Clinical and Ultrasonographic Characteristics of the Achilles Tendon in Hemodialysis Patients

Background and Objectives: The early recognition of tendon alterations in chronic hemodialysis (HD) patients, an awareness of the factors that influence the condition, and active intervention have considerable clinical relevance. The aim of this study was to investigate the musculoskeletal ultrasound (MSUS) features of the Achilles tendon in chronic HD patients and determine the factors associated with tendon abnormalities. Materials and Methods: This study was conducted on 46 HD patients and 24 sex- and age-matched controls. All participants were evaluated clinically for any signs of Achilles tendon abnormalities. Then, the Achilles tendon was scanned bilaterally using MSUS. Results: Among the 92 Achilles tendons in the HD patients, there was tenderness and swelling of only two (2.2%). Regarding MSUS features, there were statistically significant higher thicknesses in the proximal end (p < 0.001), midpoint (p < 0.001), and distal end (p < 0.001) of the Achilles tendons in the HD patients when compared with the healthy controls. Tendinosis was found in 12 (13%) of the HD patients' Achilles tendons, which was statistically significant in comparison to the healthy controls (p = 0.008). There were statistically significant higher scores of structural abnormalities (p = 0.005), bone erosions (p = 0.017), and calcifications (p = 0.015) in the HD patients when compared to the healthy controls. According to the results of a univariate regression analysis, age and male gender were predictive for US abnormalities in HD patients (p = 0.002 and 0.025, respectively). Conclusions: The Achilles tendon in subjects on chronic HD showed frequent US abnormalities. These abnormalities in HD patients appear to be more related to age and gender and may be asymptomatic.

Attitudes and concerns regarding booster dose of COVID-19 vaccine among Egyptian patients with autoimmune and rheumatic diseases: a cross-sectional survey study

BACKGROUND

COVID-19 booster dose vaccination acceptance and actual vaccination behavior is not known among Egyptian individuals with autoimmune and rheumatic diseases (ARDs). The aim of this study was to investigate the acceptability of booster dose of the COVID-19 vaccine, as well as the factors that drive and inhibit that acceptance among Egyptian patients diagnosed with ARDs.

METHODS

This interview-based, cross-sectional analytical study was carried out on ARD patients from 20 July to 20 November 2022. A questionnaire was created to assess sociodemographic and clinical data, as well as COVID-19 vaccination status and the intention to receive a COVID-19 vaccine booster dose, perception of health benefits of it in addition to the perceived barriers and/or concerns.

RESULTS

A total of 248 ARD patients were included, with a mean age of 39.8 years (SD = 13.2), and 92.3% were females. Among them, 53.6% were resistant to the COVID-19 booster dose, whereas 31.9% were acceptant and 14.5% were hesitant. Those who were administering corticosteroids and hydroxychloroquine shown significantly greater booster hesitancy and resistance (p = 0.010 and 0.004, respectively). The primary motivation for taking a booster dose among the acceptant group was own volition (92%). Most acceptants believed that booster dose can prevent serious infection (98.7%) and community spread (96.2%). Among the hesitant and resistant groups, the main concerns for booster dose were fear about its major adverse effects (57.4%) and long-term impact (45.6%).

CONCLUSIONS

There is a low acceptability rate of booster dose of COVID-19 vaccine among Egyptian patients with ARD diseases. Public health workers and policymakers need to make sure that all ARD patients get clear messages about accepting the COVID-19 booster dose.

Utility of diffusion tensor imaging in differentiating benign from malignant hepatic focal lesions

OBJECTIVES

To assess the diagnostic accuracy of diffusion tensor imaging (DTI) in the characterization of hepatic focal lesions (HFLs) and compare it to diffusion-weighted imaging (DWI).

METHODS

Prospective analysis was done for 49 patients (23 male and 26 female) with 74 HFLs who underwent dynamic MRI, DWI, and DTI. Apparent diffusion coefficient (ADC) values from DWI, fractional anisotropy (FA) values, and mean diffusivity (MD) values from DTI were measured by two independent radiologists. HFLs were classified into benign and malignant HFLs; the latter were subdivided into HCC and non-HCC lesions. Binary logistic regression was performed to analyze the associations between the DTI parameters and the distinction of malignant lesions.

RESULTS

The ADC, MD, and FA at cutoff values of ≤ 1.17 × 10^-3 mm²/s, ≤ 1.71 × 10^-3 mm²/s, and > 0.29, respectively, are excellent discriminators for differentiating malignant and benign HFLs. The mean ADC and MD values of hemangiomas were significantly higher than HCC and non-HCC malignant lesions. In contrast, the mean FA values of hemangiomas were significantly lower than those of non-HCC malignant lesions and HCCs. The ADC and MD were very good discriminators at cutoff values of > 1.03 × 10^-3 mm²/s and > 1.12 × 10^-3 mm²/s, respectively. The FA at a cutoff value > 0.38 is an excellent discriminator for HCC versus non-HCC malignant lesions. Only FA value > 0.38 was a statistically significant independent predictor of HCC versus non-HCC lesions among the three parameters. There was an excellent inter-observer agreement with ICC > 0.9.

CONCLUSION

MD and FA of DTI are non-invasive, very good, and excellent discriminators superior to ADC measured by DWI for the differentiation of HFLs.

KEY POINTS

• The ADC, MD, and FA at cutoff values of ≤ 1.17 × 10^-3 mm²/s, ≤ 1.71 × 10^-3 mm²/s, and > 0.29, respectively, are excellent discriminators for differentiating malignant and benign HFLs. • The mean ADC and MD values of hemangiomas were significantly higher than those of HCC and non-HCC malignant lesions. In contrast, the mean FA values of hemangiomas were significantly lower than those of non-HCC malignant lesions and HCCs, respectively. • Multivariate regression analysis revealed that only FA value > 0.38 was a statistically significant independent predictor of HCC vs. non-HCC lesions. A lesion with FA > 0.38 has 34 times higher odds of being HCC rather than non-HCC lesions.

Applying the Health Belief Model to predict preference for surgical intervention versus medical therapy among patients with open-angle glaucoma

Objective

To determine the factors influencing patient preference of surgical intervention versus medical therapy for open-angle glaucoma based on the Health Belief Model.

Methods and analysis

The study is a cross-sectional study. The study was conducted on 309 patients having open-angle glaucoma attending glaucoma clinic at Alexandria Ophthalmology Hospital, Alexandria, Egypt. The patients were subjected to an interview questionnaire comprising demographic data, patient knowledge and beliefs about glaucoma, glaucoma medications and treatment options, and patient preference of treatment modality, based on the Health Belief Model.

Results

About half of the patients (46%) were found to prefer surgical intervention. Patients were less knowledgeable about glaucoma, in general, but knowledge scores of patients preferring surgical intervention were significantly higher than those preferring medical therapy (Percentage Mean Score, PMS: 42.46%–37.37%, respectively). Male and female patients using more medications were significantly more likely to prefer surgical intervention (p=0.015 and p=0.003, respectively). Patients having preference for surgical intervention reported higher scores for perceived susceptibility and severity of long-term medical therapy (PMS=72.61% vs 54.62%–68.62% versus 52.83%, respectively), higher scores for perceived benefits of surgical intervention (PMS=92.90% vs 43.96%, respectively) and higher scores for self-efficacy (PMS=97.18% vs 50.37%, respectively). Meanwhile, they obtained lower scores for perceived barriers to surgical intervention (PMS=53.43% vs 86.07%, respectively).

Conclusions

Male gender, increased number of used eye-drops and more knowledge about glaucoma were significantly associated with patient preference for surgical intervention. Perceived benefits and barriers and self-efficacy were the significant predictors for patient surgical interference preference.

Аssessment of E-learning readiness among different levels of Nursing Learners in KING SAUD MEDICAL CITY

Aim: Nurses’ and students’ willingness to increase information and practical skills through electronic platforms may help in setting up hundreds of timesaving and economical e-learning programs. The aim of this study is to evaluate the readiness of e-learning among different levels of nurses and nursing students. Methods: In this quantitative research, 425 participants from King Saud Medical City in Riyadh, Saudi Arabia were included. The study population included nurses and nursing students. Results: With p < 0.042 the research indicated that there are statistically significant differences between nursing groups with respect to e-Learning readiness. Conclusions: The nursing staff and students in King Saud Medical City demonstrated significant readiness levels towards e-learning, while the level of readiness and experience towards e-learning vary for different nursing groups

Effects of sex on carcass composition and physicochemical, textural and rheological properties of meat from grey partridge

The study aimed to determine the effects of sex on bodyweight (BW) and dimensions, carcass weight, dressing percentage, percentage of carcass components, chemical composition, mineral content, acidity and electrical conductivity of the breast and leg muscles of grey partridges (Perdix perdix L.). The experiment also determined the colour attributes, textural and rheological characteristics, and mineral content in the liver of the grey partridge. Fifteen males and 15 females were examined. Carcasses were weighed on electronic scales, then dissected. The chemical compounds in the breast and leg muscles were determined with a near-infrared spectrophotometer. To ascertain the contents of minerals, the meat samples were analysed by spectrometry. The textural and rheological properties were established with the TPA double compression test, Warner-Bratzler (WB) test, and the relaxation test. At 36 weeks, males had significantly longer keels and shanks than females. Males and females did not differ significantly in the weight of the eviscerated carcass, dressing percentage, and percentage of carcass components. There were no significant differences between males and females in the chemical composition of meat from breasts and legs, and in the mineral contents of the breast and leg muscles and the liver. Bird sex had no significant effect on acidity and electrical conductivity of the breast and leg muscles or on the lightness (L*), redness (a*), and yellowness (b*) of the Pectoralis major muscle. No significant differences were established between 36-week-old males and females in textural and rheological characteristics. Thus, there was scant evidence for sexual dimorphism in this species.

MO145: Chest CT Total Severity Score on Admission to Predict In-Hospital Mortality in Patients with Acute and Chronic Renal Impairment with COVID-19 Infection

BACKGROUND AND AIMS

COVID-19 is an infection that has spread widely and quickly over the world, resulting in a pandemic with substantial consequences for the sociopolitical environment and healthcare delivery systems. The aim of this study was to explore the clinical, laboratory characteristics and chest CT severity score in patients with renal impairment who died with COVID-19 infection.

METHOD

This retrospective study examined the electronic clinical and laboratory data of consecutive patients aged 18 years and older, with serum creatinine > 2 mg/dL who tested positive for COVID-19 and admitted to Mansoura University Hospital between June 2020 and May 2021. CT scans of the chest were retrospectively examined by one reviewer with 10 years’ experience in thoracic imaging for the following characteristics based on the Fleischner Society Nomenclature recommendations: ground-glass opacity (GGO), consolidation, nodules, crazy-paving pattern, subpleural lines, bronchial wall thickening, lymph node enlargement and pleural effusion.

 We attempted to measure the magnitude of the abnormalities by the total severity score to assess the severity of lung parenchymal involvement. The total severity score was primarily a numeric score that assessed the existence of GGOs, consolidation or mixed GGOs in each of the five lobes of both lungs. Each lobe will be rated from 0 to 4 points based on the percentage of the involved lobe: (0) = 0%, (1) = 1–25%, (2) = 26–50%, (3) = 51–75% or (4) = 76–100%. The overall score, which varies from 0 to 20, is the sum of the points from each lobe. Death events were collected, and the ROC curve analysis for CT severity score was used to determine the best cutoff that predict mortality.

RESULTS

Of a total 100 patients, 54 were males, with a mean age of 60 ± 15 years. Sixty patients died. Mortality was higher in those with acute renal impairment (P = .033) than chronic kidney disease. Non-survivors had higher respiratory rate (P = .000), C-reactive protein (CRP) (P = .003), ICU admission (P = .000), oxygen supply needs (P = .005), pulmonary consolidation (P = .000) and crazy paving pattern (P = .000). Furthermore, non-survivors had higher CT chest total severity score (P = .000).

 Univariate regression analysis showed increasing odds of in-hospital mortality associated with increased respiratory rate (OR 1.149, 95% CI 1.057–1.248, P = .001), total bilirubin (OR 2.532, 95% CI 1.099–5.836, P = .029), lactate dehydrogenase (OR 1.001, 95% CI 1.000–1.003, P = .018), CRP (OR 1.010, 95% CI 1.002–1.017, P = .012), invasive mechanical ventilation (OR 7.667, 95% CI 2.118–27.755, P = .002), predominant pattern of pulmonary consolidation (OR 21.714, 95% CI 4.799–98.261, P = .000) and high CT chest total severity score (OR 2.082, 95% CI 1.579–2.745, P = .000) . The optimum cut-off value of CT chest total severity score to predict in-hospital mortality was 8.5 with a sensitivity of 86.7% and a specificity of 87.5% (Figure 1).

CONCLUSION

In-hospital mortality is high in patients with renal impairment with COVID-19 infection especially those with acute renal impairment. High bilirubin, predominant pattern of pulmonary consolidation and CT chest total severity score are the most significant predictors of mortality in these patients. CT chest total severity score on admission ≥8.5 could effectively predict in-hospital mortality in these patients.

MO804: Clinical and Ultrasonographic Features of 104 Knee Joints in Haemodialysis Patients and Their Association with Semiquantitative Measurement of Suprapatellar Effusion and Influence of Age, Gender and Duration of Haemodialysis

BACKGROUND AND AIMS

Musculoskeletal disorders remain a major problem in haemodialysis (HD) patients. The aim of this study was to determine knee clinical and ultrasonographic (US) abnormalities in HD patients to evaluate the influence of age, gender and HD duration.

METHOD

This cross-sectional descriptive study was conducted on 52 patients (104 knee joints) who had been on regular HD for at least 6 months. Demographic, clinical, therapeutic and laboratory data were recruited. Participants were questioned about the presence of chronic knee pain and its duration, severity and laterality. Both knees were evaluated for the presence of joint swelling, crepitus and tenderness.

All patients underwent musculoskeletal (MSUS) evaluation of both knees, which was conducted according to EULAR standardized procedures. MSUS was used to determine the presence of suprapatellar effusion, synovial thickening and Baker's cyst and to detect any abnormalities in the cartilage morphology. Quadriceps and patellar tendons and menisci were also sonographically assessed. Cartilage thickness was measured bilaterally from the central points of the medial condyle and lateral condyle patients were then compared according to age, gender and HD duration.

RESULTS

The mean age of the patients was 52.4 ± 14.15 years,  25 females and 27 males,  and the median duration of HD was 3.5 (0.6–13) years.  Chronic knee pain was present in 31/104 (29.8%) knees. Among the scanned 104 knee joints, there was at least one US abnormality in 91 (87.5%); suprapatellar effusion was found in 57 (54.8%), synovial thickening in 13 (12.5%), abnormal cartilage morphology in 68 (65.4%), quadriceps tendon abnormalities in 58 (55.8%), patellar tendon abnormalities in 34 (32.7), medial meniscus abnormalities in 30 (28.8%), lateral meniscus abnormalities in 13 (12.5%) and Baker’s cyst in 5 (4.8%) (Fig. 1).

MSUS abnormalities were significantly more frequent in HD patients aged &gt;40 years (94.9% versus 65.4; P = .000) than others. Chronic knee pain and abnormal cartilage morphology were more likely to occur in females (40% versus 20.4% and 74.1% versus 56%, respectively) than in males (Fig. 2).

According to HD duration, quadriceps and patellar tendons showed more frequent US abnormalities in patients with HD duration &gt; 3 years (86.5% versus 42% and 38.9% versus 26%, respectively) than in others.

The prevalence of mild, moderate and severe suprapatellar effusion was 37.5%, 14.4% and 2.9%, respectively. There was a significant association between semiquantitative measurement of suprapatellar effusion and synovial thickening (P = .000), abnormal cartilage morphology (P = 0.023), quadriceps (0.002) and patellar tendon abnormalities (0.011) (Table 1).

CONCLUSION

Knee US abnormalities are prevalent among HD patients, especially those with female gender, older age and higher HD duration. These abnormalities may be subclinical. The severity of suprapatellar effusion is usually related to other knee structural abnormalities.

Kidneys in SARS-CoV-2 Era; a challenge of multiple faces

INTRODUCTION

With the evolution of SARS-CoV-2 pandemic, it was believed to be a direct respiratory virus. But, its deleterious effects were observed on different body systems, including kidneys.

AIM OF WORK

In this review, we tried as much as we can to summarize what has been discussed in the literature about the relation between SARS-CoV-2 infection and kidneys since December, 2019.

METHODS

Each part of the review was assigned to one or two authors to search for relevant articles in three databases (Pubmed, Scopus and Google scholar) and collected data were summarized and revised by two independent researchers.

CONCLUSION

The complexity of COVID-19 pandemic and kidney could be attributed to the direct effect of SARS-CoV-2 infection on the kidneys, different clinical presentation, difficulties confronting dialysis patients, restrictions of the organ transplant programs, poor outcomes and bad prognosis in patients with known history of kidney diseases who got infected with SARS-CoV-2. This article is protected by copyright. All rights reserved.

741 Restarting Elective Orthopaedic Surgery During The COVID-19 Pandemic: Experiences and Patient Outcomes

Aim

The COVID-19 pandemic resulted in postponing all non-urgent elective surgeries from April 2020. As we emerged from the first peak, restarting non-urgent services such as elective orthopaedic surgery was important for patients with chronic debilitating conditions. Our hospital successfully restarted orthopaedic surgery during the pandemic to help improve the quality of life of patients. This study describes the development of local protocols and pathways to allow for a safe restart of elective orthopaedic surgery in a COVID-19 free site. It presents the morbidity and mortality outcomes of those patients.

Method

This is a prospective cohort study evaluating all patients undergoing non-emergency orthopaedic procedures through a COVID-19 free pathway in a DGH from 18th May – 10th July 2020. 104 patients were identified, and their outcomes analysed during the 2 weeks following their surgery.

Results

No patients developed COVID-19 in the 2-weeks post-operative period. There were no ITU admissions or in-hospital deaths. 22(21.15%) out of 104 patients developed 23 complications within 2 weeks of surgery. These included: TIA, PE, AF, superficial wound infection, oozy wound and post-operative anaemia. They all made full recovery. There was no statistical difference in the development of complications for age (&lt; 70; &gt;70), gender, BMI, or ASA grades.

Conclusions

This study describes a roadmap to setting up a protocolised elective operating service for orthopaedic surgery. It has shown that standardised protocols in a COVID-19 free site, pre-operative COVID-19 testing and adherence to national guidelines on self-isolation prior to surgery can help prevent COVID-19 infection and its related risks post-operatively.

AB0637 THE STATE OF GOUT MANAGEMENT IN WALES RHEUMATOLOGY UNITS

Background:

Gout is the most common inflammatory arthritis with both the prevalence and incidence showed significant rise in the UK in recent years1.

The most frequent reasons for referral from primary care were diagnostic uncertainty 54%, failure to respond to primary care management 28%, and complex comorbidity 25%2.

From primary care perspective, increased urate level (p=0.0001), young age (p=0.009), fewer comorbidities (p=0.039) constituted the most common risk for gout General Practice consultations and in addition to poor compliance to urate lowering treatment ULT (p=0.004) and lower CVS risk scores (p=0.038) these all factors comprised the independent risk factors for Gout flares3.

Objectives:

To compare the management of gout in the rheumatology services in Wales against the 2017 British Society for Rheumatology (BSR) Guidelines.

Methods:

•A descriptive study over an 8-week period from January to February 2019, used Simple Analysis in calculating the frequency (%).

•Data were collected from notes of 79 patients referred to rheumatology departments across Wales using the British Society for Rheumatology (BSR) 2017 Gout Guidelines Audit Tool.

•The audit cohort comprised 62% of chronic gout patients and 38% of acute admissions.

Results:

Conclusion:

•Gout management by rheumatologists across Wales concords well with the recent BSR guidelines for most audit standards and showed an improvement in percentage of patients who achieved a target serum uric acid level <300 and <360 umol/L according to the BSR and EULAR guidelines, respectively.

•Areas for improvement include documentation of Patient Education, improvement of audit tool (Age, Alcohol, current ULT).

•To spread the message to primary care setting, where gout is predominantly managed, to ensure that ULT is optimized to achieve target serum uric acid level to benefit patients.

References:

[1]Kuo C, Grainge MJ, Mallen C, et al Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study, Annals of the Rheumatic Diseases 2015;74:661-667.

[2]*Management of gout by UK rheumatologists: a British Society for Rheumatology national audit.Roddy E, Packham J, Obrenovic K, Rivett A, Ledingham JM.Rheumatology (Oxford). 2018 May 1; 57(5):826-830.

[3]Callear J, Blakey G, Callear A, et al Gout in primary care: Can we improve patient outcomes? BMJ Open Quality 2017;6:u210130.w4918. doi: 10.1136/bmjquality.u210130.w4918

Acknowledgements:

Dr Martin Bevan for supervising the work and Rheumatology Units across Wales for collecting data and the British Society for Rheumatology in formulating the audit tool.

Disclosure of Interests:

None declared.

A participatory and systemic training approach for IPC improvement in Nigerian health facilities

Background

Health care-associated infections (HAI) are one of the most common adverse events in care delivery and a major public health problem. A large percentage of HAI in hospitals are preventable through effective infection prevention and control (IPC) measures. IPC trainings for health care personnel based only on technical content do not lead to sustainable improvement of IPC standard precautions. To address this problem, the Nigeria Centre for Disease Control (NCDC) in collaboration with the Robert Koch Institute (RKI) developed a multimodal training approach to facilitate the transfer of IPC competences into working routine in Nigerian health facilities.

Objectives

The training should foster the ability of health care workers to act and communicate participatory, analyze IPC problems systemically and to develop and perform tailored IPC activities in their health facilities. It should empower health care workers to initiate and promote sustainable IPC improvement locally.

Results

We developed a participatory training approach which focusses on the relational and organizational dimension of IPC. It addresses the human and infrastructural factors for IPC compliance in daily working routine. A variety of training methods offers practice tools in communication, systemic thinking and team work, and allows experiencing a participatory attitude. The training program consists of two face to face workshops and an interjacent field project. 28 Health care workers of 14 health facilities in Lagos State participated the first implementation of the training program in 2018. The training evaluation showed the high relevance of the training to the HCW. The field projects showed that the participants could apply the participatory approach for IPC improvement.

Conclusions

A participatory and systemic approach for IPC trainings enables health care workers to take action for IPC improvement locally.

Key messages

We developed and implemented a participatory training approach that addresses the relational and organizational dimension of IPC. Health care workers took tailored actions for IPC improvement locally.

P0414URINARY HEPCIDIN AS A BIOMARKER OF NEPHRITIS IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS

Background and Aims

Lupus nephritis (LN) is a common complication of systemic lupus erythematosus (SLE) that is associated with poor prognosis. The current available urinary biomarkers are neither sensitive nor specific for diagnosing LN. This study was undertaken to investigate whether urinary hepcidin represents a marker of nephritis in SLE patients.

Method

A cross-sectional study was conducted with 3 study groups compromising 30 patients with biopsy proven LN, 30 patients with non-nephritis SLE and 20 healthy control. Spot urinary samples were collected from all participants and the levels of hepcidin in urine were measured by ELISA, 24 h urinary proteins, urinary and serum creatinine were measured.

Results

Urinary hepcidin was significantly higher in LN patients than in non-nephritis SLE and control (470, 258, 43.0 ng/mg creatinine respectively) (P &lt; 0.001) as shown in figure 1. Urinary hepcidin was significantly correlated with serum creatinine (P 0.017) and 24 hours urinary proteins (P 0.003). ROC curve cut-off values of urinary hepcidin were 4.3000, Area under curve (AUC) of hepcidin was 0.553, with sensitivity (SN) of 63.3%, specificity (SP) of 60%, Positive predictive value (PPV) 70.4, negative predictive value (NPV) 52.2 in SLE patients as shown in table 1 and figure 2.

Conclusion

Although urinary hepcidin level was significantly higher in LN patients than in non-nephritis SLE and control, it failed to discriminate patients with LN from those without. Further studies are still needed before considering urinary hepcidin as a non-invasive diagnostic marker of LN.

Carcass, physicochemical and sensory characteristics of meat from genetic reserve ducks after two reproductive seasons

The aim of the study was to compare carcass composition and meat quality of i) Pekin ducks of French origin (P9), ii) crosses of wild mallard and Pekin duck (K2), and iii) crosses of Khaki Campbell drakes and Orpington Fauve ducks (KhO1). Twenty carcasses from 110-week-old ducks of each genetic group were used. Carcass weight of P9 was significantly higher than that of K2 and KhO1. Carcasses of K2 ducks had a significantly lower percentage of neck and leg muscles and giblet weight compared with P9 and KhO1 ducks, while carcasses of KhO1 ducks had a significantly higher percentage of wing meat compared with K2 and P9, and a significantly lower percentage of breast muscles compared with P9 ducks. Breast and leg muscles of P9 contained significantly more water than those of K2 and KhO1, and the breast muscles of P9 ducks had more protein and less fat than those of KhO1 birds. The leg muscles of KhO1 contained significantly more protein, and those of K2 had significantly more fat than the other duck groups. Breast muscles of P9 and KhO1 ducks had significantly more collagen but had less in leg muscles compared with K2. Breast fillets from P9 ducks showed higher L*, a*, and b* colour values and shear force than K2 and KhO1 ducks. Keywords: carcass composition, conservation flocks, meat quality, spent duck

[Placoid pigment epitheliopathy and serpiginous choroiditis]

Placoid pigment epitheliopathy and serpiginous choroiditis are among the white dot retinal syndromes and possess similarities that can cause confusion between these two diseases. However, they are very different in terms of their progression and prognosis, which requires a diagnosis of certainty in order to better manage the patients with the diseases and identify potentially serious progressive complications. The clinical presentation, results of testing, differential diagnoses and treatment of these two pathologies are discussed in this article.

Placoid pigment epitheliopathy and serpiginous choroiditis

Placoid pigment epitheliopathy and serpiginous choroiditis are among the white dot retinal syndromes and possess similarities that can cause confusion between these two diseases. However, they are very different in terms of their progression and prognosis, which requires a diagnosis of certainty in order to better manage the patients with the diseases and identify potentially serious progressive complications. The clinical presentation, results of testing, differential diagnoses and treatment of these two pathologies are discussed in this article.

P963Coronary orbital atherectomy manufacturers and user facility device experience (MAUDE) database: a 5-year analysis of real-world complications

Background

Coronary Orbital Atherectomy System was approved by the United States FDA (food and Drug Administration) on October 21st, 2013. The initial safety data were published in the ORBIT I trial.

Purpose

Evaluation of the reported real-life complications related to utilization of orbital coronary atherectomy system since its approval in the United States using the online FDA database.

Methods

The Manufacturer and User facility Device Experience (MAUDE) database was queried for all complication reports involving the orbital atherectomy (OA) “Diamondback 360 coronary orbital atherectomy system” from 1/1/2013 through 12/31/2018. All reports were searched for complications; mortality, perforation, dissections, device fragmentation, and the need for surgical intervention among reported procedures. Duplicate entries and data with no reporting on final procedure outcome were excluded.

Results

Over the allocated interval519 reports were identified. Seven reports were excluded (according to exclusion criteria).

Over the period of slightly more than five years, coronary perforation was the most commonly reported complication mounting to 44.14% of all the reports (226 reports). Device fragmentation was reported in 18.94% of the reports (97 reports). Surgery was needed to retrieve device fragments in 13 cases (13.4% of all device fragmentation reports). Coronary dissection represented 16.21% of the reports (83 reports) and total surgical interventions were needed in 14.25% of the cases (73 reports). Finally, total reported deaths were 121 cases (23.63% of the total reports).

Year 2013 2014 2015 2016 2017 2018 Number of reported complications 4 28 46 81 113 247

Percentage of reported complications

Discussion

The current analysis, representing data from real world reported complications to the FDA over a period of 5 years, shows that the most common reported complication during coronary orbital atherectomy was coronary perforations, followed by device breakings and fragmentation (which necessitated surgical intervention in almost 13.4% of those device fragmentation cases reported). It is hard to compare these data with published safety trials since the FDA database is involved in reporting complications and not total number of procedures. However the most striking complication involved device fragmentation, which was not seen or reported among the pivotal trials evaluating device safety. The current analysis may shed some light on a non reported complication among patients undergoing orbital atherectomy which might represent a gap between the device performance in real world as opposed to a well-designed study world.

[Screening for diabetic retinopathy by non-mydriatic fundus photography: First national campaign in Lebanon]

INTRODUCTION

Diabetic retinopathy (DR) is a leading cause of blindness worldwide. Non-mydriatic fundus photography (NMFP) has been adopted as a screening tool for this disease. We aim to determine the prevalence of DR through this method in Lebanese diabetic patients and to evaluate the impact of such screening in this population.

MATERIALS AND METHODS

This study explores data from an awareness and screening campaign conducted in Lebanon. Diabetic patients from multiple regions were referred by their endocrinologists to undergo NMFP using the Optomed SmartScope^® handheld fundus camera. Photographs were interpreted by a remote observer, and recommendations were given accordingly. The prevalence of DR was calculated, and statistical analyses were performed on the clinical characteristics, fundus findings and number of referrals to ophthalmologists.

RESULTS

The campaign lasted 11 months, during which 2205 patients were examined in 37 screening locations. Out of the 97.41% of patients with type 2 diabetes mellitus, 12.56% had signs of DR, with no significant difference between the regions. 6.28% of the photos were uninterpretable. Positive results were associated with a longer duration of diabetes (P<0.01), treatment with insulin (P<0.01), as well as the presence and chronicity of systemic hypertension (P=0.01). 25% of patients with positive testing were retrospectively asked about their follow-up; only one third had an ophthalmologic examination as per the recommendation, among whom 68.18% underwent treatment for proliferative DR and/or diabetic macular edema.

CONCLUSION

Tele-ophthalmology is useful in mass screening for DR. The importance of dilated fundus examinations still needs to be highlighted for diabetic patients, and better collaboration between endocrinologists and ophthalmologists is required to improve screening outcomes.

Transition to active learning in rural Nepal: an adaptable and scalable curriculum development model

BACKGROUND

Traditional medical education in much of the world has historically relied on passive learning. Although active learning has been in the medical education literature for decades, its incorporation into practice has been inconsistent. We describe and analyze the implementation of a multidisciplinary continuing medical education curriculum in a rural Nepali district hospital, for which a core objective was an organizational shift towards active learning.

METHODS

The intervention occurred in a district hospital in remote Nepal, staffed primarily by mid-level providers. Before the intervention, education sessions included traditional didactics. We conducted a mixed-methods needs assessment to determine the content and educational strategies for a revised curriculum. Our goal was to develop an effective, relevant, and acceptable curriculum, which could facilitate active learning. As part of the intervention, physicians acted as both learners and teachers by creating and delivering lectures. Presenters used lecture templates to prioritize clarity, relevance, and audience engagement, including discussion questions and clinical cases. Two 6-month curricular cycles were completed during the study period. Daily lecture evaluations assessed ease of understanding, relevance, clinical practice change, and participation. Periodic lecture audits recorded learner talk-time, the proportion of lecture time during which learners were talking, as a surrogate for active learning. Feedback from evaluation and audit results was provided to presenters, and pre- and post-curriculum knowledge assessment exams were conducted.

RESULTS

Lecture audits showed a significant increase in learner talk-time, from 14% at baseline to 30% between months 3-6, maintained at 31% through months 6-12. Lecture evaluations demonstrated satisfaction with the curriculum. Pre- and post-curriculum knowledge assessment scores improved from 50 to 64% (difference 13.3% ± 4.5%, p = 0.006). As an outcome for the measure of organizational change, the curriculum was replicated at an additional clinical site.

CONCLUSION

We demonstrate that active learning can be facilitated by implementing a new educational strategy. Lecture audits proved useful for internal program improvement. The components of the intervention which are transferable to other rural settings include the use of learners as teachers, lecture templates, and provision of immediate feedback. This curricular model could be adapted to similar settings in Nepal, and globally.

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

BACKGROUND

The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications.

METHODS

ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery.

RESULTS

The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784.

CONCLUSIONS

This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance.

CLINICAL TRIAL REGISTRATION

NCT03044899.

High-resolution imaging of photoreceptors in healthy human eyes using an adaptive optics retinal camera

PURPOSE

To determine the effects of age on perifoveal cone density in healthy subjects using adaptive optics.

METHODS

Healthy subjects of various ages were imaged using an adaptive optics retinal camera (RTX-1^® Imagine Eyes, Orsay, France). All patients underwent a comprehensive ophthalmologic examination and retinal imaging using spectral-domain optical coherence tomography (Spectralis^®, Heidelberg Engineering, Heidelberg, Germany). Cone density together with cone spacing and cone mosaic packing were measured in the nasal and temporal area 450 µm from the fovea. A multivariate analysis was performed to determine which of the following parameters were related to a decrease in cone density: age, axial length, central macular thickness, and retrofoveal choroidal thickness.

RESULTS

One hundred and sixty-seven eyes of 101 subjects aged 6-78 years were studied. Perifoveal cone density significantly decreased with age (R² = 0.17, p<0.01). Inversely, cone spacing increased with age (R²=0.18, p<0.01). There was no change in the cone packing mosaic (p>0.05). The mean coefficient of variation between fellow eyes was 3.9%. Age and axial length were related to a cone density decrease, while choroidal and retinal thicknesses did not affect cone metrics in healthy subjects.

CONCLUSIONS

A moderate perifoveal cone loss occurs with age. The precise consequences of these findings on visual function should be investigated. In addition to a better understanding of normal retinal anatomy, these results could act as a comparative database for further studies on normal and diseased retinas.

Androgen receptor mutations in patients with castration-resistant prostate cancer treated with apalutamide

Background

Mutations in the androgen receptor (AR) ligand-binding domain (LBD), such as F877L and T878A, have been associated with resistance to next-generation AR-directed therapies. ARN-509-001 was a phase I/II study that evaluated apalutamide activity in castration-resistant prostate cancer (CRPC). Here, we evaluated the type and frequency of 11 relevant AR-LBD mutations in apalutamide-treated CRPC patients.

Patients and methods

Blood samples from men with nonmetastatic CRPC (nmCRPC) and metastatic CRPC (mCRPC) pre- or post-abiraterone acetate and prednisone (AAP) treatment (≥6 months' exposure) were evaluated at baseline and disease progression in trial ARN-509-001. Mutations were detected in circulating tumor DNA using a digital polymerase chain reaction-based method known as BEAMing (beads, emulsification, amplification and magnetics) (Sysmex Inostics' GmbH).

Results

Of the 97 total patients, 51 had nmCRPC, 25 had AAP-naïve mCRPC, and 21 had post-AAP mCRPC. Ninety-three were assessable for the mutation analysis at baseline and 82 of the 93 at progression. The overall frequency of detected AR mutations at baseline was 7/93 (7.5%) and at progression was 6/82 (7.3%). Three of the 82 (3.7%) mCRPC patients (2 AAP-naïve and 1 post-AAP) acquired AR F877L during apalutamide treatment. At baseline, 3 of the 93 (3.2%) post-AAP patients had detectable AR T878A, which was lost after apalutamide treatment in 1 patient who continued apalutamide treatment for 12 months.

Conclusions

The overall frequency of detected mutations at baseline (7.5%) and progression (7.3%) using the sensitive BEAMing assay was low, suggesting that, based on this assay, AR-LBD mutations such as F877L and T878A are not common contributors to de novo or acquired resistance to apalutamide.

ClinicalTrials.gov identifier

NCT01171898.

Development of a Cerebral Palsy Follow-up Registry in Jordan (CPUP-Jordan)

AIMS

This study aims to describe the development of a Cerebral Palsy Follow-up Registry in Jordan (CPUP-Jordan) and to provide a baseline child and parent demographic information, birth history of the child participants, and distribution of the participants based on topographical distribution of cerebral palsy (CP) and functional classification systems.

METHODS

The CPUP-Jordan was developed using a similar framework of a follow-up surveillance programme for persons with CP in Sweden (CPUP). Standard assessment forms were utilized to collect data related to child and family demographics, child birth history, and functional classifications and physiotherapy and occupational therapy assessments and interventions. Research assistants were trained to conduct the assessments. A secured web-based system was developed to store data and disseminate knowledge maintained in the registry. Children with CP were included in the registry if they have confirmed diagnosis of CP. The ascertainment age of inclusion and the minimum age of survival required are 4 years.

RESULTS

One hundred sixty-seven children were registered between 2013 and 2015 (mean age is 3.6 ± 3.0 years). Forty-two percent were born premature, and 48% were less than the normal birthweight. Perinatal causes were reported for 54% of the participants. The most common type of CP based on tone disturbance was spastic type, and the most common topographical distributions of motor dysfunction were quadriplegia followed by diplegia. Fifty-six percent of the participants had severe limitation in ambulation; 48% had restricted manual abilities, and 47% had limited communication abilities even with familiar family members and partners.

CONCLUSIONS

The development of CPUP-Jordan registry for children with CP proved to be both feasible and informative. The registry baseline descriptive data were similar to those reported in previous research in Jordan supporting validity of the data. The implementation of CPUP-Jordan at national level is expected to have a positive impact on children with CP, clinicians, policymakers, and researchers.

Reliable gradient search directions for kurtosis-based deflationary ICA: Application to physiological signal processing

Efficient gradient search directions for the optimisation of the kurtosis-based deflationary RobustICA algorithm in the case of real-valued data are proposed in this paper. The proposed scheme employs, in the gradient-like algorithm typically used to optimise the considered kurtosis-based objective function, search directions computed from a more reliable approximation of the negentropy than the kurtosis. The proposed scheme inherits the exact line search of the conventional RobustICA for which a good convergence property through a given direction is guaranteed. The efficiency of the proposed scheme is evaluated in terms of estimation quality, the execution time and the iterations count as a function of the number of used sensors and for different signal to noise ratios in the contexts of non-invasive epileptic ElectroEncephaloGraphic (EEG) and Magnetic Resonance Spectroscopic (MRS) analysis. The obtained results show that the proposed approach offer the best estimation performance/iterations count and execution time trade-off, especially in the case of high number of sensors.