One treatment fits all: Effectiveness of a multicomponent cognitive behavioral therapy program in data-driven subtypes of perinatal depression

Introduction

It has been well established that depressive disorders including perinatal depression are very heterogeneous, which partly explain the ineffectiveness of available treatments for many patients. Recent innovations in data science can help elucidate the nature of perinatal depression especially the heterogeneity in its presentation.

Objectives

The present study aime to elucidate heterogeneous subtypes of PND and assess the effectiveness of a multicomponent cognitive behavioral therapy (CBT) across heterogenous subtypes of PND.

Methods

This study was conducted in 2005 in two rural areas of Rawalpindi, Pakistan. Out of a total of 3,898 women, 903 pregnant women were identifed with PND (using DSM-IV) and randomly assigned to intervention and control group. Baseline assessments included interviewer admininstered Hamilton Depression Scale (HDS) and social risk factors. Follow-up assessments were conducted at 6 months and 12 months post-intervention. Principle component analysis was run to reduce dimensionality of the HDS. Two step cluster analysis was then run to elucidate subtypes of PND using the dimensional scores. Thereafter, effectiveness of CBT was compared across these subtypes of PND using multilevel modelling.

Results

Principle component analysis revealed a four component solution for the Hamilton depression rating scale. Using these dimensional scores, cluster analysis (average silhouette= 0.5) revealed a parsimonius four cluster soultion of participants with mild PND symptoms (n=326); predominant sleep problems (n=311) c) predominant atypical symptoms (n=80) and d) comorbid depressive and anxiety symptoms (n=186). CBT yielded moderate effect sizes across all these subtypes of PND (cohen’s d > 0.8).

Conclusions

Multicomponent CBT is effective across hetergeneous presentations of PND.

Disclosure

No significant relationships.

A242 THE AIR BETWEEN US: A CASE OF PSEUDOCYST PERFORATION POST-ENDOSCOPIC CLIPPING OF A BLEEDING PANCREATIC-COLONIC FISTULA

Background

Pancreatic fistula is an uncommon complication of pancreatitis and is associated with increased morbidity. We discuss a case of pancreatic-colonic fistulization followed by the first reported case of pseudocyst perforation post-colonoscopy.

Aims

Case

Methods

A 51 year-old female with decompensated alcoholic cirrhosis admitted with hepatic encephalopathy developed large volume hematochezia during admission. Past medical history includes pancreatic pseudocyst, GERD and remote hernia repairs. For the hematochezia, she was investigated with an EGD and colonoscopy. In the distal descending colon, a bleeding lesion was identified and treated with clips and epinephrine injection (Figures 1 and 2). Five hours post-procedure, she developed abdominal distention. CT abdomen pelvis revealed large volume of free air and simple fluid within the abdominal cavity likely secondary to rupture pseudocyst rupture. The previously visualized pseudocyst was filled with gas plastered against the descending colon. She remained medically stable with conservative management.

Results

Discussion

Conclusions

Pancreatic-colonic fistula is an uncommon but potentially life-threatening complication of acute pancreatitis associated with high risk of complications. They are found in 4% of admitted inpatients with acute pancreatitis. There are three proposed mechanisms for their development: firstly, inflammation and activated pancreatic lytic enzymes; secondly, pressure necrosis from a contiguous mass; thirdly, localized portal hypertension. Classically, pancreatic-colonic fistulas present with diarrhea, fever and hematochezia. Gastrointestinal bleeding occurs in 60% of cases. The source of bleed has been described to be originating most commonly from the splenic artery and to a lesser extent, the margin of the fistula or, rarely, erosion of splenic parenchyma. Reported therapeutic management strategies include: hemoclippings and Greenplast sprayings, endoscopic pancreatic stent, transgastric nasocystic drainage catheter placements, injection of N-butyl-2-cyanocrylate and transpapillary nasopancreatic drainage.

Pseudocysts arise in 25% of patients with chronic pancreatitis. Pseudocysts may regress through a variety of mechanisms: spontaneously after inflammation from pancreatitis resolves, natural drainage through the pancreatic duct into the duodenum, or through a complicating fistulous tract connecting to the gastrointestinal tract. Rarely, the pseudocyst can resolve as it leaks or perforates into the abdominal cavity. Pancreatic pseudocysts may perforate spontaneously into the free peritoneal cavity, stomach, duodenum, colon, portal vein, pleural cavity, or through the abdominal wall. We report the first case, to our knowledge, of pancreatic pseudocyst perforation post-clipping of bleeding pancreatic-colonic fistula.

Funding Agencies

None

A5 GM-CSF AUTOANTIBODIES: PREDICTORS OF CROHN’S DISEASE DEVELOPMENT AND A NOVEL THERAPEUTIC APPROACH

Background

Crohn’s disease (CD) is a heterogenous, chronic inflammatory disorder driven by a combination of genetic, environmental, and microbiota-dependent risk factors. Mononuclear phagocytes (MNP) are crucial cells that maintain intestinal homeostasis. An important cytokine for MNP survival and function is granulocyte-macrophage colony stimulating factor (GM-CSF). Interestingly, several studies reported CD-associated genetic risk variants within the GM-CSF receptor and its downstream signaling components. Furthermore, high titers of autoantibodies specific to GM-CSF can be detected in CD patients. Taken together, this data suggests an important role for GM-CSF in abrogation of CD development in a subgroup of patients.

Aims

This study sought to investigate the function of GM-CSF autoantibodies in CD.

Methods

We retrospectively quantified and characterized GM-CSF autoantibodies in sera of 220 CD, 200 ulcerative colitis (UC) patients, and 220 healthy controls (HC) sampled at 3 time points prior to disease diagnosis and one time point after diagnosis. ELISA was used to determine GM-CSF autoantibody titers and isotypes followed by in vitro multiplexed mass cytometry (CyTOF) neutralization assays on peripheral blood mononuclear cells. Flow cytometry and CyTOF were used to map the profile of immune cells isolated from inflamed and non-inflamed CD mucosa.

Results

Our data demonstrates that GM-CSF autoantibodies are specific to CD, significantly elevated up to 7 years prior to diagnosis of disease, and correlate with disease location, severity, and complications at the time of diagnosis. Moreover, in contrast to GM-CSF autoantibodies in pulmonary alveolar proteinosis patients, CD-associated autoantibodies neutralize GM-CSF via specific recognition of post-translational modifications (PTM), affecting MNP function. Removal of PTM enabled GM-CSF to escape autoantibody binding and restored MNP response to GM-CSF in the presence of neutralizing antibodies, indicating a potential therapeutic avenue. Furthermore, we identified group 3 innate lymphoid cells (ILC3) as a major source of GM-CSF in the healthy intestinal tract, suggesting intriguing crosstalk of MNP and ILC3 across the GM-CSF-GM-CSFR axis.

Conclusions

Our results identify GM-CSF autoantibodies as predictive serological biomarker for CD in a subgroup of patients presenting with severe and complicated form of disease at the time of diagnosis. The presence of GM-CSF autoantibodies precedes the onset of CD by several years and likely abrogates homeostatic immune cell crosstalk involving ILC3 and MNP, suggesting the development of a pre-diseased state in CD patients.

Funding Agencies

CIHRDr. Edward Ketchum Graduate Scholarship

A survey of noise-induced auditory symptoms in manufacturing workers in Brunei Darussalam

Noise-induced auditory symptoms (NIASs) refer to symptoms that develop after exposure to loud noise, where common symptoms are tinnitus and hearing difficulty. If not detected early or prevented, NIASs may lead to the development of noise-induced hearing loss (NIHL). This cross-sectional study aimed to investigate the prevalence rate of common NIASs and contributing occupational factors among manufacturing workers in Brunei Darussalam. The response rate for this study was 81.7%. The prevalence rate of NIASs was 18% and the most commonly reported symptom was 'ears feeling full after leaving a very noisy place' (10.5%). This study showed a strong association between the absence of hearing protective device use (adjusted odds ratio = 2.118, p = 0.040) and having at least one reported NIAS. The study findings can be used to plan and implement policies where there is a risk of occupational noise exposure to prevent NIASs and further development of NIHL.

Clade-Specific Biosurveillance of Pseudoperonospora cubensis Using Spore Traps for Precision Disease Management of Cucurbit Downy Mildew

Pseudoperonospora cubensis is an obligate oomycete and cause of cucurbit downy mildew (CDM), the most destructive foliar disease affecting cucurbit hosts. Annual epidemics develop throughout the United States as windborne sporangia travel great distances and survive prolonged exposure to solar radiation. Recent genomic evidence suggests that P. cubensis isolates display host adaptation based on their respective clade. Early detection is key for fungicide application timing, and identification of the host-adapted clade provides information on the risk of infection for specific cucurbit crops. In this study, a multiplex quantitative PCR assay was developed based on species- and clade-specific nuclear genomic markers. The assay detected as few as 10 sporangia or DNA at 100 fg/ml for both clades and was validated in the field by deploying rotorod spore samplers in cucurbit sentinel plots located at two research stations in North Carolina. Using this assay, sporangia DNA was detected in spore trap sampling rods before signs of P. cubensis or CDM symptoms were observed in the sentinel plots. Both clade 1 and clade 2 DNA were detected in late-season cucumber and watermelon plots but only clade 2 DNA was detected in the early-season cucumber plots. These results will significantly improve disease management of CDM by monitoring inoculum levels to determine the cucurbit crops at risk of infection throughout each growing season.

Non-destructive sex-specific monitoring of early embryonic growth rate in light brown broiler eggs using light transmission and its correlation with hatching time and chick weight

1. Monitoring early embryonic growth rate (EGR) has significant economic and animal welfare benefits. This study focuses on monitoring sex-specific early EGR using light transmission, and correlating this with hatching time and chick weight. For broiler eggs in particular, spectral masking of the light brown eggshells needed to be addressed. This was done using longitudinal visible transmission spectroscopy combined with eggshell colour image analysis. 2. Prior to incubation, colour images of eggs were captured followed by daily measurements of transmission spectra of eggs from days one to nine of incubation. The sex of the eggs was subsequently verified 2 d after hatching. 3. To accurately and sensitively determine sex differences in EGR using light transmission, while minimising interference from eggshell colour and thickness, the ratio of longitudinal transmissions was determined to be most effective at 575 and 610 nm. 3. Embryonic growth was detectable from d 3 (72 h) of incubation, 24 h earlier than previously reported lateral transmission measurements. However, at this time, low blood levels meant that no significant sex-differences (P > 0.05) for the mean T575/T610 ratio were detectable. This may have been due, in part, to spectral masking from the light brown eggshells. At d 7, female embryos had a significantly lower (P < 0.05) mean T575/T610 ratio than males. 4. Although the T575/T610 ratio had low correlations with hatching time and hatch-weight of chicks, this could be a good starting point for further non-destructive investigations for such predictions. 5. In conclusion, the methodology had the sensitivity to differentiate sex-specific early EGR in broiler eggs, even with pigmented eggshells, and has the potential to advance precision hatchery management and poultry research.

Comparing trends of perinatal mortality in two rural areas of Matlab, Bangladesh

The study conducted in a rural sub-district, Matlab, Bangladesh among adolescent motherhood (10-19 years) in the International Centre for Diarrhoeal Disease Research, Bangladesh included total of 4,996 adolescent mothers in the analysis. Chi-square tests and binary logistic regression were used to document adolescent pregnancy trends and the differences in and causes of perinatal death. The fertility rate was 27 per 1000 adolescent mothers in ISA and 20 per 1000 adolescent mothers in GSA, during the 9 year of study period. The adjusted odds of an adolescent mother having a perinatal death in ISA, relative to GSA was 0.69 (95% CI: 0.52 - 0.91, p-value&lt;0.05). Significant determinants of perinatal death among adolescent mothers were: maternal education, paternal education, mothers' age at first birth, asset score and distance from nearest facility. Dr. Rahman will raise the importance of addressing these determinants in designing health policy interventions targeting this specifically vulnerable group.

Bacteriology of Chronic Supporative Otitis Media (CSOM) at a Tertiary Care Hospital, Mymensingh

Chronic suppurative otitis media (CSOM) is a notorious infection in developing countries causing serious local damage and threatening complications. It was a cross sectional observational study to isolate and identify aerobic bacteria and to analyze the susceptibility pattern of the aerobic bacterial isolates. It was carried out from March 2017 to July 2018 in the department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh. Samples were collected from Outpatient of ENT department, MMCH. Out of a total 300 patients with CSOM were enrolled in this study and 209 were culture positive. Among them gram negative organisms were 129(61.72%) and gram positive organisms were 70(33.49%). The most frequently isolated organism in this study was Pseudomonas aeruginosa 72(34.44%), gram positive organisms S. aureus 63(30.14%), E. coli 21(10.04%), other Pseudomonas spp (other than P. aeruginosa) 15(7.17%), mixed bacterial infectios 10(4.78%), Proteus spp 9(4.30%), CoNS 7(3.34%), Klebsiela lspp 7(3.34%), Acinetobactor spp 5(2.39%). P. aeruginosa isolates had least resistant to imipenem and colistin, S. aureus were showed high sensitivity to Vancomycin and Linezolid and E. coli were sensitive to imipenem and amikacin, ciprofloxacin and amikacin respectively. Pseudomonas aeruginosa was the most common bacteria isolated from chronic discharging ears followed by Staphylococcus aureus. Piperacillin-Tazobactum, Ciprofioxacin, Gentamicin and Amikacin were found to be the most suitable drug for Pseudomonas aeruginosa, S. aureus and E. coli. The resistance against ceftriaxone and aztreonam was found to be very high.

Opportunities for gender transformative approaches in a community-based drowning reduction program in Bangladesh

Background

Community-based programs in rural low-and middle-income country settings are well-placed to conduct gender transformative activities that aid program sustainability and catalyse wider social change, such as reducing gender inequities that in turn improve health outcomes. The Anchal program is a drowning prevention intervention for children aged 1–5 years old in rural Bangladesh. It provides community crèche-based supervision delivered by local trained paid-female volunteers. We aimed to identify the influence of the Anchal program on gender norms and behaviours in the community context, and the effects these had on program delivery and men and women’s outcomes.

Methods

Qualitative in-depth interviews, focus group discussions and observations were conducted with program beneficiaries and providers. Gender outcomes were analysed using FHI 360’s Gender Integration Framework.

Results

The Anchal program was found to be a gender accommodating program as it catered for communities’ gender-based roles and constraints but did not actively seek to change underlying beliefs, perceptions and norms that led to these. The program in some cases enhanced the independence and status of female community staff. This changed perceptions of communities towards acceptable levels of physical mobility and community involvement for women. Conversely, gender affected program delivery by reducing the ability of female supervisory staff to engage with male community leaders. The double burden of wage and household labour carried by local female staff also limited performance and progression. Gender-based constraints on staff performance, attrition and community engagement affected efficiency of program delivery and sustainability.

Conclusions

The Anchal program both adapted to and shaped community gender norms and roles. The program has well-established relationships in the community and can be leveraged to implement gender transformative activities to improve gender-based equity. Health programs can broaden their impacts and target social determinants of health like gender equity to increase program sustainability and promote equitable health outcomes.

Isolation and High Throughput Flow Cytometric Apoptosis Assay of Human Neutrophils to Enable Compound Library Screening

The study of human neutrophils in vitro is challenging due to their short half-life and propensity for activation. However, with careful handling and manipulation in the laboratory, they can be a powerful tool to investigate immune responses in health and disease. Here we describe a method for the isolation of human neutrophils from peripheral blood samples, followed by a high-throughput screen to assess the efficacy of a library of compounds in inducing neutrophil apoptosis, which may have therapeutic potential in neutrophil-driven diseases. This protocol is based on previously-published neutrophil isolation methods utilizing Dextran sedimentation of red blood cells followed by the separation of granulocytes with plasma/Percoll discontinuous gradient centrifugation. Yields of ~1 x 10⁶ neutrophils per millilitre of blood, and purities of > 95% neutrophils are typical. Neutrophils are treated with a library of kinase inhibitors, followed by flow cytometry to assess the rate of neutrophil apoptosis. This protocol allows for the high-throughput screening of primary human immune cells to identify compounds with a potential to modify neutrophil function, and could be modified to assess other phenotypes if required.

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Table 1.

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

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

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

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

*Significant difference between the proliferative and membranous groups

Figure 1.

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

Conclusion:

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

Disclosure of Interests:

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

OP0006 ABNORMAL IRON METABOLISM AND MITOCHONDRIAL DYSFUNCTION: INVESTIGATING A NOVEL PATHOLOGICAL MECHANISM IN SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Iron is vital for numerous essential physiological processes including erythropoiesis and energy metabolism (as iron is found in the mitochondrial electron transport chain, the central site of ATP production). Iron homeostasis is tightly controlled by a number of regulators including; 1. Hepcidin, which prevents iron release from stores (under the influence of IL6 and IL1β); 2. Ferritin, an iron storage protein; 3. Lipocalin-2 (LCN2), which is released upon innate immune activation that induces iron sequestration; 4. Transferrin, which binds circulating iron and enables its transport to effector cell targets; 5. Haptoglobin, which binds free haemoglobin and assisting iron recycling; 6. Erythropoietin (EPO), which stimulates erythropoiesis as a result of hypoxia.

Chronic inflammation may result in dysregulation of iron metabolism and in turn impair mitochondrial function yet little is known regarding how these processes change in systemic lupus erythematosus (SLE).

Objectives:

In this study, we investigated how dysregulation of iron metabolism may occur in SLE and subsequently sought to identify how a lack of iron may ultimately induce abnormal mitochondrial function.

Methods:

1. Investigating abnormal iron metabolism in SLE.Serum samples from patients with SLE (n=39) and healthy controls (HC, n=17) were assessed hepcidin, IL-1ß, IL-6, ferritin, LCN2, EPO, haptoglobin and transferrin levels by ELISA. Hierarchical cluster analysis of normalised data (converted to Z-scores) was performed using MeV software in order to characterise patient groups based upon iron metabolism profile. Anti-dsDNA antibody titres, complement C3 levels and SLEDAI-2K were excluded to limit the influence of these variables on cluster analysis. Results were presented as a heatmap.

2. Studying mitochondrial function in iron deficiency and SLE. Peripheral blood mononuclear cells (PBMCs) from HCs and patients with SLE were analysed using Seahorse Respirometry, which measures mitochondrial oxygen consumption rate (a measure of energy metabolism dependent upon oxidative phosphorylation). To assess differences between health, iron deficiency and SLE 3 groups were assessed; 1. PBMCs derived from HCs; 2. PBMCs from patients with SLE; 3. Healthy PBMCs cultured in iron deficient condition, in which cells were treated with the potent iron chelator, Deferiprone.

Results:

Figure 1a demonstrates that four groups were identified following cluster analysis. In spite of excluding markers of disease activity, these groups showed significant differences in SLEDAI-2K (shown in Figure 1b). In summary, patients with more active disease (Groups C and D) showed higher levels of hepcidin (which prevents the release of iron from stores, under the influence of IL-1ß and IL-6) and reduced transferrin thus suggesting that iron is inefficiently transported when compared with those with less active disease (in Groups A and B).

Figure 2a demonstrates that basal mitochondrial respiration is significantly reduced in PBMCs derived from healthy controls when grown in iron deficiency conditions (following treatment with Deferiprone and is lower still in those with SLE. Figure 2b shows that PBMCs from patients with SLE have reduced maximal mitochondrial respiration capacity that is comparable to the levels seen in iron deficient healthy PBMCs.

Conclusion:

Patients with SLE demonstrate abnormalities in iron metabolism that results in cellular iron deficiency as iron is not released from stores, nor adequately transported at the rate required to meet physiological demands. Furthermore, PBMCs derived from patients with SLE who impaired basal and maximal respiration that is comparable with healthy PBMCs treated potent iron chelation. This suggests that abnormal iron metabolism may in turn limit mitochondrial energy metabolism in SLE and represents a potential future therapeutic target.

References:

Nil

Acknowledgments:

Versus Arthritis (Grant No 594143) and LUPUS UK

Disclosure of Interests:

None declared

AB0675 RED CELL DISTRIBUTION WIDTH AND FATIGUE IN AXIAL SPONDYLOARTHRITIS: A SLEEPER SIGNAL

Background:

Fatigue is a ubiquitous feature of autoimmune conditions, and axial Spondyloarthritis (axSpA) is no exception, with over 50% of patients reporting some degree of fatigue1. Erythrocyte size variability (as measured by red cell distribution width (RDW)) has been found to correlate with fatigue in a cohort of systemic lupus erythematous (SLE) patients and may reflect early iron deficiency2. We investigate whether this finding holds true in axSpA.

Objectives:

To investigate the relationships between fatigue, disease activity, and RDW (as a proxy for functional iron deficiency) in patients with axSpA.

Methods:

Cross-sectional analysis performed on patients with axSpA, as defined by the Assessment of SpondyloArthritis international Society (ASAS) criteria, enrolled in a longitudinal data collection study from October 2017 until January 2020 in a single outpatient setting. Patients required a minimum of 1 set of patient-reported outcome measures (PROMs), including the completion of a Functional Assessment of Chronic Fatigue Illness Therapy (FACIT) Fatigue Scale v4 (numerical score between 0–52 with a lower score indicating greater fatigue), and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). C-reactive protein (CRP) as a biochemical marker of disease activity, as well as Haemoglobin (Hb) and RDW performed within 3 months either side of a PROMs set were extracted and matched. Only one pair of matched data was selected per patient according to the least timeframe between a set of PROMs and bloods of interest (if multiple were available). Anaemia was defined according to World Health Organisation criteria, i.e., Hb <120 g/L in females and Hb <130 g/L in males. Non-parametric analysis of variables was performed using Spearman’s rank correlation with significance defined at a p-value <0.05.

Results:

63 patients were included in the analysis (63.5% (40) male, mean time to diagnosis 11.46 (±9.04) years, 79.4% (50) HLA-B27 positive, 46% (29) current or ex-smokers). Blood parameters showed mean Hb of 139.6 (±16.03) g/L, mean RDW of 13.55 (±1.46) %, mean CRP of 5.23 (±10.82) mg/L. Mean BASDAI score of cohort was 3.69 (±2.02) and FACIT score 34.18 (±11.30). Mean absolute interval time difference between a PROMs set and bloods of interest was 16.14 (±41.11) days.

Univariate analysis showed a statistically significant, negative correlation between fatigue (FACIT) and disease activity (BASDAI), (p<0.001; r= -0.63), but failed to demonstrate an association between fatigue and Hb, RDW, or CRP. Sub-group analysis of 51 patients, following exclusion of patients with anaemia (12), engendered a significant and moderately negative correlation between fatigue and RDW (p=0.02, r=-0.32) (Figure 1), maintained a significant correlation between fatigue and BASDAI (p<0.0001, r=-0.56) and showed a non-significant association between RDW and BASDAI (p=0.07, r=0.25).

Figure 1.

Negative correlation between FACIT score and RDW

Conclusion:

These findings suggest that RDW may potentially represent a surrogate marker of disease activity in patients with axSpA. RDW may also be implicated in the multi-faceted aetiology of fatigue in axSpA patients, and may reflect functional iron deficiency. A recent cohort study of axSpA patients found anti-TNF therapy ineffective at alleviating fatigue in nearly 80% of patients1. Management of potential functional iron deficiency as reflected by RDW may offer an alternative treatment target for fatigue in these patients.

References:

[1]Bedaiwi M, Sari I, Thavaneswaran A, et al. J Rheumatol. 2015;42(12):2354.

[2]Wincup C, Parnell S, Cleanthous B, et al. Clin Exp Rheumatol. 2019 Sep-Oct;37(5):852-54.

Disclosure of Interests:

Saion Chatterjee: None declared, Chris Wincup: None declared, Anisur Rahman: None declared, Raj Sengupta Grant/research support from: Research grants from UCB, Pfizer, Abbvie and Novartis, Speakers bureau: Received honoraria for giving talks from Abbvie, Biogen, UCB, Novartis, Pfizer

Impact of Industrial Wastewater Irrigation on Heavy Metal Deposition in Farm Soils of Bhaluka Area, Bangladesh

The study was conducted to determine heavy metal contents in industrial wastewater and contaminated soils of Bhaluka, Mymensingh and to assess their pollution level. A total of 9 industrial wastewater and 12 contaminated farm soil samples were collected directly from the farmers’ fields of Bhaluka area and analysed for this study. Considering EC, salinity and TDS, 56 to 89% wastewater samples were found problematic for long term irrigation. The concentration of CO3, HCO3 and Cl in wastewater ranged from 0.20-1.60, 2.0-11.2 and 1.30-4.79 me L-1, respectively and the content of Ca, Mg, Na and K in wastewater ranged from 16.03-52.10, 4.86-21.87, 101.98-678.90 and 5.59-48.63 mg L-1, respectively. The study results revealed that all wastewater samples were found unsuitable for irrigation in respect of CO3, HCO3 and K. Among the heavy metals studied, Pb, Cd and Fe concentrations in all wastewater samples and Mn content in 5 samples were found above than the acceptable limit for irrigation. The concentration of Zn, Cr, Cu, Pb, Ni, Cd, Mn and Fe in wastewater irrigated soils of Bhaluka industrial area ranged from 50.48 to 448.56, 47.22 to 83.65, 19.13 to 328.23, 42.37 to 77.96, 22.93 to 43.86, 0.70 to 1.40, 161.5 to 341.7 and 38105 to 65399 μg g-1, respectively. Considering geoaccumulation index, the Igeo values for Pb and Cd for all locations of the study area exhibited positive values (0.495< Igeo <1.624), that means Igeo class: 1-2, indicate moderately polluted soil quality. On the other hand, as regards to enrichment factor (EFc), 9 locations for Pb, 5 for Cd, 1 for Zn and 1 for Cu had EFc values > 5.0, indicate contaminated soil quality. The study concluded that industrial wastewater used for irrigation was directly linked with the heavy metals deposition in the farm soils.

Pistacia terebinthus as a dietary supplement for laying hens

The aim of this study was to explore the potential of Pistacia terebinthus (terebinth) seed meal as a dietary supplement for laying hens. One hundred and ninety-two Babcock 30-week-old laying hens were assigned to one of six treatments (n = 32) with four replicates (n = 8). The hens were fed diets containing 0%, 1%, 2%, 3%, 4%, and 5% terebinth seed meal for eight weeks. Weekly egg production, feed consumption, egg weight, and egg mass were recorded. Egg quality was assessed at the beginning, middle and end of the study. Blood sampling was carried out on 12 birds from each treatment. Total antioxidant capacity, total oxidant status and oxidative stress index were determined. Egg production was greater from hens fed 3% and 4% terebinth than those in the other treatments. Egg weight was increased by supplementation with 2% or more terebinth. Feed consumption, feed conversion ratio, eggshell breaking strength, yolk colour, Haugh units, concentrations of glucose, total cholesterol, high density lipoprotein, low density lipoprotein, alanine aminotransferase, aspartate aminotransferase, total protein, phosphorus and calcium in serum, and total antioxidant capacity, total oxidant status, and the oxidative stress index did not differ across treatments. It is concluded that dietary terebinth seed supplementation generated positive effects on egg production and egg weight without adverse effects on egg quality or the metabolism of the hen.Keywords: antioxidant, egg production, egg quality, feed consumption, serum biochemistry

Feasibility of Using a Wearable Biosensor Device in Patients at Risk for Alzheimer's Disease Dementia

BACKGROUND

Alzheimer's disease (AD) is the most common and most costly chronic neurodegenerative disease globally. AD develops over an extended period prior to cognitive symptoms, leaving a "window of opportunity" for targeted risk-reduction interventions. Further, this pre-dementia phase includes early physiological changes in sleep and autonomic regulation, for which wearable biosensor devices may offer a convenient and cost-effective method to assess AD-risk.

METHODS

Patients with a family history of AD and no or minimal cognitive complaints were recruited from the Alzheimer's Prevention Clinic at Weill Cornell Medicine and New York-Presbyterian. Of the 40 consecutive patients screened, 34 (85%) agreed to wear a wearable biosensor device (WHOOP). One subject (2.5%) lost the device prior to data collection. Of the remaining subjects, 24 were classified as normal cognition and were asymptomatic, 6 were classified as subjective cognitive decline, and 3 were amyloid-positive (one with pre-clinical AD, one with pre-clinical Lewy-Body Dementia, and one with mild cognitive impairment due to AD). Sleep-cycle, autonomic (heart rate variability [HRV]) and activity measures were collected via WHOOP. Blood biomarkers and neuropsychological testing sensitive to cognitive changes in pre-clinical AD were obtained. Participants completed surveys assessing their sleep-patterns, exercise habits, and attitudes towards WHOOP. The goal of this prospective observational study was to determine the feasibility of using a wrist-worn biosensor device in patients at-risk for AD dementia. Unsupervised machine learning was performed to first separate participants into distinct phenotypic groups using the multivariate biometric data. Additional statistical analyses were conducted to examine correlations between individual biometric measures and cognitive performance.

RESULTS

27 (81.8%) participants completed the follow-up surveys. Twenty-four participants (88.9%) were satisfied with WHOOP after six months, and twenty-three (85.2%) wanted to continue wearing WHOOP. K-means clustering separated participants into two groups. Group 1 was older, had lower HRV, and spent more time in slow-wave sleep (SWS) than Group 2. Group 1 performed better on two cognitive tests assessing executive function: Flanker Inhibitory Attention/Control (FIAC) (p=.031), and Dimensional Change Card Sort (DCCS) (p=.061). In Group 1, DCCS was correlated with SWS (ρ=.68, p=0.024) and HRV (ρ=.6, p=0.019). In Group 2, DCCS was correlated with HRV (ρ=.55, p=0.018). There were no significant differences in blood biomarkers between the two groups.

CONCLUSIONS

Wearable biosensor devices may be a feasible tool to assess AD-related physiological changes. Longitudinal collection of sleep and HRV data may potentially be a non-invasive method for monitoring cognitive changes related to pre-clinical AD. Further study is warranted in larger populations.

National Clinical Guidance for the Management of Cardiovascular Intervention in the COVID-19 Pandemic: From Bangladesh Society of Cardiovascular Interventions (BSCI)

Since the first recorded case of SARS-CoV-2 in Bangladesh on 8th March 2020, COVID-19 has spread widely through different regions of the country, resulting in a necessity to re-evaluate the delivery of cardiovascular services, particularly procedures pertaining to interventional cardiology in resource-limited settings. Given its robust capacity for human-to-human transmission and potential of being a nosocomial source of infection, the disease has specific implications on healthcare systems and health care professionals faced with performing essential cardiac procedures in patients with a suspected or confirmed diagnosis of COVID-19. The limited resources in terms of cardiac catheterization laboratories that can be designated to treat only COVID positive patients are further compounded by the additional challenges of unavailability of widespread rapid testing on-site at tertiary cardiac hospitals in Bangladesh. This document prepared for our nation by the Bangladesh Society of Cardiovascular Interventions (BSCI) is intended to serve as a clinical practice guideline for cardiovascular health care professionals, with a focus on modifying standard practice of care during the COVID-19 pandemic, in order to ensure continuation of adequate and timely treatment of cardiovascular emergencies avoiding hospital-based transmission of SARS-COV-2 among healthcare professionals and the patients. This is an evolving document based on currently available global data and is tailored to healthcare systems in Bangladesh with particular focus on, but not limited to, invasive cardiology facilities (cardiac catheterization, electrophysiology & pacing labs). This guideline is limited to the provision of cardiovascular care, and it is expected that specific targeted pharmaco-therapeutics against SARS-CoV-2 be prescribed as stipulated by the National Guidelines on Clinical Management of Corona virus Disease 2019 (COVID-19) published by the Director General of Health Services, Ministry of Health and Family Welfare of Bangladesh.

59 A Qualitative Study Evaluating Patient Education in the Pre-Operative Pathway for Elective Hip and Knee Arthroplasty at A Major London Teaching Hospital

Introduction

Rising demands for hip and knee arthroplasty have been met with incremental advancements in both implant design and surgical technique. Despite these advancements in the intraoperative setting, the preoperative pathway has remained largely unchanged. The resulting ineffective demand management and improper patient optimisation through education and engagement, has contributed to long waiting times and increasing surgical cancellations. This has in turn lead to both patient distress and the disruption of clinical workflow.

Aims

This study aimed to investigate the effectiveness of patient education in the pre-operative pathway for elective hip and knee arthroplasty, at Imperial College Healthcare NHS Trust, from the perspective of key clinical stakeholders.

Methods

16 Semi Structured Interviews were conducted with Healthcare professionals (HCPs) along the preoperative pathway. These included GPs, Orthopaedic Surgeons, Nurses, Anaesthetists, Orthogeriatricians, Occupational Therapists and Physiotherapists. Interviews were recorded, transcribed and thematically analysed. Sampling continued until information redundancy was reached.

Results

HCPs stressed that patient education lacked engagement & effectiveness. Whilst joint school (an MDT run seminar) is in place for patients before surgery, it was resource intensive meaning sessions were infrequent and often overcrowded.

Furthermore, not all patients were invited/attended joint school as a result of problems with scheduling and transport. Of those whom did, information retention was identified as a problem, highlighted by patients not bringing in medication, and failing to follow fasting instructions, leading to cancellations on the day of surgery. A significant proportion of elderly patients also needed additional and continued support in understanding and interpreting information, a key issue that was not addressed by traditional joint school.

Conclusions

This study has provided a more in-depth analysis of patient education in the pre-operative pathway revealing inadequate tailoring, and delivery of education material particularly for the older patient. Both timing, content and frequency of patient education could be improved in order to improve quality of care and reduce cancellations in turn improving the management of demand for orthopaedic services. Future studies may want to evaluate the use of digital technology in this area of the pathway in efforts to overcome these issues.

Diverse biological processes coordinate the transcriptional response to nutritional changes in a Drosophila melanogaster multiparent population

Background

Environmental variation in the amount of resources available to populations challenge individuals to optimize the allocation of those resources to key fitness functions. This coordination of resource allocation relative to resource availability is commonly attributed to key nutrient sensing gene pathways in laboratory model organisms, chiefly the insulin/TOR signaling pathway. However, the genetic basis of diet-induced variation in gene expression is less clear.

Results

To describe the natural genetic variation underlying nutrient-dependent differences, we used an outbred panel derived from a multiparental population, the Drosophila Synthetic Population Resource. We analyzed RNA sequence data from multiple female tissue samples dissected from flies reared in three nutritional conditions: high sugar (HS), dietary restriction (DR), and control (C) diets. A large proportion of genes in the experiment (19.6% or 2471 genes) were significantly differentially expressed for the effect of diet, and 7.8% (978 genes) for the effect of the interaction between diet and tissue type (LRT, P_adj. < 0.05). Interestingly, we observed similar patterns of gene expression relative to the C diet, in the DR and HS treated flies, a response likely reflecting diet component ratios. Hierarchical clustering identified 21 robust gene modules showing intra-modularly similar patterns of expression across diets, all of which were highly significant for diet or diet-tissue interaction effects (FDR P_adj. < 0.05). Gene set enrichment analysis for different diet-tissue combinations revealed a diverse set of pathways and gene ontology (GO) terms (two-sample t-test, FDR < 0.05). GO analysis on individual co-expressed modules likewise showed a large number of terms encompassing many cellular and nuclear processes (Fisher exact test, P_adj. < 0.01). Although a handful of genes in the IIS/TOR pathway including Ilp5, Rheb, and Sirt2 showed significant elevation in expression, many key genes such as InR, chico, most insulin peptide genes, and the nutrient-sensing pathways were not observed.

Conclusions

Our results suggest that a more diverse network of pathways and gene networks mediate the diet response in our population. These results have important implications for future studies focusing on diet responses in natural populations.