V. A, Rana MH, Gurpur P, Skandarajah A, D’Ambrosio M, Ramanjinappa RD, Mohan SP, Raghavan N, Kandasarma U, N. S, Raghavan S, Hedne N, Koch F, Fletcher DA, Selvam S, Kollegal M, N. PB, Ladic L, Suresh A, Pandya HJ, Kuriakose MA. A smart tele-cytology point-of-care platform for oral cancer screening

Early detection of oral cancer necessitates a minimally invasive, tissue-specific diagnostic tool that facilitates screening/surveillance. Brush biopsy, though minimally invasive, demands skilled cyto-pathologist expertise. In this study, we explored the clinical utility/efficacy of a tele-cytology system in combination with Artificial Neural Network (ANN) based risk-stratification model for early detection of oral potentially malignant (OPML)/malignant lesion. A portable, automated tablet-based tele-cytology platform capable of digitization of cytology slides was evaluated for its efficacy in the detection of OPML/malignant lesions (n = 82) in comparison with conventional cytology and histology. Then, an image pre-processing algorithm was established to segregate cells, ANN was trained with images (n = 11,981) and a risk-stratification model developed. The specificity, sensitivity and accuracy of platform/ stratification model were computed, and agreement was examined using Kappa statistics. The tele-cytology platform, Cellscope, showed an overall accuracy of 84–86% with no difference between tele-cytology and conventional cytology in detection of oral lesions (kappa, 0.67–0.72). However, OPML could be detected with low sensitivity (18%) in accordance with the limitations of conventional cytology. The integration of image processing and development of an ANN-based risk stratification model improved the detection sensitivity of malignant lesions (93%) and high grade OPML (73%), thereby increasing the overall accuracy by 30%. Tele-cytology integrated with the risk stratification model, a novel strategy established in this study, can be an invaluable Point-of-Care (PoC) tool for early detection/screening in oral cancer. This study hence establishes the applicability of tele-cytology for accurate, remote diagnosis and use of automated ANN-based analysis in improving its efficacy.

An evaluation of straw-extract agar media for the growth and sporulation of Madurella mycetomatis

Four new media, namely Wheat straw extract agar, Bajra straw extract agar, Jowar straw extract agar and Paddy straw extract agar, were evaluated for their potential to stimulate the growth and sporulation of Madurella mycetomatis in comparison with the conventional Sabouraud dextrose agar and Soil extract agar. Vegetative growth of M. mycetomatis on the four types of Straw extract agars was superior to that obtained on Sabouraud dextrose agar. Isolates of M. mycetomatis sporulated better and faster on the Straw extract agars than on the Sabouraud dextrose agar and Soil extract agar. Straw extract agar is recommended as a sporulation medium for M. mycetomatis. It may prove useful especially for studies of the conidium ontogeny of the fungus for elucidating its taxonomic status.

Incidence and significance of opportunistic fungi in leukemia patients in India

Twenty-four patients with acute leukemia were investigated for the incidence of opportunistic fungi. Culture isolations of the sputum and urine samples revealed significant levels of Candida in 14 patients; Candida albicans, C. tropicalis and C. pseudotropicalis were the predominant ones isolated. Aspergillus flavus was isolated from blood in two cases and C. albicans and a black yeast from the blood of another two. Serological studies showed fungal antibodies in seven patients; precipitins against Candida were detected in five and Aspergillus in two. Both of the Aspergillus positive cases and two patients who had rising antibodies against Candida died during the course of investigation. In this study 13 of 24 patients developed oral candidiasis.

894 What Proportion of Acute Admissions for Urinary Tract Infection Under Urology Require Surgical Intervention Within 6 Months?

Introduction

All male patients with urinary tract infections (UTI) at this large district general hospital are admitted under the care of the urology department. This audit aims to establish how many male patients over the age of 70 with a diagnosis of UTI required surgical intervention in the 6 months following admission.

Method

We performed a retrospective audit of all patients over 70 admitted with a UTI over a five-month period. Patients with recent instrumentation or other pathologies, including visible haematuria or ureteric stones confirmed on imaging in the accident and emergency department were excluded.

Results

Of the 30 patients included, five (16.7%) required invasive intervention. Three (10%) acutely, (two ureteric stents, one nephrostomy), two (6%) as an outpatient on an elective basis (flexible ureteroscopy and prostate artery embolisation).

Conclusions

Over 80% of patients included in this audit did not require surgical intervention within six months. Whilst UTI is a significant finding in younger men suggestive of structural or systemic abnormality, UTIs in incontinent, catheterised, or older men does not carry the same risks and rarely requires intervention. Elderly care wards were established to ensure older patients receive support to improve health functioning and prevent acute deterioration in physical and mental health during admission. Given that less than 20% of men required intervention, this cohort of patients would be better admitted to wards geared towards elderly care who are better able to manage their co-morbidities and have the resources for early physiotherapy and occupational therapy input.

906 Schistosomiasis: The New ‘Gap Year’ Problem

Introduction

Schistosomiasis is endemic in Africa, Asia, and South America. The parasite, found in freshwater lakes, ultimately deposits eggs in the veins around organs including the bladder. It causes chronic inflammation resulting in fibrosis of the urogenital tract and malignancy. In the UK, cases of schistosomiasis are unusual and historically confined to the immigrant population.

The patient

We present the case of a British born 21-year-old who returned from a round-the-world gap year. Upon return he reported dysuria, abdominal pain, poor flow, and malaise. He was investigated for tropical diseases, treated for recurrent urine infections, and sexually transmitted infections before disclosing on direct questioning to swimming in Malawi. Cystoscopy demonstrated tight pan-urethral strictures. Sandy patches were seen throughout the bladder. Histology from bladder biopsy confirmed schistosomiasis eggs. The patient was treated with Praziquantel. Despite treatment he will likely require repeat urethral dilatations.

Discussion

Changes in travel practice has led to a shift in patients who present with schistosomiasis. Clinicians should consider the diagnosis in anyone with lower urinary tract symptoms who has visited Asia, Africa, or South America. In those diagnosed, clinicians have a duty to encourage them to urge fellow swimmers to seek urological input. Similarly travel-clinics should be encouraged to warn travellers against fresh-water swimming prior to travel.

To avoid long term schistosomiasis sequelae, prevention is preferable, but early and prompt intervention is the next best alternative. Clinicians need a low threshold to suspect and exclude this damaging diagnosis.

Immunoglobulin G4-Related Lesions in Autoimmune Diseases: Unusual Presentations at Atypical Sites-A Tale of 2 Cases with Literature Review

Immunoglobulin G4-related disease (IgG4-RD) coexisting with clinically apparent autoimmune diseases, such as rheumatoid arthritis (RA) or antiphospholipid syndrome (APS), is a rarely documented combination in the scientific literature. In this case-based review, we present 2 intriguing cases with preexisting autoimmune diseases, namely, RA and primary APS, who exhibited coexistent IgG4- related lesions at unusual sites. The first case pertains to a patient with known RA who presented with an encasing mass in the esophagus leading to stricture, with histopathological diagnosis of IgG4-RD.The second patient, diagnosed with primary APS, experienced breathlessness, and imaging revealed a right atrial mass. Histopathological examination of the mass confirmed IgG4-RD. Notably, both patients demonstrated significant clinical improvement upon initiation of steroid therapy. Rheumatoid arthritis patients commonly exhibit elevated levels of IgG4 in their sera; however, RA with coexisting IgG4-RD is rarely reported in the literature. Similarly, APS with IgG4-related lesions is exceedingly rare. Although there are few case reports and series on esophageal and cardiac IgG4-RD, the occurrence of such unusual location of IgG4-related lesions in the context of known autoimmunity is presented here for the first time.

The Profile of Women Attending the National Maternity Hospital Emergency Out Of Hours Service – Two Decades On. A Retrospective Review

Introduction This study aimed to review the profile of women attending an out of hours emergency service (OHS) in a maternity hospital and compare it to a previous study. Methods Retrospective study. Demographic information was recorded including timing of presentation, reason and outcome. Results In 2017, 9,020 women attended the OHS, a 334% increase since 1993. On detailed review of 2,143 charts, most (84.7%, n=1,815) were antenatal. The most common reason for presenting to the OHS then was first trimester bleeding. In 2017, over half of antenatal women (51%, n=1,092) presented with “other” reasons, such as vomiting, hypertension or suspected pre-eclampsia. Admission rates significantly decreased from 1993 (38% (n=1,053) in 1993 vs. 16% (n=338) in 2017; p<0.05). Discussion Numbers attending for emergency maternity care have increased in both numbers and variety of presentations. It is important that women are seen and cared for in a compassionate, kind and evidence based manner.