A current novel perspective approach for coronavirus disease-2019 pandemic outbreak

Coronavirus disease-2019 is a serious health threat around the globe. Across the world, approximately 142 million people were infected, and three million deaths happened. The fast propagation is also associated with constant anxiety, mental stress, and discomfort in public and health-care professionals. Lack of approved drugs regimen to combat the pandemic challenge concretely is a challenging project for all who are committed to developing remedial assistance. However, the successful development of three vaccines gives a solid roadmap to combat this disease. In this review, we highlighted the current development and challenges of this pandemic.

RADIATION EXPOSURE IN ACCESSORY PATHWAY ABLATION PROCEDURES IN CARDIAC ELECTROPHYSIOLOGY: A RETROSPECTIVE ANALYSIS

Background. Radiofrequency catheter ablation (CA) has been the treatment of choice in patients with accessory pathway (AP)-mediated tachycardias. Most of these procedures are done under fluoroscopic guidance, leading to significant radiation exposure to the patient and the laboratory personnel. In this analysis, we have looked at the amount of radiation exposure in AP CA procedures performed without the support of a three-dimensional electroanatomic mapping system. We have analyzed changes in exposure indices over the study period and the impact of change in fluoroscopy frame rate (FFR). Objectives. The objectives of this study are to quantify radiation exposure in accessory pathway ablation procedures; to analyze the radiation exposure trend over time; and to evaluate the effect of fluoroscopy frame rate reduction on the radiation exposure indices in these procedures. Methods. All the AP ablation procedures performed at our institute from January 2016 to December 2019 were retrospectively analyzed. The collected data were age, sex, location of APs based on successful site of ablation on fluoroscopy, procedure time, fluoroscopy time, and dose-area product (DAP). Effective dose (ED) was estimated from DAP. The data of procedures performed before January 2018 (“pre” group) were compared with those of the procedures performed after that date (“post” group). Pre-group procedures were performed at an FFR of 7.5 frames per second (fps), and post-group procedures – at an FFR of 3.75 fps. Results. The total number of procedures included in the analysis was 635. The mean age of the patients was 39±14 years, and 401 of them (63%) were males. The most common location of the APs was left lateral (38%). Procedure time and radiation indices showed a significant decrease over the study period (p < 0.001). Post group procedures had significantly shorter procedure time and lower radiation exposure than pre group procedures. Conclusions. A decrease in the FFR was associated with a significant reduction in radiation exposure in AP ablation procedures

An aggressive case of Warthin-like variant of papillary thyroid carcinoma (PTC)

Introduction/Objective

Warthin-like variant of PTC is a rare subtype of PTC, characterized by papillary growth lined with oncocytic neoplastic cells and lymphocytic rich stroma in the stalks of the papillae. It is frequently associated with Hashimoto thyroiditis and has good prognosis due to lower risk of metastasis. An association with BRAF V600E mutation has been reported. Here we report an aggressive case of Warthin-like variant of PTC.

Methods/Case Report

A 33-year-old Hispanic female presented with a progressively expanding neck mass, difficulty swallowing, voice hoarseness, and neck pain. Ultrasound showed a 3.8 cm left thyroid nodule which on biopsy was positive for PTC. Laboratory tests were positive for anti-peroxidase and anti-thyroglobulin antibodies. A total thyroidectomy was performed. Grossly, the left thyroid lobe nodule was well-circumscribed, unencapsulated, and firm with solid homogenous gray-tan cut surface. Microscopically, the nodule consisted of large eosinophilic cells demonstrating characteristic PTC nuclear features, arranged in papillary structures with the cores packed with prominent lymphoplasmacytic infiltrate consistent with Warthin-like variant of PTC (figure). Separate sub-centimeter foci of PTC with similar features were identified in a background of chronic lymphocytic thyroiditis. Central and left neck dissection showed extensive lymph node metastasis which had features similar to the primary tumor but with less pronounced lymphoplasmacytic cores. The patient is currently 6-month post operation and is receiving iodine ablative therapy.

Results (if a Case Study enter NA)

NA

Conclusion

Molecular analysis of the tumor may aid in identifying molecular aberrations responsible for the aggressive nature in this case and potentially guide treatment.

Is Oncotype DX Testing Necessary For Patients With Node Negative, Low-Grade Invasive Ductal Breast Carcinoma?

Introduction/Objective

Oncotype DX (Genomic Health/Exact Sciences, Redwood City, CA) is a 21-gene expression test that is used to predict the risk of recurrence following hormonal therapy and adjuvant chemotherapy (CT) benefit for patients with early-stage, ER-positive and HER2-negative invasive breast carcinoma (IBC). Testing is performed on formalin-fixed, paraffin-embedded tumor tissue from patients that are either lymph node (LN) negative, have micro- metastases, or 1-3 positive LNs. For years pathologists have studied traditional prognostic features of IBC (tumor grade, size, and LN status), as well as biomarker testing results (ER, PR, HER2, and Ki-67), in an effort to identify surrogate equations that could help identify patients that would benefit from CT. The “TAILORx” clinical trial, performed to study CT benefit in patients with midrange recurrence scores (11-25), has shown that the majority of these patients do not derive benefit from CT. Post-TAILORx, we have observed that only a small subset of our node- negative patients who were tested showed a benefit for CT. Following the examination of Oncotype DX results from testing performed on our patients, we hypothesized that overall tumor grade (Nottingham) might predict which patients with invasive ductal breast carcinoma (IDBC) do not require Oncotype DX testing; therefore, eliminating the need for Oncotype DX testing.

Methods/Case Report

We reviewed the surgical pathology reports and Oncotype DX reports for 251 patients with node-negative disease who underwent surgery at our institution from September 2019 through June 2021. All excisional tumors sent for Oncotype DX testing were ER-positive (Allred score ≥6/8) and HER2-negative by IHC and/or FISH.

Results (if a Case Study enter NA)

Oncotype DX recurrence scores ranged from 0-65. A benefit for CT was seen in 10.4% (26/251) of the patients with node-negative IDBC. A benefit for CT was seen in 6.1% (7/114) of patients with an overall tumor grade of II and 44.2% (19/43) of patients with an overall grade of III. No patients (0/94) with IDBC and an overall tumor grade of I showed a benefit for CT.

Conclusion

In the post-TAILORx era, patients with ER-positive (Allred ≥6/8), HER2-negative IDBC, who are node- negative and show an overall tumor grade of I, apparently do not require Oncotype DX testing. Additional studies from other institutions are needed to confirm our observation.

The inhibitory effect of Cannabis Sativa L. and Morus nigra L. against lipid peroxidation in goat liver and brain homogenates

The present study was aimed to evaluate the antioxidant potential and inhibitory effect ofCannabis sativa and Morus nigra against lipid peroxidation in goat brain and liver homogenates. The formation of free radicals, highly reactive oxygen species (ROS) and reactive nitrogen species (RNS) is a normal metabolic process for cellular signaling and countering the antigens. However, they may cause serious damage if they produced at amplified tolls. In addition, metabolic disorders also serve as sources of these reactive species. Although the issue can be addressed through supplements and other phytochemicals. In this study, two plant species were evaluated for their biological potential by employing a spectrum of antioxidant assays. The antioxidant activity was performed by lipid peroxidation assay. The water extract prepared from leaves of Cannabis sativa and Morus nigra showed significant (P<0.05) inhibition as compared to control i.e., 522.6±0.06 and 659.97±0.03 µg/mL against iron-induced lipid peroxidation in goat brain homogenate while the inhibitions were 273.54±0.04 and 309.18±0.05 µg/mL against nitroprusside induced lipid peroxidation of the brain. The iron and nitroprusside induced lipid peroxidation was also significantly inhibited by leaf extracts of Cannabis sativa and Morus nigra in liver homogenates such as 230.63±0.52 and 326.91±0.01 µg/mL (iron-induced) while 300.47±0.07 and 300.47±0.07 µg/mL (nitroprusside induced), respectively. The extracts of Cannabis sativa extract showed promising activity (96.04±0.060%) against DPPH radicals while Morus nigra showed a moderate activity (34.11±0.120%). The results suggest that different accessions ofCannabis sativa and Morus nigra are a potential source of antioxidants and have a therapeutic effect against disease induced by oxidative stress and hence can be used for novel drug discovery and development.

Stereoselective Synthesis of the Di-Spirooxindole Analogs Based Oxindole and Cyclohexanone Moieties as Potential Anticancer Agents

A new series of di-spirooxindole analogs, engrafted with oxindole and cyclohexanone moieties, were synthesized. Initially, azomethine ylides were generated via reaction of the substituted isatins 3a-f (isatin, 3a, 6-chloroisatin, 3b, 5-fluoroisatin, 3c, 5-nitroisatin, 3d, 5-methoxyisatin, 3e, and 5-methylisatin, 3f, and (2S)-octahydro-1H-indole-2-carboxylic acid 2, in situ azomethine ylides reacted with the cyclohexanone based-chalcone 1a-f to afford the target di-spirooxindole compounds 4a-n. This one-pot method provided diverse structurally complex molecules, with biologically relevant spirocycles in a good yields. All synthesized di-spirooxindole analogs, engrafted with oxindole and cyclohexanone moieties, were evaluated for their anticancer activity against four cancer cell lines, including prostate PC3, cervical HeLa, and breast (MCF-7, and MDA-MB231) cancer cell lines. The cytotoxicity of these di-spirooxindole analogs was also examined against human fibroblast BJ cell lines, and they appeared to be non-cytotoxic. Compound 4b was identified as the most active member of this series against prostate cancer cell line PC3 (IC50 = 3.7 ± 1.0 µM). The cyclohexanone engrafted di-spirooxindole analogs 4a and 4l (IC50 = 7.1 ± 0.2, and 7.2 ± 0.5 µM, respectively) were active against HeLa cancer cells, whereas NO2 substituted isatin ring and meta-fluoro-substituted (2E,6E)-2,6-dibenzylidenecyclohexanone containing 4i (IC50 = 7.63 ± 0.08 µM) appeared to be a promising agent against the triple negative breast cancer MDA-MB231 cell line. To explore the plausible mechanism of anticancer activity of di-spirooxindole analogs, molecular docking studies were investigated which suggested that spirooxindole analogs potentially inhibit the activity of MDM2.

1464 Breaking Tradition – A Rural DGH’s Experience of The Management of Acute Appendicitis During the First Wave of the COVID-19 Pandemic

Aim

Acute appendicitis (AA) is the most common abdominal surgical emergency in the UK and traditionally, operative management is the mainstay of treatment. However, during the first wave of the COVID-19 pandemic, ACPGBI discouraged laparoscopy, due to potential risks of aerosol viral transmission. We aimed to review clinical outcomes of patients treated for AA at our DGH prior to and after the change in ACPGBI guidance.

Method

The first 30 patients treated for AA prior to (Group A) and following the update in ACPGBI guidance (Group B), were identified.

Results

Group A: 7% managed conservatively vs 93% operative management. Group B: 74% managed conservatively vs 26% operative management. No statistically significant difference was seen in the rate of post-operative complications, or readmission. In Group B, of those managed conservatively and then readmitted, 75% underwent an operation (RR &lt; 1.00). The average length of stay (LOS) of those managed conservatively in Group A was 3.5 days vs 2.4 days in Group B (p &lt; 0.05). Statistically significant differences in LOS were also observed in patients who underwent surgery - Group A 5.5 day vs 8.25 days in Group B (p &lt; 0.001).

Conclusions

In conclusion, the change in ACPGBI guidance in the early stages of the COVID-19 pandemic, saw statistically significant differences in LOS at our DGH. A shorter LOS in those conservatively managed in Group B could be explained by hospital bed pressures. An increase in LOS for Group B patients with operative management is understandable, as only cases of complicated AA, or those readmitted underwent emergency surgery.

Diversity of the Anisoptera & Zygoptera (Odonata: Insecta) of Swat, Pakistan

Odonates are important biological control agents for the control of insect pests and insect disease vectors of medical and veterinary importance. The present study was conducted to evaluate the odonate fauna of Swat, Pakistan from March to October 2019. A total of 200 specimens of odonates were collected from diverse habitats. The collected specimens of the order Odonata belonged to 5 families, three families of suborder Anisoptera namely Libellulidae, Gomphidae and Aeshnidae while two families of suborder Zygoptera (Chlorocyphidae and Coenagrionidae). The specimens were categorized into 12 genera and 22 species. Libellulidae was the dominant family (n = 138) accounting for 69% of the odonate fauna. Orthetrum was the dominant genus (n = 73) of suborder Anisoptera accounting for 36.5% of the odonate fauna. The least dominant genera were Anax, Paragomphus and Rhyothemis (n = 5 each) accounting each for 2.5% of the odonate fauna. In Zygoptera, the dominant genus was Ceriagrion (12.5%) and the least dominant genus was Ischnura (6%). Pantala flavescens (Fabricius, 1798) was the most abundant odonate species in the study area recorded from all surveyed habitats. Shannon Diversity Index (H) was 2.988 and Simpson Diversity Index (D) was 0.95 for the collected odonate fauna. The highest abundance of Odonata was recorded in August, September and May while no odonate species were recorded in January, February, November and December. Lotic water bodies were the most suitable habitats with abundant odonate fauna. Anax immaculifrons (Rambur, 1842) was the largest sized odonate species having a wingspan of 53.2±1.63 mm and body length of 56.3 ± 0.4 mm. The present study shows the status of odonate fauna of Swat, Pakistan in diverse habitats and seasonsonal variation throughout the year. Further work is recommended to bridge the gaps in the existing literature.

Evaluation of serum procalcitonin level as a biomarker for disease severity in COVID-19 patients

The pandemic of coronavirus disease 2019 (COVID-19) has infected millions of individuals around the globe. Forecasting the COVID-19 severity is essential, and various biomarkers could be used to evaluate it. The current study was therefore aimed to evaluate the serum pro-calcitonin (PCT) level as a biomarker for bacterial co-infection and disease severity in COVID-19 patients. A total of 430 COVID-19 positive individuals were examined, in which 332 (77.2%) were male individuals while 98 (22.8%) were female individuals. Among the examined samples, 281 were classified as moderate (PCT value 0.07 ± 0.06 ng/mL), 95 were severe (PCT value 0.5 ± 0.4 ng/mL), and 54 were classified as critical (PCT value > 1 ng/mL) individuals. The increase in the total serum level of PCT was observed with the severity of the disease (p < 0.05). The statistical analysis represented no association of PCT value with gender (p 0.9650) while revealed a significant association (p < 0.001) with the age and PCT value in COVID-19 patients. It can be concluded that the serial PCT measurement could determine the prognosis of the disease and the presence of bacterial co-infection in COVID-19 patients. Further exploration of the topic is needed to evaluate the effect of different therapies on the PCT level and to prescribe specific treatment options for coinfection.

Effect of low temperature and high humidity stress on physiology of cucumber at different leaf stages

Low temperature (LT) and high humidity (HH) are important environmental factors in greenhouses and plastic tunnels during the cold season, as they hamper plant growth and development. Here, we studied the effect of LT (day/night: 9/5 °C, 25/18 °C as control) and HH (95%, 80% as control) on young cucumber plants at the 2, 4 or 6 leaf stages. LT+HH stress resulted in a decline in shoot, root and total fresh and dry weights, and decreased P_n , g_s , T_r , F_v /F_m , qP, ETR and chlorophyll, and increased MDA, H₂ O₂ , O₂ ^- , NPQ and C_i as compared to the control at the 2 leaf stage. SOD, POD, CAT, APX and GR were upregulated under LT+HH stress as compared to the control at the 6 leaf stage. ABA and JA increased under LT+HH stress as compared to the control at the 6 leaf stage, while IAA and GA decreased under LT+HH stress as compared to the control at the 2 leaf stage. Our results show that LT+HH stress affects young cucumber plant photosynthetic efficiency, PSII activity, antioxidant defence system, ROS and hormone profile. Plants at the 6 leaf stage were more tolerant than at the 2 and 4 leaf stages under stress conditions.

Aniline-co-o-anthranilic Acid Copolymer-Chitosan/Ag@AgCl Nanohybrid as a Carrier for (E)-N'-(Pyridin-2-ylmethylene) Hydrazinecarbothiohydrazide Release and Antimicrobial Activity

Poly(aniline-co-o-anthranilic acid)-chitosan/silver@silver chloride (PAAN-CS/Ag@AgCl) nanohybrids were synthesized using different ratios of Ag@AgCl through a facile one-step process. The presence of CS led to the formation of the nanohybrid structure and prevented the aggregation of the copolymer efficiently. The synthesized nanohybrids were fully characterized by transmission electron microscopy, X-ray diffraction, Fourier transform infrared (FTIR) spectroscopy, and thermogravimetric analysis. (E)-N'-(Pyridin-2-ylmethylene) hydrazinecarbothiohydrazide I was prepared using thiosemicarbazide and confirmed by ¹H-NMR, ¹³C-NMR, and FTIR analyses. Loading of the azine derivative I using various concentrations at different pH values onto the nanohybrid was followed by UV-vis spectroscopy. Langmuir and Freundlich adsorption isotherm models were used to describe the equilibrium isotherm, and the adsorption followed the Langmuir adsorption isotherm. A pseudo-second-order model was used to describe the kinetic data. A PAAN-CS/Ag@AgCl nanohybrid loaded with azine I interestingly showed efficient antimicrobial activity against Escherichia coli and Staphylococcus aureus more than the azine derivative I. The release of azine I at different pH values (2-7.4) was investigated and the kinetics of release were studied using zero-order, first-order, second-order, Higuchi, Hixson-Crowell, and Korsmeyer-Peppas equations.

Diversity, distribution and relative abundance of the mosquito fauna (Diptera: Culicidae) of Malakand and Dir Lower, Pakistan

The present study was conducted to evaluate the diversity, distribution (C) and relative abundance (RA) of the mosquito fauna (Diptera: Culicidae) of Malakand and Dir Lower, Pakistan. Collection of specimens (n = 1087) was made during September 2018 to July 2019 at six different habitats including freshwater bodies, rice fields, animal sheds, indoors, drains and sewage waters. Specimens were collected through light traps, pyrethrum spray, aspirators and nets and subsequently killed, preserved and then arranged in entomological boxes for identification. Three genera were identified namely Culex, Anopheles and Aedes. A total of fourteen species were identified namely: Cx. quinquefasciatus (Say, 1823), An. stephensi (Liston, 1901), Cx. tritaeniorhynchus (Giles, 1901), Ae. vittatus (Bigot, 1861), An. maculatus (Theobald, 1901), An. fluviatilis (James, 1902), Cx. vishnui (Theobald, 1901), Ae. aegypti (Linnaeus, 1762) An. subpictus (Grassi, 1899), An. dthali (Patton, 1905), An. culicifascies (Giles, 1901), An. pallidus (Theobald, 1901), Ae. albopictus (Skuse, 1894) and An. annularis (van der Wulp, 1884). Cx. quinquefasciatus was found constantly distributed in the study area with RA = 16.5% and C = 100%. An. annularis was found as a satellite species, sporadically distributed in the study area having RA = 0.9% and C = 17%. Diversity indices of mosquitoes in the studied habitats were found as, Shannon-Wiener Index (2.415), Simpson Index (9.919), Fisher's Index (2.269) and Margalef's Index (1.859). A statistically significant difference was recorded in mosquito diversity in the six habitats (Kruskal-Wallis, chi-squared, H = 17.5, df = 5, P = 0.003 at α = 0.05). The present study encompasses mosquito fauna of Malakand, Pakistan with respect to diversity, relative abundance and distribution in diverse habitats and all seasons of the year. This will assist scientists working in various fields related with epidemiology, medical and veterinary entomology, ecology and allied areas of biological sciences.

Surgical Management of Dystocia Due to Unilateral Uterine Torsion in a Domestic Shorthair Cat

A 2-year-old pluriparous domestic shorthair queen was brought to the Madras Veterinary College Teaching hospital with a history of full-term pregnancy, straining for the past 24 hours and brown vaginal discharge. Radiography of the abdomen showed presence of 3 fetal skeletons, and ultrasonography revealed no fetal heartbeat. An emergency caesarean section was performed, and a 720° torsion of the right uterine horn was revealed. Three dead kittens were delivered, 2 from the right horn and 1 from the left horn. An ovariohysterectomy was also performed.

Antibody responses after first and second Covid-19 vaccination in patients with chronic lymphocytic leukaemia

B-cell chronic lymphocytic leukaemia (CLL) is associated with immunosuppression and patients are at increased clinical risk following SARS-CoV-2 infection. Covid-19 vaccines offer the potential for protection against severe infection but relatively little is known regarding the profile of the antibody response following first or second vaccination. We studied spike-specific antibody responses following first and/or second Covid-19 vaccination in 299 patients with CLL compared with healthy donors. 286 patients underwent extended interval (10-12 week) vaccination. 154 patients received the BNT162b2 mRNA vaccine and 145 patients received ChAdOx1. Blood samples were taken either by venepuncture or as dried blood spots on filter paper. Spike-specific antibody responses were detectable in 34% of patients with CLL after one vaccine (n = 267) compared to 94% in healthy donors with antibody titres 104-fold lower in the patient group. Antibody responses increased to 75% after second vaccine (n = 55), compared to 100% in healthy donors, although titres remained lower. Multivariate analysis showed that current treatment with BTK inhibitors or IgA deficiency were independently associated with failure to generate an antibody response after the second vaccine. This work supports the need for optimisation of vaccination strategy in patients with CLL including the potential utility of booster vaccines.

Scanning Thermal Microscopy and Ballistic Phonon Transport in Lateral Spin Valves

Using scanning thermal microscopy, we have mapped the spatial distribution of temperatures in an operating nanoscale device formed from a magnetic injector, an Ag connecting wire, and a magnetic detector. An analytical model explained the thermal diffusion over the measured temperature range (2-300 K) and injector-detector separation (400-3000 nm). The characteristic diffusion lengths of the Peltier and Joule heat differ remarkably below 60 K, a fact that can be explained by the onset of ballistic phonon heat transfer in the substrate.

537 AGE, FRAILTY AND COMORBIDITY IN COVID-19 INPATIENTS 65 AND OLDER

Introduction

Higher incidence of COVID-19 and poorer outcomes have been shown to be associated with age, frailty and comorbidity. Older people have more risk of severe COVID 19; hospitalization, ITU admission, ventilation and mortality.

Aim

To assess the correlation between age, frailty and comorbidity in COVID-19 inpatients 65 years and older.

Methods

A retrospective, cross-sectional analysis was carried out on COVID 19 inpatients 65 and older in a UK district general hospital. Patients with no microbiological evidence of COVID-19 and patients with incomplete data were excluded from the study. Demographic data, frailty score and comorbidity index were extracted from the electronic records of patients. SPSS 27 statistical software was used to perform descriptive analysis and linear regression coefficient.

Results

357 COVID-19 patients 65 and over were assessed; 207 males and 150 females. Mean age was 81.9 +/− 9.31. Frailty scores were measured using the Rockwood Clinical Frailty Scale (CFS) and comorbidity was calculated using the Charlson Comorbidity Index (CCI). There was positive correlation between age and Clinical Frailty Scale (r=. 436; p&lt;. 001), between age and Charlson Comorbidity Index (r=. 448; p&lt;. 001, and between frailty and comorbidity (r=. 429; p&lt;. 001).

Conclusion

In COVID-19 inpatients 65 and older, there was positive correlation between age and Clinical Frailty Scale, between age and Charlson Comorbidity Index and between frailty and comorbidity. More studies are needed to explore the interaction between age, frailty and comorbidity and COVID 19 morbidity and mortality.

POS0653 IMPACT OF UPADACITINIB OR ADALIMUMAB AS INITIAL THERAPY ON THE ACHIEVEMENT OF 48-WEEK TREATMENT GOALS IN PATIENTS WITH RHEUMATOID ARTHRITIS AND INADEQUATE RESPONSE TO METHOTREXATE: POST HOC ANALYSIS OF A PHASE 3 STUDY

Background:

In the randomized, double-blinded, Phase 3 SELECT-COMPARE study, upadacitinib (UPA) + MTX demonstrated greater clinical and functional responses vs adalimumab (ADA) + MTX in patients (pts) with RA and inadequate response to MTX.1,2 Pts with insufficient response to initial therapy were switched from UPA to ADA (and vice versa) according to treat-to-target (T2T) principles.

Objectives:

We analyzed 1-year treatment outcomes in SELECT-COMPARE according to initial randomization group, regardless of whether pts subsequently switched therapy.

Methods:

Pts initially randomized to UPA 15 mg once daily (QD) or ADA 40 mg every other week (EOW; both + MTX) for up to 48 weeks in SELECT-COMPARE were included in the analysis. As per the protocol-directed rescue strategy, pts experiencing <20% improvement in tender or swollen joint counts at Week 14, 18, or 22, or Clinical Disease Activity Index (CDAI) >10 at Week 26, were switched from UPA to ADA or ADA to UPA in a blinded fashion. Efficacy outcomes included CDAI remission (≤2.8) and low disease activity (LDA; ≤10), DAS of 28 joints using CRP (DAS28[CRP]) <2.6 and ≤3.2, and a composite of “deep response” (CDAI remission, HAQ-Disability Index <0.5, and pain score <20). Data are presented and attributed to initial randomized group (UPA or ADA) regardless of any subsequent switch in therapy. Time-averaged response rates were calculated as area under the curve of response rate standardized by 48 weeks. The proportions of pts who maintained Week 26 responses through 6 months of follow-up are also reported.

Results:

This analysis included 651 pts initially randomized to UPA (of whom 245 switched to ADA) and 327 pts initially randomized to ADA (of whom 157 switched to UPA). Baseline characteristics including age, sex, and BMI were generally well balanced between randomized groups. At Week 48, similar proportions of pts initially randomized to UPA or ADA therapy achieved CDAI remission/LDA (27.6%/61.9% vs 24.8%/59.0%) and DAS28(CRP) <2.6/≤3.2 (45.0%/60.2% vs 43.7%/59.0%) (Figure 1). However, a small but significantly greater proportion of pts achieved a deep response with initial UPA vs initial ADA therapy (17.8% vs 12.8%; p<0.05). In addition, time-averaged response rates over 48 weeks were higher for initial UPA vs initial ADA therapy across efficacy outcomes. Similar trends were observed for other outcomes. Additionally, similar proportions of pts maintained Week 26 responses with initial UPA vs initial ADA therapy based on CDAI remission/LDA and DAS28(CRP) <2.6/≤3.2 during 6-month follow-up (Table 1).

Conclusion:

Using a stringent T2T approach to RA management, rates of LDA or remission at 1 year were similar, regardless of whether pts were initially randomized to UPA or ADA. However, initial UPA therapy led to more frequent deep responses and higher time-averaged response rates vs initial ADA therapy.

References:

[1]Fleischmann R, et al. Arthritis Rheumatol 2019;71:1788–800.

[2]Fleischmann R, et al. Ann Rheum Dis 2019;78:1454–62.

Table 1.

Proportion of patients maintaining Week 26 CDAI and DAS28(CRP) responses during 6-month follow-up by initial therapy with UPA or ADA in SELECT-COMPAREa-c

UPA 15 mg QDADA 40 mg EOWCDAI LDA (≤10)43.936.3CDAI Remission (≤2.8)35.022.7DAS28(CRP) ≤3.239.135.3DAS28(CRP) <2.630.530.1

aAs observed.

bBlinded rescue from UPA to ADA or ADA to UPA was permitted at Week 14, 18, and 22 for patients with <20% improvement in TJC or SJC and at Week 26 for patients with a CDAI <10. Data are presented and attributed to original randomized group (UPA or ADA) regardless of any subsequent switch in therapy.

cMaintaining response defined as never losing response at any visit during ~6 months (22–26 weeks) follow up after first achieving response before or at Week 26.

ADA, adalimumab; CDAI, Clinical Disease Activity Index; DAS28(CRP), DAS of 28 joints using CRP; EOW, every other week; QD, once daily; SJC, swollen joint count; TJC, tender joint count; UPA, upadacitinib.

Acknowledgements:

AbbVie funded this study and participated in the study design, research, analysis, data collection, interpretation of data, reviewing, and approval of the publication. All authors had access to relevant data and participated in the drafting, review, and approval of this publication. No honoraria or payments were made for authorship. Medical writing assistance was provided by Frances Smith, PhD, of 2 the Nth, which was funded by AbbVie.

Disclosure of Interests:

Eduardo Mysler Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, Janssen, Pfizer, Roche, and Sandoz., Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, Janssen, Pfizer, Roche, and Sandoz., Yoshiya Tanaka Speakers bureau: AbbVie, Asahi Kasei, Astellas, Bristol-Myers Squibb, Eli Lilly, Chugai, Daiichi-Sankyo, Eisai, Gilead, GlaxoSmithKline, Janssen, Mitsubishi-Tanabe, Novartis, Pfizer, Sanofi, and YL Biologics, Consultant of: AbbVie, Asahi Kasei, Astellas, Bristol-Myers Squibb, Eli Lilly, Chugai, Daiichi-Sankyo, Eisai, Gilead, GlaxoSmithKline, Janssen, Mitsubishi-Tanabe, Novartis, Pfizer, Sanofi, and YL Biologics, Grant/research support from: AbbVie, Chugai, Daiichi-Sankyo, Eisai, Mitsubishi-Tanabe, Takeda, and UCB., Arthur Kavanaugh Consultant of: AbbVie, Amgen, AstraZeneca, Bristol-Myers Squibb, Celgene, Janssen, Pfizer, Roche, and UCB., Grant/research support from: AbbVie, Amgen, AstraZeneca, Bristol-Myers Squibb, Celgene, Janssen, Pfizer, Roche, and UCB., Daniel Aletaha Consultant of: AbbVie, Amgen, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, Roche, Sanofi, and UCB., Grant/research support from: AbbVie, Amgen, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, Roche, Sanofi, and UCB., Peter C. Taylor Speakers bureau: AbbVie, Biogen, Bristol-Myers Squibb, Celgene, Celltrion, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Fresenius, Nordic Pharma, Pfizer, Roche, Sanofi, and UCB., Consultant of: AbbVie, Biogen, Bristol-Myers Squibb, Celgene, Celltrion, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Fresenius, Nordic Pharma, Pfizer, Roche, Sanofi, and UCB., Grant/research support from: AbbVie, Biogen, Bristol-Myers Squibb, Celgene, Celltrion, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Fresenius, Nordic Pharma, Pfizer, Roche, Sanofi, and UCB., In-Ho Song Shareholder of: AbbVie, Employee of: AbbVie, Tim Shaw Shareholder of: AbbVie, Employee of: AbbVie, Yanna Song Shareholder of: AbbVie, Employee of: AbbVie, Ryan DeMasi Shareholder of: AbbVie, Employee of: AbbVie, Mira Ali Shareholder of: AbbVie, Employee of: AbbVie, Roy Fleischmann Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sanofi-Aventis, and UCB., Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sanofi-Aventis, and UCB.

Chryseobacterium gleum bacteraemia: first reported cases from Qatar

Chryseobacterium gleum is a Gram-negative aerobic bacillus. It commonly colonizes mechanical devices, causing device-associated infections like central line–associated bloodstream infection and ventilator-associated pneumonia. We describe two cases of C. gleum bacteraemia in patients admitted to our intensive care unit in Qatar, one of which resulted in death. Long hospital stays and indwelling devices are risk factors for C. gleum bacteraemia. Because C. gleum is inherently resistant to β-lactam antibiotics, rapid identification and antimicrobial susceptibility testing are essential for guiding therapy.

Novel practice to produce safe and healthy dry fish using irradiated chitosan coating

In Bangladesh, dry fishes are mostly produced by drying in an open environment under sunlight, and so the producers are forced to use insecticides and fungicides to prevent microbial and blowfly infestation. That is why dry fishes are often contaminated with residual insecticides and fungicides, which cause a severe threat to human health. In this experiment, gamma radiation treated chitosan solution was used while drying the fishes, and the effect was evaluated. Experimental results suggested that chitosan coating did not hinder the drying process but improved the quality of the produces. Chitosan coating was found as a repellant of blowflies as well. Besides, it also prevented microbial contamination. The nutritional value of the produced dry fishes was examined and found very satisfactory. Overall results suggested that the application of irradiated chitosan can be a very suitable and cost-effective way to produce safe and healthy dry fishes.

A35 ASSOCIATIONS BETWEEN AUTONOMIC DYSFUNCTION, COLONIC DYSMOTILITY AND ABSENT DEFECATION REFLEXES IN PATIENTS WITH CHRONIC REFRACTORY CONSTIPATION

Background

A defecation reflex involves sensory information from the colon sent to the central nervous system which results in propulsive motor patterns in the colon through programmed neural activity from the autonomic nervous system. Neurological causes of constipation are recognized but specific neurological pathways that contribute to pathophysiology of the disease is underexplored. Diagnosis and treatment usually do not involve the autonomic nervous system.

Aims

Our objective was to assess autonomic dysfunction and abnormal defecation reflexes as a possible cause of chronic constipation.

Methods

Defecation reflexes were assessed by high-resolution colonic manometry through balloon distention, meal intake, and rectal bisacodyl. Specific heart rate variability (HRV) parameters were used to assess general orthostatic autonomic reactivity, and autonomic functioning during high resolution colonic manometry, in 14 patients with chronic refractory constipation considered for surgery.

Results

All patients had a unique combination of motility, reflex ability and HRV profiles. Patients overall did not generate HAPWs or had lower HAPW amplitude and lower propulsive activity compared to healthy individuals. Half of the 14 patients were tested to have high sympathetic tone based on Baevsky’s stress index prior to HRCM, and 11 of the patients had sympathetic hyper-reactivity and/or low parasympathetic reactivity to at least one type of colonic stimulation during HRCM. Abnormal autonomic tone or autonomic reactivity to colonic stimulation was present in all four patients with absence of the vagosacral defecation reflex. Five of the seven patients with absence of the sacral defecation reflex showed high sympathetic tone or high sympathetic reactivity to stimulation. Only two patients had abnormality in coloanal coordination and this was associated with low parasympathetic reactivity to stimulation in both patients.

Conclusions

The assumption that colonic resection was needed to remove an inert colon was wrong in most patients, but most patients had some form of reflex abnormality. Sympathetic dominance far outweighed parasympathetic dysfunction. Incorporation of assessments of defecation reflexes and autonomic nervous system activity into diagnosis of chronic refractory constipation provides a comprehensive pathophysiological understanding of specific defective neurological pathways contributing to dysmotility. This forms the basis for our individualized treatment efforts through sacral neuromodulation.

Funding Agencies

CIHR

A235 EFFECTS OF SACRAL PHOTOBIOMODULATION ON THE AUTONOMIC NERVOUS SYSTEM IN PATIENTS WITH COLONIC DYSMOTILITY

Background

Patients with chronic refractory constipation show colon dysmotility, including impaired coordination of descending colon-sigmoid colon-rectum-anal sphincter motor functions; this may involve slow colonic transit and colo-anal dyssynergia. Impaired neuronal communication between the sacral defecation center and the distal colon may be causative. In addition, patients with lumbosacral neurological conditions (with lower back pain) may not be able to evoke an effective defecation reflex.

Aims

To evaluate if a single therapeutic session of sacral low-level laser therapy (LLLT) would affect the autonomic activity in patients with chronic constipation as revealed by changes in heart rate variability, and to report a multi-session treatment case study.

Methods

In 41 patients with chronic constipation, one session of LLLT was executed, using red LED light at a wavelength of 660 nm for 10 minutes and infrared LED light at wavelength of 840 nm for 10 minutes followed by infrared laser light with wavelength of 825 nm for 20 minutes, while measuring the electrocardiogram. One patient received this treatment 8x over 3 weeks.

Results

The lumbar-sacral light array treatment showed a significant decrease in parasympathetic activity (RSA & RMSSD) whereas pure sacral laser light treatment showed a significant increase in parasympathetic activity (RSA & RMSSD) as well as a reduction in sympathetic activity (Baevsky’s stress index: SI) (table). A single session of LLLT was also executed during HRCM in 8 patients with some but not all showing evoked colonic motility. Before COVID-19 shutdown, one patient was successfully treated. With a history of chronic constipation without ability to have spontaneous bowel movements for 5 years, symptoms improved from 13 to 8 (on a 20 scale) and quality of life improved from 1.5 to 2.5 (on a 0–4 scale) after 8 sessions. Sympathetic reactivity from supine to standing markedly reduced, from highly elevated measured as the Baevsky index from 55 to 153 s-2 it improved from 42 to 75 s-2 upon standing after 4 sessions. Parasympathetic reactivity did not change.

Conclusions

A single session of sacral LLLT markedly affected autonomic nervous activity reflected in changes in HRV. The LLLT is likely affecting the sacral defecation center through peripheral nerves entering and exiting the spinal cord including the dorsal root ganglia. LLLT treatment of a patient with inability to generate spontaneous bowel movements, resulted in ability to have complete evacuations associated with marked reduction in sympathetic reactivity during the supine-standing test, after 4 LLLT sessions.

Funding Agencies

CIHRFarncombe Family Digestive Health Research Institute

A232 AUTONOMIC FUNCTION ANALYSIS VIA HEART RATE VARIABILITY ASSOCIATED WITH PROPULSIVE MOTOR PATTERNS OF THE HUMAN COLON

Background

Although parasympathetic activity is the primary driver of colonic propulsive activity, and sympathetic activity a major inhibitor of colonic motility, they are rarely measured and almost play no role in diagnosis of dysfunction or standard treatments.

Aims

Our aim was to develop assessment of autonomic nervous system activity associated with the major propulsive motor patterns, an essential part of defecation reflexes in the human colon orchestrated by neural reflexes.

Methods

One hundred and forty-five motor patterns were recorded from eleven healthy volunteers using high resolution colonic manometry (HRCM) with concurrent electro- and impedance cardiography to evaluate changes in parameters of heart rate variability (HRV).

Results

High-amplitude propagating pressure waves (HAPWs) that often start in the proximal colon, traverse distally and end with anal sphincter relaxation, were associated with a 8.2% (P&lt;0.02) increase in the respiratory sinus arrhythmia (RSA) value, a 24.6% increase in the root mean square of successive differences of beat to beat intervals (RMSSD), indicated a strong parasympathetic reactivity that subsided within 2 min of termination of the HAPW (Figure 1). The measure of sympathetic reactivity to motor patterns was best reflected by the Baevsky Stress Index (or Sympathetic Index, SI) that reduced by 45% (P&lt;0.02). We developed a measure of autonomic balance, the SI/RSA ratio that changed from 18.8 to 8.7 (54%; P&lt;0.01) during motor activity and recovered to 16.1 immediately after (P&lt;0.005). The SI/RMSSD reduced by 65% (P&lt;0.01). When HAPWs occurred in quick succession, the parasympathetic activity showed rhythmicity at the HAPW frequency that slowly terminated when motor activity stopped. During motor activity, the heart rate did not significantly change.

Conclusions

The major propulsive motor pattern of the human colon, the HAPW as measured by HRCM that is part of the major defecation reflexes, is associated with marked changes in parasympathetic and sympathetic activity that is reflected and measurable as heart rate variability parameters. This opens the way to evaluate autonomic dysfunction in patients with colon motor disorders.

Funding Agencies

CIHRNSERC, Farncombe Institute

An updated knowledge of Black seed (Nigella sativa Linn.): Review of phytochemical constituents and pharmacological properties

N. sativa (N. sativa) has been used since ancient times, when a scientific concept about the use of medicinal plants for the treatment of human illnesses and alleviation of their sufferings was yet to be developed. It has a strong religious significance as it is mentioned in the religious books of Islam and Christianity. In addition to its historical and religious significance, it is also mentioned in ancient medicine. It is widely used in traditional systems of medicine for a number of diseases including asthma, fever, bronchitis, cough, chest congestion, dizziness, paralysis, chronic headache, back pain and inflammation. The importance of this plant led the scientific community to carry out extensive phytochemical and biological investigations on N. sativa. Pharmacological studies on N. sativa have confirmed its antidiabetic, antitussive, anticancer, antioxidant, hepatoprotective, neuro-protective, gastroprotective, immunomodulator, analgesic, antimicrobial, anti-inflammatory, spasmolytic, and bronchodilator activity. The present review is an effort to explore the reported chemical composition and pharmacological activity of this plant. It will help as a reference for scientists, researchers, and other health professionals who are working with this plant and who need up to date knowledge about it.