Exploring Suitability of Salsola imbricata (Fetid Saltwort) for Salinity and Drought Conditions: A Step Toward Sustainable Landscaping Under Changing Climate

In context of the climate change, major abiotic stresses faced by plants include salt stress and drought stress. Though, plants have similar physiological mechanisms to cope with these salt and drought stresses. The physiological and biochemical response of native plants to the combined application of salinity and drought stresses are still not well-understood. Thus, to investigate the combined effect of salinity and drought stresses, an experiment was conducted on Salsola imbricata with four levels of salinity and four drought intensities under the arid climatic conditions. The experiment was conducted in a randomized complete block design with a split-plot arrangement replicated three times. S. imbricata had been found resistant to different levels of individual and combined salt and drought stresses. S. imbricata survived till the end of the experiment. Salt and water stress did not show any significant effects on shoot weight, shoot length, and root length. The drought stress affected the photosynthetic rate, ion uptake and leaf water potential. However, salt stress helped to counter this effect of drought stress. Thus, drought stress did not affect plant growth, photosynthesis rate, and ion uptake when combined with salt stress. Increased Na⁺ and Cl^- uptake under the salt stress helped in osmotic adjustment. Therefore, the leaf water potential (LWP) decreased with increasing the salt stress from 5 dSm^-1 until 15 dSm^-1 and increased again at 20 dSm^-1. At lower salt stress, ABA and proline content declined with increasing the drought stress. However, at higher salt stress, ABA content increased with increasing the drought stress. In conclusion, the salt stress had been found to have a protective role to drought stress for S. imbricata. S. imbricata utilized inorganic ion for osmotic adjustment at lower salinity stress but also accumulate the organic solutes to balance the osmotic pressure of the ions in the vacuole under combined stress conditions. Due to the physical lush green appearance and less maintenance requirements, S. imbricata can be recommended as a native substitute in landscaping under the salt and drought stresses conditions.

POS1458 HOW EASY IS IT FOR PATIENTS TO READ AND UNDERSTAND AVAILABLE PATIENT EDUCATIONAL MATERIALS FOR LUPUS?

Background

Health Literacy (HL) informs health behaviors such as follow-up with health care providers & management plans. Poor HL is linked to poor health outcomes & healthcare disparity. In addition to personal HL, health care providers/systems & Organizations can also empower patients by developing & providing educational resources that foster HL & support a patient’s understanding of their health condition (organizational HL). Patient educational handouts are frequently provided after a physician visit to supplement instructions/education & are often obtained from online resources accessible to both physicians & patients.

Lupus, a multisystem disease, preferentially effects people of color, a group at higher risk of health disparities, & poor HL. It is paramount for lupus patients to understand their disease & management to optimize health outcomes & reduce health disparities. The provision of easy to read & comprehend patient educational resources are one way to address this need.

Objectives

The Center for Disease Control (CDC) recommends the readability of patient educational material to be at eight-grade level, while the National Institute of Health (NIH) & the American Medical Association (AMA) recommend a level no higher than sixth-grade. The Readability & Comprehension (RC) of commonly available lupus-related patient educational materials are not known & may offer an opportunity to improve patient care & outcomes.

Methods

We searched for the RC of Lupus-related patient educational materials, available at the American College of Rheumatology (ACR) & Lupus Foundation of America (LFA) websites. These reputable national organizations are at the forefront of Lupus education & research. RC were evaluated using the following measures: Flesch Kincaid Readability Ease (FKRE), Flesch Kincaid Grade Level (FKGL), Gunning Fog Score (GFS), Simple Measure of Gobbledygook (SMOG) Index, Coleman Liau Index (CLI) & Automated Readability Index (ARI).

FKRE score is a widely used measure of readability with scores ranging from 0-100 & higher scores denoting greater reading ease (Goal is >60). FKGL represents the U.S. school grade needed to comprehend the text (Target is 7th grade). GFS estimates the years of formal education required to understand the text on the first reading (Goal is 7-8). SMOG index estimates the years of education needed to comprehend written materials. CLI is used to assess the U.S. grade level necessary to comprehend text material. The ARI assesses how easy a text material is to learn & estimates the U.S. grade level necessary to comprehend a passage.

Descriptives for RC were obtained & compared using t test between the two sources.

Results

There were 12 patient educational pamphlets on Lupus available (4 from ACR & 8 from LFA). Mean (SD) FKRE & FKGL were 52.73 (11.44) & 10.46 (2.14) respectively (Table 1). Mean GFS & CLI exceeded 12, while mean ARI was 18.

Table 1.

Reading & Comprehension of Patient Educational Materials on Lupus

RC Test (Values are Mean (SD))AllACRLFAPFlesch Kincaid Reading Ease52.7347.1855.500.25(11.44)(4.93)(13.00)Flesch Kincaid Grade Level10.4610.7310.330.78(2.14)(0.64)(2.64)Gunning Fog Score12.1912.6511.960.41(1.78)(0.31)(2.19)SMOG Index8.949.68.610.27(1.41)(0.67)(1.60)Coleman Liau Index13.5114.6512.940.18(2.04)(1.34)(2.15)Automated Readability Index18.0211.121.470.49(23.13)(1.45)(28.27)

There were no significant differences in the RC scores among patient educational materials from the ACR or LFA.

Conclusion

Patient educational materials on Lupus, available at the ACR & LFA websites, are not easy to read or comprehend, using standardized RC metrics. Additionally, they are not aligned with recommended reading levels suggested by leading organizations (CDC, NIH or AMA). Patient’s understanding is critical in a complex disease like lupus to optimize health outcomes.

Revision of patient lupus educational resources at these websites, to target 6-7th grade RC metrics, is recommended & could be overseen by the development of a new taskforce.

Disclosure of Interests

None declared

Exploring the potential effect of Achnatherum splendens L.-derived biochar treated with phosphoric acid on bioavailability of cadmium and wheat growth in contaminated soil

Biochar remediation efficiency could be enhanced through numerous treatments such as acids treatment. Still, there has little work done on H₃PO₄-treated biochar particularly biochar derived from Achnatherum splendens L. feedstock. Therefore, the present study has been conducted to further explore the potential effect of A. splendens L.-derived biochar treated with H₃PO₄ on bioavailability of Cd and wheat growth in Cd contaminated soil. Phosphoric acid and untreated biochar each applied at the rate of 1% and 2% to Cd contaminated/spiked soil in pots and having one contaminated/spiked control without biochars amendment. The results show that 2% phosphoric acid-treated biochar has the most significant increase in plant height, shoot dry weight, and grain yield of wheat as compared to contaminated control. As compared to contaminated control, maximum improvement in total chlorophyll contents, photosynthetic rate, transpiration rate, and stomatal conductance occurred with 2% phosphoric acid-treated biochar. The 2% phosphoric acid-treated biochar also declined bioavailable Cd in soil by 53%, and its accumulation in shoot and grain by 65% and 90%, respectively, compared to contaminated control. Overall, phosphoric acid-treated biochar most effectively immobilized Cd in soil and reducing its uptake and translocation to grains. Therefore, A. splendens L.-derived biochar treated with phosphoric acid could be successfully utilized for remediation of contaminated soil.

Effects of Se nanoparticles supplementation on growth performance, hematological parameters and nutrient digestibility of Labeo rohita fingerling fed sunflower meal based diet

The aim of the present study is to assess the effects of selenium nanoparticles on the growth, hematology and nutrients digestibility of Labeorohita fingerlings. Fingerlings were fed with seven isocaloric sunflower meal-based diet supplemented with different concentrations of nanoparticles naming T1 to T7 (0, 0.5, 1, 1.5, 2, 2.5, and 3 mg/kg), with 5% wet body weight while chromic oxide was used as an indigestible marker. After experimentation for 90 days T3 treated group (1mg/kg -1Se-nano level) showed the best result in hematological parameters (WBC's 7.97 ×103mm-3, RBC's 2.98 ×106 mm-3 and Platelet count 67), nutrient digestibility (crude protein: 74%, ether extract: 76%, gross energy: 70%) and growth performance (weight gain 13.24 g, weight gain% 198, feed conversion ratio 1.5, survival rate 100%) as compared to the other treatment groups. Specific growth rates were found significantly higher in T5 than in other groups. The present study indicated positive effect of 1 mg/kg Se-nanoparticles on growth advancement, hematological parameters, and nutrients digestibility of L. rohita fingerlings.

Effect of two fascial incision options for access to the temporomandibular joint on facial nerve function: objective investigation

This study was performed to compare the effects on facial nerve (FN) function of the deep supra-temporalis muscle subfascial approach (DSFA) and traditional fascial approach (TFA) for access to the temporomandibular joint (TMJ), via qualitative and quantitative evaluations. Thirty patients requiring open TMJ surgery were randomly allocated to one of two groups: group A patients underwent the DSFA approach, while group B patients underwent the TFA approach. The TMJ was accessed via modified endaural incision with temporal extension. Clinical examinations, FN conduction tests, and electromyography (EMG) of the frontalis and orbicularis oculi muscles were used to assess FN function. A FN function deficit was noted in 50% of the whole sample population immediately after surgery, with no statistically significant difference between the groups (P = 0.082). Overall, 37.5% of the total study population experienced temporary loss of frontalis muscle activity, while zygomatic nerve injury was seen only in 25% of group A. Within 2-6 months, normal function returned in both groups. Nerve conduction studies showed no statistically significant difference between the groups in terms of nerve amplitude or latency after surgery. However, EMG of orbicularis oculi activity showed a significant difference between the groups after 6 months (P = 0.010). The results suggest that the traditional dissection approach is more protective of the FN, especially the zygomatic branch, than the deeper dissection technique.

Trends in hospitalized patients with cancer and stress cardiomyopathy

Introduction

Although cardiovascular disease (CVD) and cancer remain the top two causes of death worldwide, novel therapeutics have resulted in a decreased mortality rate in both groups. Accordingly, there has been a heightened awareness of patients with cancer experiencing stress cardiomyopathy (SC). In patients with cancer, the emotional stress of the diagnosis of cancer is compounded by the physical stress of treatments such as surgery, chemotherapy, immunotherapy, and radiotherapy. Previous studies have shown that SC in patients with cancer is associated with higher odds of in-hospital mortality when compared to patients with SC alone. No studies have examined the differences between patients with active cancer and SC compared to patients with active cancer without SC.

Purpose

To explore the unique impact that a diagnosis of SC has on patients with specific types of cancer, so that clinicians may recognize these phenomena and reduce morbidity associated with this disease.

Methods

We queried the 2016 United States National Inpatient Sample, which is the largest publicly available all-payer inpatient healthcare database, to identify demographic characteristics and outcomes in patients with active cancer and SC.

Results

Of 30,195,722 adult hospitalized patients, 4,719,591 (15.63%) had active cancer of whom 568,239 (12.04%) had SC. Among patients with active cancer, patients with SC versus those without SC were significantly more likely to have the following characteristics: female sex, white race, commercial insurance, hypertension, anemia, thrombocytopenia, and coagulation disorder (p<0.003 for all variables). The five most common primary malignancies in patients with SC were breast (13.4%), lung (10.2%), skin (9.5%), colon (8.1%), and leukemia (4.8%) (Figure 1).

In machine learning-augmented propensity score-adjusted multivariable regression fully adjusting for age, race, income, and presence of metastases, the only primary malignancies that significantly increased the likelihood of SC were lung cancer (OR 1.25; p=0.003) and breast cancer (OR 1.81; p<0.001) (Table 1). In separate regression, neither SC alone nor having both SC and cancer was significantly associated with mortality. The presence of concomitant SC and breast cancer was significantly associated with reduced mortality (OR 0.48; p=0.032).

Conclusion

In patients with active cancer, SC was not associated with in-hospital mortality. In addition, patients with both SC and breast cancer had significantly reduced mortality when compared to all patients with cancer. Further investigation will be necessary to confirm these findings and determine the possible protective factors in patients with SC and breast cancer. Furthermore, clinicians should be aware, early during hospitalization, of the increased likelihood of SC in patients with lung cancer and breast cancer, in order to reduce morbidity associated with these diagnoses.

Funding Acknowledgement

Type of funding sources: None.

POS0701 ANIFROLUMAB, AN ANTI-INTERFERON-Α RECEPTOR MONOCLONAL ANTIBODY IN SYSTEMIC LUPUS ERYTHEMATOSUS- A META ANALYSIS

Background:

Type I interferons such as Anifrolumab have been implicated in Systemic lupus erythematosus (SLE) pathogenesis on the basis of increased interferon-stimulated gene expression and genetic susceptibility. Little is known regarding its efficacy and safety profile.

Objectives:

To assess the efficacy and safety of Anifrolumab in patients with SLE.

Methods:

Electronic databases (PubMed, Embase, Scopus, Cochrane) were searched from inception until December 15th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p<0.05. The primary outcome of interest was British Isles Lupus Assessment Group (BILAG)-based Composite Lupus Assessment (BICLA). Secondary outcomes included the proportion of patients who achieved an SLE responder index of 4 (SRI-4) reduction of 50% or more in the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI), reductions in the glucocorticoid dose and adverse effects.

Results:

A total of three studies1,2,3 with 839 participants (Anifrolumab=372, Placebo=467) were included in our analysis. Follow-up duration was at week 52. A statistically significant different was observed in the Anifrolumab arm in terms of BICLA response (OR 0.44 95%CI 0.34-0.59;p < 0.00001, I2=4), ≥50% reduction in CLASI activity score (OR 0.36 95%CI 0.21-0.60;p=0.0001, I2=0), glucocorticoid reduction (OR 0.41 95%CI 0.28-0.59;p<0.00001; I2=0) and SRI-4 response (OR 0.52 95% CI 0.30-0.90; p=0.02, I2=75). However, Adverse events were less likely in the placebo arm as compared to Anifrolumab (OR 1.54 95%CI 1.05-2.25; p=0.03; I2=0).

Conclusion:

Anifrolumab was found to be more effective than placebo for the management of SLE, but may also cause more severe adverse effects.

References:

[1]Morand EF, Furie R, Tanaka Y, Bruce IN, Askanase AD, Richez C, Bae SC, Brohawn PZ, Pineda L, Berglind A, Tummala R; TULIP-2 Trial Investigators. Trial of Anifrolumab in Active Systemic Lupus Erythematosus. N Engl J Med. 2020 Jan 16;382(3):211-221. doi: 10.1056/NEJMoa1912196. Epub 2019 Dec 18. PMID: 31851795.

[2]Furie R, Khamashta M, Merrill JT, Werth VP, Kalunian K, Brohawn P, Illei GG, Drappa J, Wang L, Yoo S; CD1013 Study Investigators. Anifrolumab, an Anti-Interferon-α Receptor Monoclonal Antibody, in Moderate-to-Severe Systemic Lupus Erythematosus. Arthritis Rheumatol. 2017 Feb;69(2):376-386. doi: 10.1002/art.39962. PMID: 28130918; PMCID: PMC5299497.

[3]Furie RA, Morand EF, Bruce IN, et al. Type I interferon inhibitor anifrolumab in active systemic lupus erythematosus (TULIP-1): a randomised, controlled, phase 3 trial. Lancet Rheumatol 2019; 1(4):e208-e219.

Disclosure of Interests:

None declared

Influence of semi-arid environment on radiation use efficiency and other growth attributes of lentil crop

Solar radiation (SR) is essential for yield improvement in lentil, which is a crop of marginal environments. Herein, experiments were conducted over 2 years under a semi-arid environment to study the radiation interception (RI), efficiency, growth, and development of three lentil genotypes (Punjab Masoor-2009 (PM-2009), NIAB Masoor-2006 (NM-2006), and NIAB Masoor-2002 (NM-2002)) in relation to three nitrogen rates (13, 19, and 25 kg ha^-1). Seasonal dynamics of intercepted photoactive radiation (IPAR) and cumulated photosynthetic photon flux density were highly associated with seasonal dynamics of leaf area index (LAI), with a high value of R² (0.93 and 0.89) across all nitrogen rates and genotypes in both years. Nitrogen application promoted growth, and maximum LAI (3.97 and 3.57) and RI (324 and 301 MJ m^-2) were attained for the first and second years of study, respectively. Biomass and yield were positively associated with IPAR. Variation in radiation absorption (RA) among genotypes was due to different patterns of LAI development. In both years, yield (23% and 25%) and radiation use efficiency (RUE) for grain yield (0.44 and 0.37 g MJ^-1) were respectively higher for PM-2009 than for the other genotypes. Genotype PM-2009 had 15 days shorter crop cycle than others while 14% higher GDDs accumulated in the first year compared with the second due to the higher temperature. High nitrogen (25 kg ha^-1) application resulted in higher dry matter (DM), and grain yield (GY), while RUE and PAR were not statistically different under 19 kg N ha^-1 application across years. Genotypes PM-2009 and NM-2006 may perform reasonably well under arid to semi-arid regions at farmer field. These findings may assist researchers and crop modelers to optimize the lentil ideotype for efficient light utilization.

Can preoperative parameters predict successful sperm retrieval and live birth in couples undergoing testicular sperm extraction and intracytoplasmic sperm injection for azoospermia?

Background

We aimed to determine if the success of TESE and live-birth following TESE-ICSI can be predicted from readily available preoperative parameters for couples with azoospermia. Our methodology was as follows, this was a cohort study of couples who attended the fertility service (from 2009-2019) at an NHS hospital in whom the male partner was diagnosed with azoospermia and required conventional TESE with multiple biopsies to obtain sperm. Of 414 men included, 223 had successful TESE and of those 178 have used sperm in ICSI cycle(s). Predictive models were developed using logistic regression. We assessed model performance by internally validated concordance statistics and calibration plots. Successful sperm retrieval was defined as the presence of motile sperm which survived the freeze-thaw process and live-birth defined as delivery after 34 weeks of gestation.

Results

Successful TESE was associated with higher male age and lower FSH. The TESE model discriminated well with a c statistic of 0.81 (0.77-0.85). Live-birth was associated with lower maternal age, earlier ICSI cycle, and lower testicular volume. The live-birth model also discriminated well with a c statistic of 0.70 (0.64-0.76).

Conclusions

These results support the pragmatic counselling of couples diagnosed with azoospermia about the chances of success of the TESE procedure and of biological parenthood prior to surgical intervention. The models help to discriminate between men who have a high or low chance of successful TESE and couples who have a higher chance of achieving a live-birth after successful TESE. This will allow couples to make a better assessment of the balance of risk versus benefit prior to commitment to surgical interventions.

Cellulose acetate based Complexation-NF membranes for the removal of Pb(II) from waste water

This study investigates the removal of Pb(II) using polymer matrix membranes, cellulose acetate/vinyl triethoxysilane modified graphene oxide and gum Arabic (GuA) membranes. These complexation-NF membranes were successfully synthesized via dissolution casting method for better transport phenomenon. The varied concentrations of GuA were induced in the polymer matrix membrane. The prepared membranes M-GuA2–M-GuA10 were characterized by Fourier transform infrared spectroscopy, scanning electron microscopy, transmission electron microscopy, atomic force microscope and bio-fouling studies. Thermal stability of the membranes was determined by thermogravimetric analysis under nitrogen atmosphere. Dead end nanofiltration was carried out to study the perm- selectivity of all the membranes under varied pressure and concentration of Pb(NO₃)₂. The complexation-NF membrane performances were significantly improved after the addition of GuA in the polymer matrix membrane system. M-GuA8 membrane showed optimum result of permeation flux 8.6 l m⁻² h⁻¹. Rejection of Pb(II) ions was observed to be around 97.6% at pH 9 for all the membranes due to electrostatic interaction between CA and Gum Arabic. Moreover, with the passage of time, the rate of adsorption was also increased up to 15.7 mg g⁻¹ until steady state was attained. Gum Arabic modified CA membranes can open up new possibilities in enhancing the permeability, hydrophilicity and anti-fouling properties.

Immediate versus staged revascularisation in multivessel coronary disease: an updated meta-analysis

Background

Percutaneous coronary interventions (PCIs) are often aimed at the culprit vessel in acute coronary syndromes (ACSs) followed by revascularisation of other stenoses later in the index hospitalisation or shortly after discharge. PCI delay of non-culprit coronary vessels stenoses is supported by lower contrast fluid use and thrombocyte aggregation. Distinct coronary interventions increase the risk of both non- and coronary artery complications, e.g. acute abdominal and periphery artery bleeding, suggesting undertaking all PCIs at the same time.

Purpose

To assess the effect on mortality and re-myocardial infarction (MI) of immediate versus staged revascularisation in multivessel coronary disease, with the latter constrained to initial PCI of the culprit coronary vessel.

Methods

The syntax of “randomised controlled trial (RCT) & acute coronary syndrome & complete revascularisation” was undertaken in PubMed.

Clinical characteristics were gathered at the index hospitalisation. The intervention scenario was acute coronary syndrome or not.

Meta-analyses calculated relative risk (RR) reductions on outcomes of 1) mortality and 2) re-MI. Meta-regression assessed linear difference between interventional treatment benefits and baseline characteristics.

Results

A total of 148 studies was found. Of those, 8 was found eligible for further analyses and their baseline characteristics are shown in Table 1.

Comparison of immediate versus staged revascularisation on mortality was nonsignificant (RR, 1.19; 95% CI: 0.78–1.81, p=0.43) (Figure 1). The impact of Immediate vs staged revascularisation on re-MI was also nonsignificant (RR, 0.83; 95% CI: 0.44–1.55, p=0.56). Meta-regression found no associations between the outcomes and study characteristics (not shown).

Conclusion

The intervention of immediate compared to staged revascularisation assessed on outcomes of all-cause mortality and re-MI were nonsignificant.

Figure 1

Funding Acknowledgement

Type of funding source: None

Plastic physicians: The surgical salamanders of the COVID-19 pandemic

At the time of writing, coronavirus disease-2019 (COVID-19) has affected 6.42 million people globally and over 380,000 deaths, with the United Kingdom now having the highest death rate in Europe. The plastic surgery department at Leeds Teaching Hospitals put necessary steps in place to maintain an excellent urgent elective and acute service whilst also managing COVID-positive medical patients in the ward. We describe the structures and pathways implemented together with complex decision-making, which has allowed us to respond early and effectively. We hope these lessons will prove a useful tool as we look to open conversations around the recovery of normal activity.

Age and gender specific cut-off points for body fat parameters among adults in Qatar

Background

Excessive body fat is the leading cause of many metabolic disorders. Therefore, assessing levels of body fat associated with risk of disease in specific populations is crucial. The present study aimed to identify optimal cut-off values of body fat composition including total body fat, body fat percentage, visceral fat, and trunk fat, in order to predict metabolic risk in the Qatari population.

Methods

This cross-sectional study was based on Qatar Biobank data of 2407 Qatari adults (1269 male and 1138 female) aged 21–70 years old. Individuals’ height, weight and body fat percentage were obtained. Blood test data including lipid profile, blood glucose and HbA1c data were also obtained. The area under the curve was calculated using ROC analysis to obtain the body fat percentage associated with risk of disease.

Results

The cut-off points for total fat for those aged < 40 were 34.0 kg, and for those aged ≥40 were 30.7 kg and 35.6 kg in men and women, respectively. The cut-off for body fat percent for those aged < 40 were 35.1 and 45.1%, and for those aged ≥40 were 34.8 and 46.3% in men and women, respectively. The cut-off points for trunk fat percent for those aged < 40 were 19.5 and 22.4%, and for those aged ≥40 were 21.6 and 23.4% in men and women, respectively. The cut-off points for visceral fat percent for those aged < 40 were 1.4 and 1.0%, and for those aged ≥40 were 1.9 and 1.4% in men and women, respectively.

Conclusion

This study established Qatari adult-specific cut-off values of body fat for different age and gender groups.

Describing the resource utilisation and costs associated withvertebral fractures: the Build Better Bones with Exercise (B3E) Pilot Trial

This analysis examined costs/resources of 141 women with vertebral fractures, randomised to a home exercise programme or control group. Total, mean costs and the incremental cost-effectiveness ratio (ICER) were calculated. Quality of life was collected. Cost drivers were caregiver time, medications and adverse events (AEs). Results show adding an exercise programme may reduce the risk of AEs.

INTRODUCTION

This exploratory economic analysis examined the health resource utilisation and costs experienced by women with vertebral fractures, and explored the effects of home exercise on those costs.

METHODS

Women ≥ 65 years with one or more X-ray-confirmed vertebral fractures were randomised 1:1 to a 12-month home exercise programme or equal attention control group. Clinical and health system resources were collected during monthly phone calls and daily diaries completed by participants. Intervention costs were included. Unit costs were applied to health system resources. Quality of life (QoL) information was collected via EQ-5D-5L at baseline, 6 and 12 months.

RESULTS

One hundred and forty-one women were randomised. Overall total costs (CAD 2018) were $664,923 (intervention) and $614,033 (control), respectively. The top three cost drivers were caregiver time ($250,269 and $240,811), medications ($151,000 and $122,145) and AEs ($58,807 and $71,981). The mean cost per intervention participant of $9365 ± $9988 was higher compared with the mean cost per control participant of $8772 ± $9718. The mean EQ-5D index score was higher for the intervention participants (0.81 ± 0.11) compared with that of controls (0.79 ± 0.13). The differences in quality-adjusted life year (QALY) (0.02) and mean cost ($593) were used to calculate the ICER of $29,650.

CONCLUSIONS

Women with osteoporosis with a previous fracture experience a number of resources and associated costs that impact their care and quality of life. Caregiver time, medications and AEs are the biggest cost drivers for this population. The next steps would be to expand this feasibility study with more participants, longer-term follow-up and more regional variability.

Prevalence and Incidence of Non-neutralizing Antibodies in Congenital Hemophilia A- A Systematic Review and Meta-Analysis

Objectives: In hemophilia A the presence of non-neutralizing antibodies (NNAs) against Factor VIII (FVIII) may predict the development of neutralizing antibodies (inhibitors) and accelerate the clearance of administrated FVIII concentrates. This systematic review aimed to assess: (1) the prevalence and incidence of NNAs in patients with congenital hemophilia without inhibitors and (2) the association between NNAs and patient and treatment characteristics.

Methods: We conducted a search in MEDLINE, Embase, Web of Science and the Cochrane database. We included cross-sectional and longitudinal studies reporting on NNAs in patients with hemophilia A and B, who were inhibitor-negative at the start of the observation period. Data were extracted on: hemophilia type and severity, patient and treatment characteristics, NNA prevalence and incidence, NNA assays and inhibitor development. Two independent reviewers performed study selection, data extraction and risk of bias assessment, using adapted criteria of the Joanna Briggs Institute. Studies were classified as high-quality when ≥5/9 criteria were met. NNA assays were classified as high-quality when both quality criteria were met: (1) use of positive controls and (2) competition with FVIII to establish FVIII-specificity. We reported NNA prevalence and incidence for each study. The pooled NNA prevalence was assessed for well-designed studies in previously treated patients, employing high-quality NNA assays.

Results: We included data from 2,723 inhibitor-negative patients with hemophilia A, derived from 28 studies. Most studies were cross-sectional (19/28) and none reported on NNAs in hemophilia B. Study design was of high quality in 16/28 studies and the NNA assay quality was high in 9/28 studies. Various NNA assays were used, predominantly ELISA (18/28) with different cut-off values. We found a large variety in NNA prevalence (Range, 0–100%). The pooled NNA prevalence in high-quality studies was 25% (95% CI, 16–38%). The incidence of new NNA development was reported in one study (0.01 NNA per person-exposure day).

Conclusion: This systematic review identified studies that were heterogeneous in study design, patient population and NNA assay type, with NNA prevalence ranging from 0 to 100% in inhibitor-negative patients with hemophilia A. The pooled NNA prevalence was 25% in high-quality studies including only previously treated patients and performing high-quality NNA assays.