Thigh Pain and Peri-Implant Fractures with the Use of Short Cephalo-medullary Nails: A Retrospective Study of 122 Patients

Introduction

To assess the incidence and causes of persistent thigh pain and peri-implant fractures after union in patients of intertrochanteric fractures treated with short cephalo-medullary nails.

Materials and methods

A retrospective observational study conducted at a Level 1 Trauma centre. A total of 122 patients of intertrochanteric fractures who were operated using short cephalo-medullary nails (170mm and 200mm lengths) between January 2018 to June 2019 were included in the study. Main outcomes measured were the incidence of thigh pain and peri-implant fractures.

Results

Out of the 122 patients with a mean follow-up of 14.1 month, 12 patients had persistent thigh pain. Six patients had the helical blade protruding from the lateral cortex, two of them had distal tip of nail abutting on the anterior cortex and four cases had prominent proximal segment of nail which may explain the cause of their pain. Five of these patients had a combination of these findings. Two patients had pain for which no other obvious cause was found. There were no cases of peri-implant fractures in our study.

Conclusion

Thigh pain associated with the use of short cephalon-medullary nails is often unrelated to nail length and can be prevented by using proper surgical technique. There seems to be no association between the use of short nails and peri-implant fractures.

A cross-sectional questionnaire based study to assess and compare knowledge of drug schedules amongst healthcare professionals in a medical college

Background

Ensuring quality, safety and efficacy of all pharmaceuticals is the responsibility of drug regulators. However, healthcare workers should be aware of the legal/regulatory provisions involved. This study was planned to assess and compare the knowledge of various drugs schedules under the Drugs and Cosmetics Act, 1940 amongst medical students, post graduate residents and pharmacists.

Methods

A questionnaire was designed based on review of literature and was validated. After obtaining ethical clearance and consent from participants, questionnaire was administered to students undergoing internship/6 th semester/4 th semester, post graduate residents and pharmacy students. Participants' knowledge was assessed based on the percentage of correct responses and the intergroup comparison was done by applying ANOVA test.

Results

Overall, nearly half of the participants had poor knowledge about schedule H1. Sixth semester MBBS students had maximum knowledge followed by interns whereas pharmacy students, 4 th semester MBBS students and PG residents had poor knowledge about drug schedules.

Conclusion

The study clearly highlights the need for further knowledge dissemination about drug schedules. We recommend that a capsule course be developed especially for post graduate residents and final year pharmacy students.

Findings of second multicentric follow-up serosurvey among Health Care Workers in government hospitals

Background

The change in serological status of community may be used as input for guiding the public health policy. Hence, the present study was conducted to determine change in seroprevalence of COVID-19 among healthcare workers (HCWs).

Methods

From the baseline multicentric study sample, a subsample was followed up, and a seroepidemiological study was conducted among them between 6 and 22 weeks after the second dose of the vaccination. Multistage population proportion to size sampling was performed for the selection of subsample of HCWs. The serosurvey was conducted using the enzyme-linked immunosorbent assay-based IgG antibody test (COVID KAVACH).

Results

Follow-up serological testing was done in subsample of 1122 participants of original 3253 participants. The mean age of the participants was 34.6 (8.13) years. A total of 300 (26.7%) participants were females. The seroprevalence was 78.52, (95%CI:76-80.1). Among those who were seronegative at initial test, 708 (77.04%) were seroconverted. Those who were not seroconverted (241 (21.5%)) have longer duration from the second dose of the vaccination (93 (31.4) vs. 56 (38.4); p value < 0.001). The COVID-19 infection was significantly associated with seropositive status and being a medical staff was associated with remaining seronegative on follow-up. The higher age (≥50 years) was found to be significantly associated with seroreversion.

Conclusion

Four in five HCWs had detectable antibodies. Seroepidemiological studies carry vital information to control the public health response in the course of the pandemic. The study can also further help as a platform to study the seroconversion and effect of vaccination among HCWs for newer variants of SARS-CoV-2.

AB1074 FATAL BUT PREVENTABLE - SINGLE CENTRE SERIES OF 6 CASES OF PNEUMOCYSTIS JIROVECII PNEUMONIA (PJP) IN PATIENTS WITH AUTO-IMMUNE INFLAMMATORY RHEUMATIC DISEASE (AIIRD) IN ONE YEAR

Background

Pneumocystis jirovecii pneumonia (PJP) is an uncommon but frequently fatal fungal infection, which can affect patients with rheumatic diseases treated with immunosuppressants or high doses of steroids. There are no clear guidelines on when to prescribe primary prophylaxis and available agreements differ depending on the disease or immunosuppressant.

Objectives

To raise awareness about this preventable infection and to highlight the urgent need to create a tailored probability scoring, before starting any immunosuppression so that the risk benefit of prophylaxis can be objectively assessed.

Methods

This is a retrospective case series of six patients who developed definite or probable PJP known to the Rheumatology Department at Oxford University Hospitals NHS FT since the beginning of 2021. These patients were identified through the microbiology and infectious disease teams, and notes were reviewed to collate data regarding the clinical characteristics. Of these, five were being treated for large vessels vasculitis (LVV) whilst the other one had seropositive rheumatoid arthritis (RA). The diagnosis of PJP was made on clinical picture, laboratory results, bronchoscopy and CT findings.

Results

In this series, the median age was 78 years (range 55-93) with equal gender distribution. In three LVV patients, the diagnosis was confirmed on ultrasound, one had a positive PET-CT whilst the other case had a high probability clinical diagnosis. Comorbidities included chronic kidney disease and hypertension in three patients, diabetes, or previous underlying malignancy in other two. Smoking history was present in four patients, while five patients had lymphopenia with counts <1x10^9/L. Four of the six cases were on combined therapy with disease modifying anti-rheumatic therapy drugs (DMARDs) and prednisolone, only one was exclusively on prednisolone and the patient with RA was on Methotrexate and Humira.

The chronology of the infection was variable, still most of the patients developed PJP infection during the first three months of starting either a biologic or corticosteroids. The median steroids dose by the time of PJP infection was 30 mg and unfortunately three of the patients died. None of the patients who developed PJP had been given antibiotic prophylaxis prior to infection.

Some proposed scoring systems for serious infection risk in patients with AIIRD exist, however they focused on RA or biologics use rather than patients with vasculitis or connective tissue disorders who might be on high dose corticosteroids. Additionally, PJP prophylaxis is not recommended in any of the current guidelines for LVV management (BSR, EULAR, ACR). Cochrane review suggests reduction of risk by 85% in patients given prophylaxis.

Conclusion

Pneumocystis Jirovecii pneumonia (PJP) prophylaxis is not current practice for patients with large vessel vasculitis. Consideration needs to be given to PJP prophylaxis for patients on high dose steroids for a prolonged period, particularly in the presence of other risk factors. More data will be needed to help establish guidelines on PJP primary prophylaxis.

References

[1]Park JW, Curtis JR, Moon J, Song YW, et al. Prophylactic effect of trimethoprim-sulfamethoxazole for pneumocystis pneumonia in patients with rheumatic diseases exposed to prolonged high-dose glucocorticoids. Ann Rheum Dis. 2018 May;77(5):644-649.

[2]Stern A, Green H, Paul M, Vidal L, Leibovici L. Prophylaxis for Pneumocystis pneumonia (PCP) in non-HIV immunocompromised patients. Cochrane Database Syst Rev. 2014 Oct 1;2014(10)

Table 1.

Baseline characteristics of the cases (*n)

Male gender3Age, year Median78Underlying disease  Large vessels vasculitis5Confirmed on imaging (n)4  Seropositive Rheumatoid arthritis1Smoking4Lymphopenia5Steroid dose ≥ 30 mg by the time of PJP infection4Concomitant DMARDs used4Numbers of deaths3

*n = numbers

Disclosure of Interests

None declared

POS0565 WORSE OUTCOMES LINKED TO ETHNICITY FOR EARLY INFLAMMATORY ARTHRITIS IN ENGLAND AND WALES: A NATIONAL COHORT STUDY

Background

Patients from ethnic minority backgrounds suffer considerable health inequality, with generally poorer health outcomes relative to the rest of the population.1 Further exploration of these differences is essential if we are to deliver the best care for all, and close the health gap for our patients.

Objectives

We used the National Early Inflammatory Arthritis Audit (NEIAA) to assess variability in care quality and treatment outcomes across ethnicities for patients diagnosed with early inflammatory arthritis (EIA) in England and Wales.

Methods

NEIAA is an observational cohort design. Data were from adult patients newly diagnosed with EIA, and seen by rheumatology in England and Wales between May 2018 and March 2020. Quality of care outcomes were assessed against six metrics contained within the National Institute for Health and Clinical Excellence (NICE) Quality Standard for Rheumatoid Arthritis.2 Clinical outcomes were measured using DAS28. Outcomes were compared between ethnic groups (White, Black, Asian, Mixed, Other), and adjusted for confounders (age, sex, smoking, comorbidity, seropositivity and disease severity at presentation) using Logistic regression models with multiple imputation for missing data.

Results

Data for 35,807 eligible patients were analysed, of whom 30,643 (85.6%) were White and 5,164 (14.6%) were from ethnic minority backgrounds: 1,035 (2.8%) Black; 2,617 (7.3%) Asian; 238 (0.6%) Mixed; 1,274 (3.5%) Other. A total of 12,955 patients had confirmed EIA. Of those, 11,315 were White and 1,640 were from ethnic minority backgrounds: 314 (2.4%) Black; 927 (7.1%) Asian; 70 (0.5%) Mixed; 329 (2.5%) Other.

Of 35,160 eligible patients who had data available, 14,803 (42.1%) were assessed by rheumatology within three weeks of referral. Of 9,900 EIA-eligible patients with data available, 5,642 (57.0%) started treatment within six weeks of referral. There were no significant differences in these outcomes by ethnicity. Ethnic minority patients did, however, have lower odds of disease remission at three months, relative to patients of White ethnicity (adjusted odds ratio 0.79; 95% CI: 0.65-0.96; p=0.02). This difference was due to lower odds of disease remission in Black and Asian patients, relative to White patients (Table 1). Ethnic minority patients were significantly less likely to receive initial treatment with methotrexate (0.68; 95% CI: 0.52-0.90; p=0.008) or with glucocorticoids (0.63, 95% CI: 0.49-0.80; p< 0.001).

Table 1.

Associations between ethnicity and disease remission at three months in EIA patients

ModelOdds ratio95% CIP-valueUnadjustedAll ethnic minority0.76(0.62,0.93)0.01backgroundsBlack0.48(0.34,0.67)<0.001Asian0.74(0.59,0.93)0.01Mixed0.61(0.28,1.35)0.22Other1.09(0.71,1.68)0.67Age and sex-adjustedAll ethnic minority0.78(0.63,0.96)0.01backgroundsBlack0.49(0.35,0.69)0.00Asian0.75(0.60,0.94)0.01Mixed0.63(0.28,1.39)0.25Other1.11(0.71,1.71)0.63Fully-adjustedAll ethnic minority0.79(0.65,0.96)0.02backgroundsBlack0.57(0.41,0.79)0.001Asian0.76(0.62,0.93)0.009Mixed0.63(0.27,1.46)0.29Other1.04(0.71,1.54)0.80

Conclusion

The results from this large cohort demonstrate that some minority ethnic groups are less likely to reach disease remission in the early months following an EIA diagnosis. Our results are not explained by delays in referral or treatment. Intitial treatment strategies varied across ethnic groups. These data highlight the need for investigation into the possible drivers of these inequitable outcomes and reappraisal of EIA management pathways.

References

[1]Greenberg JD, Spruill TM, Shan Y, Reed G, Kremer JM, Potter J, et al. Racial and ethnic disparities in disease activity in patients with rheumatoid arthritis. Am J Med. 2013;126(12):1089-98.

[2]NICE quality standard for rheumatoid arthritis in over 16s. Nice.org.uk. 2013 [cited 25 January 2022]. Available from: https://www.nice.org.uk/guidance/qs33/documents/previous-version-of-quality-standard.

Disclosure of Interests

Maryam Adas: None declared, Sathiyaa Balachandran: None declared, Sam Norton: None declared, Edward Alveyn: None declared, Mark Russell Speakers bureau: Has received speaker fees and educational grants from Janssen, Lilly, Menarini, Pfizer and UCB, Tom Esterine Speakers bureau: Patient review of P.I.S and consent form into lay language for KCL that was linked to Pharma company., Paul Amlani-Hatcher: None declared, Sarah Oyebanjo: None declared, Heidi Lempp: None declared, Jo Ledingham: None declared, Kanta Kumar Speakers bureau: Has received training form Pfizer and speaker fees 2021 from Janssen., Paid instructor for: Has received training form Pfizer, James Galloway Speakers bureau: Has received honoraria from AbbVie, Celgene, Chugai, Gilead, Janssen, Eli Lilly, Pfizer, Roche and UCB., Shirish Dubey: None declared.

Perception of Employees Regarding the Quality Management System Implemented at a Tertiary Care Eye Hospital in North India: A Mixed-Methods Study

Background:

Quality management in healthcare is critical for hospitals and everyone in the loop —from physicians to support staff—needs to be aware of and involved in this process.

Objectives:

To assess the perception of employees about the quality management system (QMS) implemented at a tertiary care eye hospital in north India and to use it to identify scope for further improvement.

Methods:

This cross-sectional mixed-method study involved both questionnaire-based survey and an in-depth interview by a third party. The questionnaire had 12 questions to assess the changes in culture, infrastructure, environment, system, operation theatre and outpatient department. Employees shared their opinion about improvements brought by the QMS in eight years. Respondents were divided into five groups based on their job description: (i) doctors, (ii) technical staff (nursing/operation theatre/laboratory), (iii) optometrists/opticians/audiologists, (iv) patient care executives and (v) human resources/administration/others.

Results:

Of the 73 employees interviewed, 94.5% perceived an improved treatment and care process and 91.8% perceived improved treatment results. According to 83.6% of the employees, they were encouraged to report patient safety concerns and 71.2% saw improved incidence and adverse event management. The QMS has increased patient satisfaction according to 83%, while 91.8% felt it improved the profile of the hospital. The employees stated no negative effects of the QMS except a long waiting time of the patients and the duplication of paperwork.

Conclusion:

QMS has brought many positive changes across the hospital. Still, there is scope to reduce the patient waiting time and paperwork duplication.

Corticosteroids reduce vascular ultrasound sensitivity in fast- track pathways (FTP): results from Coventry Multi-Disciplinary FTP for cranial Giant Cell Arteritis

OBJECTIVES

This study aims to assess the feasibility of the Coventry multidisciplinary fast-track cranial giant cell arteritis (FTGCA) pathway, which was set up in 2013 in collaboration with vascular physiology and ophthalmology to enable prompt multidisciplinary assessment, including ultrasound (US). This study also looks at the impact of prior corticosteroid (CS) use on the performance of US in real life.

METHOD

Data were collected retrospectively for patients who attended the Coventry FTGCA pathway between 1 January 2014 and 31 December 2017. Patients were identified from US lists and clinical details were obtained from electronic medical records.

RESULTS

In total, 620 eligible patients were included in this study. US had a sensitivity of 50%, which improved to nearly 56% in CS-naïve patients. The median duration of CS use prior to US was 2 days, and sensitivity was around 46% in this group. The specificity of US was > 96%, and CS use was avoided completely in 345 patients (56%). CSs negatively impacted on the utility of US, with US more likely to be false negative.

CONCLUSIONS

This novel multidisciplinary pathway demonstrates excellent feasibility and minimizes the use of CSs in patients without giant cell arteritis. US was performed promptly, was cost effective- and had reassuring real-life sensitivity and specificity in this cohort, with excellent patient feedback. CS-naïve patients showed higher sensitivity for US despite the short duration of CS use.

Lateral Transtumoral Transforaminal Removal of Cervical Dumbbell Tumors

Background Cervical dumbbell tumors constitute 15% of cervical nerve sheath tumors. These tumors occupy intraspinal, foraminal, and extraspinal compartments. Laminectomy, laminectomy and facetectomy and anterolateral partial vertebrectomy are the approaches used to address these multicompartment tumors. Laminectomy leads to incomplete tumor removal. Other approaches ensure complete tumor excision but involve more extensive bone work.

Objective We describe our surgical technique and clinical experiences of six patients treated through single lateral approach, addressing all compartments (transforaminal approach) with minimal or no bony resection.

Methods Six patients with cervical dumbbell tumors underwent minimally invasive transforaminal approach and tumor excision. The cohort consisted of four women and two men. All patients underwent complete tumor excision

Technique Intraoperative X-ray and ultrasound are used to localize the respective foramen. Skin is entered from the lateral side and sequential dilatation is done through muscles. The dilators and port are docked to the lateral surface of articular facets. Standard technique of capsule dissection, internal decompression and capsule mobilization is done to remove the tumor. Arachnoid is seen at the end. Tumor cavity is obliterated with fat graft.

Results Total excision of tumor was documented in all patients with postoperative MRI scan. The mean blood loss was 100 mL. The patients could be discharged on second or third postoperative day. Mean follow-up is of 48 months (18–70 months) and all patients had resolution in features of myelopathy.

Conclusions Endoportal transforaminal approach is technically feasible and minimally invasive option to remove the dumbbell schwannomas.

Nidus delineation and dosimetric comparison in arteriovenous malformation in stereotactic radiosurgery by using MRI and 3DCT angiography

Purpose/Objectives

Accurate delineation of target is key to any successful radiosurgery. C-arm Dyna CT/ 3DCT angiography (3DCTA) has the potential of improving the accuracy of nidus delineation in intracranial arteriovenous malformations (AVM) due to high temporo-spatial resolution of vessel architecture. Here, we present a comparison of nidus delineation and dosimetric parameters between digital 3DCTA and MRI.

Materials/Methods

Ten consecutive patients treated for intracranial AVMs were included in this study. All patients underwent MRI/MRA, and 3DCTA and all images were co-registered. AVM were delineated using 3DCTA (GTV_3DCTA) and contrast enhanced MRI/MRA (GTV_MRI). Hausdorff distance (HD) matrices and dice similarity coefficient (DSC) matrices were analysed. Stereotactic radiosurgery plans were developed for both the volumes for all patients and statistical analysis were performed with T-test.

Results

Mean volumes of GTV_3DCTA and GTV_MRI were 1.771 cc (SD 1.794cc, range 0.124-4.191cc) and 2.183cc (SD 2.16cc, range 0.221-6.133cc), respectively. Significant deviation (p=0.018) was found when taking GTV_MRI as a primary and comparing it to GTV_3DCTA (MD=0.723cc±0.816cc). Similar result was observed with GTV_3DCTA as primary and GTV_MRI as secondary (MD=0.188cc, SD=0.193cc, p=0.024). Maximum HD was in the range of 1.71 to 7.44mm (mean=4.27mm, SD=1.56). For GTV_3DCTA based plans, significant deviation was found between GTV_MRI and GTV_3DCTA in dose coverage and the mean difference was 22.17% (SD 16.73). In GTV_MRI based plans, the mean CIRTOG deteriorated from 1.33 to 2.18 for GTV_MRI and GTV_3DCTA, respectively. Significant deviation was found in CI_RTOG (0.005) and mean deviation was 0.86(SD=0.72) when comparing GTV_MRI and GTV_3DCTA. Highly significant (p=0.002) deviation was found in CI_Paddick between GTV_MRI and GTV_3DCTA for GTV_MRI based plans with mean difference of 0.26(SD=0.4, for GTV_MRI=0.3, GTV_3DCTA=0.46).

Conclusion

Nidus volume was significantly altered with the use of 3DCTA compared to that of MRA/MRI images. Multimodality imaging is crucial for accurate target delineation, and successful radiosurgical obliteration of nidus.

Measurement of Differential Branching Fractions of Inclusive B→X_{u}ℓ^{+}ν_{ℓ} Decays

The first measurements of differential branching fractions of inclusive semileptonic B→X_{u}ℓ^{+}ν_{ℓ} decays are performed using the full Belle data set of 711  fb^{-1} of integrated luminosity at the ϒ(4S) resonance and for ℓ=e, μ. With the availability of these measurements, new avenues for future shape-function model-independent determinations of the Cabibbo-Kobayashi-Maskawa matrix element |V_{ub}| can be pursued to gain new insights in the existing tension with respect to exclusive determinations. The differential branching fractions are reported as a function of the lepton energy, the four-momentum-transfer squared, light-cone momenta, the hadronic mass, and the hadronic mass squared. They are obtained by subtracting the backgrounds from semileptonic B→X_{c}ℓ^{+}ν_{ℓ} decays and other processes, and corrected for resolution and acceptance effects.

Precise Measurement of the D^{0} and D^{+} Lifetimes at Belle II

We report a measurement of the D^{0} and D^{+} lifetimes using D^{0}→K^{-}π^{+} and D^{+}→K^{-}π^{+}π^{+} decays reconstructed in e^{+}e^{-}→cc[over ¯] data recorded by the Belle II experiment at the SuperKEKB asymmetric-energy e^{+}e^{-} collider. The data, collected at center-of-mass energies at or near the ϒ(4S) resonance, correspond to an integrated luminosity of 72  fb^{-1}. The results, τ(D^{0})=410.5±1.1(stat)±0.8(syst)  fs and τ(D^{+})=1030.4±4.7(stat)±3.1(syst)  fs, are the most precise to date and are consistent with previous determinations.

Search for B^{+}→K^{+}νν[over ¯] Decays Using an Inclusive Tagging Method at Belle II

A search for the flavor-changing neutral-current decay B^{+}→K^{+}νν[over ¯] is performed at the Belle II experiment at the SuperKEKB asymmetric energy electron-positron collider. The data sample corresponds to an integrated luminosity of 63  fb^{-1} collected at the ϒ(4S) resonance and a sample of 9  fb^{-1} collected at an energy 60 MeV below the resonance. Because the measurable decay signature involves only a single charged kaon, a novel measurement approach is used that exploits not only the properties of the B^{+}→K^{+}νν[over ¯] decay, but also the inclusive properties of the other B meson in the ϒ(4S)→BB[over ¯] event, to suppress the background from other B meson decays and light-quark pair production. This inclusive tagging approach offers a higher signal efficiency compared to previous searches. No significant signal is observed. An upper limit on the branching fraction of B^{+}→K^{+}νν[over ¯] of 4.1×10^{-5} is set at the 90% confidence level.

Seropositivity of severe acute respiratory syndrome coronavirus 2 infection among healthcare workers of the Armed Forces medical services, India: A multicentric study

Background

Serosurveys provide the prevalence of infection and over time will reveal the trends. The present study was conducted to estimate the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among healthcare workers (HCWs) and to analyse various characteristics (risk factors) associated with SARS CoV-2 infection.

Methods

Eight government designated Corona virus disease -19 (COVID-19) hospitals were selected based on the hospital admission of patients with COVID-19 and the local epidemiological situation in the region. Multistage population proportion to size sampling was performed for the selection of HCWs. Serosurvey was conducted using the enzyme-linked immunosorbent assay-based IgG antibody test (COVID KAVACH). Bivariate and multiple logistic regression was performed to find out the factor/factors associated with the positive antibody test.

Results

Out of 3255 HCWs that participated in the study, data of 3253 were analysed. The seroprevalence was 19.7% (95% confidence interval: 18.5-21.3%). Factors associated were location, category of HCWs, male sex, previously tested positive by the molecular test, training on infection prevention and control, personal protective measures, handwashing technique, close contact with a patient confirmed with COVID-19, use of personal protective equipment and symptoms in the last 30 days. However, in multiple logistic regression, only location, category, previously tested positive by the molecular test and symptoms in the last 30 days were statistically significant.

Conclusion

HCWs are vulnerable to SARS-CoV-2 infection. One in five HCWs had detectable antibodies. The presence of antibodies among HCWs may help in their placement and triage. HCWs may be advised to report early in case of any symptoms of COVID-19. Preventive measures may be targeted based on the location, with particular emphasis on ancillary workers and nurses.

Assessment of materno-foetal transmission of SARS-CoV-2: A prospective pilot study

BACKGROUND

The issue of vertical transmission of SARS-CoV-2 infection to the foetus has not yet been resolved. Its main reason is lack of a bigger study to analyse this question. The evidence of the affection of the foetus during antenatal or intrapartum period is limited to some anecdotal reports. To look for the possibility of vertical transmission of Severe Acute Respiratory Syndrome - Corona Virus-2 (SARS-CoV-2) infection to the foetus, this prospective pilot study was conducted at a tertiary health care COVID-19 designated centre of Armed Forces.

METHODS

This study was conducted during 01 June 2020 and 15 October 2020 and included 54 covid-positive pregnant mothers. During delivery, amniotic fluid and cord blood samples were collected in a sterile manner. Amniotic fluid samples were not collected during vaginal deliveries as chances of contamination was very high. These samples were tested for the presence of SARS-CoV-2 gene by Reverse Transcriptasee Polymerase Chain Reaction (RT-PCR) test, and the results were analysed. Newborns were allowed to room in with mother, and they underwent throat and nasal swab RT-PCR testing of covid within 24-48 h of delivery.

RESULTS

A total of 1520 pregnant mothers underwent RT-PCR test during the study period. Total positivity rate among our pregnant women was 2.8%. Out of 54 covid-positive women during the study period, amniotic fluid RT-PCR tests were carried out for 43 women, and cord blood was tested for 45 women.

CONCLUSION

RT-PCR test of amniotic fluid, cord blood and nasal and throat swab of all newborns delivered by SARS-CoV-2-positive pregnant women were negative. Based on our study, the possibility of intrauterine vertical transmission of SARS-CoV-2 infection appears to be unlikely.

OP0063 SINGLE CENTRE EXPERIENCE OF THE CLINICAL SPECTRUM, AETIOLOGIES AND MANAGEMENT OF NON-INFECTIOUS AORTITIS

Background:

Aortitis, a rare form of large vessel vasculitis, may occur in the context of a primary systemic vasculitis, as a part of systemic autoimmune disease or in isolation. The evidence and guidelines to diagnose, manage and monitor aortitis remain limited. However, PET CT and vascular MRI scans have facilitated our ability to make the diagnosis more readily. The optimal management strategy and complication rates remain uncertain.

Objectives:

Our aim was to explore the clinical, laboratory and radiological features of aortitis. We sought to review the management and complications of this illness by collecting detailed information on the outcomes and treatments used, including disease modifying agents (DMARDs) and biologics.

Methods:

Patients diagnosed with aortitis since 2006 that had been managed in a single tertiary centre were identified using the Rheumatology Assessment Database Innovation in Oxford (RHADIO). Their medical notes were retrospectively reviewed using a local electronic patient record system and the following information was obtained: demographics, underlying risk factors, imaging and laboratory results (including biopsy reports if available), management and outcome.

Results:

We identified 155 patients who met the inclusion criteria. There was a female preponderance of 57.4% (n=89). At the time of diagnosis, the average age was 69 (range 30-92) and the mean symptomatology length prior to diagnosis was 12 months (range 0-120). The majority of patients (60.4%, n=94) had aortitis secondary to giant cell arteritis (GCA), isolated aortitis was identified in 29.7% (n=46) and IgG4-related disease aortitis was uncommon (2.6%, n=4). Those with cranial GCA-like symptoms were diagnosed on average 3.9 months before those who presented differently (10.1 months versus 14.0 months).

Common presentations comprised: systemic inflammatory response syndrome (49.0%, n=76), cranial GCA-like symptoms (26.5%, n=41) and unexplained weight loss (24.5%, n=38). Importantly, 18.7% (n=29) of patients presented with ischaemic symptoms that included angina, TIAs/strokes and claudication. Aortic dissection was the primary presentation for 6.5% (n=10) of patients.

At presentation, the mean CRP was 84 mg/L (range 1-249) and the ESR was 72 mm/hr (range 2-164). Most (73.5%, n=114) had diagnostic PET CT changes. For those patients with GCA, diagnostic ultrasound changes were seen in 27.7% (n=26).

Nearly all were treated with prednisolone (92.3%, n=143) and all but 8 (5.1%) received a DMARD at some point. Methotrexate was the most commonly used DMARD (93.9%, n=138), followed by leflunomide (22.3%, n=35) and azathioprine (19.1%, n=28). Cyclophosphamide was used in 23.8% of patients (n=38) and 15 patients (9.7%) received tocilizumab.

Around a third (34.1% n=53/155) had received at least two DMARDs during their treatment course. On average, patients required 3.46 drugs to manage their aortitis. Those who relapsed (43.2%, n=67) were more likely to have GCA (65.7%, n=44).

Vascular sequelae were present in 37.4% (n=58). The most common complications were ischaemic in nature with stroke/TIA and claudication reported in 16.8% (n=26). Aortic aneurysms were recorded in 11.6% (n=18) of cases and 5.1% (n=8) developed dissections despite being on treatment for their aortitis. One patient developed renal infarcts and ischaemic bowel leading to intestinal failure because of florid vasculitis.

Conclusion:

Aortitis has a varied presentation with systemic inflammatory response syndrome being the most common. Delayed diagnosis remains a problem and especially for those with non-GCA related aortitis, which is likely to contribute to the risk of subsequent vascular complications. Vascular events including dissection are common, many of which could be preventable, emphasising the importance of early diagnosis and good disease control.

References:

[1]Koster M et al. Large-vessel giant cell arteritis: diagnosis, monitoring and management. Rheumatology [Internet]. 2018 Feb 1;57(suppl_2):ii32–42. Available from: https://doi.org/10.1093/rheumatology/kex424

Disclosure of Interests:

None declared

Test of Lepton-Flavor Universality in B→K^{*}ℓ^{+}ℓ^{-} Decays at Belle

We present a measurement of R_{K^{*}}, the branching fraction ratio B(B→K^{*}μ^{+}μ^{-})/B(B→K^{*}e^{+}e^{-}), for both charged and neutral B mesons. The ratio for the charged case R_{K^{*+}} is the first measurement ever performed. In addition, we report absolute branching fractions for the individual modes in bins of the squared dilepton invariant mass q^{2}. The analysis is based on a data sample of 711  fb^{-1}, containing 772×10^{6}  BB[over ¯] events, recorded at the ϒ(4S) resonance with the Belle detector at the KEKB asymmetric-energy e^{+}e^{-} collider. The obtained results are consistent with standard model expectations.

Using Circular Dichroism to Control Energy Transfer in Multiphoton Ionization

Chirality causes symmetry breaks in a large variety of natural phenomena ranging from particle physics to biochemistry. We investigate one of the simplest conceivable chiral systems, a laser-excited, oriented, effective one-electron Li target. Prepared in a polarized p state with |m|=1 in an optical trap, the atoms are exposed to co- and counterrotating circularly polarized femtosecond laser pulses. For a field frequency near the excitation energy of the oriented initial state, a strong circular dichroism is observed and the photoelectron energies are significantly affected by the helicity-dependent Autler-Townes splitting. Besides its fundamental relevance, this system is suited to create spin-polarized electron pulses with a reversible switch on a femtosecond timescale at an energy resolution of a few meV.

Using protease inhibitors to improve protein stability in the presence of skin: A case study on the stability of insulin like growth factor 1

Insulin-like growth factor 1 (IGF-1) is indicated for growth failure in pediatric patients with primary IGF-1 deficiency and for patients with neutralizing antibodies to growth hormone. IGF-1 was cloned, expressed and purified in-house. Preliminary stability studies prior to the transdermal delivery experiments showed that although stable in contact with stratum corneum, the solution concentration of IGF-1 decreased to 23.63 ± 2.48 and 21.58 ± 2.62% of the initial value upon exposure for 8 h to porcine dermis of 250 and 750 µm thickness. This led to an investigation into how it might be possible to improve the stability of IGF-1 in the presence of porcine/human skin. The stability of IGF-1 in the presence of dermis improved upon heating the skin samples at 60 °C for 2 min suggesting that IGF-1 was subject to enzymatic degradation. Although addition of the protease inhibitor, phenylmethanesulfonyl fluoride (PMSF) alone, did not improve stability, the use of a protease inhibitor cocktail completely blocked proteolytic degradation of IGF-1; the solution concentration after an 8 h exposure to porcine skin was equivalent to the initial level (103.87 ± 9.15%). The results obtained with porcine skin were confirmed with human skin (IGF-1 recovery was 99.31 ± 9.98%). These findings suggest that the inclusion of protease inhibitor cocktails may be useful in limiting the degradation of therapeutic proteins during iontophoresis and transdermal delivery in general - this could be of particular interest for local delivery of peptide/protein therapeutics for dermatological applications.