Molecular detection and MST genotyping of Coxiella burnetii in ruminants and stray dogs and cats in Northern Algeria

Aiming at identifying the reservoir and contamination sources of Coxiella burnetii in Northern Algeria, we investigated the molecular presence of the bacterium in 599 samples (blood, placenta, liver, spleen, and uterus) collected from cattle, sheep, dogs and cats. Our qPCR results showed that 15/344 (4.36%) blood samples and six/255 (2.35%) organ specimens were positive for C. burnetii. In cattle, three (4%) blood and liver samples were positive. In sheep, one blood (1.19%) and 3 (8.57%) placenta samples were positive. At the Algiers dog pound, 8 (10%) and 3 (5%) blood samples were qPCR positivein dogs and cats, respectively. In addition, MST genotyping showed that MST 33 was present in cattle and sheep, MST 20 in cattle,andMST 21 in dogs and cats.

In-silico optimisation of ICD defibrillation efficacy by modifying lead/can configurations using a cohort of high-resolution whole-torso heart models

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Medical Research Council, UK

Background

ICD is an effective direct therapy against VT/VF by applying a strong electrical shock across the heart between the shocking coil and can. Conventionally, patients will have a shocking coil inside the right ventricle (RV) and a can at the upper left chest. However, due to infections or other conditions, the can may need to place towards the right chest. The placement of the RV coil may also vary in different cases, for example avoiding scar. However, it is unclear how defibrillation efficacy may be altered by these unavoidable modifications to conventional lead/can configurations and whether optimisation may be possible.

Purpose

To compare defibrillation efficacy of modifications of ICD configurations in a cohort of whole-torso models.

Methods

A cohort of 15 whole torso models was generated from high resolution CT data and contrast CT cardiac scans, including 5 dilated cardiomyopathy (DCM), 5 hypertrophic cardiomyopathy (HCM) and 5 structurally normal patients (Fig A). Transvenous ICDs were represented by a shocking coil inside the RV (near apex) and a (ground) can at the upper left chest as default settings. Configurations were then varied by moving the can to the right chest, moving the RV coil up the mid-septum or adding extra grounds (Superior Vena Cava (SVC) coil, coronary sinus (CS) coil (Fig A)). Defibrillation-strength shocks were applied to all models (Fig B). DFTs and mean electrical field were evaluated across the whole heart as well as specific LV, RV, RV insertion regions, along with overall impedance.

Results

Shifting the can from left to right significantly increased DFT for the whole heart (23 J vs 15 J, P=0.03) and LV (25 J vs 17 J, P=0.03) (Fig C) and reduced the mean electrical field. Moving the RV coil further up the septum did not significantly alter DFT (Fig D), but did reduce mean electrical field for all regions and reduce impedance significantly. Additional separate coils significantly reduced DFT for all regions (Fig D) by increasing mean electrical field, whilst adding both coils significantly reduced DFT the most (whole heart: 15 J vs 6 J, P=0.03) (Fig E). Impedance was increased significantly by adding SVC coil, but reduced significantly by adding CS coil. Adding both coils increased impedance slightly.

Conclusions

Although a right-sided can increases DFT by over 50%, additional leads (grounds) may mitigate this increase by increasing mean electrical field. Moving the RV coil closer to the mid-septum reduces DFT slightly, but also reduces mean electrical field and impedance significantly.

Effect of recreational exercise and fitness on left ventricular torsion and wall mechanics study (FIT-TWIST/Health)

Background

Left ventricular (LV) remodeling is associated with elite athletics. This study aimed to assess the effects of recreational exercise on LV remodeling and mechanics in healthy adults.

Methods

A prospective cross-sectional study evaluated 38 healthy adult recreational exercise participants with a Bruce protocol treadmill exercise stress test, and 2D and speckle-tracking echocardiography. Fitness level was stratified by the achieved age- and sex-predicted metabolic equivalents (METS) as average/good (group A, N=20; METS=13.9) and high (group B, N=18; METS=18.2) groups.

Results

Mean age was 33 years, and 58% were female. Participants in Group B used more multi-modality (67 vs 20%; p=0.008) or running (50% vs 15%; p=0.04) exercise regimens, and had larger LV mass (66 vs 56 g/m2; p=0.05) and left atrial volume indices (28 vs 22 ml/m2; p=0.02), when compared with group A. However, all LV strain and torsion mechanics were similar between groups (Figure). Multivariate linear regression analysis revealed independent associations between global longitudinal strain (GLS) and transmitral E-wave (β=−0.57), maximum systolic blood pressure (β=0.32), and LV end-diastolic volume index (β=0.32) (model r=0.72; p<0.001). No correlation between METS achieved and LV parameters was observed.

Conclusion

Recreational exercise and fitness are associated with healthy LV geometry and mechanics in adults. Early diastolic LV filling, LV chamber size, and peak exercise blood pressure are correlated with GLS.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Florida Heart Research Foundation

835 Evaluation of an International Virtual Teaching Series for UK Academic Foundation Programme Applications and Interviews: A Cross-Sectional Study

Background

UK academic foundation programme (AFP) is an important steppingstone into academic surgical training, but there is paucity in undergraduate preparedness. We aimed to evaluate the effectiveness of a virtual webinar series to prepare students for applications and interviews.

Method

A cross-sectional study was conducted between 18/10/2020 – 19/12/2020. Ethical approval was not required as this was an evaluation of teaching interventions. Medical students interested in AFP were included. Three 1-hour presentations, delivered by two AFP doctors, focused on evidence-based frameworks to approach AFP applications, critical appraisal, personal and clinical interviews. Pre- and post-webinar electronic surveys compared preparedness in self-reported knowledge (SRK) and confidence (SRC) on a Likert scale (1: not knowledgeable/confident – 5: very knowledgeable/confident). SPSS v27.0 was used to perform Wilcoxon Signed-rank test; P-value<0.05 was considered statistically significant.

Results

Mean attendance per presentation was 136, with 93(68.4%) pre-webinar responses and 62(45.6%) post-webinar responses. Both SRK and SRC regarding AFP applications improved by the same value (median 3 versus 4; p < 0.0001). Both SRK and SRC in critical appraisal also improved by the same value (median 2 versus 4; p < 0.0001). SRK and SRC in using interview answer frameworks (SPIES, STARR and CAMP) improved from median 2 versus 4 (p < 0.0001) and median 1 versus 4 (p < 0.0001), respectively. Across all pre-surveys, 129(46.4%) had no preference regarding teaching platforms, 115(41.3%) preferred webinars and 34(12.2%) preferred face-to-face teaching.

Conclusions

Webinars, teaching evidence-based frameworks can improve preparedness for AFP applications and interviews. Medical schools should address students’ perceived lack of knowledge and confidence in critical appraisal.

Priorities and preferences of advanced soft tissue sarcoma patients starting palliative chemotherapy: baseline results from the HOLISTIC study

INTRODUCTION

Palliative chemotherapy is the principal treatment of patients with advanced soft tissue sarcomas (STS); however prognosis is limited (median overall survival 12-19 months). In this setting, patient values and priorities are central to personalised treatment decisions.

PATIENTS AND METHODS

The prospective HOLISTIC study was conducted in the UK and the Netherlands assessing health-related quality of life in STS patients receiving palliative chemotherapy. Participants completed a questionnaire before starting chemotherapy, including attitudes towards quality of life (QoL) versus length of life (LoL), decisional control preferences, and decisional conflict. Chi-square and Fisher's exact tests were used to evaluate associations between patient characteristics and preferences.

RESULTS

One hundred and thirty-seven patients with advanced STS participated (UK: n = 72, the Netherlands: n = 65). Median age was 62 (27-79) years. Preference for extended LoL (n = 66, 48%) was slightly more common than preference for QoL (n = 56, 41%); 12 patients (9%) valued LoL and QoL equally (missing: n = 3). Younger patients (age <40 years) prioritised LoL, whereas two-thirds of older patients (aged ≥65 years) felt that QoL was equally or more important than LoL (P = 0.020). Decisional conflict was most common in patients who prioritised QoL (P = 0.024). Most patients preferred an active (n = 45, 33%) or collaborative (n = 59, 44%) role in treatment decisions. Gender, performance status, and country were significantly associated with preferred role. Concordance between preferred and actual role in chemotherapy decision was high (n = 104, 76%).

CONCLUSIONS

Heterogeneous priorities and preferences among advanced STS patients support personalised decisions about palliative treatment. Considering individual differences during treatment discussions may enhance communication and optimise patient-centred care.

Embryonal and Alveolar Rhabdomyosarcoma in Adults: Real-Life Data From a Tertiary Sarcoma Centre

AIMS

Embryonal and alveolar rhabdomyosarcoma (ERMS, ARMS) are subtypes of RMS that mainly occur in children, with relatively good outcomes. The incidence in adults is extremely low and survival is significantly worse compared with children. Data are scarce and literature generally combines all RMS subtypes, including pleomorphic RMS, which primarily occurs in adults and behaves more like undifferentiated pleomorphic sarcoma. The aim of this study was to evaluate patient and tumour characteristics, outcome and prognostic factors in adult patients with ERMS and ARMS.

MATERIALS AND METHODS

All adult (18 years or older) ERMS and ARMS patients (presenting 1990-2016) were identified from a prospectively maintained database and were included in this analysis.

RESULTS

Overall, 66 patients were included (42 men, 24 women). The median age at presentation was 28 years (range 18-71). The median overall survival for all ARMS (n = 42) and ERMS (n = 24) patients was 18 months, with a 5-year overall survival rate of 27%. Patients presenting with localised disease (n = 38, 58%) and metastatic disease (n = 25, 42%), had a 5-year overall survival rate of 36% and 11%, respectively. In univariate analysis we found alveolar subtype, fusion gene positivity, infiltrative tumour and metastatic presentation to be negative prognostic factors.

CONCLUSION

Survival in adult ERMS and ARMS patients is poor and the current data may be useful in the design of trials with novel agents. Ideally, paediatric and adult oncologists should set up trials together to get a better understanding of biological, genetic and clinically relevant factors in this disease.

Clinical Profile and Outcome of Paraphenylene Diamine Poisoning

OBJECTIVE

To determine the clinical presentation, complications, and outcome of paraphenylene diamine (PPD) poisoning in patients presenting to Nishtar Hospital, Multan.

STUDY DESIGN

Descriptive study.

PLACE AND DURATION OF STUDY

Medical Unit II and III, Nishtar Hospital, Multan, from April 2015 to September 2016.

METHODOLOGY

All adult patients admitted with history of paraphenylene diamine ingestion were evaluated for clinical features, complications, and outcomes on a pre-designed proforma.

RESULTS

Out of 122 patients, 95 were females (77.9%) and 101/122 patients had ingested the poison with an intention of suicide or self harm (82.8%). The mean age of presentation was 23.21 ±8.2 years. Cervico-facial edema was the chief presenting complaint, seen in 116/122 (95%) of patients, with median of 2 (interquartile range=3) for time of onset after ingestion of poison. Tracheostomy was needed in 95/116 (82%) patients with cervico-facial edema. Other common complaints were dark urine in 95/122 (77.9%) and pain in limbs in 98/122 (80.3%) patients. Rhabdomyolysis was evident in 91/122 (74.5%) patients at admission. Acute kidney injury developed in 37/122 (30.3%) patients. Among these, 16 (43.2%) patients required haemodialysis. Myocarditis was diagnosed in 33/122 (27%) patients. The median for hospital stay was 9.50 days (interquartile range=6.25). The mortality was 34/122 (28%). Ventricular arrhythmias were the commonest cause of death in 25/34 (73.5%), followed by renal failure in 5/34 (14.7%), asphyxia in 2/34 (5.88%), and aspiration pneumonia in 2/34 (5.88%) patients.

CONCLUSION

Paraphenylene diamine is an emerging domestic poison in Pakistan, with a high morbidity and mortality.

Abstract P2-05-10: Withdrawn

This abstract was withdrawn by the authors.

Prime-boost using separate oncolytic viruses in combination with checkpoint blockade improves anti-tumour therapy

The anti-tumour effects associated with oncolytic virus therapy are mediated significantly through immune-mediated mechanisms, which depend both on the type of virus and the route of delivery. Here, we show that intra-tumoral oncolysis by Reovirus induced the priming of a CD8+, Th1-type anti-tumour response. By contrast, systemically delivered Vesicular Stomatitis Virus expressing a cDNA library of melanoma antigens (VSV-ASMEL) promoted a potent anti-tumour CD4+ Th17 response. Therefore, we hypothesised that combining the Reovirus-induced CD8+ T cell response, with the VSV-ASMEL CD4+ Th17 helper response, would produce enhanced anti-tumour activity. Consistent with this, priming with intra-tumoral Reovirus, followed by an intra-venous VSV-ASMEL Th17 boost, significantly improved survival of mice bearing established subcutaneous B16 melanoma tumours. We also show that combination of either therapy alone with anti-PD-1 immune checkpoint blockade augmented both the Th1 response induced by systemically delivered Reovirus in combination with GM-CSF, and also the Th17 response induced by VSV-ASMEL. Significantly, anti-PD-1 also uncovered an anti-tumour Th1 response following VSV-ASMEL treatment that was not seen in the absence of checkpoint blockade. Finally, the combination of all three treatments (priming with systemically delivered Reovirus, followed by double boosting with systemic VSV-ASMEL and anti-PD-1) significantly enhanced survival, with long-term cures, compared to any individual, or double, combination therapies, associated with strong Th1 and Th17 responses to tumour antigens. Our data show that it is possible to generate fully systemic, highly effective anti-tumour immunovirotherapy by combining oncolytic viruses, along with immune checkpoint blockade, to induce complementary mechanisms of anti-tumour immune responses.

A CASE OF ENLARGED VIRCHOW ROBIN SPACES CAUSING PROGRESSIVE HEMI SENSORY SYMPTOMS

Introduction

Virchow Robin Spaces (VRS) or perivascular spaces are usually an incidental finding but rarely they can enlarge and causes neurological symptoms. We report a case of symptomatic VRS with striking appearance on MRI Scan.

Case description

A 33 year lady presented with progressive sensory disturbances which initially affected her right arm and later on right side of face. Her MRI Brain scan showed enlarged Virchow Robin Spaces in the left corona radiata corresponding to her symptoms.

Importance

Our case highlights a common MRI finding, typically considered incidental but which can be symptomatic in some cases. The typical scan characteristic and location of Virchow Robin spaces can help to differentiate from close mimics like cystic mass lesion. Its awareness can avoid frequent repeated imaging and interventions.

Defining and managing risk in asthma

Asthma attacks are a major global source of morbidity and cost. The incidence and impact of asthma attacks have not improved despite widespread adoption of effective universal treatment guidelines. Consequently, there is increasing interest in managing asthma based on specific assessments of both current symptoms and future risk. In this review, we consider 'risk' in asthma, and how it might be assessed from the patient's history and objective measurements. We also discuss the potential for encouraging shared decision-making and improving medical consensus through explicit communication of risk and highlight the potential opportunities and challenges in risk assessment to improve asthma management through individualised treatment strategies.

Prospects for the sustainability of delivering the Basic Package of Health Services in Afghanistan: a stakeholder analysis

This study explored the readiness of stakeholders in Afghanistan for sustaining delivery of the Basic Package of Health Services (BPHS) without external technical and financial assistance. A stakeholder analysis was applied using qualitative methods. Fifteen stakeholders were purposively drawn from the Afghanistan ministries of public health and finance, political representatives, development partners, nonprofit organizations and public health experts. Data were collected through in-depth interviews with the stakeholders and desk review of pertinent documents. We found that sustainability of the BPHS in Afghanistan is questionable as stakeholders are suboptimally organized to come up with effective alternatives. Uneven ownership and divisive positioning are bottlenecks to the evolution of a realistic continuation plan. Those with the most significant influence are lukewarm, while those who are most supportive have the least influence. Sustainability needs to be tackled at the start in designing the BPHS rather than in the wake of eventual donor withdrawal.

Antitumour activity of abiraterone and diethylstilboestrol when administered sequentially to men with castration-resistant prostate cancer

BACKGROUND

Abiraterone is a standard treatment for men with castration-resistant prostate cancer (CRPC). We evaluated the antitumour activity of abiraterone following the synthetic oestrogen diethylstilboestrol (DES).

METHODS

Castration-resistant prostate cancer patients treated with abiraterone were identified. Demographics, response variables and survival data were recorded.

RESULTS

Two-hundred and seventy-four patients received abiraterone, 114 (41.6%) after DES. Pre-chemotherapy abiraterone resulted in ≥50% PSA declines in 35/41 (85.4%) DES-naïve and 20/27 (74.1%) DES-treated patients. Post-docetaxel abiraterone resulted in ≥50% PSA declines in 40/113 (35.4%) DES-naïve and 23/81 (28.4%) DES-treated patients. Time to PSA progression was similar regardless of prior DES.

CONCLUSION

Abiraterone has important antitumour activity in men with CRPC even after DES exposure.

Oncolytic Vaccinia virus and radiotherapy in head and neck cancer

OBJECTIVE

Oncolytic forms of attenuated Vaccinia virus are now in clinical development, assessing the compatibility of this novel treatment with radiotherapy may reveal exploitable synergistic relationships.

MATERIALS AND METHODS

In vitro analyses of cell killing, cell cycle effects and caspase activation were carried out on HN3, HN5, CAL27, Detroit, SIHN5B, and PJ41 cells. In vivo studies of the virus and X-radiation were performed on H&N xenografts in CD1 nude mice.

RESULTS

Cell killing in vitro was demonstrated to be dose- and time-dependent. Infection causes an increase in S-phase and sub-G1 cells. A dose dependent increase in active caspase-3 indicated induction of apoptosis. Xenografts injected with Vaccinia stabilised and frequently completely regressed. Combination with radiation generated additional cell death, induction of caspase activity and in vivo further improved long term regression rates.

CONCLUSIONS

These data support continued exploration of this therapy combination and indicates potential for clinical trials in head and neck cancer.

Synergistic cytotoxicity of oncolytic reovirus in combination with cisplatin-paclitaxel doublet chemotherapy

Oncolytic reovirus is currently under active investigation in a range of tumour types. Early phase studies have shown that this agent has modest monotherapy efficacy and its future development is likely to focus on combination regimens with cytotoxic chemotherapy. Indeed, phase I/II clinical trials have confirmed that reovirus can be safely combined with cytotoxic drugs, including a platin-taxane doublet regimen, which is currently being tested in a phase III clinical trial in patients with relapsed/metastatic head and neck cancer. Therefore, we have tested this triple (reovirus, cisplatin, paclitaxel) combination therapy in a panel of four head and neck cancer cell lines. Using the combination index (CI) method, the triple therapy demonstrated synergistic cytotoxicity in vitro in both malignant and non-malignant cell lines. In head and neck cancer cell lines, this was associated with enhanced caspase 3 and 7 cleavage, but no increase in viral replication. In vitro analyses confirmed colocalisation of markers of reovirus infection and caspase 3. Triple therapy was significantly more effective than reovirus or cisplatin-paclitaxel in athymic nude mice. These data suggest that the combination of reovirus plus platin-taxane doublet chemotherapy has significant activity in head and neck cancer and underpin the current phase III study in this indication.

The use of computerised tomography guided percutaneous fine needle aspiration in the evaluation of solitary pulmonary nodules

The evaluation of a solitary pulmonary nodule (SPN) has changed over the years with increased access to percutaneous computerised tomography (CT) guided fine needle aspiration (FNA), where bronchoscopy is unhelpful. The aim of our study was to evaluate the sample adequacy, diagnostic and complication rate of CT-FNA of a SPN at our academic teaching hospital over an 18 month period. CT-FNA was performed by a radiologist, with a cytopathologist in attendance to confirm the adequacy of the sample obtained. The size of the nodule, sample material and adequacy, diagnosis and complications were recorded. A total of 101 patients were included, 54 male and the mean age was 68 +/- 11 years. The mean size of the SPN was 2.3 cm (range 1-11 cm). 56 (56%) patients had a right SPN, 45 (45%) had a left SPN. CT-FNA was diagnostic in 80 (80%) patients and non-diagnostic in 21 (20%) patients. The sample was insufficient for immunocytochemistry, although the morphological appearance was diagnostic in 20 (25%) of the 80 patients. Pneumothorax occurred in 26/101 (26%) patients post CT-FNA, of these 7 (27%) required chest drain insertion, while 19 (73%) were managed conservatively. CT FNA is a useful tool for the diagnosis of a SPN, with our diagnostic accuracy comparable to that reported in the literature. However, CT-FNA may not provide adequate sample volume to perform ancillary testing and has a moderate complication rate.

Factorial design analysis for sorption of zinc on hydroxyapatite

A factorial design was employed to evaluate the quantitative removal of zinc from aqueous solutions on synthesized hydroxyapatite. The experimental factors and their respective levels studied were the initial zinc concentration in solution (35≤C(Zn)≤85 mg/L), adsorbent dosage (4.5≤C(susp)≤9.5 g/L), Ca/P molar ratio (1.667≤Ca/P≤2) and calcination temperature of hydroxyapatite (600≤T(Cal)≤800 °C). The adsorption parameters were analysed statistically by means of variance analysis by using the STATISTICA software. The experimental results and statistical analysis show that increasing in the calcination temperature from 600 to 800 °C decrease the zinc adsorption whereas the increase of adsorbent dosage increases it. Based on the analysis of variance and the factorial design of experiments, adsorbent dosage has a positive effect on the removal of zinc, whereas zinc concentration, Ca/P molar ratio and calcination temperature have a negative effect on this process. The factorial results also demonstrate the existence of statistically significant binary interactions of the experimental factors. The experimental results were fitted to the Langmuir and Freundlich equations to find out adsorption capacities. In most cases, the results indicate that the sorption data fits well in the Freundlich isotherm model. The results of XRD analysis, pH(PZC) and pH(Final) values indicated that ion exchange and dissolution/precipitation mechanisms predominate for the sorption of zinc on our hydroxyapatite.