A151 RISK FACTORS FOR VENOUS THROMBOEMBOLISM AFTER HOSPITAL DISCHARGE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background

Inflammatory bowel disease (IBD) is a chronic inflammatory condition which is independently associated with venous thromboembolism (VTE). Although the absolute risk of VTE is greatest during hospitalization, the risk remains elevated in the early post-discharge period. The risk factors for VTE during this vulnerable period remain unknown.

Aims

We performed a systematic review and meta-analysis to determine risk factors for VTE in the post discharge period among adult patients with IBD.

Methods

We performed a systematic search of Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials from inception through April 29, 2021 for publications that reported risk factors for VTE during the post-discharge period among patients with IBD. Study eligibility was assessed independently in duplicate without age or language restriction. We defined the post-discharge period as within 6 months of discharge. Pooled summary estimates of adjusted hazard/odds ratios, when available, were calculated for individual risk factors using random effects model with 95% confidence intervals. The analysis was performed when a minimum of three studies were available for a given risk factor. Heterogeneity was assessed using I² statistic. Study quality was assessed using an adapted version of the National Institute of Health criteria.

Results

We identified 10 studies from a total of 4339 abstracts that met our inclusion criteria: 8 population-based studies, 1 multicenter observational study and 1 single center observational study. Risk factors for post-discharge VTE were assessed at 6 weeks in 1 study, 1 month in 5 studies, 3 months in 2 studies, and 6 months in 2 studies. The variables assessed in our meta-analysis are reported in Table 1. Exposure to corticosteroid (odds ratio [OR], 1.77; 95% CI, 1.53–2.06) but not biologics (OR, 1.21; 95% CI 0.80–1.82) was associated with an increased risk of VTE. Furthermore, greater length of stay (OR 1.49; 95% CI, 1.01–2.20), ulcerative colitis (OR 1.41; 95% CI, 1.19–1.66), history of malignancy (OR 1.35; 95% CI, 1.12–1.62), and surgery during admission (OR 1.26; 95% CI, 1.12–1.42) but not female sex (OR 0.98; 95% CI, 0.88–1.10) or surgery type (OR 1.09; 95% CI, 0.75–1.57) were associated with increased risk of VTE after discharge. Overall, the study quality was rated as fair.

Conclusions

In our meta-analysis, which consisted of moderate quality of evidence, we identified multiple risk factors associated with VTE in the post-discharge period. This work will help inform which factors should be considered for developing point of care clinical predictive models to help guide when extended VTE prophylaxis is required.

Funding Agencies

None

A194 A POSSIBLE ASSOCIATION BETWEEN SECUKINUMAB AND NEW-ONSET INFLAMMATORY BOWEL DISEASE: A CASE SERIES

Background

Secukinumab is a monoclonal antibody targeting interleukin-17A and is commonly used for managing autoimmune diseases such as, psoriasis, psoriatic arthritis, and ankylosing spondylitis. Prior studies have suggested that anti-IL17 therapy may worsen symptoms in patients with pre-existing inflammatory bowel disease (IBD). However, it remains unclear if secukinumab is associated with new-onset IBD or in provoking a flare of previously quiescent IBD.

Aims

We evaluated patients referred to our IBD clinic who developed intestinal inflammation after starting secukinumab for the management of autoimmune diseases.

Methods

We performed a retrospective, observational study at a single tertiary care center between 2017 and 2020. Patients referred to our IBD clinic who developed intestinal inflammation after starting secukinumab were included. We excluded patients with an established pre-existing diagnosis of IBD and patients who had positive stool testing for infectious organisms. Patient demographics, disease characteristics, distribution of intestinal inflammation and clinical outcomes were assessed. The pathology slides were reinterpreted by a single pathologist with a specialty in gastroenterology to determine the histologic characteristics of the inflammation.

Results

A total of 8 patients developed gastrointestinal symptoms after starting secukinumab: 4 (50%) males with a median age of 42.5 (IQR: 35–50 years old). Secukinumab was initiated for psoriasis in 3 (37.5%) patients, psoriatic arthritis in 2 (25%) patients, ankylosing spondylitis in 2 (25%) patients and juvenile idiopathic arthritis in 1 (12.5%) patient. The median time of onset for gastrointestinal symptoms after starting secukinumab was 7 months (IQR: 4–15 months). Of the patients who underwent testing for inflammatory biomarkers, the median CRP was 25.5 (IQR 25.4–34.2). Endoscopic disease distribution involved the colon in 5 (62.5%) patients and the ileum and colon in 3 (37.5%) patients. In this series of patients, the histologic characteristics demonstrated three patterns of colitis: IBD-like (ulcerative colitis or Crohn’s disease) in 6 (75%) patients based on mucosal granulomas and/or chronic inflammatory changes, MMF-like histology in 1 (12.5%) patient, characterized by an abundance of intraepithelial eosinophils in the lamina propria and numerous crypt apoptotic bodies, and finally active colitis in 1 (12.5%) patient characterized by an absence of chronic mucosal injury or granulomas. The treatment for these patients was cessation of secukinumab and initiating alternative therapies with close clinical monitoring.

Conclusions

In this small case series, Secukinumab was temporally associated with the development of gastrointestinal inflammation. Further larger studies are required to confirm this association and to determine if IL-17 contributes to the pathogenesis of IBD.

Funding Agencies

None

Can CSF spectrophotometry for "Xanthochromia" be used to detect leaking subarachnoid aneurysms in patients with sickle cell anemia with negative MRI or CT angiogram despite hyperbilirubinemia?

CSF (Cerebrospinal Fluid) xanthochromia by spectroscopy should not be dismissed in the context of hyperbilirubinemia in a patient with sickle cell anemia. Xanthochromia detected by spectrophotometry offers a vital clue that further invasive diagnosis is required.

A153 INCIDENCE OF DEEP VEIN THROMBOSIS (DVT) & PROPHYLAXIS PRACTICES IN DECOMPENSATED CIRRHOSIS INPATIENTS

Background

The coagulation cascade is disturbed in cirrhosis. Patients are at risk for bleeding and coagulation through an imbalance of pro and anticoagulant factors.

Aims

We evaluated the incidence of DVTs and prevalence of DVT prophylaxis in hospitalized patients with decompensated cirrhosis.

Methods

A retrospective study of decompensated cirrhotic patients admitted to a tertiary care hospital. We evaluated the incidence of DVTs and use of DVT prophylaxis in this cohort. We also evaluated differences in patient characteristics in those who received DVT prophylaxis and between patients who did or did not develop DVTs.

Results

This study consisted of 520 cirrhotic patients, of which 258 patients (49.6%) received DVT prophylaxis. Of the remaining 262 patients who did not receive DVT prophylaxis, 199 (75.9%) had a documented contraindication to prophylaxis (bleeding, thrombocytopenia, both, or other). Compared to patients without DVT prophylaxis, patients who received prophylaxis were older (61.2 ± 11.2 vs 56.6 ± 10.9, p= 0.00001), had less varices (16.2% vs. 46%, p=0.0048), had more severe liver disease (MELD-Na 21 ± 6.5 vs 19.7 ± 7.3, p = 0.032), and fewer incidents of variceal (3.4% vs. 35.1%, p <0.001) and non-variceal (5.4% vs. 17.1%, p <0.001) gastrointestinal bleeding. DVT prophylaxed patients also had higher mean platelet values (149 ± 89 vs 112 ± 84, p <0.001), but similar baseline INRs (1.6 ± 0.4 vs 1.7 ± 0.8, p= 0.16), and were more likely to be admitted for non-bleeding complications of liver disease, including incidence of hepatic encephalopathy (37.9% vs 25.1%, p = 0.002) and spontaneous bacterial peritonitis (12.1% vs 6.5%, p=0.029). The incidence of radiographically identified DVT events in cirrhotic patients receiving DVT prophylaxis and those not receiving DVT prophylaxis was similar at 1.1 and 0.7%, respectively (OR 1.52, 95% CI 0.254 to 9.1, p = 0.65). There was no difference in liver disease severity between those with DVTs to those who did not develop DVTs, including similar MELD-Na, INR, platelets and hemoglobin values. Compared to patients without DVTs, those who developed DVTs had a higher bilirubin (95.8 ± 78.0 vs. 64.1 ± 24, p = 0.202) and INR (2.1 ± 0.7 vs. 1.6 ± 0.6, p = 0.07), as well as lower platelets (81.8 ± 23.3 vs. 131.4 ± 88.9). These groups had comparatively similar MELD-Na, albumin, creatinine, and hemoglobin levels.

Conclusions

DVT prevalence in this cohort of decompensated liver disease patients was overall low. DVT prophylaxis rates were moderate overall, however taking into account perceived contraindications such as thrombocytopenia or bleeding, patients appeared to be appropriately prophylaxed when indicated. Further study is required to identify which cirrhotic patients are at highest risk for DVTs and the safety of prophylaxis among patients with deranged lab values such as low platelets and elevated INR.

Funding Agencies

None

Capturing the Patient's Perspective: a Review of Advances in Natural Language Processing of Health-Related Text

Background: Natural Language Processing (NLP) methods are increasingly being utilized to mine knowledge from unstructured health-related texts. Recent advances in noisy text processing techniques are enabling researchers and medical domain experts to go beyond the information encapsulated in published texts (e.g., clinical trials and systematic reviews) and structured questionnaires, and obtain perspectives from other unstructured sources such as Electronic Health Records (EHRs) and social media posts. Objectives: To review the recently published literature discussing the application of NLP techniques for mining health-related information from EHRs and social media posts. Methods: Literature review included the research published over the last five years based on searches of PubMed, conference proceedings, and the ACM Digital Library, as well as on relevant publications referenced in papers. We particularly focused on the techniques employed on EHRs and social media data. Results: A set of 62 studies involving EHRs and 87 studies involving social media matched our criteria and were included in this paper. We present the purposes of these studies, outline the key NLP contributions, and discuss the general trends observed in the field, the current state of research, and important outstanding problems. Conclusions: Over the recent years, there has been a continuing transition from lexical and rule-based systems to learning-based approaches, because of the growth of annotated data sets and advances in data science. For EHRs, publicly available annotated data is still scarce and this acts as an obstacle to research progress. On the contrary, research on social media mining has seen a rapid growth, particularly because the large amount of unlabeled data available via this resource compensates for the uncertainty inherent to the data. Effective mechanisms to filter out noise and for mapping social media expressions to standard medical concepts are crucial and latent research problems. Shared tasks and other competitive challenges have been driving factors behind the implementation of open systems, and they are likely to play an imperative role in the development of future systems.

Effect of Serum Lipoprotein (a) [Lp(a)] in Menopausal Women

The behavior of LP during the menopausal trinities and their relationship with sex hormones and body fat distribution is still unclear. The aim of this case control study was to estimate the serum lipoprotein (a) in postmenopausal women and women in reproductive age group and comparison of the above mention serum lipids between the two groups and was carried out in the Department of Biochemistry, Dhaka Medical College (DMC), Dhaka, in co-operation with the Department of Immunology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka from July-2005 to June 2006. A total number of 70 women were selected. Selected women were grouped as Group A and Group B. In Group A 30 postmenopausal women were selected with age range 55-70 years. In Group B, 40 women within reproductive age were selected. Group B was again divided into two groups - Group B1 & Group B2 according to their ages. In Group B1 20 women were selected with age range 25-35 years, and in Group B2 another 20 women were selected with age range 36-45 years. Serum lipoprotein (a) or Lp(a) and lipid profile of all groups were measured. Mean sLp(a) concentration were compared between groups by" Mann Whitney U" test. Mean concentrations of every individual components of lipid profile (sTAG, sTc, sLDL & sHDL) were compared with different groups. sLp(a) concentration of Group A compared to Group B1 was found to be significantly higher (p<0.001). In the same way mean serum Lp(a) concentration of Group A compared to Group B2 was also significantly higher (p<0.001). Mean sLp(a) concentration of B1 compared B2 did not differ significantly. Mean values of lipid profiles were slightly elevated in Group A compared to Group B1 and Group B2 except sHDL-c level. Mean concentrations HDL-c was significantly lower in Group A compared to Group B1 and Group B2. Thus the present study has revealed that there is increased Lp(a) in menopause & decreased HDL in menopause.

Role of ultrasonography in diagnosis of solid space occupying lesion in the liver correlation with FNAC

This cross sectional study was carried enrolling 47 subjects with suspected solid liver mass, in the Department of Radiology and Imaging, Dhaka Medical College Hospital, Dhaka, over a period of twelve months. The aim of this study was to evaluate the diagnostic usefulness of transabdominal ultrasonography in the diagnosis of solid SOL in the liver. Majority of the respondents (42.55%) were found between 41-60 years of age. Five (10.63%) subjects were found below 20 years of age. There were 31 men (65.95%) and 16 women (34.05%). Majority of the metastasis were multiple (85%), hypoechoic (35%) and only 15% had internal calcifications. HCC was single lesion (61.53%) with hyperechoic (38.35%) echogenicity, with a central halo (76.92%) and 15.38% had internal calcifications. Majority of the cholangiocarcinoma were solitary (80%), hypoechoic (60%) and 60% had internal calcifications. Hepatoblastoma were solitary and had calcifications (60%) with mixed echogenicity (60%). Majority of the adenomas were solitary (80%), hypoechoic (60%) and only 20 % had internal calcifications. The validity of transabdominal sonography for the diagnosis of metastasis was confirmed by calculating sensitivity (100%), specificity (96.42%), accuracy (97.87%), positive (95%) and negative predictive (100%) values by using the standard formula given. The sensitivity, specificity, accuracy, positive and negative predictive values for HCC were 92.3%, 97.05%, 95.74%, 92.3% and 97.05% respectively. The sensitivity, specificity, accuracy, positive and negative predictive values for cholangiocarcinoma and hepatoblastoma were 80%, 97.61%, 95.74%, 80% and 97.61% respectively. Sensitivity, specificity, accuracy, positive and negative predictive values were 80%, 100%, 97.87%, 100% and 97.67% respectively for adenoma. From the study result it was concluded that transabdominal ultrasonography could be reliable, non- ionizing and relatively cheap procedure for diagnosis solid hepatic mass lesion.

Biochemical consequences of bariatric surgery for extreme clinical obesity

Obesity, defined as a body mass index over 30 kg/m2 for adults, poses a major healthcare challenge with important economic, personal and social consequences. Although public health measures, lifestyle change and pharmacological therapies have an important role in the management of obesity, patients with established morbid obesity (body mass index over 40 kg/m2) may also require bariatric surgery. Bariatric or metabolic surgery is associated with effective and enduring weight loss but is also known to improve glucose homeostasis, blood pressure and dyslipidaemia. Patients who have bariatric surgery need lifelong clinical follow-up to identify and prevent nutritional deficiencies and other complications. Clinical biochemistry laboratories have an important role in the nutritional assessment of obese patients and in the identification of complications following bariatric surgery. The aim of this article is to review the different bariatric procedures available and to summarize their complications, especially nutrient deficiencies and those of particular relevance to clinical biochemistry laboratories.

Genetic improvement of grass pea for low neurotoxin (β-ODAP) content

Grass pea is a promising crop for adaptation under climate change because of its tolerance to drought, water-logging and salinity, and being almost free from insect-pests and diseases. In spite of such virtues, global area under its cultivation has decreased because of ban on its cultivation in many countries. The ban is imposed due to its association with neurolathyrism, a non-reversible neurological disorder in humans and animals due to presence of neurotoxin, β-N-oxalyl-L-α,β-diaminopropionic acid (β-ODAP) in its seedlings and seeds. The traditional varieties of grass pea contain 0.5-2.5% β-ODAP. Exploitable genetic variability for β-ODAP has been observed for development of low ODAP varieties, which along with improved agronomic and detoxification practices can help reduce the risk of lathyrism. Collaborative efforts between ICARDA and NARS have resulted in development of improved varieties such as Wasie in Ethiopia, Ratan, Prateek and Mahateora in India, and BARI Khesari-1 and BARI Khesari-2 in Bangladesh with <0.10% β-ODAP. Soil application of 15-20 kg ha(-1) zinc sulphate, early planting, and soaking seeds in water have shown significant effects on β-ODAP. Because of the often cross-pollination nature, the current breeding procedures being followed in grass pea requires paradigm shift in its approach for a possible genetic breakthrough.

A genetic linkage map of Lens sp. based on microsatellite and AFLP markers and the localization of fusarium vascular wilt resistance

Microsatellites have currently become the markers of choice for molecular mapping and marker-assisted selection for key traits such as disease resistance in many crop species. We report here on the mapping of microsatellites which had been identified from a genomic library of lentil (Lens culinaris Medik.). The majority of microsatellite-bearing clones contained imperfect di-nucleotide repeats. A total of 41 microsatellite and 45 amplified fragment length polymorphism (AFLP) markers were mapped on 86 recombinant inbred lines derived from the cross ILL 5588 x L 692-16-1(s), which had been previously used for the construction of a random amplified polymorphic DNA and AFLP linkage map. Since ILL 5588 was resistant to fusarium vascular wilt caused by the fungus Fusarium oxysporum Shlecht. Emend. Snyder & Hansen f.sp. lentis Vasud. & Srini., the recombinant inbreds were segregating for this character. The resulting map contained 283 markers covering about 751 cM, with an average marker distance of 2.6 cM. The fusarium vascular wilt resistance was localized on linkage group 6, and this resistance gene was flanked by microsatellite marker SSR59-2B and AFLP marker p17m30710 at distances of 8.0 cM and 3.5 cM, respectively. These markers are the most closely linked ones known to date for this agronomically important Fw gene. Using the information obtained in this investigation, the development and mapping of microsatellite markers in the existing map of lentil could be substantially increased, thereby providing the possibility for the future localization of various loci of agronomic interest.

Absence of the inducible form of nitric oxide synthase in the brains of patients with the acquired immunodeficiency syndrome

A majority of human immunodeficiency virus type I (HIV-1)-infected-individuals manifest a plethora of central nervous system (CNS) diseases unrelated to opportunistic infections, including acquired immune deficiency syndrome (AIDS)-dementia complex (ADC), encephalitis, and various other disorders of the CNS. A series of devastating clinical conditions in the CNS of certain HIV-1-infected-individuals may be caused by infection of cells in the brain parenchyma. ADC is characterized by cognitive dysfunction, motor difficulties, coordination abnormalities and other neurological signs and symptoms, which develop in many HIV-1-infected-individuals. The precise molecular mechanisms leading to AIDS dementia remain incompletely explained. Various mechanisms including cytokine dysregulation, toxic effects of viral proteins and release of certain toxic substances from macrophages, especially nitric oxide, have been implicated as pathogenic mediators in the development of ADC. We have examined post mortem CNS tissues collected from 22 patients, previously diagnosed with AIDS, to explore if nitric oxide is responsible for the observed pathology in ADC. As controls, we utilized tissues collected from the brains of patients who expired without AIDS or other CNS pathologies. In addition, we also utilized post-mortem brain tissues from eight patients who were diagnosed with multiple sclerosis (MS) and were found to express inducible nitric oxide synthase (iNOS) in our previous studies, as positive controls. Highly sensitive in situ reverse transcriptase-initiated polymerase chain reaction (RT-IS-PCR) studies demonstrated that iNOS mRNA was present in the CNS tissues from all the positive MS controls, but were absent in all 22 specimens from AIDS patients, as well as in the brain tissues from normal controls. We have also analyzed the tissues for the presence of the NO reaction product, nitrotyrosine, to evaluate the presence of a protein nitrosalation adduct. Nitrotyrosine was not demonstrable in any of the AIDS brains. These findings indicate that iNOS may not play a significant role in the neuropathogenesis of most cases of ADC.

Measurement of the ultrasonic intima-media complex thickness in normal subjects

PURPOSE

The evolution of atherosclerosis can be studied before development of symptomatic plaque by evaluating morphologic changes of the intima-media (I-M) complex, seen on high-resolution ultrasonography of the arterial wall. These qualitative changes require large alterations in vessel wall appearance to recognize progression of atherosclerosis. It has been suggested that measurement of the thickness of the I-M complex may be a quantitative and more sensitive method of assessing these early atherosclerotic changes.

METHODS

High-resolution ultrasonography has been used to measure the thickness of the I-M complex in 140 symptom-free subjects.

RESULTS

The mean thickness of the I-M complex of the common carotid arteries was linearly related to the age (r = 0.77; p < 0.001), pack-years of smoking (r = 0.39; p < 0.05), the systolic blood pressure (r = 0.51, p < 0.01), and to the arterial ultrasound score (r = 0.85). The arterial ultrasound score has previously been shown to correlate with the presence of asymptomatic myocardial ischemia and with the development of cardiovascular symptoms. The mean thickness of the I-M complex in subjects without plaque (in the common carotid or common femoral artery bifurcations) was significantly thinner than in subjects with plaque (p < 0.001).

CONCLUSION

The thickness of the I-M complex of the common carotid arteries is a measure of the risk for the development of cardiovascular symptoms in symptom-free individuals.

PREVALENCE OF INFECTIOUS DISEASES OF BROILER CHICKENS IN GAZIPUR DISTRICT

The study was conducted to determine the occurrence of infectious diseases in broiler chickens at kapasia in Gazipur district during the period from 16th October to 16th December 2008. Detection was made on the basis of history, clinical findings and post-mortem lesions. A total of 199 broiler chickens were examined during the study where Colibacillosis 104 (52.26%), Mycoplasmosis 25 (12.56%), Salmonellosis 02 (1.01%), Omphalitis 23 (11.56%), Coccidiosis 09 (4.52%), Gumboro 22 (11.06%), Mycotoxicosis 11 (5.53%) and mixed infection of Gumboro & Coccidiosis 03 (1.51%) were recorded. In the conclusion it has been remarked that Collibacillosis is a major problem for broiler production and hence poultry farmers can not earn their profit perfectly due to adverse effect of those diseases. Further laboratory examination is needed to confirm the identified diseases.