Search for Subsolar-Mass Binaries in the First Half of Advanced LIGO's and Advanced Virgo's Third Observing Run

We report on a search for compact binary coalescences where at least one binary component has a mass between 0.2  M_{⊙} and 1.0  M_{⊙} in Advanced LIGO and Advanced Virgo data collected between 1 April 2019 1500 UTC and 1 October 2019 1500 UTC. We extend our previous analyses in two main ways: we include data from the Virgo detector and we allow for more unequal mass systems, with mass ratio q≥0.1. We do not report any gravitational-wave candidates. The most significant trigger has a false alarm rate of 0.14  yr^{-1}. This implies an upper limit on the merger rate of subsolar binaries in the range [220-24200]  Gpc^{-3} yr^{-1}, depending on the chirp mass of the binary. We use this upper limit to derive astrophysical constraints on two phenomenological models that could produce subsolar-mass compact objects. One is an isotropic distribution of equal-mass primordial black holes. Using this model, we find that the fraction of dark matter in primordial black holes in the mass range 0.2  M_{⊙}<m_{PBH}<1.0  M_{⊙} is f_{PBH}≡Ω_{PBH}/Ω_{DM}≲6%. This improves existing constraints on primordial black hole abundance by a factor of ∼3. The other is a dissipative dark matter model, in which fermionic dark matter can collapse and form black holes. The upper limit on the fraction of dark matter black holes depends on the minimum mass of the black holes that can be formed: the most constraining result is obtained at M_{min}=1  M_{⊙}, where f_{DBH}≡Ω_{DBH}/Ω_{DM}≲0.003%. These are the first constraints placed on dissipative dark models by subsolar-mass analyses.

Scintillation light detection in the 6-m drift-length ProtoDUNE Dual Phase liquid argon TPC

DUNE is a dual-site experiment for long-baseline neutrino oscillation studies, neutrino astrophysics and nucleon decay searches. ProtoDUNE Dual Phase (DP) is a 6  ×  6  ×  6 m3 liquid argon time-projection-chamber (LArTPC) that recorded cosmic-muon data at the CERN Neutrino Platform in 2019-2020 as a prototype of the DUNE Far Detector. Charged particles propagating through the LArTPC produce ionization and scintillation light. The scintillation light signal in these detectors can provide the trigger for non-beam events. In addition, it adds precise timing capabilities and improves the calorimetry measurements. In ProtoDUNE-DP, scintillation and electroluminescence light produced by cosmic muons in the LArTPC is collected by photomultiplier tubes placed up to 7 m away from the ionizing track. In this paper, the ProtoDUNE-DP photon detection system performance is evaluated with a particular focus on the different wavelength shifters, such as PEN and TPB, and the use of Xe-doped LAr, considering its future use in giant LArTPCs. The scintillation light production and propagation processes are analyzed and a comparison of simulation to data is performed, improving understanding of the liquid argon properties.

P-394 Peripheral and uterine natural killer cell cut-off levels and their correlation in fertile controls and women with unexplained recurrent implantation failure (RIF)

Study question

What is cut-off value for peripheral and uterine natural killer (pNK, uNK) cells and any correlation between them in fertile and RIF women?

Summary answer

Cut-off values were 7% for uNK and 11.6% for pNK in fertile controls. No significant correlation observed among fertile and infertile women with RIF.

What is known already

Association of uNK and pNK cells with infertility is debatable. It is not clear whether measuring NK cell levels in RIF has a role. pNk cell levels however has been used in various studies to guide the need of immunotherapy in RIF women. Definition of normal range of uNK cell numbers has also not been stated clearly because of lack of standardised protocol. Literature reveals the cut off values for pNk cells to be 12% or 18% and for uNK cells between 5-12.9%. Correlation between uNK and pNK cells in fertile or RIF women has not been studied earlier.

Study design, size, duration

A prospective study was conducted at ART Centre, Department of Obstetrics and Gynecology at tertiary care institute during a period from January 2019 to January 2021. Thirty women with RIF and fifty fertile controls with age &lt;35 years having regular menstrual cycles and no hormonal treatment in last 3 months were enrolled in the study for uNK and pNK cell testing. The permission was obtained from the Institute Ethics Committee.

Participants/materials, setting, methods

Subjects included women with RIF with age 20-35 years, tubal and unexplained factors, normal ovarian reserve, normal karyotype and normal uterine cavity. In both subjects and controls, midluteal endometrial biopsy sample was taken for Immunohistochemistry staining of CD 56+ cells to determine uNK cells. Peripheral venous blood was also obtained at the time of biopsy for flow cytometry in peripheral blood mononuclear cells to determine pNK cells. Cut off values were derived from fertile controls.

Main results and the role of chance

The mean age and BMI were comparable between fertile control and study group(29.45±3.3 vs 31.17±3.3 years, 22.97±1.89 vs 23.21±2.2 kg/m2; p-value &gt;0.05). The control group had median value of 7% for uNK cell levels and 11.6% for pNK cell levels. In RIF subjects, the median value for uNK cells was 13.5% and even though higher compared to controls it was not statistically significant(p-value &gt;0.05) . The median pNK values were comparable among controls and RIF group (11.6% vs. 12%). All RIF subjects did not have elevated NK cell levels. 18 (60%) subjects had elevated uNK cell levels (more than 7%) whereas 40% had below the reference value. pNK cells were also elevated in only 53.3% of subject population. There was positive correlation found between uNK and pNK cell levels in RIF subjects, however it was not statistically significant (r 0.312, p-value 0.09). In fertile controls, there was insignificant negative correlation between uNK and pNK cell levels (r -0.231, p-value 0.33).

Limitations, reasons for caution

The small sample size is the foremost limitation of study.

Wider implications of the findings

uNK cell testing may be worthwhile in women with unexplained RIF so as to guide immunotherapy to improve pregnancy outcomes. As no significant correlation has been found between pNK and uNK cells in fertile and RIF women, pNK cell testing in RIF women may be done with caution.

Trial registration number

Not Applicable

Spatiotemporal representativeness of air pollution monitoring in Dublin, Ireland

The importance of selecting appropriate air pollution monitoring sites in a city is vital for accurately reporting air quality, enhancing the quality of high-resolution modelling and informing policy to implement measures to deliver cleaner air in the urban environment. COVID-19 restrictions impacted air quality in urban centres worldwide as reduced mobility led to changes in traffic-related air pollution (TRAP). As such, it offered a unique dataset to examine the spatial and temporal variations in air quality between monitoring stations in Dublin, Ireland. Firstly, an analysis of mobility data showed reductions across almost all sectors after COVID-19 restrictions came into place, which was expected to lower TRAP. In addition, similar changes in air quality were evident to other cities around the world: reductions in fine particulate matter (PM_2.5) and nitrogen dioxide (NO₂) concentrations and an increase in ozone (O₃) concentrations. Average daily and diurnal concentrations for these three pollutants presented more statistically significant spatial and temporal changes during COVID-19 restrictions at monitoring sites with urban or traffic classifications than suburban background sites. Furthermore, substantial reductions in the range of average hourly pollutant concentrations were observed, 79% for PM_2.5 and 75% for NO₂, with a modest 24% reduction for O₃. Correlation analysis of air pollution between monitoring sites and years demonstrated an improvement in the R² for NO₂ concentrations only, suggesting that spatiotemporal homogeneity was most notable for this TRAP due to mobility restrictions during COVID-19. The spatiotemporal representativeness of monitoring stations across the city will change with greener transport, and air quality during COVID-19 can provide a benchmark to support the introduction of new policies for cleaner air.

Bioreducible polyethylenimine core-shell nanostructures as efficient and non-toxic gene and drug delivery vectors

Low molecular weight branched polyethylenimine (LMW bPEIs 1.8 kDa) have received considerable attention for the fabrication of nucleic acid carriers due to their biocompatible and non-toxic nature. However, due to the inadequate nucleic acid complexation ability and transportation across the cell membrane, these show poor transfection efficacy, limiting their clinical applications. Therefore, to overcome these challenges, in this study, we have grafted bPEI 1.8 kDa with a disulfide bond containing hydrophobic moiety, 3-(2-pyridyldithio) propionic acid (PDPA), via amide linkages through EDC/NHS-mediated coupling to obtain N-[3-(2-pyridyldithio)] propionoyl polyethylenimine (PDPP) conjugates. The best formulation for nucleic acid transfection was evaluated after preparing a series of PDPP conjugates by varying the amount of PDPA. In an aqueous environment, these PDPP conjugates self-assembled to form spherical shaped core-shell PDPP nanostructures with size ranging from ∼188-307 nm and zeta-potential from ∼ +3 to +19 mV. The positively charged surface of the core-shell nanocomposites helps in the binding of plasmid DNA (pDNA), its transportation inside the cell, and protection against enzymes. Evaluation of PDPP/pDNA complexes on mammalian cells revealed that all these complexes showed significantly improved transfection efficacy without hampering cytocompatibility. Amongst all, the pDNA complex of PDPP-2 exhibited the best transfection efficiency (i.e. >6-fold) in comparison to pDNA complex of the native bPEI. The nanocomposites exhibited the redox responsive behavior advantageous for therapeutic delivery to the tumor cells. The core of the nanostructures facilitate the encapsulation of a hydrophobic model drug, ornidazole. In vitro drug release analysis showed a faster release rate in response to a reductant mimicking the cellular environment. Altogether, these nanostructures have great potential to co-deliver both drug and gene simultaneously in response to tumor cell reductive microenvironment in vitro and could be used as the next-generation delivery system.

POS1275 A RETROSPECTIVE STUDY ON UVEITIS FLARES FOLLOWING COVID19 VACCINATION: SHARING EXPERIENCE FROM A TEACHING HOSPITAL COMBINED RHEUMATOLOGY AND UVEITIS CLINIC

Background

Uveitis is a sight threatening disease caused by inflammation of the uveal tract of the eye. Uveitis is a manifestation of many autoimmune conditions and is associated with seronegative axial spondyloarthritis, reactive arthritis, Behçet’s disease, inflammatory bowel disease, and psoriatic arthritis. Acute anterior uveitis is the most common presentation and is most commonly idiopathic or associated with the HLA-B27 gene (around 20% of cases). Studies have shown that anterior uveitis frequently recurs in patients after it has previously remitted. (1) Patients suffering from autoimmune conditions are frequently prescribed immunosuppressant drugs to control their illness, thus leaving them more susceptible to bacterial and viral illnesses including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Previous studies have shown that some patients suffer exacerbation of their autoimmune condition after coronavirus vaccination, including uveitis(2). We aim to evaluate our cohort of patients suffering from autoimmune conditions treated at Leicester Uveitis Service at Leicester Royal Infirmary and explore any proposed link.

Objectives

To assess if COVID19 vaccination is associated with uveitis flares in immunosuppressed patients.

Methods

A retrospective study, to determine if patients diagnosed with autoimmune conditions suffered from uveitis following COVID-19 vaccination. A data collection sheet was used to document demographic and clinical data: age, sex, ethnicity, autoimmune condition, dates of COVID-19 vaccination(s), type of vaccine, medication at the time of vaccine, symptoms of autoimmune recurrence, date of uveitis onset and number of days between uveitis onset and latest vaccine. We used an already existing uveitis database with an active register of 2346 patients, of which 246 were on immunomodulation.

Results

After reviewing the first 50 patients on immunosuppression for uveitis, we found a total of 4 patients had a uveitis flare despite tight control previously; 3 are female and 1 male, their median age was 39.5 years. They experienced a recurrence of uveitis in the last 6 months. Of these 4 patients 3 were on synthetic DMARDS (2 mycophenolate mofetil, 1 azathioprine), 1 was on steroids and 1 was on a biological DMARD (adalimumab). 2 of the patients suffered from posterior uveitis and 2 from anterior uveitis. All the 50 patients had been vaccinated against COVID19 however there was no clear record of booster dose.

Conclusion

Our study showed that of 50 immunosuppressed patients, 4 had a uveitis flare following vaccination. Clinicians need to be aware of uvetis flares in rheumatology patients following vaccination. This is a small retrospective analysis of our cohort however a large observational study on flare of uveitis following COVID-19 primary vaccination and booster vaccination would be useful to get meaningful data.

References

[1]Grunwald L, Newcomb CW, Daniel E, Kaçmaz RO, Jabs DA, Levy-Clarke GA, Nussenblatt RB, Rosenbaum JT, Suhler EB, Thorne JE, Foster CS, Kempen JH; Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Risk of relapse in primary acute anterior uveitis. Ophthalmology. 2011 Oct;118(10):1911-5. doi: 10.1016/j.ophtha.2011.02.044. Epub 2011 Jun 16. PMID: 21680024; PMCID: PMC3179829.

[2]Bolletta E, Iannetta D, Mastrofilippo V, De Simone L, Gozzi F, Croci S, Bonacini M, Belloni L, Zerbini A, Adani C, Fontana L, Salvarani C, Cimino L. Uveitis and Other Ocular Complications Following COVID-19 Vaccination. J Clin Med. 2021 Dec 19;10(24):5960. doi: 10.3390/jcm10245960. PMID: 34945256; PMCID: PMC8704915.

Disclosure of Interests

None declared

AB0038 DUAL TARGETING PEPTIDE RLS-0071 REDUCES AND INHIBITS MYELOPEROXIDASE (MPO) IN HEALTHY HUMAN VOLUNTEER

Background

RLS-0071-101 was a first in human clinical trial to evaluate safety of the peptide RLS-0071 in healthy volunteers in a single ascending dose and multiple ascending dose format. RLS-0071, previously referred to as Peptide Inhibitor of Complement C1 (PIC1) is a dual-targeting peptide being developed for clinical use to moderate humoral and cellular inflammation via inhibition of complement activation and neutrophil effectors including myeloperoxidase (MPO) and Neutrophil extracellular trap formation (NETosis).1,2 Humans that are otherwise asymptomatic are considered at risk for cardiovascular complications if they have a plasma MPO level of > 420 pmol.3 A post hoc analysis of plasma samples from subjects participating in RLS-0071-101 identified an individual with mildly elevated baseline MPO level (142 pmol/L).

Objectives

Evaluate if RLS-0071 dosing would change MPO level or activity in a subject with elevated baseline MPO.

Methods

Frozen plasma samples prepared from blood collected by venipunture into K2EDTA tubes (BD) was utilized to determine MPO quantity and activity levels. MPO quantity in the plasma was analyzed using a human MPO ELISA kit (BMS2038INST, Invitrogen) and MPO activity within the plasma was analyzed using a fluorescence-based myeloperoxidase assay kit (K745-100, BioVision).

Results

Upon screening 54 subjects from RLS-0071-101 we identified one individual with a mildly elevated MPO level at baseline, a 21-year-old white female with BMI of 21.7. The subject received 9 intravenous infusions of RLS-0071 each at a dose of 10 mg/kg. Her vital signs and body temperature remained normal throughout the study and the only blood laboratory abnormality were a mildly low plasma protein concentration of Day 2 and Day 4 which was noted both among recipients of the peptide and placebo subjects. Analysis of MPO blood concentrations demonstrated a mildly elevated baseline plasma MPO concentration that decreased after multiple doses of RLS-0071 with partial recovery to baseline 24 hours after cessation of dosing. MPO activity analyzed using a fluorescence-based myeloperoxidase assay kit demonstrated an elevated baseline plasma MPO activity level that decreased after multiple doses of RLS-0071 with partial recovery after 24 hours.

Conclusion

These results suggest promise for RLS-0071 to reversibly moderate plasma MPO activity and potentially affect MPO-mediated diseases including acute coronary syndrome (ACS), atheromatous plaque vulnerability and auto immune conditions.4,5,6,7.

References

[1]Sharp, Julia A., et al. “Peptide inhibitor of complement c1, a novel suppressor of classical pathway activation: mechanistic studies and clinical potential.” Frontiers in immunology 5 (2014): 406.

[2]Hair, Pamela S., et al. “Inhibition of myeloperoxidase activity in cystic fibrosis sputum by peptide inhibitor of complement C1 (PIC1).” PLoS One 12.1 (2017): e0170203.

[3]Tang WH, Wu Y, Nicholls SJ, Hazen SL. Plasma myeloperoxidase predicts incident cardiovascular risks in stable patients undergoing medical management for coronary artery disease. Clin Chem. 2011;57(1):33-9.

[4]Malle, E.; Marsche, G.; Panzenboeck, U.; Sattler, W. Myeloperoxidase-mediated oxidation of high-density lipoproteins: Fingerprints of newly recognized potential proatherogenic lipoproteins. Arch. Biochem. Biophys., 2006, 445 (2), 245-255.

[5]Nurcombe, H. L.; Bucknall, R. C.; Edwards, S. W. Activation of the neutrophil myeloperoxidase-H2O2 system by synovial fluid isolated from patients with rheumatoid arthritis. Ann. Rheum. Dis., 1991, 50 (4), 237-242

[6]Malle, E.; Buch, T.; Grone, H. J. Myeloperoxidase in kidney disease. Kidney Int., 2003, 64 (6), 1956-1967.

[7]Nicholls, S. J.; Hazen, S. L. Myeloperoxidase and cardiovascular disease. Arterioscler., Thromb., Vasc. Biol., 2005, 25 (6), 1102- 1111.

Disclosure of Interests

Parvathi Kumar Shareholder of: I have stock options available, Consultant of: Served as a consultant for ReAlta life Sciences INC from April- July 2020, Employee of: I am employed by ReAlta Life Sciences, Kenji Cunnion Shareholder of: Shareholder of ReAlta life sciences, Employee of: ReAlta Life Sciences, Neel Krishna Employee of: I am an employee of ReAlta Life Sciences., Ulrich Thienel Shareholder of: Shareholder of ReAlta and JNJ, Employee of: ReAlta Life Sciences, Pamela Hair Employee of: ReAlta Life Sciences, Jessica Goss Employee of: ReAlta Life Sciences, Christos Gabriel: None declared

AB1501 EFFECT OF SARS-COV-19 PANDEMIC ON RHEUMATOLOGY TRAINING IN INDIA

Background

The current study aims to gauge the magnitude of the effect the pandemic has had on Rheumatology training (including the effect on clinical, academic and research training) in India, their physical, mental and social wellbeing during the pandemic and the perceived changes in Rheumatology training and care during the pandemic from the trainee’s view

Objectives

1.To asses the Impact of COVID-19 Pandemic on the training of Rheumatology Residents (DM, DNB and Fellows)

2.Understand the issues faced by trainees and the extent of affection.

Methods

Study design: We conducted an observational cross-sectional study using an online survey sent to rheumatology trainees in India.

Sample: Convenience sampling was used, so the sample size was not calculated.

Inclusion and exclusion criteria: Rheumatology trainees from India including DM/DNB residents and fellows with the ability and desire to complete the survey were included.

Data collection and instruments: The link to the survey was sent to the rheumatology trainees through social media platforms like WhatsApp, Telegram and email.

Statistical analysis: Descriptive statistics were performed by calculating measures of central tendency for quantitative variables and using counts and percentages for qualitative and nominal variables.

Results

A total of 78 trainees from 24 institutes in 12 states participated in the study. Mean age of the participants was 31 with 70% of trainees being male and 30 % females. 56 (70%) participants were DM students, 15 (19%) participants were DNB students, 5 fellowship students and 2 Non- academic Senior Residents. An overwhelming majority of residents (84%) felt COVID-19 Pandemic Negatively impacted their residency and their Physical (65%), Mental(74%) and Social wellbeing (80%). 79% of trainees felt burnt-out due to the pandemic. Majority of trainee felt the pandemic negatively impacted their training with clinical teaching(91%), Clinical examination skill (74%), current(80%) and future(70%) research opportunities suffered during the pandemic. Most residents felt diminution and significant reduction of the overall footfall(99% & 72%) of patients in rheumatology including OPD(100% & 77%) and indoor(99% & 67%) admissions along with academics(85% & 35%), procedures(97% & 66%) and exposure to musculoskeletal ultrasound(96% & 71%). Almost 60% and 40% of trainees had their OPDs and indoor admissions stopped during COVID-19 pandemic of these 20% had their OPDs and Admissions closed for more than 6 months. 85% of the participants had one or the other psychological symptoms with almost half experiencing anxiety(44%), low mood(47%) or lack of sleep(41%); 85% were concerned about their family members being infected and 40% lost a close relative to COVID. 91% of the trainee were posted in COVID-duties 2/3rd of them in ICUs, 50% being posted for 1-3 months and 20% more than 3 months, a quarter of trainees got infected during their duties (COVID and Non-COVID) and though most had asymptomatic to mild COVID, 15% still had moderate to severe COVID. Teleconsultation was started by more than half of the respondents after COVID related lockdowns with greater than half not being happy with teleconsultations.

Conclusion

The COVID-19 Pandemic has completely altered the status quo for rheumatology trainees and has affected their physical, social and mental wellbeing. Academic and clinical training has reduced, Current and future Research has become difficult, disruptions in OPDs and Admissions, recurrent COVID postings and reduction in patient footfall, Procedures and MSK-US have been detrimental to trainees.

References

[1]Chandwar K, Dixit J, Kishor K, Ekbote D,Dogga P. COVID‑19 anniversary – The hits, the misses, and the wayforward: A resident’s view. Indian J Rheumatol 2021; 10.4103/injr.injr_97_21

Disclosure of Interests

None declared

AB0006 ESTABLISHED RISK LOCI FOR SYSTEMIC LUPUS ERYTHEMATOSUS AT NCF2, STAT4, TNPO3, IRF5 AND ITGAM ASSOCIATE WITH DISTINCT CLINICAL MANIFESTATIONS: A DANISH GENOME-WIDE ASSOCIATION STUDY

Background

Systemic lupus erythematosus (SLE) has been associated with more than 100 genetic loci. This parallels positively to the clinical diversity that is reflected by the classification of SLE.

Objectives

We aimed to investigate associations between disease manifestations of SLE and risk gene variants relevant to Danish subjects of European ancestry.

Methods

We included 427 SLE patients of European ancestry similar to previous reports.[1] We also included 89,699 controls from the Danish Blood Donor Study Genomic Cohort. SLE risk loci in this population were identified by genome-wide association methodology and hereafter correlated to cumulative occurrence of SLE classification items.

Results

Fourteen variants mapped to the following genes: NCF2, STAT4, TNPO3/TPI1P2, IRF5, and ITGAM, were significantly associated (p<5E-8) with SLE.

The five lead variants were associated (p<0.05) with the following manifestations; NCF2: proteinuria and anti-phospholipid antibodies, STAT4: arthritis, serositis, neurologic disorder, lymphopenia, and anti-Smith antibodies, IRF5: seizures and proteinuria, TNPO3: proteinuria, and ITGAM: photosensitivity (Table 2).

Conclusion

Our findings support the future use of select, relevant genetic markers in predicting various SLE phenotypes.

References

[1]Leffers HCB, Troldborg A, Voss A, et al. Smoking associates with distinct clinical phenotypes in patients with systemic lupus erythematosus: a nationwide Danish cross-sectional study. Lupus Sci Med 2021;8(1).

Table 1.

Associations between five SLE risk loci and specific disease manifestations in 427 Danish patients with SLE*.

NCF2STAT4IRF5TNPO3ITGAMrs17849502_Trs7574865_Trs4728142_Ars13239597_Ars11860650_TN (%)Malar rash233 (55%)1.28 (0.84-1.96)0.83 (0.62-1.11)1.01 (0.74-1.38)1.44 (0.97-2.12)1.14 (0.80-1.61)Discoid rash46 (11%)1.49 (0.81-2.73)0.90 (0.56-1.45)1.01 (0.62-1.66)1.16 (0.63-2.12)0.76 (0.42-1.41)Photosensitivity219 (51%)0.96 (0.63-1.46)1.09 (0.81-1.47)0.98 (0.71-1.34)0.84 (0.57-1.25)0.67 (0.47-0.97)Oral ulcers132 (31%)0.96 (0.61-1.50)0.90 (0.65-1.23)0.83 (0.60-1.16)1.30 (0.87-1.96)1.43 (0.99-2.05)Non-erosive Arthritis342 (80%)0.84 (0.52-1.37)1.49 (1.02-2.18)0.93 (0.63-1.36)1.04 (0.64-1.68)1.16 (0.74-1.80)Serositis-Pleuritis124 (29%)0.63 (0.38-1.05)1.38 (1.01-1.89)1.22 (0.87-1.72)0.85 (0.56-1.29)0.84 (0.57-1.24)-Pericarditis72 (17%)0.75 (0.41-1.40)1.35 (0.93-1.96)1.05 (0.70-1.58)1.15 (0.70-1.89)1.09 (0.70-1.72)Persistent proteinuria158 (37%)1.63 (1.07-2.49)1.08 (0.80-1.46)0.68 (0.49-0.94)1.74 (1.16-2.61)1.09 (0.76-1.57)Neurologic disorder-Seizures23 (5%)1.58 (0.75-3.35)1.49 (0.80-2.76)2.10 (1.04-4.25)0.61 (0.26-1.44)0.93 (0.42-2.06)-Psychosis8 (2%)0.76 (0.097-5.87)2.77 (0.94-8.15)0.35 (0.10-1.23)0 (0)2.96 (0.85-10.3)Haematologic disorder-Haemolytic anaemia38 (9%)0.78 (0.34-1.76)1.37 (0.85-2.22)0.75 (0.44-1.29)1.11 (0.57-2.19)1.24 (0.70-2.20)-Leukopenia130 (30%)1.04 (0.67-1.61)1.19 (0.87-1.63)1.00 (0.72-1.39)0.90 (0.60-1.37)0.94 (0.64-1.37)-Lymphopenia228 (53%)0.95 (0.63-1.44)1.35 (1.01-1.81)0.95 (0.70-1.29)1.16 (0.79-1.70)1.09 (0.77-1.54)-Thrombocytopenia102 (24%)1.42 (0.91-2.22)0.84 (0.60-1.18)0.83 (0.58-1.18)1.35 (0.86-2.11)0.91 (0.60-1.37)Immunologic disorder-anti-DNA ab.330 (77%)0.69 (0.44-1.09)1.02 (0.72-1.44)0.94 (0.65-1.35)0.97 (0.62-1.53)1.08 (0.71-1.65)-anti-Smith ab.44 (10%)1.44 (0.79-2.64)1.58 (1.00-2.49)1.23 (0.73-2.07)1.47 (0.80-2.69)1.07 (0.61-1.84)-anti-phospholipid ab.183 (43%)1.63 (1.07-2.49)1.05 (0.79-1.41)0.84 (0.61-1.14)1.14 (0.77-1.68)1.14 (0.80-1.62)

* Logistic regression models for each manifestation included all five lead variants (multivariate) and were adjusted for age and sex

Disclosure of Interests

Henrik Leffers: None declared, David Westergaard: None declared, Saedis Saevarsdottir: None declared, Ingileif Jonsdottir: None declared, Ole Birger Pedersen: None declared, Anne Troldborg: None declared, Anne Voss: None declared, Salome Kristensen: None declared, Jesper Lindhardsen: None declared, Prabhat Kumar: None declared, Asta Linauskas: None declared, Lars Juul: None declared, Niels Steen Krogh: None declared, Bent Deleuran: None declared, Lene Dreyer Speakers bureau: Speakers bureau: Eli Lilly, Galderma and Janssen, Grant/research support from: from BMS outside the present work, Michael Schwinn: None declared, Lise wegner Thørner: None declared, Lotte Hindhede: None declared, Christian Erikstrup: None declared, Henrik Ullum: None declared, Søren Brunak Shareholder of: SB has ownerships in Intomics A/S, Hoba Therapeutics Aps, Novo Nordisk A/S, Lundbeck A/S, Kari Stefansson: None declared, Karina Banasik: None declared, Søren Jacobsen: None declared

AB1086 VACCINE HESITANCY AGAINST COVID-19 VACCINES IN PATIENTS WITH AUTOIMMUNE RHEUMATIC DISEASES AND EFFECT OF SPECIALIST COUNSELLING ON VACCINE HESITANT PATIENTS WILLINGNESS TO TAKE VACCINE

Background

Vaccination is one of the most significant public health achievements; however, the success has been marred with vaccine hesitancy. The reasons for vaccine hesitancy are neither singular nor straightforward and arise from a complex interplay between scientific, religious and political beliefs. This study aims to understand the possible reasons for vaccine hesitancy in patients with autoimmune rheumatic diseases and the effectiveness of Specialist counselling on vaccine-hesitant patients willingness to take the vaccine.

Objectives

1. To assess causes of Vaccine hesitancy against COVID-19 vaccines in patients with autoimmune rheumatic diseases.

2. To study the effect of specialist counselling on vaccine-hesitant patients willingness to take vaccine.

Methods

Study design: We conducted an observational survey-based in person cross-sectional study. Patients attending a tertiary care hospital’s outpatient department were asked about their vaccination status. Those unvaccinated were asked reasons for vaccine hesitancy The vaccine-hesitant patients were counselled by the treating rheumatologist and asked regarding their willingness to take the vaccine after the counselling. The patient responses were recorded.

Sample: Convenience sampling was used, so the sample size was not calculated.

Inclusion and exclusion criteria: All adults(>18yrs) with AIRD coming to the rheumatology OPD. Those vaccinated, recently infected(within 6 weeks), and non-AIRD patients were excluded.

Data collection: The questionnaire included patients’ demographic details, Diagnosis, medication details, and response to the reason for vaccine hesitancy.

Statistical analysis: Descriptive statistics were performed by calculating measures of central tendency for quantitative variables and using counts and percentages for qualitative and nominal variables.

Results

A total of 322 patients participated in the study with a mean age of 40 years(18-76), with 73%(234) females and 27%(88) males. Most patients had Rheumatoid Arthritis(40%) followed by SPA (27%), SLE(13%) and others and may were on immunosuppressive medications(95%). A significant proportion of patients(60%) had more than one reason for vaccine hesitancy. Almost 60% of the respondents feared their disease might flare post-vaccination, while almost half(44.4%) were hesitant to take the vaccine due to the fear of vaccine side effects and more than one third (35%) feared vaccine may not be effective on them as they were on immunosuppressive medications. Other major causes of vaccine hesitancy were the inability to get a chance to get vaccinated (18%), doubts about vaccine efficacy (15%), and fear of injections (10%).Most patients(91%) were willing to take the vaccine after specialist counselling and only 28 of the 322 (9%) were unwilling even after specialist counselling.

Conclusion

Vaccine hesitancy can be multifactorial. Major reasons for vaccine hesitancy in patients with autoimmune rheumatic diseases were fear of flare of disease post-vaccination, fear of vaccine side effects and doubts whether the vaccine would work in patients taking immunosuppressive medications. Most patients were willing to take vaccine after counselling by a rheumatologist.

Disclosure of Interests

None declared

Airway Complications After Lung Transplant for Post Coronaviral Disease (COVID-19) Acute Respiratory Distress Syndrome (ARDS) Related End Stage Lung Disease: Single Centre Experience

Purpose

Severe COVID-19 ARDS related end stage lung fibrosis with irreversible changes is a newer indication for lung transplantation with acceptable survival rate. Airway complication post lung transplant is a major source of morbidity and mortality with incidence as high as 25 to 49 percent. Patients with end stage COVID-19 fibrosis are likely to be clinically deconditioned with long duration of extracorporeal oxygenator (ECMO) support, high burden of sepsis and prolonged respiratory support which may affect the airways post lung transplantation.

Methods

This is a retrospective observational study after obtaining institutional ethical clearance. We reviewed electronic medical data of patients who underwent lung transplantation for post COVID-19 ARDS related fibrosis. We evaluated the incidence and type of airway complications and the various therapeutic interventions applied for its management.

Results

Between May 2020 and September 2021 our centre performed 23 bilateral lung transplants for end stage COVID-19 ARDS related fibrosis. 22 patients were on ECMO support with mean duration of 50.9 days before transplantation. All patients underwent lung transplantation with central Veno-Arterial ECMO support with mean organ ischaemia time of 360±154 minutes. The incidence of airway complication in our study group was 56%. We observed anastomotic narrowing in 3(13%), distal airway narrowing in 4(17%) and sloughing/coating of anastomotic site in 5(22%) patients. Nonspecific inflammatory polypi around the bronchial anastomotic site were noticed in 4(17%) and mild airway anastomotic dehiscence in 2 subjects. 8(34%) patients required serial bronchoscopy and balloon dilatation; 2 among them mandated additional cautery usage. 2 cases underwent polypectomy, further 4 subjects needed bronchial stent placement. 5 (21%) recipients were discharged with Tracheostomy while rest were successfully decannulated in the ward.

Conclusion

We observed a high incidence of airway complications in post lung transplant for COVID-19 ARDS related fibrosis. Early detection, timely management and serial follow up is of paramount importance in this subset of patients.

Causal discovery of drivers of surface ozone variability in Antarctica using a deep learning algorithm

The discovery of causal structures behind a phenomenon under investigation has been at the heart of scientific inquiry since the beginning. Randomized control trials, the gold standard for causal analysis, may not always be feasible, such as in the domain of climate sciences. In the absence of interventional data, we are forced to depend only on observational data. This study demonstrates the application of one such causal discovery algorithm using a neural network for identifying the drivers of surface ozone variability in Antarctica. The analyses reveal the overarching influence of the stratosphere on the surface ozone variability in Antarctica, buttressed by the southern annular mode and tropospheric wave forcing in mid-latitudes. We find no significant and robust evidence for the influence of tropical teleconnection on the ground-level ozone in Antarctica. As the field of atmospheric science is now replete with a massive stock of observational data, both satellite and ground-based, this tool for automated causal structure discovery might prove to be invaluable for scientific investigation and flawless decision making.

Effectiveness of Decision Aid in Men with Localized Prostate Cancer: a Multicenter Randomized Controlled Trial at Tertiary Referral Hospitals in an Asia Pacific Country

There are several treatment options for localized prostate cancer with very similar outcome but vary in terms of technique and side effect profiles and risks. Considering the potential difficulty in choosing the best treatment, a patient decision aid (PDA) is used to help patients in their decision-making process. However, the use and applicability of PDA in a country in Asia Pacific region like Malaysia is still unknown. This study aims to evaluate the effectiveness of a PDA modified to the local context in improving patients' knowledge, decisional conflict, and preparation for decision making among men with localized prostate cancer. Sixty patients with localized prostate cancer were randomly assigned to control and intervention groups. A self-administered questionnaire, which evaluate the knowledge on prostate cancer (23 items), decisional conflict (10 items) and preparation for decision-making (10 items), was given to all participants at pre- and post-intervention. Data were analyzed using independent T test and paired T test. The intervention group showed significant improvement in knowledge (p = 0.02) and decisional conflict (p = 0.01) from baseline. However, when compared between the control and intervention groups, there were no significant differences at baseline and post-intervention on knowledge, decisional conflict and preparation for decision-making. A PDA on treatment options of localized prostate cancer modified to the local context in an Asia Pacific country improved patients' knowledge and decisional conflict but did not have significant impact on the preparation for decision-making. The study was also registered under the Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12614000668606 registered on 25/06/2014.