factor-α (TNF-α), Transforming growth factor-β1 (TGF-β1), and the apoptotic related genes [caspase3 and Proliferating cell nuclear antigen (PCNA)] showed insignificant changes among groups. The histopathological examination of the intestine, liver, and spleen supports our findings and confirms the benefits and safeness of N. oculata dietary inclusion. Collectively, N. oculata is a very promising nutraceutical for improving fish health and sustainability of aquaculture production.

OnabotulinumtoxinA in elderly patients with chronic migraine: insights from a real-life European multicenter study

INTRODUCTION

Although migraine prevalence decreases with aging, some older patients still suffer from chronic migraine (CM). This study aimed to investigate the outcome of OnabotulinumtoxinA (OBT-A) as preventative therapy in elderly CM patients.

METHODS

This is a post hoc analysis of real-life prospectively collected data at 16 European headache centers on CM patients treated with OBT-A over the first three treatment cycles (i.e., Cy1-3). We defined: OLD patients aged ≥ 65 years and nonOLD those < 65-year-old. The primary endpoint was the changes in monthly headache days (MHDs) from baseline to Cy 1-3 in OLD compared with nonOLD participants. The secondary endpoints were the responder rate (RR) ≥ 50%, conversion to episodic migraine (EM) and the changes in days with acute medication use (DAMs).

RESULTS

In a cohort of 2831 CM patients, 235 were OLD (8.3%, 73.2% females, 69.6 years SD 4.7). MHDs decreased from baseline (24.8 SD 6.2) to Cy-1 (17.5 SD 9.1, p < 0.000001), from Cy-1 to Cy-2 (14.8 SD 9.2, p < 0.0001), and from Cy-2 to Cy-3 (11.9 SD 7.9, p = 0.001). DAMs progressively reduced from baseline (19.2 SD 9.8) to Cy-1 (11.9 SD 8.8, p < 0.00001), to Cy-2 (10.9 SD 8.6, p = 0.012), to Cy-3 (9.6 SD 7.4, p = 0.049). The 50%RR increased from 30.7% (Cy-1) to 34.5% (Cy-2), to 38.7% (Cy-3). The above outcome measures did not differ in OLD compared with nonOLD patients.

CONCLUSION

In a population of elderly CM patients with a long history of migraine OBT-A provided a significant benefit, over the first three treatment cycles, as good as in non-old patients.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

National audit of non-melanoma skin cancer excisions performed by plastic surgery in the UK

A national, multi-centre audit of non-melanoma skin cancer excisions by plastic surgery.

Prevalence of Virulence Genes in Acinetobacter baumannii Isolated from Clinical Samples in Mymensingh Medical College Hospital, Bangladesh

Acinetobacter baumannii is an opportunistic bacterial pathogen that is the most important cause of hospital-acquired infections. The objective of this study was to evaluate the predominance and determination of virulence encoding genes in A. baumannii isolates. During this cross-sectional study period from February 2019 to March 2020 of 380 clinical samples including endotracheal aspirates (70), wound swab or pus (175), urine (70) and blood (65) analysed in inpatients admitted to the hospital in different unit like ICU, Surgery and Burn unit of Mymensingh Medical College Hospital. Out of 380 studied samples, 130(34.21%) strains were yielded growth. Among 130 isolates, Acinetobacter spp. was 49(37.69%). Totally, 39(79.59%) were Acinetobacter baumannii which was detected by molecular technique PCR. Further more, the determination of virulence genes csgA and fimH detected by PCR. Among two studied virulence genes, csgA (38.46%) was the most prevalent virulent genes associated with disease severity and co-morbidity of the patient in A. baumannii infections.

Scoping Review of Existing Evaluations of Smokeless Tobacco Control Policies: What Is Known About Countries Covered, Level of Jurisdictions, Target Groups Studied, and Instruments Evaluated?

OBJECTIVE

The implementation of smokeless tobacco control policies lags behind those for smoking. This scoping review summarizes the studies that evaluated public policies on smokeless tobacco regulation (SLT) and provides an overview of the jurisdictional level, target groups, and policy instruments.

METHODS

Seven databases were systematically searched for studies reporting on public policies regulating SLT. Two reviewers independently screened all studies. Data extraction was performed using a predefined extraction form. Extraction was replicated for 10% of the identified studies for quality assurance. A narrative synthesis of the included studies was used to analyze and interpret the data. The protocol was published beforehand with the Open Science Foundation (OSF).

RESULTS

Fourty articles comprising 41 studies were included. Most of the studies reported in the articles were conducted in the United States (n = 17) or India (n = 14). Most studies reported outcomes for students (n = 8), retailers/sellers (n = 8), and users/former users (n = 5). The impact of public policies on smokeless tobacco use, in general, was most frequently assessed (n = 9), followed by the impact of taxes (n = 7), product bans (n = 6), sales/advertising bans near educational institutions (n = 4), and health warnings (n = 3) on consumer behavior.

CONCLUSIONS

There are significant gaps in the evaluation of smokeless tobacco regulation studies that need to be filled by further research to understand the observed outcomes. WHO reporting on Framework Convention on Tobacco Control (FCTC) implementation should be linked to studies evaluating smokeless tobacco control measures at all levels of jurisdictions and in countries not members of the WHO FCTC or do not provide data.

IMPLICATION

Large gaps in the evaluation of SLT control policies exist. For some countries, WHO FCTC evaluations are available for different levels of jurisdictions. In countries with a strong federal structure, there is a lack of data beyond the national level to provide a more detailed look at compliance, indirect effects, or implementation gaps. More research is needed at all levels of jurisdictions, which add to the work of the WHO to understand what works for which target group, how the different levels of jurisdiction interact, how the real-world context can be incorporated, and what indirect effects may occur.

Early Impact of Cardiopulmonary Bypass on Renal Function after Valve Replacement Surgery

Renal dysfunction following cardiopulmonary bypass is well recognized. The pathophysiology of renal injury is multifactorial and culmination of the interplay of several pathophysiological mechanism. Cardiac surgery requiring cardiopulmonary bypass (CPB) is being carried out on an extended patient population of different age groups and undergoing complex surgical procedure, and thus it places them at an increased risk of renal impairment. Valve replacement surgery is a major and complex surgical procedure requiring CPB. This study was therefore designed to observe the impact of CPB and short term outcome on patients with reduced estimated Glomerular Filtration Rate (eGFR) (60-89ml/min/1.73m²) after valve replacement surgery. This cross-sectional study was conducted in the Department of Cardiac Surgery, National Institute of Cardio Vascular Diseases (NICVD) during the period of January 2015 to August 2016. After fulfillment of enrollment criteria 100 patients were studied for the purpose of the study and they were grouped in two, patients with normal eGFR (≥90ml/min/1.73m²) in Group A and patients with reduced eGFR (60-89ml/min/1.73m²) in Group B. A total of 100 patients, 50 in each group were studied for renal function alteration after valve replacement surgery under cardiopulmonary bypass. The incidence of Acute Kidney Injury (AKI) was higher in Group B. Chi-square test was done and p value was 0.011 which is statistically significant. Postoperative blood loss (ml/hr) (p=0.038), duration of Intensive Care Unit (ICU) stay (in hours) (p=0.009), postoperative hospital stay (days) (p=0.014) was significantly higher and postoperative Urine Output (ml/hr) (p=0.001) was significantly lower in patients with reduced eGFR (60-89ml/min/1.73m²) in Group B. Deterioration of renal function is more in patient with eGFR (60-89ml/min/1.73m²) after valve replacement surgery under cardiopulmonary bypass in comparison with patients with eGFR (≥90ml/min/1.73m²).

Molecular Detection of MBL Encoding Genes in Acinetobacter baumannii strains Isolated from Various Samples at a Tertiary Care Hospital in Mymensingh

MBL producing Acinetobacter baumannii is a major threat for therapeutic treatment of hospital acquired infections. The aim of this study was to determine the prevalence of metallo-β-lactamase genes VIM, IMP & SIM genes amongst isolated A. baumannii. This cross sectional study conducted in the department of Microbiology Mymensingh Medical College from March 2019 to February 2020. 49 Acinetobacter spp. were isolated from different clinical samples including endotracheal aspirates, wound swab/pus, urine and blood. Among 380 clinical samples 130 organisms were isolated growth was 34.21%. Out of 130 isolated strains, 49(37.69%) were Acinetobacter spp identified by standard bacteriological method and resistance to different antibiotics was assessed with Kirby- Bauer Disc diffusion method. Among 49 Acinetobacter spp, 39(79.59%) were Acinetobacter baumannii which was identified by molecular method PCR directing OXA-51 like gene. Multiplex PCR was done to determine MBL genes existence VIM, IMP & SIM. Ceftriaxone (79.48%) showing higher resistance and colistin (12.82%) showing lower resistance. All the strains were sensitive to tigecycline. The distribution of MBLs genes such as VIM 20(51.28%), IMP 5(12.82%) and SIM 0 (0%). This study showed that high level of antibiotic resistance and VIM was the most prevalent MBL genes among A. baumannii highlighting the need for indigenous antibiotic usage plan & infection control measures to prevent the spread of these resistance genes.

Therapeutic Intervention with Dietary Chitosan Nanoparticles Alleviates Fish Pathological and Molecular Systemic Inflammatory Responses against Infections

Marine bio-sourced chitosan nanoparticles (CSNP) are antimicrobial and immunomodulatory agents beneficial for fish medicine. Herein, dietary CSNP was investigated for the amelioration of the systemic inflammatory responses of an induced fish model. One hundred and forty-four rainbow trout were assigned to one pathogen-free and non-supplemented group (negative control), and three challenged groups: non-supplemented (positive control), CSNP-preventive, and CSNP-therapeutic. After a feeding experiment extended for 21 days, the organosomatic indices (OSI) and molecular aspects were assessed. After a challenge experiment extended for further 28 days, CSNP-therapeutic intervention was assessed on fish survival and systemic inflammatory responses on pathology, histo-morphology, and molecular aspects. With CSNP administration, OSI nonsignificantly decreased and the relative expression of targeted inflammatory-mediator genes was significantly increased. The CSNP-therapeutic fish showed an RPS of 80% as compared to the positive control group, and CSNP-therapeutic administration retained the highest gene expression augmentation up to 28 days after the challenge. Notably, the splenic reticulin fibers framework of the CSNP-therapeutic group retained the highest integrity among the groups during the infection. After recovery, reticulin fibers density in the CSNP-therapeutic samples was significantly higher than in the negative control group, which indicates high innate immunity. Thus, CSNP showed promising biotherapeutic features enhancing fish resistance against infections.

AB0852 Assessment of endothelial dysfunction in spondyloarthritis

Background

Endothelial dysfunction is the earliest step in the pathogenesis of atherosclerosis, preceding structural vascular alterations. Few studies have focused on the endothelial dysfunction in spondyloarthritis.

Objectives

The aim of our study was to assess endothelial dysfunction using Flow-Mediated dilatation (FMD) in patients with spondyloarthritis.

Methods

Forty-seven consecutive patients meeting ASAS 2009 criteria for spondyloarthritis and 47 matched healthy subjects were included in the study. Subjects with traditional cardiovascular risk factors were excluded. Sociodemographic, clinical, biological and radiological features related to the disease as well as therapeutics were recorded. FMD was assessed ultrasonographically according to guidelines of American college of cardiology (ACC) (1).

Results

Spondyloarthritis group included 47 patients with a sex ratio of 2.35 and a median age of 36 years (IQR: 28-46). Median body mass index (BMI) was 24.5 kg/m2 (IQR 25-75%: 20.7-26.8) with no significant difference compared with the control group (p=0.238). Physical examination showed normal values of blood pressure (BP) with a median systolic BP of 121 mmHg (IQR 25-75%: 110-130) and a median diastolic BP of 71 mmHg (IQR 25-75%: 67-78). In laboratory findings, total cholesterol and triglyceride levels were increased in 2 and 3 patients respectively.

Median age at onset of SpA was 20 years (IQR 25-75%; 18-32). For disease activity, median CRP level was 6.45 mg (IQR 25-75%: 1.45-19.9) and median ASDAS-CRP and BASDAI were respectively 2.18 (IQR 25-75%: 1.62-2.91) and 2.6 (IQR 25-75%: 1.8-3.8). Median MASES score was 0 (IQR 25-75%; 0-0). Median BASFI and BASMI were 3 (IQR 25-75%; 1.5-5.1) and 1.5 (IQR 25-75%: 0-4). Regarding treatment, 92% of patients were using NSAIDs, csDMARDs (51%) and 38% were on TNF inhibitors.

Patients with spondyloarthritis exhibited significantly lower FMD values than healthy age and gender matched controls with a median value of FMD 14.6% (IQR; 9-24) versus 18.8% (IQR; 12.8-23.1%); p=0.008.

Conclusion

Our study demonstrates impairment of endothelial function in patients with spondyloarthritis compared with healthy population, confirming the accelerated atherosclerosis in spondyloarthritis.

References

[1]Thijssen DHJ, Bruno RM, van Mil ACCM, Holder SM, Faita F, Greyling A, et al. Expert consensus and evidence-based recommendations for the assessment of flow-mediated dilation in humans. Eur Heart J. 2019 Aug 7;40(30):2534–47.

Disclosure of Interests

None declared

AB0922 Psoriatic Arthritis Disease Activity Differs by Race/Ethnicity

Background

Psoriatic arthritis (PsA) affects up to 30% of individuals with psoriasis. Studies have demonstrated that the presenting disease severity and quality of life impact of psoriasis differs by race/ethnicity in patients with and without PsA, but little is known about disease activity among different racial/ethnic groups [1-3].

Objectives

The objective of our study was to evaluate disease activity by race/ethnicity among patients with PsA.

Methods

We performed a cross-sectional study of adult (≥18 years old) patients with PsA who had at least one outpatient visit within the University of Pennsylvania health system between 2010 and 2019. Patients with PsA were identified by the presence of at least two International Classification of Diseases (ICD)-9 or ICD-10 codes for PsA associated with two different healthcare encounters. The primary outcome was disease activity as measured by the Routine Assessment of Patient Index Data 3 (RAPID3) assessment. The RAPID3 score is a validated patient-reported measure of physical function, pain, and global status [4]. RAPID3 scores range from 0 to 30, with higher scores indicating greater disease activity. Patients were included if they had at least one documented RAPID3 score. For patients with multiple RAPID3 scores, the median value was used. The primary independent variable was race/ethnicity categorized as White (reference), Black, Asian, Hispanic, or other race. Multivariable linear regression was used to assess the relationship between race/ethnicity and RAPID 3 score.

Results

The study population included 742 patients. Mean (standard deviation [SD]) age was 47.2 (13.3) years and 57.4% were female. The racial/ethnic distribution was 79.4% White, 7.0% Black, 5.0% Asian, 3.1% Hispanic, 2.6% other race, and 3.0% missing race/ethnicity. The means of the median Rapid3 scores were statistically significantly different across racial/ethnic groups (p<.001): White mean (SD) 9.79 (6.02), Black mean (SD) 14.86 (14.86), Asian mean (SD) 9.79 (5.44), Hispanic mean (SD) 15.09 (7.11), other race mean (SD) 10.57 (6.91). In an adjusted multivariable model controlling for other sociodemographic factors, body mass index, treatment history, and medical comorbidity, Hispanic patients had higher RAPID3 scores compared to White patients, indicating greater disease activity (β 3.36; 95% confidence interval [CI] 1.04 – 5.67, p <.005). In exploratory stratified analyses to evaluate effect modification by sex, among males, Black (β 3.43; 95% CI 0.23 – 6.63, p=.04) and Hispanic (β 5.94; 95% CI 2.18 – 9.70, p <.005) patients had higher RAPID3 scores than White patients. Among females, no significant racial/ethnic differences in RAPID3 scores were identified.

Conclusion

Black and Hispanic patients report greater disease activity as indicated by higher RAPID3 scores compared to White patients. Larger studies are necessary to confirm our findings and understand the causes of racial/ethnic differences in disease activity among patients with PsA.

References

[1]Abrouk M, Lee K, Brodsky M, Nakamura M, Singh R, Zhu TH, et al. Ethnicity affects the presenting severity of psoriasis. J Am Acad Dermatol. 2017;77(1):180-2.

[2]Shah SK, Arthur A, Yang YC, Stevens S, Alexis AF. A retrospective study to investigate racial and ethnic variations in the treatment of psoriasis with etanercept. J Drugs Dermatol. 2011;10(8):866-72.

[3]Takeshita J, Augustin M, de Jong E, Lafferty K, Langholff W, Langley R, Leonardi C, Menter A, Alexis A. Psoriasis-Related Quality-of-Life Differs by Race/Ethnicity. J Invest Dermatol. 2019; 139(5S, Supplement 1):S148.

[4]Coates LC, Tillett W, Shaddick G, Pincus T, Kavanaugh A, Helliwell PS. Value of the Routine Assessment of Patient Index Data 3 in Patients With Psoriatic Arthritis: Results From a Tight-Control Clinical Trial and an Observational Cohort. Arthritis Care Res (Hoboken). 2018;70(8):1198-1205.

Disclosure of Interests

Fahad Ahmed: None declared, Alexis Ogdie Consultant of: A. Ogdie has received consulting fees from Amgen, AbbVie, Bristol Myers Squibb, Celgene, CorEvitas (formerly Corrona), Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB., Grant/research support from: A. Ogdie has received grant support from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, Rheumatology Research Foundation, National Psoriasis Foundation, Abbvie (University of Pennsylvania), Pfizer (University of Pennsylvania), Amgen (FORWARD), and Novartis (FORWARD)., Robert Fitzsimmons: None declared, Daniel Shin: None declared, Junko Takeshita Consultant of: JT has served as a consultant for Pfizer Inc. and Janssen Biotech receiving honoraria., Grant/research support from: JT has received a research grant (to the Trustees of the University of Pennsylvania) from Pfizer Inc.

A Literature Review of Diagnostic Applicability of ICD 11 Classification of Personality Disorders in Comparison with ICD 10

Introduction

Personality disorders are frequently encountered by all healthcare professionals and can often pose a diagnostic dilemma due to the crossover of different traits amongst the various subtypes. The ICD 10 classification comprised of succinct parameters of the 10 subtypes of personality disorders but lacked a global approach to address the complexity of the disease. The ICD 11 classification provides a more structural approach to aid in clinical diagnosis.

Objectives

A literature review of the diagnostic applicability of ICD 11 classification of personality disorders is presented in comparison with the ICD 10 classification.

Methods

A retrospective analysis of the literature outlining the ICD 10 and 11 classifications of personality disorders, exploring the differences in evidence-based applications of both.

Results

The ICD 11 classification of personality disorders supersedes the ICD 10 classification in describing the severity of the personality dysfunction in conjunction with a wide range of trait domain qualifiers, thus enabling the clinician to portray the disease dynamically. The current evidence available on the utility of the ICD 11 classification gives a promising outlook for its application in clinical settings.

Conclusions

The ICD 11 has transformed the classification of personality disorders by projecting a dimensional description of personality functioning, aiming to overcome the diagnostic deficiencies in the ICD 10 classification. The versatility offered by the application of the ICD 11 classification can be pivotal in reshaping the focus and intensity of clinical management of the disease.

Disclosure

No significant relationships.

POS1049 ASSESSING TREATMENT PATTERNS WITH DISEASE-MODIFYING ANTIRHEUMATIC DRUGS AND PREDNISONE FOR PSORIATIC ARTHRITIS BY RACE/ETHNICITY

Background

Psoriatic arthritis (PsA) is a comorbidity commonly associated with psoriasis. Studies have demonstrated delays in the diagnosis and treatment of PsA[1] that may disproportionately affect racial/ethnic minority patients as indicated by one study that found Black Medicaid patients with PsA to be less likely to receive disease-modifying antirheumatic drugs [DMARDs] than White Medicaid patients with PsA [2]. Yet much remains unknown about potential racial/ethnic disparities in PsA management.

Objectives

The objective of our study was to evaluate treatment patterns for PsA by race/ethnicity.

Methods

We performed a cross-sectional study of adult (≥18 years old) patients with PsA who had at least one outpatient visit within the University of Pennsylvania health system between 2010 and 2019. Patients with PsA were identified by the presence of at least two International Classification of Diseases (ICD)-9 or ICD-10 codes for PsA associated with two different healthcare encounters. The primary outcomes were receipt of a prescription for: (i) an oral DMARD, (ii) a biologic DMARD, and (iii) prednisone. Oral DMARDs included apremilast, methotrexate, sulfasalazine, leflunomide, azathioprine, cyclosporine, tofacitinib, hydroxychloroquine, and upadacitnib. Biologic DMARDs included abatacept, adalimumab, brodalumab, certolizumab, etanercept, golimumab, guselkumab, infliximab, ixekixumab, secukinumab, ustekinumab, and risankizumab. The primary independent variable was race/ethnicity categorized as White (reference), Black, Asian, Hispanic, or other race. Multivariable logistic regression was used to assess the relationship between race/ethnicity and each treatment outcome.

Results

The study population included 1781 patients with PsA who were a mean age of 50.7 (SD 14.3), 54.6% female, and 72.5% commercially insured. The racial/ethnic distribution was 81.9% White, 5.6% Black, 4.0% Asian, 3.0% Hispanic, 2.5% other race, and 3.1% missing race/ethnicity. Of these patients, 64.3% were prescribed an oral DMARD, 55.6% were prescribed a biologic, and 44.1% were prescribed prednisone. There were no statistically significant differences across race/ethnicity for prescription of either oral or biologic DMARDs. However, prescription of prednisone did differ by race/ethnicity (p<.005) with Black (54.6%) and Hispanic (56.6%) patients being more likely to receive prednisone prescriptions and Asian (32.4%) patients being less likely to receive prednisone prescriptions than White (44.2%) patients. In adjusted logistic regression models controlling for sociodemographic and other factors, Hispanic patients were more likely to receive a prednisone prescription (OR 1.79, 95% CI 1.01 – 3.20, p=0.05) while Asian (OR 0.58, 95% CI 0.34 – 0.97, p=0.04) patients were less likely to receive a prednisone prescription compared to White patients.

Conclusion

We found Hispanic patients with PsA to be more likely to receive prednisone prescriptions than White patients with PsA but did not identify any racial/ethnic differences in prescription patterns for oral or biologic DMARDs for PsA. Greater use of prednisone among Hispanic patients may reflect different diseases trajectories (e.g., more disease flares or greater disease severity) or other factors that affect prescription patterns that require further study.

References

[1]Favier G, Gladman DD, Merola JF, Armstrong AW, Boehncke WH, Helliwell PS. Benchmarking Care in Psoriatic Arthritis - The QUANTUM Report: A Report from the GRAPPA 2016 Annual Meeting. J Rheumatol. 2017;44(5):674-678.

[2]Ogdie A, Matthias W, Thielen RJ, Chin D, Saffore CD. Racial Differences in Prevalence and Treatment for Psoriatic Arthritis and Ankylosing Spondylitis by Insurance Coverage in the USA. Rheumatol Ther. 2021;8(4):1725-1739.

Disclosure of Interests

Fahad Ahmed: None declared, Alexis Ogdie Consultant of: A. Ogdie has received consulting fees from Amgen, AbbVie, Bristol Myers Squibb, Celgene, CorEvitas (formerly Corrona), Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB., Grant/research support from: A. Ogdie has received grant support from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, Rheumatology Research Foundation, National Psoriasis Foundation, Abbvie (University of Pennsylvania), Pfizer (University of Pennsylvania), Amgen (FORWARD), and Novartis (FORWARD)., Robert Fitzsimmons: None declared, Daniel Shin: None declared, Junko Takeshita Consultant of: JT has served as a consultant for Pfizer Inc. and Janssen Biotech receiving honoraria., Grant/research support from: JT has received a research grant (to the Trustees of the University of Pennsylvania) from Pfizer Inc.

AB0777 Influence of TNF inhibitors on subclinical atherosclerosis in Spondyloarthritis patients

Background

Spondyloarthritis is a chronic inflammatory disease associated with increased cardiovascular morbidity and mortality due to accelerated atherosclerosis. Recent studies have reported the benefit of TNF inhibitors in reducing the risk of cardiovascular events and its association with changes in lipid profile. Nevertheless, it remains controversial.

Objectives

We aimed to investigate the effect of TNF inhibitors on subclinical atherosclerosis assessed with carotid intima-media thickness (CIMT) and flow mediated dilatation (FMD) in patients with spondyloarthritis (SpA).

Methods

We performed a cross sectional study including 47 patients meeting ASAS 2009 criteria for SpA. Patients with traditional cardiovascular risk factors were excluded. We collected clinical data, therapeutic modalities and biological tests including total cholesterol, HDL, LDL and triglyceride after 12 hours of fasting. FMD and mean CIMT (mean value of right and left carotid artery) were measured with a Mindray Resona 7 ZST+ ultrasound machine by an experienced radiologist.

Results

Among the 47 subjects, 18 patients (38%) were receiving TNF inhibitors for a median duration of 36 months (IQR 25-75%: 24-72) (9 were on Etanercept, 7 were on Adalimumab, one patient was on Infliximab and one was on Golimumab). The group treated with TNF inhibitors had a median age of 43 years (IQR 25-75%: 36-46.5) and a median duration of the disease of 12 years (IQR 25-75%: 9.5-22). Median ASDAS and BASDAI scores were 2.40 (IQR 25-75%: 1.48-3.1) and 2.60 (IQR 25-75%: 1.55-3.75) respectively. On the other hand, patients naïve to TNF inhibitors had a median age of 32 years (IQR 25-75%: 55-42), median disease duration of 7 years (IQR 25-75%: 3-12.5), median ASDAS of 2.13 (IQR 25-75%: 1.61-2.91), and median BASDAI of 2.40 (IQR 25-75%: 1.55-3.75).

When comparing the two groups, there was no significant difference regarding disease activity scores ASDAS (p=0.431) and BASDAI (p=0.793) as well as biochemical variables; total cholesterol (p=0.483), HDL (p=0.395), LDL (p=0.263) and triglyceride (0.092). In contrast, patients on TNF inhibitors were significantly more aged (p=0.009) and had a significantly higher duration of the disease (p=0.004).

Doppler ultrasound examination showed a median CIMT of 0.56 mm (0.48-0.64) in patients treated with TNF inhibitors versus 0.55 mm (0.48-0.60) in patients naïve to TNF inhibitors with no significant difference (p=0.238). Patients on TNF inhibitors had lower values of FMD (with a median of 12.5 (6.7-16) versus 15.5 (10-24.5)). However this difference was not significant (p=0.182).

Conclusion

In our study, biological treatment with TNF inhibitors did not affect endothelial function and subclinical atherosclerosis in patients with spondyloarthritis. Given the small size of our study population and its heterogeneity in terms of age and duration of the disease, no conclusions can be drawn. Further longitudinal studies that involve larger samples are necessary.

Disclosure of Interests

None declared

AB0857 Increased carotid intima-media thickness is correlated with renal function in spondyloarthritis

Background

Cardiovascular diseases are the main cause of mortality in spondyloarthritis and seem to be multifactorial. Due to its easy application and reproductibility, carotid intima-media thickness (CIMT) is increasingly used for assessment of subclinical atherosclerosis and cardiovascular risk stratification.

Objectives

The aim of our study was to investigate the relationship between CIMT and renal function in patients with spondyloarthritis (SpA).

Methods

We performed a cross sectional study including 47 patients with SpA and no history of cardiovascular disease. Clinical and biological data were recorded. Data related to renal involvement and creatinine level were extracted. CIMT was measured in the right and the left common carotid artery by an experienced radiologist; than mean CIMT was calculated.

Results

Our study included 33 men and 14 women with a sex ratio of 2.35, a median age of 36 years (IQR 25-75%: 28-46) and a median duration of the disease of 11 years (IQR 25-75%: 5-16). Renal involvement was found in 6 patients (13%): kidney stones (n=2), tubulo-interstitial nephritis (TIN) (n=2), IgA nephropathy (n=1) and AA amyloidosis (n=1). Median creatinine level was 63 μmol/l (IQR 25-75%: 58.5 - 64). No patient had kidney failure.

Ultrasound examination found median right, left and mean (CIMT) of 0.54 mm (IQR 25-75%: 0.50-0.63), 0.55 mm (IQR 25-75%: 0.49-0.61) and 0.55 mm (IQR 25-75%: 0.48-0.62) respectively. Increased CIMT values were found in 8 patients (17%). No patient had atherosclerotic plaque.

Patients with renal involvement had significantly higher values of CIMT (0.64 mm (IQR 25-75%: 0.56-0.70) vs 0.53 mm (IQR 25-75%: 0.47-0.59); p= 0.045). Significant positive correlation was also detected between CIMT values and creatinine level (p=0.002; r=0.445).

In multivariate linear regression, creatinine level was identified as independent predictor of increased CIMT (B=0.002; 95% confidence interval=0.000-0.005; p=0.035).

Conclusion

Although all patients included have normal creatinine level, we identified creatinine level as independent predictor of subclinical atherosclerosis in SpA patients. This finding highlights the monitoring of this parameter.

Disclosure of Interests

None declared

AB0849 Assessment of Carotid Intima-Media Thickness in Spondyloarthritis patients

Background

Cardiovascular morbidity and mortality are increased in spondyloarthritis (SpA) (1), which is attributed to accelerated atherosclerosis. Recognition of subclinical atherosclerosis in asymptomatic population is important for risk stratification and optimal management. Due to its simplicity and non-invasive nature, carotid intima-media thickness (cIMT) is actually widely used for identifying subclinical atherosclerosis.

Objectives

The aim of our study was to investigate the presence of subclinical atherosclerosis in SpA patients compared with healthy controls, by evaluating cIMT.

Methods

We performed a case control study including 47 patients and 47 age and gender matched healthy controls. All subjects were included without history of cardiovascular disease or cardiovascular risk factors. Sociodemographic features, disease characteristics, radiographic structural damage and therapeutics were recorded. cIMT was measured with Mindray Resona 7 ZST+ ultrasound machine, from the right and the left carotid artery; than mean cIMT was calculated. We considered that cIMT was increased if the measurements were between 0.7 mm and 1.5 mm. Measurements higher than 1.5 were defined as an atherosclerotic plaque.

Results

Fourty seven patients with a sex ratio of 2.35 were included in our study. Median age was 36 years (IQR: 28-46) and median duration of the disease was 11 years (IQR: 5-16). Median BASDAI and ASDAS-CRP scores were 2.6 (IQR: 1.8-3.8) and 2.18 (IQR: 1.62-2.91) respectively. Of the 47 patients, 10 (21%) had an active disease according to BASDAI and 19 (40%) had an active disease according to ASDAS. Median BASFI score for functional impairment was 3 (IQR: 1.5-5.1). Median BASRI and mSASSS scores were 3 (IQR: 2-4) and 10 (IQR: 4-15) respectively. Regarding treatment, 92% of patients were using non-steroidal anti-inflammatory drugs (NSAIDs), 51% were on csDMARDs and 38% were on anti-TNF alpha drugs.

Median right, left and mean cIMT were respectively 0.54 mm (IQR: 0.50-0.63), 0.55 mm (IQR: 0.49-0.61) and 0.55 mm (IQR: 0.48-0.62) respectively. Increased cIMT values were found in 8 patients (17%). No patient had atherosclerotic plaque.

Median values of cIMT were significantly higher in patients with spondyloarthritis than the control subjects (p<0.0001) as shown in Table 1.

Table 1.

Comparaison of carotid intima-media thickness values between spondyloarthritis patients and control subjects.

SpondyloarthritisPatientsControl grouppRight cIMT (mm)*0,54 (0,50-0,63)0,45 (0,42-0,50)< 0.0001**Left cIMT (mm)*0,55 (0,49-0,61)0,47 (0,45-0,50)<0.0001**Mean cIMT (mm)*0,55 (0,48-0,62)0,46 (0,43-0,50)<0.0001**

cIMT: carotid intima-media thickness; mm: millimeters; *: median value (IQR 25-75%); **: p < 0.05 denotes statistical significance.

Conclusion

Our study demonstrated increased cIMT in patients with SpA compared with healthy population; which attests higher risk for subclinical atherosclerosis and cardiovascular atherosclerotic events.

References

[1]Bai R, Zhang Y, Liu W, Ma C, Chen X, Yang J, et al. The Relationship of Ankylosing Spondylitis and Subclinical Atherosclerosis: A Systemic Review and Meta-Analysis. Angiology. 2019 Jul;70(6):492–500.

Disclosure of Interests

None declared

WHO informal consultation on revision of guidelines on evaluation of similar biotherapeutic products, virtual meeting, 30 June – 2 July 2021

The WHO informal consultation was held to promote the revision of WHO guidelines on evaluation of similar biotherapeutic products (SBPs) adopted by the Expert Committee on Biological Standardization (ECBS) in 2009. It was agreed in the past consultations that the evaluation principles in the guidelines are still valid, but a review was recommended to provide more clarity and case-by-case flexibility. The opportunity was therefore taken to review the experience and identify areas where the current guidance could be more permissive without compromising its basic principles, and where additional explanation could be provided regarding the possibility of reducing the amount of data needed for regulatory approval. The meeting participants applauded the leading role taken by the WHO in providing a much-needed streamlined approach for development and evaluation of SBPs which will provide efficient and cost-effective product development and increase patient access to treatments. It was recognized that the principles as currently described in the draft WHO guidelines are based on sound science and experience gained over the last fifteen years of biosimilar approvals. However, since these guidelines when finalised will constitute the global standard for biosimilar evaluation and assist national regulatory authorities in establishing revised guidance and regulatory practice in this complex area, it was felt that further revision and clarity on certain perspectives in specific areas was necessary to dispel uncertainties arising in the current revised version. This report describes the principles in the draft guidelines, including topics discussed and consensus reached.

•

WHO guidelines serve as a basis for the development of national regulatory framework for biosimilars.

•

Revision of guidelines is to provide more flexibility and clarification on data required for regulatory approval.

•

Revised guidelines would contribute to improving consistency on regulatory decision and patient access to treatments.

Post-Acute Covid Neurological Symptoms among Doctors and Nurses in A Tertiary Care Hospital: An Observational Study from Bangladesh

A good number of patients experience post-Covid complications. Doctors and nurses are the front liners who are at greater risk of having this disease. Neurological symptoms are frequent in patients with post-COVID-19 infection. The study aims to observe the post-acute neurological symptoms among doctors and nurses of Mymensingh Medical College Hospital, a tertiary care hospital in Bangladesh, after they recover from initial infection or among the asymptomatic cases. It was a retrospective observational study among the doctors and nurses who became RT PCR positive from late April to mid-September 2020. A total of 100 subjects were interviewed over the phone for the presence or absence of neurological symptoms four weeks post Covid-19 infection. Total 54 doctors and 46 nurses were evaluated; the male-female ratio was 1:1.77, the mean age was 35.6±7.6 years. Post-acute COVID neurological symptoms (PACNS) were present in 60% of respondents. Fatigue (51%) was the most common symptom, followed by sleep disturbance, headache, myalgia, loss of taste and smell. PACNS were more in symptomatic patients at the initial Covid infection than asymptomatic cases.

Development and reliability testing of a tool to assess knowledge, attitude, and practice regarding physical restrain

Objective: To develop a reliable and accurate measurement tool for assessing critical care nurses' knowledge, attitude, and practice in the area of physical restraint and create an instructional module on physical restraint for critical care nurses. Methodology: The technique for creating and validating the tools involved several steps: (a) creating a theoretical framework and conducting a literature review; (b) developing the instructional module and tool items; (c) determining validity, and (d) pilot testing. A knowledge questionnaire, an attitude scale, a self-reporting practice checklist, and an instructional module were among the tools we produced. We examined the tools through face validity and content validity. We pilot tested the tool on a total of 20 critical care nurses, dividing them into 10 subjects each: experimental and control. Results: The items were assessed on their clarity, easy comprehension, and whether they effectively captured the subject being assessed, and they incorporated the expert’s suggestions into the tool development. In the questionnaire, the content validity ratio (CVR) of the item must be greater than or equal to 0.99 to be considered. Cronbach’s alpha done for the knowledge (0769 vs 0.764), attitude (0.694 vs 0.828) and practice (0.766 vs 0.624) domains show that the items have an acceptable level of internal consistency in both study groups. Conclusions: The assessment tool developed was validated by experts in the field and tested for reliability. With a good reliability score, it may be used as a tool in the field of physical restraint.

Role of Pentraxin-3 in Periodontal Inflammation - A Comprehensive Review

Acute phase reactants like C-reactive protein (CRP), and pentraxin 3 (PTX3) are increased with inflammation and tissue injury. PTX3 is an acute phase protein and a member of the long pentraxin family. CRP is synthesized in the liver but PTX3 is generated locally at the inflammatory site. It is a fluid-phase pattern-recognition molecule that regulates antimicrobial immunity and inflammation by interfering with selectin-dependent neutrophil recruitment and regulating the complement cascade. Hence, PTX3 could be used as a potential biomarker to identify inflammatory response in both acute and chronic diseases. In this review, we discuss the role of PTX3 in periodontal inflammation.

Preliminary experience using the VITOM-3D system for microvascular anastomosis in DIEP free flap breast reconstruction

Free tissue transfer has become routine practice in modern plastic surgery. The technique permits surgeons the flexibility to transfer the most suitable tissue for reconstruction. This has become possible largely due to the continued advances in microscope technology. There are however several drawbacks with even the newest traditional operating microscopes. They are usually large, heavy and although highly adjustable often require surgeons to adopt an unnatural and uncomfortable position which many of us have simply learned to live with. We describe the use of a new high-definition 3D camera system (Stortz VITOM 3D) in place of a traditional microscope to perform DIEP flap breast reconstructions in two patients. The use of this equipment has been described in other surgical specialities where a number of its benefits, including improved ergonomics for surgical team, have been highlighted. We explore the specific benefits and considerations for its use in free flap reconstruction of the breast .

Social media influencer marketing to build a counter-narrative for promoting sexuality education

Background

A recent cross sectional community readiness assessment carried out in Islamabad, Pakistan indicated that the community is at the denial or resistant stage for implementing school-based sexuality education in Pakistan. The resistance was attributed to lack of awareness and prevalent misconceptions regarding sexuality education. This study aims at qualitatively exploring strategies for targeting misconceptions and increase awareness regarding sexuality education with stakeholder involvement.

Methods

35 in-depth interviews and a focus group discussion was conducted to discuss the results of the readiness assessment comprising of community members, researchers, NGO representatives, and social media influencers. Discussion guide included topics on engagement strategies, intervention modes of delivery, target audience, misconceptions, community support, and optimizing sexuality education in local context. Qualitative content analysis was conducted for analyzing the data.

Results

Results indicate that current community support is usually passive in nature and digital or social media platforms are mostly used to talk about sexuality education. Participants believed social media can be used as a platform for disseminating information by involving social media influencers with careful narrative building around sexuality for rebranding the topic, as talking about sexuality is seen as a taboo in the society. Targeting misconceptions through counter narratives and scientific evidence was considered as a way forward for increasing community acceptability and readiness. Violence, staying safe, and age appropriateness were identified as some of the key features of sexuality education that need to be highlighted for garnering community support.

Conclusions

For promoting sexuality education in Pakistan, it is essential to tackle resistance by sensitizing the community and digital social media platforms offer an opportunity to do this through influencer marketing.

Key messages

Digital and social media offer an opportunity for promoting sexuality education in conservative settings like Pakistan. Social media influencer marketing might be useful in building counter narrative and for community engagement.

1556 Does Surgical Intervention Improve Quality of Life for Patients with Chronic Ear Disease in Nepal?

Aim

To assess change in quality of life (QoL) pre- and post-surgery for patients with chronic ear disease (CED) in Nepal. Hearing loss is the fourth leading cause of disability world-wide with 90% of those affected living in low and middle-income countries. A huge yet treatable contributor to this is chronic suppurative otitis media (CSOM). The Chronic Ear Survey is a sensitive and disease specific QoL measurement tool in patients with CSOM exploring activity restriction, symptoms and utilisation of medical services.

Method

This study was conducted at the Brinos Ear Care Centre in Nepalgunj, Nepal. A modified Chronic Ear Survey (mCES) was translated into Nepali and administered to patients before surgery and at post-operative follow up by community ear care assistants. The Mann-Whitney U test was used for statistical analysis.

Results

The mCES was administered to 64 patients pre-operatively and 28 patients post-operatively. Disease specific QOL in patients with CSOM was demonstrated to be better overall in patients post-surgery and specifically in the domains of activity limitation and symptoms. No significant change was demonstrated in utilisation of medical services (p &lt; 0.1)

Conclusions

Surgical intervention for patients with CSOM in Nepal improves ear specific QOL. This manifests specifically in a reduction in severity of symptoms and fewer restrictions on activity. Surgery in this population does not significantly change healthcare seeking behaviour and this must be explored further in the context of access to surgery and attitudes towards healthcare in this population.

387 Plastics Surgery and the COVID-19 Pandemic: How Our Practice Has Improved as A Consequence

Aim

Plastic trauma cases were impacted by the COVID-19 pandemic. Multiple plastic trauma theatres were lost due to redeployment and redistribution of staff and resources. Plastic surgery was essentially left with an emergency list to manage trauma cases. This retrospective study aims to highlight the pitfalls and solutions realised during COVID times and how different strategies can be implemented should a third national lock down occur.

Method

Plastic surgery data (trauma, elective) was analysed from the first national lockdown due to COVID-19 in 2020. This data was compared against plastic surgery trauma data from 2019. Theatre time, the number of trauma surgeries, anaesthetic used and delay to theatre were all analysed.

Results

There was a 47% reduction in plastic surgery trauma cases and a 42% reduction in delay to surgery during the national lockdown (2020) when compared with data from 2019. A significant increase in the use of Local Anaesthetic (LA) and Regional Anaesthetic (RA) during COVID times with a decrease in General Anaesthetic when compared with pre-COVID data of 2019 was also identified.

Conclusions

This study identified that the majority of plastic cases could be performed under RA/LA. This would lead to decreased aerosol generating procedures (GA) thus limiting the transmission of COVID, and decreased delay to surgery and theatre time. As a third national lockdown may be on the horizon, it would be prudent to implement these strategies into current practice and by doing so optimising theatre usage and assisting in curtailing the COVID-19 transmission rate.

750 An Unusual Presentation of a Rare Clinical Entity – A Case Report of Spontaneous Common Bile Duct Perforation in an Adult

Spontaneous or non-traumatic perforation of the extrahepatic biliary system is a rare clinical phenomenon, with few cases reported since its first mention in medical literature by Freeland in 1882. Given the rarity, misdiagnosis is common with the diagnosis almost always made during urgent exploratory laparotomy. We describe a case of spontaneous common bile duct (CBD) perforation in an 83-year-old female with no associative underlying disease process identified.

The patient presented with sudden onset abdominal pain with no identifiable trigger, with minimal past medical history. Examination was remarkable for findings of epigastric tenderness and guarding. Haematological investigation was remarkable only for hyperamylasaemia and leucocytosis. Pneumoperitoneum was ruled out and following contrast CT abdomen and pelvis a working diagnosis of mild pancreatitis was made. US Abdomen and MRCP found no evidence of cholelithiasis, with minimal biliary duct dilatation. The patient continued to deteriorate on the ward, with aspiration of new intrabdominal fluid collection raising suspicion of perforated viscus. Exploratory laparotomy revealed a 1-cm defect in the CBD with frank bile leak. A T-tube was placed in the common bile duct defect, with an abdominal robertson drain also inserted. No further bile leak was identified via Tubogram, with the patient successfully discharged following multidisciplinary rehabilitation in intensive care and the ward setting.

Surgeons should seek out this uncommon diagnosis in patients with hyperamylasaemia and suspected cholelithiasis who do not conform to normal biliary/pancreatic disease progression patterns.

158 Effect of Preoperative Continuation of Aspirin on Postoperative Bleeding After Off-Pump Coronary Artery Bypass Grafting (OPCABG)

Background

Despite ample evidence of continued preoperative aspirin to improve outcomes in coronary artery bypass surgery, practice for routine continued preoperative aspirin use is still inconsistent due to concern for increased postoperative bleeding. The purpose of this study was to investigate preoperative aspirin use and its effect on postoperative bleeding after off-pump coronary artery bypass grafting (OPCABG).

Method

This cohort study involved patients (n = 74) who underwent OPCABG at a single center between August 2017 to January 2018. After considering the inclusion and exclusion criteria, they were divided into two groups: one (n = 37) received tablet Aspirin 75mg till the day of surgery and for the other group (n = 37) aspirin was stopped 5 days before surgery. Postoperative bleeding was recorded in both groups. After considering preoperative, intraoperative, and postoperative variables statistical analysis was done.

Results

There was no significant difference between the two groups concerning preoperative and peroperative variables. No significant difference was also observed between the two groups in chest tube drainage at 1sthour, 2ndhour, 3rdhour, 24thhour, next 24 hours (at 48th hour), and next 24 hours (at 72nd hour) (p = 0.845, 0.126, 0.568, 0.478, 0.342 and 0.717 respectively). No significant difference was seen in the transfusion requirement of blood and fresh frozen plasma (FFP).

Conclusions

Continuation of preoperative aspirin till the day of surgery is not associated with an increase in chest tube drainage, re-operation for bleeding complications, or transfusion of blood and FFP.

Patterns of Health Care Utilization during Breast Cancer Diagnosis and Treatment: A Cross Sectional Study in Bangladesh

Female breast cancer can be diagnosed easily; but due to inappropriate health care utilization, health-seeking is lag behind. The objectives of the study were to find out the pattern of utilization of health care during breast cancer diagnosis and treatment and their health seeking time. We conducted this cross sectional study for one year; from July 2017 to June 2018 among 200 newly diagnose patients with breast cancer whose were selected randomly from National Institute of Cancer Research and Hospital, Dhaka, Bangladesh from the listed patients who attended at the outpatient department of chemotherapy day care center for treatment. Delay in reporting, wrong reporting, double reporting, delay in hospital admission, long queue for administrative work and delay to reach cancer specialist play a role in utilization of health care. Results showed that health care service delivery and utilization was found to be significant by (p<0.05) associated with the provider delay (p=0.010), total delay (p=0.017), delay to consult with cancer specialist (p<0.0001). By logistic regression it analyzed that utilization of health care there had 2 times more likely to cause provider delay (OR=2.5; 95% CI 1.087-5.762) p=0.03. Utilization of health care influenced stage of cancer with delay help seeking and diagnostic institution also. As low middle income country, like Bangladesh, delays in seeking consultation, late presentation and the availability of breast cancer management for all patients, represent major challenges.