957 Comparison of Inguinodynia In Patients Undergoing Prophylactic Ilioinguinal Neurectomy vs No Neurectomy In Lichtenstein Mesh Hernioplasty

Objective

The objective of this study is to compare the frequency of inguinodynia in ilioinguinal neurectomy VS no neurectomy in patients undergoing Lichtenstein mesh hernioplasty.

Method

200 male patients with unilateral, primary, reducible inguinal hernia were randomly distributed in to two groups by using lottery method to undergo Lichtenstein’s hernia repair i.e., with and without ilioinguinal neurectomy. All the operation were carried out under local anesthesia. Pain score was calculated using the VAS system at 3rd month and inguinodynia was labelled if it is more than 1 on VAS scale.

Results

200 male patients with mean age of 53.25 ± 6.768 were included. 42 (21%) had Inguinodynia after surgery. When we cross tabulated both groups with inguinodynia, results came up significant (p = 0.001). In neurectomy group 10 patients had inguinodynia while in no neurectomy group, 32 patients were having Inguinodynia. There was no effect of malnutrition on outcome. Younger age group benefitted more from procedure.

Conclusions

It is concluded that there is difference in frequency of inguinodynia in ilioinguinal neurectomy versus no neurectomy in patients undergoing Lichtenstein hernia repair. Patients with ilioinguinal neurectomy had reduced incidence of inguinodynia.

ASSESSMENT OF STROMAL AND INTRA-EPITHELIAL TUMOR INFILTRATING LYMPHOCYTES IN COLORECTAL CARCINOMA AT ARMED FORCES INSTITUTE OF PATHOLOGY

Objective: To conduct a morphological evaluation quantitatively of two types of tumor-infiltrating lymphocyte populations, including those located in the stroma and intraepithelial cancer structures, in patients with colorectal cancer. Study Design: Cross sectional study. Place and Duration of Study: Armed Forces Institute of Pathology, Rawalpindi, from Jan to Jul 2019. Methodology: Three levels of infiltration in the stroma by tumor infiltrating lymphocytes were determined. Level 1 was weak meaning (0-20% of stromal TILs), level 2 was moderate meaning (>20-50% of stromal TILs); and level 3 was strong meaning (50-90% of stromal TILs). TILs within tumor cells were divided into two groups. 0 meaning absent (no TILs present) and 1 meaning present (≥TILs in tumor cells) 1. Results: Out of 30 cases 22 were males and 8 females. Ages ranged between 25-83 with a mean of 57 years and a standard deviation of ± 16.4 years. All of the cases were diagnosed cases of adenocarcinoma. The levels of stromal tumor infiltrating lymphocytes was weak in 1 case, moderate in 18 cases and strong in 11 cases whereas intraepithelial lymphocytosis was seen in 22 cases. Conclusion: These results confirm that the infiltration of tumor infiltrating lymphocytes into the tumor in patients with colorectal carcinoma serves an important role in the invasion and progression of the disease, and should be considered in routine examinations.

P9: MANAGEMENT OF ESOPHAGEAL FOOD BOLUS OBSTRUCTION AT A UNIVERSITY TEACHING HOSPITAL – A RETROSPECTIVE ANALYSIS

Introduction

Despite the fact that esophageal food bolus obstruction is a common surgical problem, there are no clear guidelines on its management. Medical treatment with Buscopan and Glucagon is mostly in-effective, requiring a therapeutic Oesophago-Gastro-Duodenoscopy (OGD).

Method

All consecutive cases of food bolus obstructions (FBO) presenting to the Emergency Department (ED) for 18 month period between 01/01/2018 and 30/06/2019 were retrospectively reviewed.

Result

A total of 30 patients were admitted with food bolus obstruction via ED (1.67 per month). Females (67%) constituted most of these patients. Average age was 55 with range of 19-83. 84% of patients presented with Dysphagia, while Odynophagia (10%) and chest pain (6%) were other presenting symptoms. Average duration of symptoms was 17 hours (Range 2 – 48 hours). 44% of patients had OGD done under sedation while others (56%) had under General Anaesthesia (GA). In 70% of cases, food bolus was pushed into stomach, while it was retrieved out in 20%. In 10%, it had already spontaneously passed in stomach on OGD. The etiology of FBO was inflammatory in 60% cases, while an esophageal stricture was seen in 10% only. In 30% cases no cause of FBO was identified. Post-OGD length of stay was on average 1.15 days (range 12 hours – 7 days). 2 patients had aspiration pneumonia prolonging their hospital stay, there was no esophageal perforation or mortality.

Conclusion

Esophageal food bolus obstruction is a common surgical problem, OGD under GA is a safe recommended procedure, which often picks up an underlying pathology.

Take-home message

Esophageal food bolus obstruction is a common surgical problem, OGD under GA is a safe recommended procedure, which often picks up an underlying pathology.

Next Generation Sequencing-Based Germline Panel Testing for Breast and Ovarian Cancers in Pakistan

Background:

Pathogenic germline mutations in BRCA1/2 constitute the majority of hereditary breast and/or ovarian cancers worldwide. Incidence and mortality rate of breast and ovarian cancers in Pakistani women is high. Thus, to establish the diagnosis for targeted therapy in Pakistan, we conducted Next-generation sequencing-based germline testing for the detection of BRCA1/2 oncogenic variants associated with breast and ovarian cancer subtype.

Methods:

Peripheral blood of 24 women, diagnosed with breast and epithelial ovarian cancers, was taken from the recruited cases with the consent of performing germline genetic testing. DNA was isolated from the peripheral blood and subjected to indexed BRCA Panel libraries. Targeted NGS was performed for all coding regions and splicing sites of BRCA1 and BRCA2 genes using AmpliSeq for Illumina BRCA Panel and Illumina MiSeq sequencer (placed at AFIP). Analysis of the sequencing results has been done by using Illumina bioinformatics tools.

Results:

We detected 421 variants having a quality score of 100 in all cases under study. The list of identified variants in BRCA1 and BRCA2 genes was narrowed down after filtering out those which did not pass q30 and those with a minor allele frequency (MAF) > 0.05 based on gnomAD browser. To classify these variants, clinical significance was predicted using external curated databases. As a result, we interpreted (n = 4) 16.7% pathogenic variants in BRCA1 and (n = 6) 25% variants of uncertain significance (VUS) in both genes. Descriptive statistics depicted that the age and BMI of BRCA positive cases are less than BRCA negative cases.

Conclusion:

Our findings exhibit an initial report for the NGS based cancer genetic testing in Pakistan. This will enable us to pursue screening and diagnosis of hereditary BRCA mutation utilizing the latest state-of-the-art technique locally available in Pakistan ultimately resulting in targeted cancer therapy.

D-1 / PD-L1 EXPRESSION IN INVASIVE BREAST CARCINOMA / CANCER

Objective: To investigate the immunohistochemical expression of PD-1 and PD-L1 in breast cancer cases and itscorrelation with clinicopathological factors. Study Design: Cross sectional study. Place and Duration of Study: Histopathology department, Armed Forces Institute of Pathology Rawalpindi, form Jan to Jun 2019. Methodology: Sixty five cases of breast cancer were retrieved. Clinicopathological parameters like age, gender,tumor grade and receptor status were noted. Immunohistochemistry for PD-1 and PD-L1 was applied. The datawas entered and statistical analysis was done using SPSS version 21. The associations between variables werefound using the Fisher exact test. Results: Sixty five cases of breast cancer were investigated from tumour registry. The sample included femalepatients, having mean age of 50.86 ± 11.1 Years. Invasive mammary (ductal) carcinoma, NST was the most prevalent subtype 60 (92.3%) and most tumors were grade I/II 53(82%). PD-1 expression was seen in TIL’s 31 (48%) and PD-L1 expression was observed in tumour cells 30 (46%). Expression of PD-1/PD-L1 expression was more common in premenopausal age group and grade I/II tumors. Among molecular subtypes, PD-L1 expression was detected in 11 (52%) TNBC, 5 (71%) in HR-/HER2+ and 12 (32)% in HR + HER2 - and PD-1 expression was observed in 13 (62%) TNBC, 5 (71%) in HR-/HER2+ and 13 (35%) in HR+ HER2-. Conclusion: A large proportion of breast cancer cases show expression of PD-1 / PD-L1. Anti PD-1 and PD-L1therapy may benefit these patients.

DIAGNOSTIC UTILITY OF SATB2 IN METASTATIC COLORECTAL CARCINOMA

Objective: The purpose of this study was to evaluate the diagnostic utility of SATB2 in detecting CRC origin for patients presenting with metastatic carcinomas. Study Design: Cross sectional, comparative study. Place and Duration of Study: Study was conducted at department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi from January 2019 to June 2019. Materials and Methods: Already diagnosed 68 cases of metastatic carcinoma of various origins with unknown primary were retrieved from tumour registry. Paraffin embedded blocks were taken and a panel of Immunohistochemistry was applied which includes CK7, CK20,CDX2 and SATB2. Positivity of SATB2 alone, and  combination of SATB2 with CK 7,CK20 and CDX2 was evaluated. Results: Out of 68 metastatic adenocarcinoma cases 28(41%) had positive SATB2 expression and 38 (56%) were negative. All the positive SATB2 cases had 100 % (28/28) expression with CDX2, 93% (26/28) of the cases had expression with CK20 and 21% (6/28) of the cases showed expression of CK7. The sensitivity of SATB2 alone was 100% in metastatic colorectal carcinoma as compared to CK20 and CDX2. The sensitivity of SATB2 in combination with CDX2 (100%) and CK20 (93%)in comparison to the double combination of CK20 and CDX2(93 %). The sensitivity of SATB2 and CK20 combination was 93%, which was equal to CK20 and CDX2 combination. Conclusions: Our results show that SATB2 is a sensitive marker in the IHC panel for cases with suspected metastasis from colorectal region.

Effect of Post-Isometric Relaxation and Laser on Upper Trapezius Trigger Point Pain in Patients with Mechanical Neck Pain

Objective

The current study aimed to determine the effectiveness of post-isometric relaxation and LASER treatment in minimizing pain and increasing neck range of motion and function in people with upper Trapezius trigger point pain.

Methods

A total of 45 participants with upper Trapezius trigger point pain were studied. All the participants were randomly assigned into three equal groups (post-isometric relaxation, LASER, and Control) to receive the respective treatments for 1 week. The pressure threshold meter was used to assess the pain-pressure sensitivity of myofascial trigger point pain. Pain intensity and cervical range of motion were measured using the visual analogue scale and cervical goniometry, respectively. The neck disability index was used to assess neck function.

Results

The results of within group analysis indicate significant changes in all the outcomes in three groups (All groups, P = 0.001) except an insignificant improvement of pain pressure threshold in the control group (P = 0.069). Additionally, there were significant differences noted among three groups on pain-pressure threshold and visual analogue scale scores at posttest day 1, day 5, and day 12 (all P = 0.001). However, there was non-significant improvements of neck disability index and side flexion on both sides noted at all timelines except (all P > 0.05), a significant improvement at posttest day 5 (P = 0.015) among three groups.

Conclusions

Both PIR and LASER treatment have been effective in reducing pain-pressure threshold and pain intensity in the management of muscle trigger point pain. Long-term studies are warranted to further validate the effectiveness of these modalities in the management of upper Trapezius trigger point pain.

Carcinoid heart disease: the role of echocardiography in predicting post-surgical outcomes

Background

Carcinoid heart disease (CHD) often complicates neuroendocrine tumours (NET). The prognosis of CHD without intervention is poor; 3 year survival is estimated at 31%. Surgical valve replacement is the only treatment for CHD, but is associated with high 30-day mortality (10–15%).

Purpose

The aim is to identify pre-operative transthoracic echocardiogram (PTTE) findings that could determine which patients have a high likelihood of post-surgical mortality at 1 year.

Methods

This retrospective observational cohort study recruited 88 patients with a confirmed diagnosis of CHD between 2005–19 at University Hospital Birmingham; 49 (56%) of these were treated surgically. Indications for surgery: stable NET, symptomatic severe valvular dysfunction, progressive RV dilatation or RV dysfunction, no significant comorbidities. All patients underwent a standard PTTE. PTTE parameters assessed: right ventricular (RV) size, RV function (qualitative), TAPSE, RV fractional area change, RV S wave velocity, left ventricular (LV) size, LV ejection fraction and valve velocities. Surgery was performed by a single surgical team with bioprosthetic valve replacements.

Results

Patients were followed up for a median of 15 months (IQR: 6–59) after surgery, during which time there were 33 deaths, giving a median survival time of 30 months (IQR: 7–85). Increasingly severe RV dilatation was significantly associated with shorter survival (p=0.032). The estimated survival rate at three years was 67% in those with normal RV size, compared to 24% in the severe RV group (Figure 1). RV basal diameter was assessed used ROC curve analysis for the outcome of one year survival and returned an area under the curve of 0.66 (SE=0.10). Youden's index identified RV diameter >4.8cm to be the optimal cut-off for identifying high-risk patients. One year mortality rates were 26% (7/27) vs. 75% (9/12) in those with RV basal diameter of ≤4.8 vs. >4.8cm (p=0.006).

Conclusion

A pre-operative right ventricular basal diameter >4.8cm is associated with a near three-fold increase in post-operative mortality at one year. These findings highlight the importance of regular imaging in order to optimise the timing of surgery in patients with CHD.

Figure 1. Kaplan-Meier curve of post-op survival

Funding Acknowledgement

Type of funding source: None

Flow-Diversion Treatment for Unruptured Nonsaccular Intracranial Aneurysms of the Posterior and Distal Anterior Circulation: A Meta-Analysis

BACKGROUND

Treatment management and outcomes of unruptured nonsaccular aneurysms are different compared with their saccular counterparts.

PURPOSE

Our aim was to analyze the outcomes after flow diversion among nonsaccular unruptured lesions.

DATA SOURCES

A systematic search of 3 data bases (2005-2019) was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

STUDY SELECTION

We included studies reporting flow diversion for nonsaccular unruptured aneurysms of the posterior and distal anterior circulations. Anterior circulation lesions were included if located distal to the petrocavernous and supraclinoid ICA (MCA, A1, anterior communicating artery, A2). Giant dolichoectatic holobasilar lesions were excluded because of their poor treatment outcomes.

DATA ANALYSIS

Aneurysm occlusion and complication rates were calculated (random effects meta-analysis).

DATA SYNTHESIS

We included 15 studies (213 aneurysms). The long-term adequate occlusion rate was 85.3% (137/168; 95% CI, 78.2%-92.4%; I² = 42.3%). Treatment-related complications were 17.4% (41/213; 95% CI, 12.45%-22.4%; I² = 0%). Overall, 15% (37/213; 95% CI, 10%-20%; I² = 0%) were ischemic events. Procedure-related morbidity was 8% (20/213; 95% CI, 5%-12%; I² = 0%). Fusiform or dissecting types had comparable adequate occlusion (116/146 = 83%; 95% CI, 74%-92%; I² = 48% versus 33/36 = 89%; 95% CI, 80%-98%; I² = 0%; P = .31) and complication rates (35/162 = 17%; 95% CI, 10%-25%; I² = 24% versus 11/51 = 19%; 95% CI, 10%-31%; I² = 0%; P = .72). Aneurysm size (>10 versus ≤10 mm) was independently associated with a higher rate of complications (OR = 6.6; 95% CI, 1.3-15; P = .02). The rate of ischemic events after discontinuation of the antiplatelet therapy was 5% (5/93; 95% CI, 2%-9%; I² = 0%).

LIMITATIONS

Small and retrospective studies were available for this meta-analysis.

CONCLUSIONS

Unruptured nonsaccular aneurysms located in the posterior and distal anterior circulations can be effectively treated with flow diversion. Nevertheless, treatment-related complications are not negligible, with about 15% ischemic events and 8% morbidity. Larger size (>10 mm) significantly increases the risk of procedure-related adverse events.

Immunological and Neurological Manifestations of COVID-19: An Intimate Relationship

Background: COVID-19 has superseded all medical scientific challenges in 2020. It presented with a range of respiratory involvement from the mild upper respiratory tract to severe pneumonia with ARDS. A percentage of these patients manifested variable neurological presentations expanding the challenges of patients’ assessment, care, and management. Objective: To discuss the neurological manifestations and the possible immunopathology of COVID-19. Methods: A literature search was performed in the PubMed database for the relevant articles published in English language between April 9th , 2020 and June 1, 2020. Few papers were extracted from Google Scholar and pre-print material as well. The keywords used to perform search included “COVID-19,” “SARS Cov2,” “neurological manifestations,” and “immunology and pathology of COVID-19”. However, animal studies were excluded in the neurological manifestations, and the final number of literature search outcome was 27 articles. Results: The immunopathology involves angiotensin-converting enzyme (ACE) receptor 2 and spike protein S1. COVID-19 has a tremendous affinity to the ACE2 receptor. The status of secondary hemophagocytic lymphohistiocytosis (sHLH) and the cytokine storm lead to different organ damage and the corresponding clinical manifestations. The documented neurological manifestations mainly include acute ischemic stroke, hemorrhagic stroke, temporal lobe, thalamic encephalitis, and one case of Guillain-Barre Syndrome, in addition to agitation, headache, and seizures. Conclusion: Although the intimate relationship between the neurons and the immune activation is the basic concept of COVID-19 immunopathology, the definite routes of entry to the neuronal cells are yet to be disclosed. Acute stroke, myositis, headache, and meningoencephalitis are the most common types of complications of COVID-19 so far.

SAT0130 TREAT-TO-TARGET STRATEGY OF >8.000 PATIENTS WITH EARLY RHEUMATOID ARTHRITIS: DOES SMOKING AFFECT ACHIEVEMENT OF REMISSION ON METHOTREXATE AND TIME TO START OF FIRST BIOLOGIC? RESULTS FROM THE NATIONWIDE DANISH DANBIO REGISTRY

Background:

Smoking is a known risk factor for rheumatoid arthritis (RA). It is largely unknown whether smoking has any impact on disease activity and treatment outcomes (e.g. achieving remission on methotrexate and time to first biological disease modifying anti-rheumatic treatments (bDMARD)) in early RA with a modern treat-to-target strategy.

Objectives:

To explore if smoking was associated with treatment outcomes in newly diagnosed patients with RA starting first conventional synthetic (cs)DMARDs in routine care.

Methods:

Observational cohort study. Adult patients with RA starting first csDMARD during year 2010-2018 were identified in the Danish nationwide quality registry, DANBIO. Smoking status (current/never/previous) upon start of csDMARD (=baseline), disease activity, 1-year treatment outcomes and bDMARD treatment were retrieved from DANBIO. Data were censored Oct 2019.

Impact of smoking status was explored for the following outcomes: 1) median baseline disease activity baseline, 2) remission at 1-year (logistic regression analyses), 3) time to first bDMARD (Cox-regression analyses). Regression analyses were adjusted for gender and age.

Results:

Among 9515 patients, 8647 (91%) had available smoking status (Current 23%/never 50%/previous 27%) and were included. Baseline disease activity was independent of smoking status (Table 1). First line csDMARD was methotrexate in 91% of patients. Compared to never smokers, the current smokers were more often men, younger and sero-positive for IgM-RF and anti-CCP.

Table 1.

Patient characteristics and disease activity at baseline and 1 year stratified by smoking status. Numbers are medians (IQR) unless otherwise stated.

Smoking statusCurrentNeverPreviousBaselinePatient numbers, N200743082332Age, yrs58 (49-66)61 (48-71)62 (52-70)Female, %627163IgM-RF positive, %715465Anti-CCP positive, %715365DAS284.4 (3.4-5.3)4.4 (3.4-5.3)4.3 (3.3-5.3)CDAI18.7 (11.7-27.3)18.4 (10.9-27.4)18.5 (10.4-27.6)VAS patient global, mm60 (35-81)55 (30-77)55 (31-78)1 yearPatient number, N179338372053DAS282.6 (1.9-3.7)2.3 (1.7-3.4)2.5 (1.8-3.4)CDAI6.4 (2.8-12.5)4.9 (1.8-10.3)5.4 (2-10.8)DAS28-remission, %495753CDAI-remission, %273533VAS patient global, mm37 (14-67)29 (10-57)30 (11-58)

DAS28-response: DAS28(CRP)≤2.6; CDAI-remission: CDAI≤2.8

Never and previous smokers had higher odds of remission at 1 year’s follow-up compared to current smokers. In adjusted Cox regression analyses, baseline smoking was associated with shorter time to start of first bDMARD (Table 2).

Table 2.

Impact of baseline smoking status on treatment outcomes

ComparisonOdds Ratio (95% CI)pDAS28-remission 1 yr, yes vs. no*Never vs. current smoker1.43 (1.27;1.62)<0.001Previous vs. current1.14 (0.99;1.30)0.07CDAI remission 1 yr, yes vs. no*Never vs. current1.53 (1.34;1.75)<0.001Previous vs. current1.29 (1.11;1.50)<0.001ComparisonHazard Ratio (95% CI)pStart of bDMARD duringfollow-up**Never vs current smoker0.85 (0.76;0.96)0.006Previous vs. current1.05 (0.93;1.19)0.4

*Logistic regression analyses (adjusted for gender and age)

** Cox regression analyses (adjusted for gender and age)

Conclusion:

In this observational study of >8000 patients with RA starting a first csDMARD, current smoking was associated with lower odds of achieving remission on methotrexate and higher chance of having started bMDARD compared to never smokers. Seropositivity may be an intermediate variable. Further analyses are planned to study impact of comorbidities and other confounding factors.

Acknowledgments :

Thank you to all patients and departments who contribute to the DANBIO registry

Disclosure of Interests: :

Bente Glintborg Grant/research support from: Grants from Pfizer, Biogen and Abbvie, Oliver Hendricks Grant/research support from: Pfizer, MSD, Ada Colic Consultant of: Advisory board Sanofi, Hanne Merete Lindegaard: None declared, Rabiah Ahmed: None declared, Anne Gitte Loft Grant/research support from: Novartis, Consultant of: AbbVie, MSD, Novartis, Pfizer and UCB, Speakers bureau: AbbVie, MSD, Novartis, Pfizer and UCB, Gina Kollerup Speakers bureau: Eli Lilly, Marlene Andersen: None declared, Jolanta Grydehøj: None declared, Johnny Raun: None declared, Toke Thorgrimsen: None declared, Kasper Mortensen: None declared, Line Uhrenholt Speakers bureau: Abbvie, Eli Lilly and Novartis (not related to the submitted work), Dorte Jensen: None declared, Iben Ruge Grant/research support from: Novo Nordisk Foundation, Maren Kalisz: None declared, Kamilla Danebod: None declared, Niels Lomborg: None declared, Niels Steen Krogh: None declared, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen and Pfizer, Consultant of: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck and Samsung Bioepis

Antenatal testing for anaemia, HIV and syphilis in Indonesia - a health systems analysis of low coverage

BACKGROUND

Adverse pregnancy outcomes can be prevented through the early detection and treatment of anaemia, HIV and syphilis during the antenatal period. Rates of testing for anaemia, HIV and syphilis among women attending antenatal services in Indonesia are low, despite its mandate in national guidelines and international policy.

METHODS

Midwife-held antenatal care records for 2015 from 8 villages in 2 sub-districts within Cianjur district were reviewed, alongside the available sub-district Puskesmas (Community Health Centre) maternity and laboratory records. We conducted four focus group discussions with kaders (community health workers) (n = 16) and midwives (n = 9), and 13 semi-structured interviews with laboratory and counselling, public sector maternity and HIV management and relevant non-governmental organisation staff. Participants were recruited from village, sub-district, district and national level as relevant to role.

RESULTS

We were unable to find a single recorded result of antenatal testing for HIV, syphilis or anaemia in the village (566 women) or Puskesmas records (2816 women) for 2015. Laboratory records did not specifically identify antenatal women. Participants described conducting and reporting testing in a largely ad hoc manner; relying on referral to health facilities based on clinical suspicion or separate non-maternity voluntary counselling and testing programs. Participants recognized significant systematic challenges with key differences between the more acceptable (and reportedly more often implemented) haemoglobin testing and the less acceptable (and barely implemented) HIV and syphilis testing. However, a clear need for leadership and accountability emerged as an important factor for prioritizing antenatal testing and addressing these testing gaps.

CONCLUSIONS

Practical solutions such as revised registers, availability of point-of-care tests and capacity building of field staff will therefore need to be accompanied by both funding and political will to coordinate, prioritize and be accountable for testing in pregnancy.

Aston University's Antimicrobial Resistance (AMR) Roadshow: raising awareness and embedding knowledge of AMR in key stage 4 learners

Antimicrobial resistance (AMR) is a global healthcare problem and therefore raising awareness within young learners is imperative. An AMR roadshow was designed to take key stage 4 students' learning ‘out of the classroom’, assess pre-existing knowledge of AMR and determine the impact of the roadshow on knowledge retention. Knowledge and subsequent retention were measured pre- and post-event through a standardised questionnaire. The roadshow significantly improved knowledge and understanding of AMR, which was retained for a minimum of twelve weeks. Engaging and interactive strategies addressing key health issues provide a positive learning experience which contributes to retained knowledge in young learners.

Predicting Factors of Angiographic Aneurysm Occlusion after Treatment with the Woven EndoBridge Device: A Single-Center Experience with Midterm Follow-Up

BACKGROUND AND PURPOSE

Flow disruption with the Woven EndoBridge is increasingly used for the treatment of intracranial aneurysms. We examined factors leading to aneurysm occlusion and Woven EndoBridge shape change during a midterm follow-up.

MATERIALS AND METHODS

Patients with a minimum 12-month angiographic follow-up were included. Through a univariate and multivariate analysis, independent predictors of adequate occlusion (Raymond-Roy 1/Raymond-Roy 2) and Woven EndoBridge shape change (decrease of the height of the device) were assessed.

RESULTS

Eighty-six patients/aneurysms were included. The aneurysm mean size was 5.5 mm (range, 3-11.5 mm). The most common locations were the MCA (43/86 = 50%), basilar tip (13/86 = 15.1%), and anterior communicating artery (12/86 = 14%). Twenty-one patients (21/86 = 24%) had acute SAH. Immediate and long-term Raymond-Roy 1/Raymond-Roy 2 occlusion rates were 49% (42/86) and 80% (68/86), respectively. Woven EndoBridge shape change was detected among 22% (19/86) of cases. At binary logistic regression, wide ostium (≥4 mm) (OR = 0.2; 95% CI, 0.01-1; P = .04) and regular aneurysm morphology (OR = 5.9; 95% CI, 1.4-24; P = .01) were independent factors of incomplete and adequate aneurysm occlusion, respectively. In addition, irregular morphology (OR = 5.4; 95%CI, 1.4-19; P = .01) and a wide ostium (OR = 9.8; 95% CI, 1.6-60; P = .03) significantly increased the probability of the Woven EndoBridge shape change. Decrease of the Woven EndoBridge height was more common among incompletely occluded aneurysms (6/12 = 50% versus 13/74 = 17.5%), but it was not an independent prognosticator of occlusion at the multivariate model.

CONCLUSIONS

The likelihood of good occlusion was 5 times lower in the presence of a wide ostium, whereas aneurysms with regular morphology were 6 times more likely to be occluded. Woven EndoBridge shape modification was strongly influenced by the aneurysm shape and ostium size, and it was not independently associated with the angiographic occlusion.

A cross-sectional evaluation of opt-in testing for sexually transmitted and blood-borne infections in three Canadian provincial correctional facilities: a missed opportunity for public health?

PURPOSE

Incarceration provides an opportunity for screening and treatment of sexually transmitted and blood-borne infections (STBBIs) in high-risk groups. The purpose of this paper is to determine positivity rates of STBBI screening within correctional facilities using opt-in strategies and estimate the proportion of admissions tested.

DESIGN/METHODOLOGY/APPROACH

A cross-sectional, retrospective review of testing data from January 2012 to August 2015 from three provincial correctional facilities located in Alberta, Canada was completed. Analysis variables included STBBI, gender, facility, collection year and age. STBBI-stratified analysis was performed to identify correlates for positivity using univariate and logistic regressions.

FINDINGS

Overall prevalence of chlamydia was 11.2 percent and gonorrhea was 3.5 percent; correlates for both were younger age and facility type. The syphilis prevalence rate was 3.2 percent; correlates included being female, older age, adult facilities, with later years being protective. In total, 14 (0.3 percent) newly diagnosed HIV cases were found, prevalence increased with age. HBV prevalence was 1.7 percent with no significant correlations. Nearly one-tenth (n=422) of those screened for HCV antibody were positive; all variables were significantly correlated. Overall estimates of the proportion of admissions tested by STBBI were low and ranged from 4.8 to 16.1 percent.

ORIGINALITY/VALUE

This study found high rates of STBBI in correctional facilities and showed that only a small proportion of the population was tested using an opt-in strategy. Shifting to an "opt-out" strategy may be warranted.