Effect of prophylactic granulocyte-colony stimulating factor (G-CSF) on acute hematological toxicity in medulloblastoma patients during craniospinal irradiation (CSI)

OBJECTIVES

Haematological toxicity and treatment breaks are common during cranio-spinal irradiation (CSI) due to irradiation of large volume of bone marrow. We conducted this study to see the effect of prophylactic granulocyte colony stimulating factor (GCSF) in reducing treatment breaks.

PATIENTS AND METHODS

The study was conducted over a period of 15 months from August 2017 to November 2018. Histopathologically proven Medulloblastoma patients received prophylactic GCSF during CSI. Acute hematological toxicities and treatment breaks were noted and effect of age and pretreatment blood counts were analyzed by SPSS (Statistical Package for Social Sciences) version 23.

RESULTS

A total of 28 patients were included in the study. During CSI, hematological toxicity leading to treatment breaks was observed in 11 (39.3 %) patients, of which grade 3 and 2 toxicities were seen in ten and one patients respectively. Younger age (<10 years) at diagnosis was significantly associated with the development of hematological toxicity (p = 0.028, Chi-Square). No correlation was found with pre-treatment blood counts.

CONCLUSION

Prophylactic use of GCSF may be effective in preventing radiation induced hematological toxicity and treatment breaks.

Abstract 206: Descriptive Analysis of Patients Undergoing Percutaneous Coronary Interventions in India

Background: Patterns of percutaneous coronary intervention (PCI) use in economically disadvantaged patients are largely unknown in India. Yet it is important to understand PCI use given its increasing availability and the growth of social insurance programs. Leveraging a unique registry in Maharashtra from 2015 and 2016, we set out to evaluate how to collect data on PCI use in patients within a state-wide government funded health insurance scheme, the Rajiv Gandhi Jeevandayee Aarogya Yojana (RGJAY). RGJAY covers full costs for the procedure for eligible patients with an annual household income less than 100,000 rupees.

Methods: Our registry collected detailed patient and procedural information on patients 18 years and older undergoing a PCI at one of 473 empaneled hospitals. Research coordinators obtained telephonic consent from the patients to participate in the study. Standardized forms were used to abstract data from electronic medical records that were uploaded onto a centralized database managed by the Department of Health and Family Welfare of the Government of Maharashtra. The coordinators followed up with participants at one-year with an additional telephonic survey. Patients with missing demographic and clinical data were excluded from this analysis (n=52). We report descriptive statistics, focusing on risk factors as well as the indication for PCI.

Results: We included a total of 1829 PCI procedures from 34 public and 175 private hospitals that provided cardiology services. Mean age was 57.5 (SD, 10.5) and 28% were women. Nearly half of patients had no or primary school education only, and fewer than 40% were employed. Table 1 lists full descriptive statistics including risk factors. Importantly, 30% of PCIs were for chronic stable angina (in contrast to ~20% in US registries). Limited data were available on symptom burden, additional anti-anginal therapies, and ischemia evaluations prior to PCI. Overall mortality at 1-year follow-up was 4.3%.

Conclusion: Data on PCI use in patients from lower income-backgrounds covered by social insurance programs can be collected but with limitations that make it challenging to assess quality and appropriateness. Our findings have implications for the recent roll-out of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).

Abstract 226: Association Between Sleep Duration and Mediterranean Diet Score in Costa Rica

Background: Short and long sleep are risk factors for coronary artery disease. One of the mechanistic pathways is likely through diet. While many studies have examined associations between sleep and individual dietary components, few have examined diet patterns. We hypothesized that those with short sleep (< 7 hours/night) and long sleep (>9 hours/night) would have lower adherence to the Mediterranean diet. We also examined the effect of social jetlag, that is, a difference in the sleep duration between weekdays and weekends, on the Mediterranean diet.

Methods: Participants in this study are population based-controls that were recruited for a case-control study on myocardial infarction and matched by sex, age and area of residence. Study participants (1600 men and 569 women) were recruited randomly using data from the National Census and Statistics Bureau of Costa Rica between 1994 and 2004 and therefore are representative of the Costa Rican population within matching strata. Sleep and napping patterns were self-reported by the participants. Social jetlag was defined as a ≥ 1-hour difference in sleep duration from weekdays to weekends. Validated food frequency questionnaires, detailed socio-demographic, medical history and physical activity questionnaires were administered. Alternative Mediterranean Diet (AMED) scores were calculated based on the consumption of vegetables, fruits, whole grains, nuts, legumes, fish, red and processed meat, alcohol and monounsaturated fat-to-saturated fat ratios. We used adjusted linear regression models stratified by sex to study the association between sleep duration, social jetlag and AMED score.

Results: Men and women with short sleep tended to be younger, more educated, non-smokers, diabetic and have lower physical activity compared to those getting optimal hours (≥ 7 and ≤ 9 hours/night) of sleep. Among women, short sleep on weekdays was significantly associated with having a lower AMED score when compared to those with optimal hours of sleep. This association remained unchanged after adjusting for confounders including age, area of residence, education, napping frequency, caffeine intake, smoking status, physical activity and diagnosis of type 2 diabetes mellitus and hypertension (ß, -0.41 and CI, -0.69 to -0.13). Women with short sleep had a lower intake of vegetables, fruits, and legumes that contributed to their lower AMED score. There were about 20% of men and women with social jetlag. Social jetlag was associated with lower AMED scores, but it was not statistically significant amongst men (p=0.08) or women (p=0.15) after adjusting for confounders.

Conclusions: Short sleep is associated with lower adherence to a Mediterranean diet amongst women in Costa Rica. The lack of an association amongst men might imply different biological pathways and residual confounding by lifestyle factors that drive food consumption in men as compared to women.

Are we teaching our students visual communication? Evaluation of writing assignments in public health

Visuals are an important means through which public health data can be communicated to diverse audiences, yet many public health students are not trained to develop effective visuals. We evaluated writing assignments from courses taught in public health schools and programmes accredited by the Council on Education for Public Health during the 2016-2017 academic year to identify whether they mentioned a visual element, whether the assignment explained how to create the visual, and if the visual element was worth points. Only 13 of 44 writing assignments mentioned a visual element and only two provided some instructions about how to create the visual element(s). Five assignments awarded points for visual elements. The lack of emphasis on visual elements in writing assignments is significant since visual communication is a key skill needed by practitioners to accompany writing to convey important public health information. Visual communication requires a critical thinking process and therefore time to develop the skills to create effective visuals is necessary. Thus, there is a crucial need for dedicated instruction for public health students to establish competence in visual communication.

Borrelia and Chlamydia Can Form Mixed Biofilms in Infected Human Skin Tissues

Our research group has recently shown that Borrelia burgdorferi, the Lyme disease bacterium, is capable of forming biofilms in Borrelia-infected human skin lesions called Borrelia lymphocytoma (BL). Biofilm structures often contain multiple organisms in a symbiotic relationship, with the goal of providing shelter from environmental stressors such as antimicrobial agents. Because multiple co-infections are common in Lyme disease, the main questions of this study were whether BL tissues contained other pathogenic species and/or whether there is any co-existence with Borrelia biofilms. Recent reports suggested Chlamydia-like organisms in ticks and Borrelia-infected human skin tissues; therefore, Chlamydia-specific polymerase chain reaction (PCR) analyses were performed in Borrelia-positive BL tissues. Analyses of the sequence of the positive PCR bands revealed that Chlamydia spp. DNAs are indeed present in these tissues, and their sequences have the best identity match to Chlamydophila pneumoniae and Chlamydia trachomatis. Fluorescent immunohistochemical and in situ hybridization methods demonstrated the presence of Chlamydia antigen and DNA in 84% of Borrelia biofilms. Confocal microscopy revealed that Chlamydia locates in the center of Borrelia biofilms, and together, they form a well-organized mixed pathogenic structure. In summary, our study is the first to show Borrelia-Chlamydia mixed biofilms in infected human skin tissues, which raises the questions of whether these human pathogens have developed a symbiotic relationship for their mutual survival.

Clinical and laboratory profile of anti-M

Anti-M is a frequently detected naturally occurring antibody that has been reported in various clinical settings and also in voluntary donors. We describe here the clinical and laboratory findings of 11 cases with anti-M detected at our center. This report is a retrospective study in which we reviewed our immunohematology laboratory records for cases involving anti-M. Both donor and patient data from a 28-month period (September 2014 to December 2016) were reviewed. During this period, 11 examples of anti-M were detected (8 patients, 1 voluntary whole blood donor, and 1 hematopoietic stem cell donor. Anti-M was also detected in one external quality assessment scheme sample received during this period. In conclusion, anti-M can be detected in various clinical settings. This antibody can be clinically significant; in the laboratory, it can present as a serologic problem such as an ABO group discrepancy or an incompatible crossmatch. After detection, management and course of action is determined by both the antibody characteristics and the clinical setting. Anti-M is a frequently detected naturally occurring antibody that has been reported in various clinical settings and also in voluntary donors. We describe here the clinical and laboratory findings of 11 cases with anti-M detected at our center. This report is a retrospective study in which we reviewed our immunohematology laboratory records for cases involving anti-M. Both donor and patient data from a 28-month period (September 2014 to December 2016) were reviewed. During this period, 11 examples of anti-M were detected (8 patients, 1 voluntary whole blood donor, and 1 hematopoietic stem cell donor. Anti-M was also detected in one external quality assessment scheme sample received during this period. In conclusion, anti-M can be detected in various clinical settings. This antibody can be clinically significant; in the laboratory, it can present as a serologic problem such as an ABO group discrepancy or an incompatible crossmatch. After detection, management and course of action is determined by both the antibody characteristics and the clinical setting.

Global feedforward active noise control in vibro-acoustic cavities without increasing structural vibrations

Interior noise in vibro-acoustic cavities may be generated due to acoustic and structural disturbances. Earlier studies have shown that for global control, the maximum reduction in acoustic potential energy can be realised by using an optimum combination of acoustic and structural actuators. However, it is observed that this reduction in interior noise may also be accompanied with an increase in kinetic energy of the cavity structure. This paper presents the development of a feedforward technique for active noise control in vibro-acoustic cavities ensuring that the noise reduction does not lead to an increase in kinetic energy. The problem is formulated as a constrained minimisation problem to minimise the acoustic potential energy subject to a constraint that the kinetic energy does not increase. Through a numerical study, it is shown that the optimum solution of the above problem indeed is favourable in terms of reduction in acoustic potential energy in the cavity and kinetic energy of the structure. The paper further proposes a method for solution of this constrained minimisation problem using a penalty function method and solution of sequential unconstrained problems. The proposed method is validated through a numerical study on a car-like cavity for single- and multi-tonal noise.

Iontophoresis and topical application of 8% arginine-calcium carbonate to treat dentinal hypersensitivity

Aim and objectives

The aim and the objectives were. (1) to assess the efficacy of a desensitizing toothpaste containing 8.0% arginine-calcium carbonate (Colgate® Sensitive Pro-Relief™), (2) to assess the efficacy of a desensitizing toothpaste containing 8.0% arginine-calcium carbonate (Colgate® Sensitive Pro-Relief™) used in combination with iontophoresis, and (3) to compare the effectiveness of the above methods.

Subjects and Methods

Two groups of 40 patients each having dentinal hypersensitivity were treated using 8% proarginine and iontophoresis. The patients were recalled after 1, 2, and 4 weeks. The scores were tabulated and the results were analyzed using SPSS statistical software.

Results

Visual analog scale between the two groups showed a significant difference from the 1^st week till the 4^th week. ANOVA values showed the reduction in the dentinal hypersensitivity in Group 2 using the iontophoresis along with the 8.0% arginine-calcium carbonate toothpaste. The Cochran-Mantel-Haenszel correlation test of the Schiff's dentinal hypersensitivity cross-tabulation showed P < 0.001 which was statistically significant reduction after the 4^th week following the application of 8.0% arginine-calcium carbonate along with iontophoresis.

Conclusion

Iontophoresis, when used along with Colgate® Sensitive Pro-Relief™ toothpaste, can provide additional benefit as this provides a better sealing effect.

Tunica vaginalis flap for salvaging testicular torsion: A matched cohort analysis

INTRODUCTION

In testicular torsion, ischemia time from pain onset impacts testicular salvage. A tunica albuginea fasciotomy to relieve compartment pressure followed by a tunica vaginalis flap (TVF) may enhance salvage.

OBJECTIVE

To define the optimal window of ischemia time during which TVF may be most beneficial to avoid orchiectomy.

STUDY DESIGN

A retrospective cohort study of males presenting with testicular torsion at a single tertiary-care institution from January, 2003 to March, 2017. Ischemia time was defined as duration of pain from onset to surgery. Because TVF would be an option to orchiectomy, and it was found that ischemia time was longer in testicles that underwent orchiectomy, matching was performed. Cases of torsion treated with TVF were matched 1:1 with cases treated with orchiectomy on age at surgery, and ischemia time. Outcomes included postoperative viability, defined as palpable testicular tissue with normal consistency, and atrophy, defined as palpable decrease in size relative to contralateral testicle. Sensitivity analyses were performed restricting to the subgroups with postoperative ultrasound, >6 months' follow-up, and additionally matching for degrees of twist.

RESULTS

A total of 182 patients met eligibility criteria, of whom 49, 36, and 97 underwent orchiectomy, TVF, and septopexy alone, respectively. Median follow-up was 2.7 months; 26% of patients had postoperative ultrasound (61% of TVF group). In the orchiectomy, TVF, and septopexy groups, respectively, median ischemia times were 51, 11, and 8 h, postoperative viability rates were 0, 86, and 95%, and postoperative atrophy rates were 0, 68, and 24%. After matching, 32 patients with TVF were matched to 32 patients who underwent orchiectomy. In the TVF group, postoperative viability occurred in 95% (19/20) vs 67% (8/12) of patients with ischemia times ≤24 and >24 h, respectively. Atrophy occurred in 67% (12/18) vs 83% (10/12) of these same respective patients. Sensitivity analysis by ultrasound and longer follow-up found similar viability results, although atrophy rates were higher. Additional matching for degrees of twist showed lower viability and higher atrophy rates for increasing ischemia times.

DISCUSSION

Patients who presented with testicular torsion with ischemia times ≤24 h and who were being considered for orchiectomy may have benefitted most from TVF, albeit at high risk of atrophy. However, for ischemia times >24 h, TVF may still have preserved testicular viability in two-thirds of cases. A limitation was short follow-up.

CONCLUSION

A TVF was a valid alternative to orchiectomy for torsed testicles, albeit with high testicular atrophy rates.