Agromorphological traits dataset of butterfly pea accessions from Thailand, Indonesia, and Brazil

Butterfly pea (Clitoria ternatea L.) is a horticultural crop also known as underutilized crop. All parts of the butterfly pea can be used into various products including flowers that can be used as natural dyes and traditional medicines. Besides that, the plant parts can be used as fodder and cover crop. The development of butterfly pea in Indonesia is still very low both in cultivation and utilization. Therefore, a breeding program is required to increase usefulness of butterfly pea can be done for the development. To assemble superior varieties of butterfly pea, it is necessary to determine the genetic diversity of both in agronomy and morphology. Genetic diversity and relationships are needed to evaluate plant germplasm. Raw data analysis was conducted after standardization using Principal Componet Analysis (PCA) and Hierarchical Clustering Analysis (HCA) to determine phenotypic diversity and relationship among the newly collected genetic resources. The data in this article showed broad phenotypic diversity with weight of fresh flower per plant, seed color, weight of total seed, pod width, calix length, flower color, petal number, number of total pods, plant height, number of seed per pod, weight total fresh flower, seed width, weight of fresh flower per plant, and seed length as distinguishing traits among the accessions. PCA based on agromorphogical traits showed eigenvalue ranged from 1.13 to 9.47 with a cumulative contribution of 93.02%. HCA showed butterfly pea accessions divided into two cluster with euclidean distance 0.27-4.65.

Knowledge of computed tomography dose optimisation and justification among CT users and referring physicians: A single hospital study

INTRODUCTION

Radiation dose associated with computed tomography (CT) remains a concern, and radiation risk does not receive the needed attention, especially in low and middle-income countries. This because the frequency of this high-dose examination is rapidly growing and systems for protocol optimisation and dose justification are yet to be provided in CT imaging.

OBJECTIVE

To determine radiographers' and radiologists' awareness and knowledge of CT dose optimisation. We also determined knowledge of dose justification and use of the referral guidelines amongst the referring physicians.

METHODS

Radiographers and radiologists were invited to complete a web-based questionnaire whilst the referring physicians completed a self-administered questionnaire. The returned questionnaires were analysed and a significant difference was determined using Yates corrected Chi-square, and a p-value of 0.05 was considered at the 95% confidence interval.

RESULTS

The response rates were 50% (17 out 34) and 35% (16 out 46) for radiographers and radiologists respectively while referring physicians had a response rate of 84% (92 out of 110). Overall, more radiographers (47.1%) than radiologists (18.8%) had good knowledge of CT doses and image quality, however, the difference in knowledge was not found to be significant (p = 0.167). In addition, knowledge of diagnostic reference levels (DRLs) was significantly (p = 0.033) higher amongst radiographers (52.9%) as compared to radiologists (12.5%). Meanwhile, physicians understood the principles of dose justification. However, their knowledge of referral guidelines was limited.

CONCLUSION

The study revealed that radiographers were more knowledgeable on matters relating to radiation dose and image quality as well as DRLs when compared to radiologists. Meanwhile, the concept of dose justification was understood among physicians, however, they had limited awareness and knowledge of referral guidelines.

INFERIOR VENA CAVA FILTER PLACEMENT FOR PREVENTION OF PULMONARY THROMBOEMBOLISM: CASE SERIES FROM NORTHWESTERN NIGERIA

Background

Inferior vena cava (IVC) filter placement is an image-guided procedure aimed at primarily preventing pulmonary thromboembolism in patients with lower limb venous thromboembolic (VTE) disease. In Northern Nigeria with a relatively high incidence of thromboembolic disease such as Deep vein thrombosis, reports on IVC filter placement are largely low. We report the feasibility of IVC filter placement on eight patients for the first time in a typical low-resource setting in Northern Nigeria.

Case Presentations

We had an equal number of males and females of the eight patients. Their ages ranged from 20 to 80 years. Five patients presented with bilateral lower limbs Deep vein thrombosis (DVT) of which one had a pulmonary embolism. Two other patients had extensive left femoral DVT and one had extensive IVC, iliac, femoral, and popliteal veins thrombosis. The medical records of seven patients, who had IVC filter placement in our department, were reviewed. The IVC filter was deployed with the aid of a C-arm fluoroscopic unit. In a single case, access was secured via an indwelling dialysis catheter.

Conclusions

All the patients had successful deployment with satisfactory postprocedure conditions. The intended benefit of pulmonary embolism prevention was achieved in the series of procedures that were performed. Indicating the value of IVC filter even in resource-poor settings and effort should be made towards exploring such intervention.

Endophytic to total tumour volume ratio: An added variable to patients with T1b/T2 renal tumours undergoing partial nephrectomy

INTRODUCTION

Partial nephrectomy is the standard of care to patients with small renal masses. It is still encouraged to larger tumours whenever feasible. The aim of this study is to look for the endophytic to total tumour volume ratio as an added variable to study the complexity of partial nephrectomy to patients with T1b/ T2 renal tumours.

METHODS

Retrospective data collection of patients that had partial nephrectomy for T1b/T2 renal tumours by a single surgeon was done. Radiological re-assessment for the CT images to measure the endophytic to total tumour volume ratio was done.

RESULTS

The mean age of the patients was 63 years. The study included 25 males and 11 females. All cases were managed by open surgery using retroperitoneal transverse lateral lumbotomy and warm ischemia was used in all patients. The mean tumour volume was 74 cc, the mean endophytic tumour volume was 29 cc. The mean percentage of endophytic to total tumour volume was 42%.

CONCLUSIONS

Partial nephrectomy is safe for most of the patients with good performance status, having large renal masses. More complex surgery can be predicted in patients with endophytic to total tumour volume greater than 42%.

RELATIONSHIP BETWEEN SICKLE CELL NEPHROPATHY AND SOME BIOCHEMICAL MARKERS OF HAEMOLYSIS AMONGST PATIENTS WITH SICKLE CELL ANAEMIA IN KANO, NORTHWESTERN NIGERIA

Introduction

Advancements in the care of patients with sickle cell anaemia have led to significant improvement in survival with many patients reaching adulthood. As they age, long-term complications of the disease manifest in them, notable amongst which is nephropathy which is one of the leading causes of morbidity and mortality in them. There is limited information about sickle cell nephropathy and some biochemical markers of haemolysis that can detect it early in our setting. This study aimed to determine the relationship between some indirect markers of haemolysis and sickle cell nephropathy.

Methodology

The study was a descriptive cross-sectional one where 204 adolescent and adult patients with sickle cell anaemia attending the clinic of AKTH Kano were recruited. An interviewer-administered questionnaire was utilized. Blood samples were taken for determination of serum bilirubin, LDH, and reticulocyte count. Spot urine was used to quantitatively determine albumin to creatinine ratio. Data collated was analyzed using SPSS version 22.0. P-value <0.05 was considered significant.

Result

Two hundred and four (204) participants were enrolled in to the study. Their mean age was 19.6±5years. Females were the majority 131/204 (64.2%). The median (IQR) serum lactate dehydrogenase, bilirubin, direct bilirubin, and reticulocyte count were 607.0(487.3-758.5) U/L, 54.5(37.0-119.0) umol/L, 16.0(11.3-29.0) umol/L and 4.0(3.0-8.4%) respectively. Sickle cell nephropathy was found in 29/204 (14.2%). There were positive significant associations between sickle cell nephropathy with raised serum bilirubin and serum lactate dehydrogenase (p-value = 0.02 and 0.032 respectively).

Conclusion

Sickle cell nephropathy is common amongst patients with sickle cell anaemia and raised serum bilirubin and lactate dehydrogenase are predictors of sickle cell nephropathy.

Burden, Severity and Characteristic Pattern of Coronary Artery Disease using 160-Slice Computed Tomographic Angiography: Earliest Report from Northern Nigeria

BACKGROUND

Coronary computed tomography angiography (CCTA) allows for non-invasive visualization of the coronary arteries which is promising in diagnosing coronary artery disease.

OBJECTIVES

To determine the prevalence, morphology, anatomic distribution pattern and correlates of CAD in our environment.

METHODS

This cross-sectional study was conducted on the first cohort of patients referred for CCTA in our hospital. The patients were examined with 160-slice Toshiba® CT scanner. Their demographic data, relevant clinical information as well as the findings on CCTA were extracted and documented. The data were analysed using the R programming software version 4.0.4.

RESULTS

Out of a total of 153 patients who presented for CCTA within the study period, 133 (84.7%) were eligible for analysis. Their age ranged from 22-78 years with a mean ± SD of 55.8 ± 11.7 years. A total of 33 (24.8%) had normal CCTA, while 100 (75.2%) had either stenosis or total occlusion. There was a significantly higher (p-value of 0.00001) calcium score among those with stenosis compared to those with normal CCTA. The severity of the stenotic lesion was associated with the calcium score. The logistic regression analyses showed a statistically significant (P = 0.0415, OR = 1.0569, 97.5% CI =1.078152-1.123240) association between age and the presence of coronary stenosis. In addition, most of the stenotic lesions were in the left anterior descending artery (LAD).

CONCLUSION

Majority of the patients had coronary artery disease of variable severity and the LAD was the most involved artery. There was no significant association between sex and severity of the disease; however, old age and higher number of lesions were associated with severe disease.

Clinicians' interpretation of ventilation/perfusion lung scan reports: Where are we today?

Background

Clinicians' interpretation of lung scan reports will determine which further management decisions are taken when potentially fatal pulmonary embolism (PE) is suspected.

Objectives

To assess current referring clinicians' interpretation of the terminology used in ventilation/perfusion (V/Q) scan reports, whether this interpretation is affected by experience level, and how it affects clinical management decisions.

Methods

This was a questionnaire-based cross-sectional study. Between September 2020 and May 2021, 300 questionnaires were distributed among clinicians who refer patients for V/Q scans.

Results

Of the 162 clinicians who responded, 94% thought that there is >85% likelihood of PE or definitely PE present when a scan is reported as 'high probability of PE'; 87% interpreted 'low probability of PE' as <10% likelihood of PE or definitely no PE present. Overall, >70% of clinicians across all experience levels correctly interpreted the intended meaning of probability categories according to the Modified Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) II criteria. Of the respondents, 77% agreed that clinically significant PE is ruled out by a normal scan. Further investigation for inconclusive findings, features of parenchymal lung disease and cardiomegaly were selected by 72%, 93% and 98% of clinicians, respectively.

Conclusion

The findings of this study regarding high-probability scan results were in line with existing literature on lung scan report interpretation. However, our findings regarding low-probability scan results and negative V/Q scan specificity contrasted with the findings in these articles, suggesting that clinicians are now more familiar with lung scan interpretation guidelines. Experience level did not significantly affect interpretation of reports. Although most clinicians agreed that a negative scan excludes clinically significant PE, two-thirds of them would still subject the patient to further unnecessary investigations to exclude PE.

Study synopsis

What the study adds. Our findings regarding a low-probability ventilation/perfusion (V/Q) scan and the specificity of a negative V/Q scan contrasted with previous articles on lung scan interpretation, suggesting that clinicians are now more familiar with lung scan interpretation guidelines.Implications of the findings. Although most clinicians understood the negative predictive value of a V/Q scan, 20% would still investigate further with computed tomography pulmonary angiography or treat as confirmed pulmonary embolism. Education of clinicians about the negative predictive value of V/Q scans is important to avoid unnecessary radiation or anticoagulation.

History of infantile BCG immunization did not predict lamina propria invasion and/or high-grade in patients with non-muscle invasive bladder cancer

OBJECTIVE

To evaluate the utility of infantile BCG vaccination history in predicting stage and grade of tumours in non-muscle invasive bladder cancer (NMIBC).

MATERIALS AND METHODS

We retrospectively analyzed data from patients from a single center who were diagnosed with new NMIBC and underwent transurethral resection of bladder tumour (TURBT) between 2017 and 2022. We assessed BCG immunization status with various demographics and comorbidities, as well as tumour recurrence, progression, stage, and grade.

RESULTS

A total of 188 patients met the inclusion criteria for our study. The mean age of patients at the time of diagnosis was significantly lower in those that had been immunized with BCG (71 ± 9) than those who had not (77 ± 10) (p < 0.0001). History of BCG immunization did not correlate with sex, history of diabetes mellitus (DM), prior history of intravesical BCG treatment, and tumour recurrence, progression, stage, and grade.

CONCLUSIONS

History of infantile BCG vaccination did not correlate with the depth of invasion and/or the grade in patients with non-muscle invasive bladder cancer. Patients that received infantile BCG vaccination were significantly younger at the time of diagnosis of NMIBC.

Effect of Different Ratios of Mentha spicata Aqueous Solution Based on a Biosolvent on the Synthesis of AgNPs for Inhibiting Bacteria

Our work was devoted to studying the effect of different concentrations of Mentha spicata aqueous extract on the green synthesis of silver nanoparticles (AgNPs) in order to obtain the most effective of these concentrations for bacteria inhibitory activity. Different concentrations of the aqueous M. spicata extract (0.25, 0.50, 0.75, and 1.00 mM) were used as biological solvent to synthesize AgNPs by means of the reduction method. The crystal structure and morphology of the NPs were characterized UV–vis spectra, X-ray diffraction (XRD), and scanning electron microscopy (SEM). The inhibition effect of AgNPs on Escherichia coli was studied to determine the minimum inhibitory concentration (MIC). The dark yellow color of the M. spicata extract aqueous solution indicates the successful synthesis of the AgNPs. UV spectra of the NPs show a gradual increase in absorption with increasing concentration of aqueous M. spicata extract solution from 0.25 to 1.00 mM, accompanied by a shift in the wavelength from 455 to 479 nm along with a change in the nanoparticle size from 31 to 9 nm. The tests also showed a high activity of the particles against bacteria (E. coli) ranging between 15.6 and 62.5 µg/ml. From the AgNPs, it was confirmed that aqueous M. spicata extract is an effective biosolvent for the synthesis of different sizes of AgNPs according to the solvent concentration. The AgNPs also proved effectual for the killing of bacteria.

The effect of different aqueous solutions ratios of Ocimum basilicum utilized in AgNPs synthesis on the inhibition of bacterial growth

This study examined the effect of varying concentrations of Ocimum basilicum aqueous extract, which was done via the green synthesis of Silver nanoparticles (AgNPs), on the identification of the most effective concentration for bacteria inhibitory activity. Different concentrations of the aqueous Ocimum basilicum extract (0.25, 0.50, 0.75 and 1.00 mM) were used as reducing and stabilizing agent to synthesize AgNPs by means of the reduction method. The crystal structure and morphology of the NPs were characterized UV-Vis spectra, X-ray diffraction (XRD) and scanning electron microscopy (SEM). The antibacterial efficacy of AgNPs was studied against E. coli ATCC 35218 using well diffusion, MIC, MBC, and time-kill curve. The dark yellow color of the Ocimum basilicum aqueous solution indicates the successful synthesis process of the AgNPs. UV-spectra of the AgNPs display a gradual increase of absorption in sequence with concentration increase of aqueous Ocimum basilicum extract solution from 0.25 to 1.00 mM. This, in turn, led to a shift in the wavelength from 488 to 497 nm, along with a change in the nanoparticle size from 52 to 8 nm. The tests also showed a high activity of the particles against bacteria (E. coli), ranging between 15.6 and 62.5 µg/ml. Based on AgNPs, it was confirmed that an aqueous Ocimum basilicum extract can be used as an effective, reducing and stabilizing agent for the synthesis of different sizes of AgNPs based on the solvent concentration. The AgNPs also proved to be effective in inhibiting and killing bacteria.

Case - Late abdominal wall recurrence following open nephroureterectomy for urothelial carcinoma

Upper tract urothelial carcinoma (UTUC) recurrence following open nephroureterectomy to the surgical wound is very uncommon. Herein, we describe a case with late abdominal wall recurrence, surgically removed, with no evidence of further recurrence over a short period of followup.

Real-world outcomes of Selexipag for treatment of pulmonary hypertension in an Asian population

Funding Acknowledgements

Type of funding sources: None.

Introduction

Selexipag is an oral selective prostacyclin IP receptor agonist indicated for treatment of pulmonary arterial hypertension (PAH). Data on its real-world safety and efficacy in Asians is lacking.

Purpose

We sought to evaluate the clinical characteristics, treatment regimens and outcomes of patients initiated on selexipag in a tertiary cardiac centre in Asia.

Methods

This was a retrospective study on all patients initiated on selexipag from January 2017 to December 2020. Baseline and follow up characteristics including demographics, functional status and clinical data were collected. Clinical outcomes evaluated included hospitalisation for PH related complications and all-cause mortality. Patients were risk stratified using the COMPERA 2.0 risk scores.

Results

A total of 36 PAH patients were treated with selexipag. At baseline, most patients were WHO functional class II or III (36.4% and 51.5% respectively), with a NT-proBNP of 1335 pg/ml (557 – 2918) and 6 minute walk test (6MWT) duration of 327.5 ±126.4 meters. Selexipag was initiated at 200mcg twice daily dosage for all except one patient (started at 200mcg once daily) and the maximum tolerated dose ranged from 200mcg twice daily to 1400mcg twice daily, with majority tolerating up to a dose of 600mcg twice daily (58.3%). Side effects were reported in 23 patients (63.9%), of which headache (27.8%), diarrhea (30.6%) or musculoskeletal symptoms (27.8%) were predominant. After a median follow up duration of 25.9 ± 23.1 months, selexipag was stopped in 20 patients (55.6%), of which eight patients were due to PAH progression requiring alternative therapy, and 12 patients due to side effects from selexipag. At baseline, patients were classified into low (8.3%), intermediate-low (30.6%), intermediate-high (33.3%) and high risk (27.8%) respectively. Patients who continued on selexipag at follow up showed no change (46.2%), improvement (15.4%) and deterioration (38.5%) in risk score. In the overall cohort of 36 patients, majority (75%) had at least one hospitalisation for PAH related complications and 15 patients (41.7%) demised.

Conclusion

In this real-world study, while selexipag was associated with a stable or improved PAH risk scores in majority of patients, there was a subset of patients with disease progression or intolerance to the medication. Further studies are warranted to identify patients who will benefit most from this therapy.

Long-term memory and synapse-like dynamics in two-dimensional nanofluidic channels

Fine-tuned ion transport across nanoscale pores is key to many biological processes, including neurotransmission. Recent advances have enabled the confinement of water and ions to two dimensions, unveiling transport properties inaccessible at larger scales and triggering hopes of reproducing the ionic machinery of biological systems. Here we report experiments demonstrating the emergence of memory in the transport of aqueous electrolytes across (sub)nanoscale channels. We unveil two types of nanofluidic memristors depending on channel material and confinement, with memory ranging from minutes to hours. We explain how large time scales could emerge from interfacial processes such as ionic self-assembly or surface adsorption. Such behavior allowed us to implement Hebbian learning with nanofluidic systems. This result lays the foundation for biomimetic computations on aqueous electrolytic chips.

Influence of lysozyme utilization with lactic acid bacteria in yoghurt on some foodborne pathogens

Despite the existence of many different food preservation methods, foodborne pathogens are still the most common related problems to dairy products. Developing naturally alternative techniques to control such problems is necessary. This research was planned to assess the bacteriological quality of yoghurt samples commercially available in Kafr El-Sheikh city, Egypt. Also to study the impact of natural antibacterial agents on the inhibition of selected foodborne pathogens artificially inoculated in yoghurt samples. The obtained results revealed poor bacteriological quality of the examined yoghurt samples, as total staphylococci and coliforms were detected in 80% and 90% yoghurt samples, with mean values of 2.4 ×103±0.13× 103cfu/gm and 3.6×105± 2.4×105 MPN/gm, respectively. S. aureus was noticed in 4% of examined samples, polymerase chain reaction (PCR) confirmed the pres­ence of virulence adhesion gene (clfA) in one isolate. E. coli was detected in 14% of yoghurt samples, then serologically identified as O146:H5 (2), O111:H2 (2), O125:H11 (1), O26:H10 (1) and O158:H7 (1). Artificially inoculated yoghurt with S. aureus (7.39 log cfu/gm) and E. coli (8.3 log cfu/gm), were used to investigate the ability of hen egg-white lysozyme either with LAB classic or with ABT-5 (L. acidophilus LA5+ S. thermophiles + Bifidobacterium Bb12) starter cultures to inhibit the growth of these pathogens. During refrigerated storage, all yoghurt batches showed a reduction in pH value. It was observed that both pathogens couldn't be detected in the yoghurt batch containing LAB classic starter + heated lysozyme. Furthermore, S. aureus was completely inhibited in that containing ABT-5 cultures alone, while E. coli decreased by 6.23 log. Conversely, there was not complete inhibition in other batches containing (LAB classic starter, LAB classic starter+ native lysozyme, ABT-5 culture+ native lysozyme and ABT-5 culture+ heated lysozyme) as the reduction rate during all storage periods for S. aureus count was 1.66, 2.63, 4.47  and 4.19 log, While for E. coli count was  3.3, 3.81, 5.53 and 4.89 log,  respectively. This study highlighted the importance of adding natural antibacterial agents like lysozyme with LAB culture to yoghurt as a bio-control strategy to overcome foodborne pathogens that cause a public health hazard.

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.

Zero-fluoroscopy ablation of the cavotricuspid isthmus guided by intracardiac echocardiography in patients with typical atrial flutter

Introduction

In previous studies we have demonstrated the advantages of electrophysiology catheter navigation by intracardiac echocardiography (ICE). In this prospective study we investigated ICE-guided zero-fluoroscopy ablation of the cavotricuspid isthmus (CTI) involving a decapolar diagnostic and an irrigated radiofrequency (RF) ablation catheter in patients with typical atrial flutter (AFL).

Methods and results

Twenty-seven consecutive patients (mean age 73.4±11.6 years, 18 male) with ECG-recordings suggesting ongoing (n=19) or recent CTI-dependent AFL underwent an electrophysiological study (EPS) utilizing solely ICE for catheter navigation. All EPS could be successfully accomplished without the need for fluoroscopy. CTI-dependent AFL was confirmed by entrainment manoeuvre in all patients with ongoing AFL. Mean EPS duration was 44.0±20.3 minutes and mean ablation procedure duration was 22.3±16.4 minutes. RF ablation was applied for 6.3±3.1 minutes (50 Watts, irrigated RF-ablation in all patients). After the last RF application, bidirectional CTI-Block was confirmed by differential pacing in all patients. Echocardiographic parameters such as CTI-length, prominence of the eustachian ridge (ER), and depth of the CTI-pouch on the ablation plane (Figure 1) were assessed to analyse their correlation with EPS- or ablation procedure duration. CTI-pouch was shallower in patients with ablation procedure duration above median (4,9±1.09mm vs. 6.3±0.9mm, p=0.048), suggesting a more laterally ablation plane in these patients, where the CTI musculature is stronger. CTI-length or ER-prominence above the respective median did not correlated with longer EPS duration. However, in some cases with prominent ER inversion of the ablation catheter was needed to achieve contact of catheter-tip to the tissue. An asymptomatic intramural hematoma was diagnosed by ICE after successful ablation in one patient, no other major or minor complications were documented in this study.

Conclusions

Zero-fluoroscopy CTI ablation guided solely by intracardiac echocardiography in patients with CTI-dependent AFL is feasible and safe. ICE visualisation may help to localize the optimal ablation plane, to detect and correct poor tissue contact of the catheter tip and recognise early potential complications during the ablation procedure.

Funding Acknowledgement

Type of funding sources: None.

Radical cystectomy for bladder urothelial carcinoma with aggressive variant histology

Purpose: The aim of this study is to report our experience in managing bladder cancer in patients with variant pathology. Methods: Retrospective data collection for all patients managed by radical cystectomy over the last 3 years for a variant pathol-ogy was completed. We specifically included micropapillary and nested variants. Results: Ten patients were identified, with eight having micropapillary carcinoma (MPC) and two having nested vari-ants. Nine patients were male. The median age was 75. The two patients with nested variant were 56 and 62 years old, respec-tively, whereas all patients with MPC were over the age of 70. Upon cystectomy of all micropapillary cases, three patients(37.5%) had positive lymph node invasion and the final patholo-gy was T2 (two patients), T3 (two patients), and T4 (four patients). Barring a grade III complication Clavien-Dindo classi-fication due to wound dehiscence that necessitated secondary surgical closure, there were no specific perioperative complica-tions. Given the urethral invasion, cystourethrectomy was per-formed on the female patient. Within a median 13-month fol-low-up, three patients developed local recurrence, including two urethral and one new lateral pelvic mass. Conclusions: Considering the muscle invasive nature of micropapillary and nested bladder cancer, aggressive surgical management should not be postponed. Moreover, due to notable prevalence of concurrent and/or recurrent urethral involvement, initial urethrectomy or early and frequent postoperative ure-throscopy should be provided. Patients with variant histology bladder cancer may benefit from early radical cystectomy when compared to bladder sparing protocols and prostate sparing cystectomy treatment options. 

From freshwaters to bivalves: Microplastic distribution along the Saint-Lawrence river-to-sea continuum

Despite the close connection of freshwaters to human health, the occurrence and fate of microplastics in marine estuaries remain poorly documented. To study these particles in the Saint-Lawrence River (Quebec, Canada), surface water and marine bivalve samples were collected along the river-to-sea continuum. The water samples were subdivided to characterize the large microplastics (LMPs; 300-3200 µm) and the small microplastics (SMPs; 20-300 µm). Particles were identified by microscopy and infrared spectroscopy techniques. The concentration of LMPs was higher in the surface water in the downstream stations (0.0319 ± 0.0147 items.L^-1) compared to the upstream stations (0.0007 ± 0.0006 items.L^-1). No clear trend was observed for the SMPs. After digestion of the biological tissues, the microplastics ingested by the bivalves were recovered and characterized by microscopy coupled with infrared spectroscopy. Up to 3 items were found per bivalve suggesting that these particles are also present in the water column of the marine estuary and the gulf. The physico-chemical gradients along the continuum were monitored since they could be directly involved in the vertical and horizontal transport of microplastics. This study provides scarce field data collected along the world's largest estuary and gives new insights concerning the fate of microplastics along a river-to-sea continuum.

FIRST CARDIAC COMPUTED TOMOGRAPHY TYPICAL RADIATION DOSE VALUES FROM A SINGLE CENTRE IN NIGERIA: A PILOT STUDY

Concern regarding radiation dose associated with cardiac computed tomography (CT) still exists and requires the use of diagnostic reference levels for dose optimisation. Typical median doses were established for 58 consented adult patients from a single centre for coronary artery calcium score (CACS) as volume computed tomography dose index (CTDIvol): 5.9 mGy; dose length product (DLP): 86.6 mGy*cm and cardiac CT angiography (CCTA) as CTDIvol: 11.1 mGy; DLP: 190.8 mGy*cm. Wide radiation dose variability in terms of CTDIvol was noted for CACS: 2.7-15.9 mGy, a 6-fold, whereas for CCTA it ranges from 3.8 to 52.8 mGy, a 14-fold. The DLP values for CACS range from 33.2 to 344.2 mGy*cm, which is 10-fold, whereas for CCTA it ranges from 32.8 to 834.9 mGy*cm, a 25-fold. The typical values compared lower than the radiation dose from other countries; however, the wide variability in dose remains a call for concern.

POS1521-HPR UNDERSTANDING AND IDENTIFYING KEY CONTEXTUAL FACTORS THAT INFLUENCE THE PRACTITIONER-PATIENT ENCOUNTER IN THE MANAGEMENT OF OSTEOARTHRITIS: A QUALITATIVE SYSTEMATIC REVIEW

Background

Contextual factors (CFs) related to the patient, healthcare practitioners, and their therapeutic relationship are integral to the overall treatment effect of any given intervention (1). In osteoarthritis (OA), around 75% of the treatment effect is directly attributable to CFs (2). Identifying and understanding the role of CFs may encourage healthcare practitioners to develop and enhance the contextual aspects of care.

Objectives

To explore and understand the experience and perspectives of patients and health practitioners regarding CFs in consultations for OA.

Methods

A systematic search was conducted between March 15 and May 18, 2020, on the following databases: MEDLINE via Ovid, EMBASE, AMED, PsycINFO and CINAHL. The search for unpublished studies included ProQuest Dissertations and Google Scholar. The search was not limited to any language or publication year. The Joanna Briggs Institute (JBI) methodology for quality assessment, study selection, data extraction and synthesis were used. Findings were assessed for credibility, categorised based on similarity in meaning and subjected to a meta-aggregation. The ConQual approach was used to assess the confidence of the synthesised findings (3).

Results

Of 1808 records generated from the systematic search of databases and grey literature, eight studies were included in the meta-aggregation (Figure 1). All included papers were moderate to high quality based on the JBI qualitative critical appraisal tool. Meta-aggregation generated three synthesised findings. According to the ConQual criteria, all the synthesised findings’ level of evidence was rated as moderate (Table 1). The key, potentially modifiable, factors identified were positive communication; clear and relevant information provided by the health practitioner; patient expectation concerning their outcome and the consultation experience; sufficient consultation time; and easy access to consultations.

Table 1.

ConQual summary of findings

Synthesized findingType of researchDependabilityCredibilityConQual scoreI. People with OA will likely experience comprehensive and satisfactory management of their condition if the key contextual enhancers are implemented.QualitativeUnchanged*Downgrade 1 level**ModerateII. Health providers acknowledged that information provision and efficient communication skills are likely to enhance management during consultations for OA.QualitativeUnchanged*Downgrade 1 level**ModerateIII. Effective consultations are affected by an intersection of organizational challenges and patient and provider characteristics. Limited experience with OA of some practitioners, unrealistic patients’ expectations, and short consultation duration are barriers that need to be adjusted for better management.QualitativeUnchanged*Downgrade 1 level**Moderate

* The average score was (4/5) for dependability.

** Downgraded one level due to a mix of unequivocal and credible findings.

Figure 1.

PRISMA flowchart of the study selection and inclusion process

Conclusion

This qualitative systematic review has defined three synthesized findings. Identification of modifiable CFs that are deemed important by both patients and health practitioners can inform the development of a training package for healthcare professional.

References

[1]Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J. Influence of context effects on health outcomes: a systematic review. The Lancet. 2001;357(9258):757-762.

[2]Zou K, Wong J, Abdullah N, Chen X, Smith T, Doherty M et al. Examination of overall treatment effect and the proportion attributable to contextual effect in osteoarthritis: meta-analysis of randomised controlled trials. Annals of the Rheumatic Diseases. 2016;75(11):1964-1970.

[3]Munn, Z., Porritt, K., Lockwood, C., Aromataris, E. & Pearson, A. 2014. Establishing confidence in the output of qualitative research synthesis: the ConQual approach. BMC medical research methodology, 14, 1-7.

Disclosure of Interests

None declared

Radical cystectomy for clinical T4b urothelial carcinoma: An Ontario, single-center experience

INTRODUCTION

Guidelines surrounding the management of T4b muscle-invasive bladder cancer (MIBC) with radical cystectomy (RC) are limited and lack clarity. Our objective was to analyze our single-center experience to provide additional insight into the role of RC.

METHODS

We performed a retrospective data analysis using clinical, radiological, and pathological information for all patients managed by RC for cT4b MIBC at the Thunder Bay Regional Health Sciences Centre (July 2015 to July 2020). Patients that had MIBC as their first diagnosis were termed the de novo group and patients that were initially diagnosed as having non-MIBC were termed the progressive group.

RESULTS

Nineteen consecutive patients (16 males and three females), with a median age of 68 years, managed by two urologists over the last five years, met study criteria. Eleven (58%) of the patients had de novo MIBC while eight (42%) presented with progressive disease. All patients had dysuria as a presenting symptom. Only one (5%) patient received neoadjuvant chemotherapy. There were low rates of perioperative transfusion (11%), bowel resections (5%), postoperative transfusions (0%), ileus (32%), urine leak (16%), and wound dehiscence (5%). Fourteen patients (74%) had positive lymph nodes. All patients had adjuvant chemotherapy. The one-year recurrence rate in these patients was 53%, with 32% of recurrence being distant metastasis. The one-year survival rate was 95%.

CONCLUSIONS

Patients in the de novo and progressive arms of our cohort had similar rates of surgical complications and disease recurrence. We found operative morbidity and disease control to be reasonable, suggesting RC can be considered more often in the management of T4b MIBC patients.

Predictive value of doppler cerebroplacental ratio for adverse perinatal outcomes in postdate pregnancies in Northwestern Nigeria

Background

Postdate pregnancy is a very common obstetric condition, increasing the risk of perinatal morbidity and mortality from uteroplacental insufficiency.

Aim

To determine the predictive values of Doppler cerebroplacental ratio (CPR), that is, the ratio between middle cerebral artery (MCA) and UA pulsatility indices (UA PI), and other potential velocimetric predictors of adverse perinatal outcomes in women with postdated pregnancies.

Patients and Methods

A prospective cohort study was conducted on consenting 212 low-risk pregnant women beyond 40 weeks' gestational age. The pulsatility indices of MCA, UA, and CPR as well as non-stress tests (NST) and amniotic fluid index (AFI) were measured and recorded. The women were divided into two groups based on the presence or absence of adverse perinatal outcome defined as: meconium stained liquor, meconium aspiration syndrome, perinatal asphyxia, cesarean section for suspected fetal distress, and perinatal death.

Results

: Of the 200 women whose data were available for analysis, 40 (20%) of them had adverse perinatal outcome and 160 (80%) had normal perinatal outcome. The CPR showed statistically significant difference in predicting adverse perinatal outcome (P < 0.001). CPR had a better predictive value than UA-PI and outperformed MCA-PI and NST for adverse perinatal outcomes. The sensitivity, specificity, negative predictive value (NPV), and accuracy of prediction of adverse perinatal outcomes by CPR were 90%, 81.25%, 97.01%, and 83%, respectively.

Conclusion

The Doppler CPR shows the highest diagnostic accuracy in prediction of adverse perinatal outcome in pregnant women after 40 weeks' gestation than UA PI and velocimetric indices when used as stand-alone test.

Aristolochic acid: What urologists should know

To the Editor, Aristolochic acid is one of major causes for upper tract urothelial carcinoma, especially in younger population. While it is mentioned as a cause in guidelines, little is actually known about the toxin by urologists. We are aiming in our letter to provide some direct and clear information to ourselves that would help us to know more about that toxin and how it can adversely affect our patients [...].

Adverse pathological outcomes of patients with de novo muscle invasive bladder cancer in Northern Ontario

OBJECTIVE

This study aimed to investigate the clinical and pathological characteristics of patients with de novo muscle-invasive bladder cancer (MIBC) who underwent radical cystectomy in Northern Ontario.

METHODS

This is a retrospective cross-sectional study of patients with de novo T2 MIBC who underwent radical cystectomy over a 2-year-period in Thunder Bay Regional Health Sciences Centre. Clinical and pathological characteristics of Trans Urethral Resection of Bladder Tumors and cystectomy specimens were analyzed.

RESULTS

Of the 59 patients aged 67 ± 8.8 years, predominated by males (80%), 27.1% were younger than age 60. After surgery, upstaging was noted in 59.3% (T3 in 27.1% and T4 in 32.2%) while node positive was noted in 36% of patients. Prostate adenocarcinoma was incidentally discovered in 20 (34%) of patients with 50% considered significant (Gleason score ≥ 7). Downstaging was found in those who had neoadjuvant chemotherapy (p = 0.001).

CONCLUSIONS

The high prevalence of younger ages (less than 60), a high rate of upstaging, the presence of high-grade incidental prostate cancer, and lymph node positives in T2 de novo MIBC in Northern Ontario, warrants further investigation of potential causes and risk factors at individual, public, and population health levels in the region.

ESTIMATION OF SCATTERED NEUTRONS CONTRIBUTION IN A NEUTRON CALIBRATION BUNKER USING A MONTE CARLO SIMULATION

The contribution of scattered neutrons is inevitable in neutron calibration facilities. This contribution complicates the measurements of neutron radiation, therefore, it should be estimated to correct the response of neutron probe instruments. In the present work, Monte Carlo simulation was performed for a neutron calibration bunker using the MCNP-4C code. This simulation aimed to calculate the contribution ratio of scattered neutrons to the neutron field. To simulate the neutron field, 241Am-Be neutron source defined in the ISO 8529-1 was used. The results of the simulation reported in this work were found to be consistent with those found experimentally in previous work. Additionally, the distribution of both the ambient dose equivalent rate and the contribution ratio of scattered neutrons in the bunker were mapped using this simulation.

Clozapine-induced gastrointestinal hypomotility: presenting features and outcomes, UK pharmacovigilance reports, 1992-2017

BACKGROUND

Clozapine-induced gastrointestinal hypomotility (CIGH) affects some 75% of patients treated with clozapine.

AIMS

To document the incidence of potentially harmful CIGH in the UK.

METHOD

We studied spontaneous UK pharmacovigilance reports recorded as clozapine-related gastrointestinal adverse drug reactions, 1992-2017.

RESULTS

There were 527 patients reported with potentially harmful CIGH; 33% (n = 172) died. Deaths averaged 1 per year 1992-1999, 5 per year 2000-2009 and 15 per year 2010-2017. Those who died were older (median 52 years v. 49 years) and had been prescribed clozapine for longer than those who recovered (median 11.3 years v. 4.8 years), but there was no difference in prescribed dose. Within the first 4 years of clozapine treatment, there were 169 reports of CIGH, of which 3% (n = 5) were fatal. At 10-14 years there were 63 reports of CIGH, of which 25% (n = 16) were fatal. Among the deaths, males were younger (median 51, range 22-89 v. median 57, range 24-89 years) with higher clozapine doses (median 450, range 100-900 v. median 300, range 12.5-800 mg/d) than females. In non-fatal CIGH, surgery was the most frequent outcome (n = 92). The procedures included appendectomy, ileostomy, total/partial colectomy, colostomy/stoma and proctosigmoidectomy. Clozapine dosage was reduced in 6 patients, stopped and restarted in 23, 'continued' in 6 and discontinued permanently in at least 76 patients.

CONCLUSIONS

The risk of serious morbidity/mortality from CIGH is substantial. The need to actively monitor bowel function and give laxatives to patients treated with clozapine is clear.

Micropapillary bladder cancer: an added indication to prophylactic urethrectomy

There is little research on the role of urethrectomy during cystectomy in patients with micropapillary bladder cancer (MPBC). We present two cases of MPBC cystectomy and suggest that urethrectomy be performed concurrently as a preventive measure. The first case involved a woman who had a mixed solid and papillary bladder tumour. An anterior pelvic exenteration was performed as well as a total urethrectomy. The T4a micropapillary variant tumour was confirmed by pathology. The second case involved a man with T1 MPBC who was treated with a BCG induction course. A recurrent muscle-invasive MPBC was discovered during follow-up. During the radical cystoprostatectomy, the urethra was spared. T2 MPBC was discovered through pathology. He had a urethrectomy 6 months later due to urethral bleeding, and the pathology revealed micropapillary cancer of the urethra.

Lung microbiome of stable and exacerbated COPD patients in Tshwane, South Africa

Chronic obstructive pulmonary disease (COPD) is characterised by the occurrence of exacerbations triggered by infections. The aim of this study was to determine the composition of the lung microbiome and lung virome in patients with COPD in an African setting and to compare their composition between the stable and exacerbated states. Twenty-four adult COPD patients were recruited from three hospitals. Sputum was collected and bacterial DNA was extracted. Targeted metagenomics was performed to determine the microbiome composition. Viral DNA and RNA were extracted from selected samples followed by cDNA conversion. Shotgun metagenomics sequencing was performed on pooled DNA and RNA. The most abundant phyla across all samples were Firmicutes and Proteobacteria. The following genera were most prevalent: Haemophilus and Streptococcus. There were no considerable differences for alpha and beta diversity measures between the disease states. However, a difference in the abundances between disease states was observed for: (i) Serratia (3% lower abundance in exacerbated state), (ii) Granulicatella (2.2% higher abundance in exacerbated state), (iii) Haemophilus (5.7% higher abundance in exacerbated state) and (iv) Veillonella (2.5% higher abundance in exacerbated state). Virome analysis showed a high abundance of the BeAn 58058 virus, a member of the Poxviridae family, in all six samples (90% to 94%). This study is among the first to report lung microbiome composition in COPD patients from Africa. In this small sample set, no differences in alpha or beta diversity between stable and exacerbated disease state was observed, but an unexpectedly high frequency of BeAn 58058 virus was observed. These observations highlight the need for further research of the lung microbiome of COPD patients in African settings.

Drone technology in maternal healthcare in Malaysia: A narrative review

INTRODUCTION

The vast advancement of technology and breakthrough in high-tech disciplines created multiple areas of research activities, including the emergence of the medical drone. Malaysia, a rapidly developing country in Southeast Asia is on track to achieving high-income status. However, the stagnant growth of Malaysian maternal healthcare does not run parallel with the aspiration. This review paper assessed and reported narratively the current condition of maternal healthcare in Malaysia, the possible application of drones in improving the sector, exploring in detail several challenges, and providing recommendations for experts in studying the rising technological phenomena.

MATERIALS AND METHODS

A literature search was done from June 2019 to November 2019 with restrictions to the English language. The search was performed in ScienceDirect, PubMed, and EMBASE databases, using a combination of search terms related to drones, Unmanned Aerial Vehicles (UAV), Unmanned Aerial Systems (UAS), maternal, obstetric, healthcare, medical products transportation and Malaysia. A discourse analysis followed and a narrative review was provided on this subject.

RESULTS AND DISCUSSION

The validated ability of drones in the delivery of blood products is highlighted as a possible application in improving maternal healthcare in Malaysia, particularly in the state of Sabah. Five key challenges are identified: infrastructure, technicalities, regulations, expertise, and social acceptance. Future predictions of drone technology in healthcare were outlined with the suggestion of three principle arms of application.

CONCLUSION

The usage of the medical drone in medical products transportation supports the objectives of WHO MDG 5 for Malaysian maternal health. A study on the impact of drones in reducing the maternal mortality ratio is recommended for further exploration.

Antibiotic Resistance in Diarrheagenic Escherichia coli Isolated from Broiler Chickens in Pakistan

Background: Diarrheagenic Escherichia coli (DEC) strains are predominant cause of gastrointestinal tract illnesses. The main objective of the study was to determine antibiotic resistance in various types of DEC isolated from chicken broilers farmed in Pakistan. Methods: A total of 200 feces and 200 meat samples from broiler chickens were collected from the slaughtering shops in Southern Punjab, Pakistan. The confirmed fecal (n=150) and meat (n=150) E. coli isolates were investigated against 16 antibiotics. Fourteen virulence genes specific for Enteropathogenic (EPEC), Shiga Toxin-producing (STEC), Enteroinvasive (EIEC), Enteroaggregative (EAEC), and Enterotoxigenic (ETEC) E. coli were identified using Polymerase Chain Reaction. Results: EPEC was the most detected pathotype in both feces (76%) and meat (90%) samples, followed by STEC, EIEC, and ETEC. The highest resistance (40-90%) was observed against penicillin, oxytetracycline, and nalidixic acid in fecal isolates. More than 50% EPEC and EAEC fecal isolates, and 60% EAEC meat isolates were simultaneously resistant to 6 or more antibiotics. Conclusion: Conclusively, the broiler meat sold in open markets of Pakistan was considerably contaminated with multi-drug resistant DEC. To mitigate the issue, the gov- ernment should regulate the use of antibiotics at poultry farms and monitor slaughtering practices in slaughterer houses.

OP0302-HPR IDENTIFYING THE CONTEXTUAL FACTORS IN THE PATIENT-PRACTITIONER ENCOUNTER THAT HAVE THERAPEUTIC EFFECT: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background:

Placebo or contextual effect is an integral part of the treatment effect (1). The factors related to this effect are “contextual factors” (CFs) (2). CFs may be categorised into five groups as factors related to practitioner, patient, practitioner-patient interaction, treatment and therapeutic environment (3). Several CFs have demonstrated their therapeutic effect, whereas others not (4). The majority of musculoskeletal pain relief result from CFs (5). Identifying the key CFs may encourage health practitioners to optimize the contextual aspects of care.

Objectives:

To identify the modifiable CFs that can improve clinical outcomes in published randomised controlled trials (RCTs).

Methods:

A systematic search was carried out, up until April 18th 2019, on the following databases: MEDLINE via Ovid, EMBASE, AMED, PsycINFO and Cochrane library. RCTs comparing contextual enhanced interventions versus non-enhanced control in adults for any health conditions were searched. The outcomes included both self-reported outcomes and objectively measured outcomes. The effect size and 95%confidence interval were calculated using the standard mean difference. Risk of bias was evaluated using the modified Cochrane tool. The random effects model was used to pool the results.

Results:

Of 3900 records generated from the systematic search, 15 trials (4615 participants) met the inclusion criteria, and 13 were included in this meta-analysis (Figure 1). Conditions studied included musculoskeletal [4], cardiovascular [2], irritable bowel syndrome [1], diabetes [1], asthma [1], GP or hospital patients [6]. Three CFs have been identified from these trials, including empathy, patient involvement and positive communication. All were found to be effective for patient experience i.e. satisfaction. Positive communication was also effective for symptoms but not objective outcomes (Table 1).

Table 1.

Summary of results.

OutcomeInterventionNumber of studies (Number of participants) SMD (95% CI)I2Patient experience outcomes,e.g. satisfactionEmpathy2 (137)0.45 (0.11, 0.79)42.2 %Patient involvement4 (1596)0.31 (0.21, 0.41)93.0 %Positive communication3 (793)0.38 (0.24, 0.52)93.9 %Symptomatic outcomes,e.g. painEmpathy1 (221)-0.18 (-0.45, 0.08)0.0 %Patient involvement1 (314)-0.05 (-0.27, 0.17)0.0 %Positive communication3 (658)0.20 (0.05, 0.35)64.8 %Objective outcomes,e.g. peak expiratory flowPositive communication2 (266)0.10 (-0.14, 0.34)66.6 %

Positive SMD favours intervention group. SMD= Standard mean difference, CI= Confidence interval, I2= heterogeneity.

Figure 1.

Summary of screening process.

Conclusion:

This systematic review has identified three CFs (empathy, patient involvement and positive communication) that have therapeutic effects for different conditions in trials, especially for self-reported outcomes. More research is needed to examine the clinical outcomes of CFs and to understand the influence of health practitioners on disease processes.

References:

[1]Zou K, Wong J, Abdullah N, Chen X, Smith T, Doherty M et al. Examination of overall treatment effect and the proportion attributable to contextual effect in osteoarthritis: meta-analysis of randomised controlled trials. Annals of the Rheumatic Diseases. 2016;75(11):1964-1970.

[2]Miller F, Kaptchuk T. The power of context: reconceptualizing the placebo effect. Journal of the Royal Society of Medicine. 2008;101(5):222-225.

[3]Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J. Influence of context effects on health outcomes: a systematic review. The Lancet. 2001;357(9258):757-762.

[4]Howick J, Moscrop A, Mebius A, R Fanshawe T, Lewith G, L Bishop F et al. Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis. Journal of the Royal Society of Medicine. 2018;111(7):240–252.

[5]Rossettini G, Carlino E, Testa M. Clinical relevance of contextual factors as triggers of placebo and nocebo effects in musculoskeletal pain. BMC Musculoskeletal Disorders. 2018;19(1).

Disclosure of Interests:

None declared.

Synergistic of antimicrobial activities of lactic acid bacteria in fermented Tilapia nicoliticus incorporated with selected spices

Fermented tilapia (Tilapia nicoliticus) is one of the famous fermented food in Malaysia. Lactic acid bacteria (LAB) which well known as GRAS (Generally Regarded as Safe) are present in most fermented foods and they are well-known non-pathogenic bacteria that play an important role in everyday life. Apart from LAB, spices have also been used for centuries across different regions of the world to improve aroma, flavour and food preservative. This research was aimed to explore a potential natural food preservative using LAB isolated from fermented Tilapia nicoliticus incorporated with various spices (9% turmeric, 6% chilli and 9% black pepper) against foodborne pathogens. The isolation of LAB in different media (MRS, MRS+CaCO3, M17 and Tomato Juice Agar) showed the highest LAB count on day-9 and day-15 during the fermentation period in fermented Tilapia incorporated with black pepper, turmeric and chilli. The highest antimicrobial activity by LAB against Bacillus cereus was observed in fermented tilapia incorporated with black pepper. On the other hand, fermented fish incorporated with chilli showed the highest antimicrobial activity against Staphylococcus aureus, Escherichia coli and Salmonella enterica serovar Typhimurium. Higher antimicrobial activity was detected in fermented Tilapia in the presence of LAB together with the spices, in comparison to the presence of LAB alone, suggesting synergistic effects between LAB in fermented fish with spices could enhance stronger antimicrobial activities against food pathogens and therefore, served as a natural food preservative.

The Missing Uterus, the Missed Diagnosis, and the Missing Care. Mayer-Rokitansky-Küster-Hauser Syndrome in the Lives of Women in Malaysia

STUDY OBJECTIVE

To explore the effect of the diagnosis of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome on affected Malaysian women.

DESIGN

Qualitative study with a quantitative component.

SETTING

Pediatric and adolescent gynecology unit at Universiti Kebangsaan Malaysia Medical Centre, Malaysia.

PARTICIPANTS

Twelve women with MRKH.

INTERVENTIONS

Face-to-face interview and short questionnaire.

MAIN OUTCOME MEASURES

Thematic analysis was used to understand participants' experiences.

RESULTS

There were 7 themes identified: (1) delayed diagnoses; (2) doctors' roles and attitudes; (3) gender identity; (4) family and society's response; (5) reaction toward infertility; (6) managing sexual intimacy; and (7) coping mechanisms. Several participants consulted their physicians regarding their primary amenorrhea at an opportunistic setting. When they were referred to the gynecologists, they were dismayed at the lack of information given. The term, "MRKH" plays an important role to ease information-seeking. Participants felt that the doctors were insensitive toward them. Mental illness is a significant complication of MRKH. All participants acknowledged that infertility was the hardest part of the condition. The importance of blood lineage affects their outlook on childbearing options. Some were afraid of sexual intimacy and worried that they would not be able to satisfy their partners. Participants gained support and bonded with their counterparts in the MRKH support group.

CONCLUSION

A multidisciplinary approach including medical, psychological, and social support is essential for the management of MRKH. Adequate information and sexual education plays the utmost importance in preventing social-related complications of MRKH.

Bacillus Calmette-Guerin vaccine and bladder cancer incidence: Scoping literature review and preliminary analysis

BACKGROUND

The Bacillus Calmette-Guerin (BCG) vaccine has long been used for the prevention of tuberculosis (TB) around the world. BCG is also used as an immunotherapy agent for the treatment of non-muscle invasive urinary bladder cancer. This scoping literature review and preliminary data analysis aims to summarize the literature correlating infantile BCG vaccination with the incidence of future bladder cancer.

METHODS

Studies were identified by a formal literature search of MEDLINE and Cochrane Central Registrar of Controlled Trials following PRISMA guidelines. Preliminary data analysis was conducted on publicly accessible data summarizing the impact of gender, BCG vaccination, and socio-economic effects on crude and age-standardized rates of bladder cancer.

RESULTS

As part of our analysis, preliminary regression models demonstrated BCG vaccination status, gender, and socio-economic status to have statistically significant effects on crude and age-standardized rates of bladder cancer incidence. BCG vaccination was associated with a 35-37% lower age-standardized rate of bladder cancer incidence.

CONCLUSIONS

There is very little literature examining the relationship between prior BCG vaccination and rates of bladder cancer incidence. Our limited data analysis indicates that a relationship does exist between infantile BCG vaccination and later bladder cancer development, although extensive future investigation is needed in this area.

Global longitudinal strain predicts survival and response in patients with systemic AL amyloidosis. analysis of 915 patients from the ALchemy prospective trial

Background

Cardiac involvement determines prognosis in systemic AL amyloidosis. The extent is assessed by biomarker-based staging systems. This a prospective report of a large cohort of patients assessing the utility of changes in longitudinal function by 2D strain (GLS%), impairment - a hallmark of amyloidosis.

Purpose

To evaluate the prognostic role of GLS% and other echocardiographic parameters in systemic AL amyloidosis.

Methods

915 newly diagnosed patients seen at the UK National Amyloidosis Centre (February 2010–August 2017) were included. All patients underwent 6-monthly comprehensive assessments inclusive of echocardiogram. The European modification of the Mayo 2004 staging was used with Mayo stage III patients stratified into IIIa (NT-proBNP &lt;8500ng/L) and IIIb (NT-proBNP ≥8500ng/L).

Results

653/915 (71.4%) patients had cardiac involvement. Mayo stage 1, 2, 3a and 3b in 144 (15.7%), 302 (33.0%) 344 (37.6%) and 125 (13.7%) respectively. The median NT-proBNP was 2228ng/L and TNT was 0.54ng/ml. The GLS% significantly worsened with increasing Mayo stage (p&lt;0.0001 between GLS% for each Mayo stage). Poorer baseline GLS% associated with significantly worse OS and stratified patients into three groups: GLS% &lt;−12.8%: OS 69.1 months; GLS% −12.8% to −9%: OS 54.5 months; GLS% &gt;−9%: OS 45.3 months (p&lt;0.0001). On univariate analysis, 11/14 parameters predicted survival (LV wall thickness, LV ejection fraction, systolic velocities of the septal (s'sep) and lateral mitral annulus (s' lat), mitral annulus movement at the lateral corner (e' lat), transmitral early peak flow velocity (E) divided by tissue Doppler mitral annular motion velocity (e') – E/e' and mitral annular plane systolic excursion (MAPSE)). Baseline GLS% &gt;−17% was independent of Mayo stage in predicting survival [Mayo II: Hazard ratio (HR) 2.10 (95% CI: 1.12–3.92) p=0.02, Mayo III: HR 3.94 (95% CI: 2.13–7.32) p&lt;0.0001, Mayo IV: HR 7.49 (95% CI: 3.94–14.21) p&lt;0.0001, GLS &lt;17%: HR 2.14 (95% CI: 1.59–2.88) p&lt;0.0001]. At 12 months, only patients in a haematological complete response (CR) had significant improvement in overall GLS% (p=0.02) as well as baso-lateral (p=0.0004) and baso-septal (p=0.0001) GLS% and MAPSE (p=0.002). The OS was significantly better in patients who achieved a minimum absolute improvement in GLS% of 1.5% improvement (not reached in those with improved GLS% vs. 72 mo in those without) (p=0.034)).

Conclusion

These data show that baseline GLS% is an independent predictor of survival in AL amyloidosis. GLS% is the first functional marker that is independent of the Mayo staging in predicting outcomes and should be incorporated in prognostic staging for patients with AL amyloidosis. GLS% shows improvement in patients who achieve a complete haematologic response to treatment and improvement in GLS% of 1.5% is associated with improved outcomes. An absolute improvement in GLS% should be considered as a criterion for cardiac response in AL amyloidosis.

Funding Acknowledgement

Type of funding source: None

EVALUATION OF RADIATION DOSE IN DIFFERENT POSITIONS AROUND THE PATIENT TABLE DURING INTERVENTIONAL CARDIOLOGY PROJECTIONS

The aim of the present study was to evaluate the radiation exposure around the patient table as relative to the cardiologist position dose value. The dose rates at eight points presuming staff positions were measured for PA, LAO 30° and RAO 30° radiographic projections, and then normalized to the cardiologist's position dose-rate value. The results show that in PA and RAO 30° projections, the normalized dose rate was higher by 9-22% at the right side of the table at a distance of 50 cm, while it was higher up to 31% at the left side for the same measured points in the LAO 30°. The differences of normalized dose rates for the both table sides were lower and decreased at farther positions. The obtained results correspond to the recommendations of staff radiation protection in Cath-labs with regards to X-ray tube and detector positions.

AB0956 VERTICAL NAIL RIDGING IN PATIENTS WITH FIBROMYALGIA: FREQUENCY, PROPOSED GRADING AND CORRELATION WITH OTHER DISEASE FEATURES

Background:

The vertical nail ridging (VNR) has long been reported to be related to stressful conditions1

Objectives:

to evaluate the frequency of VNS in FM patients and its relation to other disease parameters depending on a proposed grading.

Methods:

VNR has been searched for in 212 FM patients (2016 criteria). The number of fingers, the degree of VNR according to this proposed grading (0: no ridging, 1: ridging only detected by a magnifying lens, 2: ridging seen by naked eye and 3: ridging that can be seen and felt) and other FM features according to the new and old ACR criteria have been recorded. 80 subjects of those consulting for knee osteoarthritis have been examined for VNR and those found positive were asked about the FM features and examined for tender points. Patients aged >50 years and those with psoriasis and fungal infections were excluded.

Results:

the mean age of patients was 32.4±9.9 (73.6% were female). The mean disease duration was 5.8±3.7, while the means of WPI, SSS and tender points were 9.4±2.9, 7.3±1.2 and 14.7±2.3 respectively. VNR was found in 209 patients (98.6%). Of 80 controls, VNR has been found in 61 subjects, of whom FM has been diagnosed in 32 patients (52.4%) by 2016 FM criteria and in 46 (75.4%) by 1990 criteria. The number of fingers with VNR has been found only correlated with the disease duration (r= 0.276, P = 0.000). The severity of VNR was significantly correlating with fatigue (P= 0.002), sleep disturbance (P= 0.001), awaking unrefreshed (P = 0.000), WPI (p = 0.01) and mean tender points (P =0.02). Considering the 2016 criteria as a gold standard, the sensitivity of VNR was 98.37%, the specificity was 9.68% and the diagnostic accuracy was 82.8%.

Conclusion:

vertical nail ridging is a frequent finding and can be considered helpful for diagnosis of patients with FM. Further studies are needed to validate this sign for diagnosis and follow up of FM patients.

References:

[1]American Academy of Dermatology. (2007, November 12). Feeling Stressed? How Your Skin, Hair And Nails Can Show It.Science Daily. Retrieved December 30, 2019 fromwww.sciencedaily.com/releases/2007/11/071109194053.htm

Disclosure of Interests:

None declared

Effect of drying methods and parameters on the antioxidant properties of tea (Camellia sinensis) leaves

Background

Conventional drying using heated air oven is commonly used as a method for preserving the product but often affects the nutritional value, taste, and texture. However, the heat from the drying method can oxidize and destroy heat-sensitive compounds. Superheated steam (SHS) drying uses superheated steam instead of hot air or combustion gases in a direct dryer and was reported better at preserving the nutritional values of food products.

Aim

To evaluate the effect of SHS drying on antioxidant properties of tea leaves. The study also compared SHS drying with conventional and freeze-drying methods.

Results

Tea leaves dried using freeze drying retained the highest level of antioxidant properties compared to other drying methods. The leaves dried using SHS exhibited significantly higher radical scavenging activity, ORAC and FRAP values compared to oven drying method. At different drying temperatures (150 °C and 175 °C), oven dried leaves showed significantly higher (p < 0.05) antioxidant properties than that of SHS dried ones. Tea leaves dried for 60, 75, and 90 min using SHS showed significantly higher (p < 0.05) FRAP and ORAC values, and also total phenolic content compared to oven dried tea leaves.

Conclusion

Tea leaves dried using SHS drying method retained higher level of antioxidant properties compared to oven drying. The drying method also retained lower antioxidant properties as drying time increased. Further study involving SHS drying in food-related fields should be conducted to support its usefulness.

Graphical abstract

Solitary prostatic cancer metastasis to the testis: A case report and lessons to learn

Prostate cancer (Pca) is a complex disease. Several case series and reports have described the spread of Pca to unusual organs, like esophagus, eye and periureteric fat causing ureteropelvic junction obstruction. Spread of Pca to the testis has been reported in few case reports, however Pca was always firstly diagnosed in all published cases and testicular spread of cancer has been diagnosed during follow up of the patients. This case is unique in that, the patient initially presented with a testicular mass and histologic examination after orchiectomy allowed to diagnose prostatic cancer. This patient was 81 years old and he never had PSA screening by his family doctor. PSA was not even done initially by us considering his age and the presentation with testicular mass. This case may impact clinical practice in several ways: 1) considering Pca always in the differential diagnosis of any disease of an adult man, regardless of its presentation because we did not do that at initial patient evaluation and PSA was only measured after orchiectomy when pathology demonstrated metastatic Pca; 2) suggesting standard orchiectomy with epididemectomy for surgical castration instead of the current surgical technique of subcapsular/subepididymal orchiectomy, because our patient had cancer involving his epididymis as well; 3) suggesting to include PSMA as a part of preoperative staging for high risk Pca patients, in consideration that PSMA is proving to be a promising new imaging technique that can help diagnosing metastatic Pca in unusual locations.

Role of TGF-β1 and C-Kit Mutations in the Development of Hepatocellular Carcinoma in Hepatitis C Virus-Infected Patients: in vitro Study

Transforming growth factor beta (TGF-β) acts as a tumor-suppressing cytokine in healthy tissues and non-malignant tumors. Yet, in malignancy, TGF-β can exert the opposite effects that can promote proliferation of cancer cells. C-Kit plays a prominent role in stem cell activation and liver regeneration after injury. However, little is known about the cross-talk between TGF-β and C-Kit and its role in the progression of hepatocellular carcinoma (HCC). Here, we studied the effect of increasing doses of TGF-β1 on CD44⁺CD90⁺ liver stem cells (LSCs) and C-Kit gene expression in malignant and adjacent non-malignant liver tissues excised from 32 HCC patients. The percentage of LSCs in malignant tumors was two times higher compared to their counterparts from the non-malignant tissues. When treated with increasing doses of TGF-β1, proliferation of both malignant and non-malignant LSCs was progressively suppressed, but low TGF-β1 dose failed to suppress the growth of malignant LSCs. Moreover, C-Kit exons 9 and 11 were expressed in malignant LSCs, but not in their non-malignant counterparts. Analysis of C-Kit detected mutations in exon 9 (but not in exon 11) in some malignant liver cells resulting in the changes in the amino acid sequence and dysregulation of protein structure and function. Interestingly, in malignant liver cells, mutations in exon 9 were associated with high-viremia hepatitis C virus (HCV), and expression of this exon was not suppressed by the TGF-β1 treatment at all doses. To our knowledge, this is the first report that mutations in the C-Kit gene in HCC patients are associated with high- viremia HCV. Our study emphasizes the need for investigation of the TGF-β1 level and C-Kit mutations in patients with chronic HCV for HCC prevention and better therapy management.