OP0046 EVALUATION OF THE EFFICACY OF TOPICALLY APPLIED TACROLIMUS IN THE TREATMENT OF ORAL ULCERS IN BEHCET’S DISEASE: A DOUBLE BLIND PLACEBO CONTROLLED STUDY

Background

Treatment of Behcet disease (BD) associating oral ulcers is still challenging despite the advances in the systemic treatment modalities.

Objectives

We aimed to evaluate the clinical efficacy of topical Tacrolimus for treatment of BD.

Methods

In this double blind placebo controlled trial, forty BD patients with persistent active oral ulceration were equally randomized into group I (20 patients received oral colchicine plus topically applied tacrolimus) and group II (20 patients received oral colchicine plus placebo oral gel). All participants were evaluated based on Behcet’s Disease Current Activity Form (BDCAF), Ulcer Severity Score (USS) and visual analog scale (VAS) before treatment, and at four-time points post-treatment (15 days, 1st, 2nd, and 3rd months).

Results

VAS was significantly lower in group I after 2 weeks (p= 0.037) and 3 months (0.025) than in group II. USS was significantly lower in group I after 3 months of follow up regarding the number of ulcers (p=0.014), ulcer size (p=0.022), and duration (p=0.009). BDCAF showed significant improvement in 3 months follow up within each group (p<0.001 for both groups), while there was insignificant difference between both groups(p=0.347).

Conclusion

Topical Tacrolimus has been proven to be a safe and effective adjunctive therapy in the management of oral ulcerations in BD.

Disclosure of Interests

Manal Hassanien: None declared, Abdelhfeez Moshrif Speakers bureau: Amgen, Jansen, Novartis, Mostafa Galal: None declared, Fathy Abuzaid: None declared, Dian Fathalla: None declared, Esraa Talaat: None declared.

Indonesia DIA-RAMADAN Study: A Real-life, Prospective and Observational of Gliclazide MR in Type-2 Diabetes Patients During Ramadan Fasting

BACKGROUND

Sulfonylureas (SUs) have been widely used in many countries for T2DM treatment. Gliclazide is one of the SUs with the lowest risk of hypoglycemia; however, the safety and effectiveness of gliclazide MR during Ramadan has not yet been reported in Indonesia. This study aimed to assess safety, efficacy, and tolerability of gliclazide modified release (MR) during Ramadan fasting.

METHODS

The study was a part of DIA-RAMADAN study, a prospective observational study with subjects of T2DM patients aged >18 years, who had either controlled or sub-optimally controlled blood glucose level, performed Ramadan fasting. Subjects had been treated with gliclazide MR for at least 90 days prior the study, and were examined for their body mass index (BMI), fasting plasma glucose (FPG) and HbA1c levels 6 to 8 weeks before Ramadan (V0) and 4 to 6 weeks after the end of Ramadan (V1).

RESULTS

Out of 198 subjects participating in the study, there were only two subjects (1.0%) who reported symptomatic HEs (either confirmed or not confirmed) and no severe HEs had been reported. There were no significant changes in HbA1c and FPG levels (p>0.05). Interestingly, there was a reduction of bodyweight (-0.4kg) from pre- to post-Ramadan (p < 0.001). Almost no subjects reported discontinuation of gliclazide MR throughout the entire study; however, there was one subject who reported a change of diabetic treatment into diet only.

CONCLUSION

gliclazide MR is safe, well tolerated and can maintain glycemic control effectively for Indonesian patients with T2DM who perform Ramadan fasting.

Implementing group research assignment in undergraduate medical curriculum; impact on students' performance and satisfaction

BACKGROUND

Medical educators need to integrate research skills within undergraduate medical curriculum to help students perceive their relevance to routine doctor's practice. The current work aimed to assess the impact of including group research assignment in the endocrine module to third year medical students on attaining some research, communication and E learning skills and on their performance in the module.

METHODS

Students carried out a group research activity (N = 10), wrote a report and presented their work as a poster, booklet or video clip. Multiple evaluation methods were used; a questionnaire to assess students' satisfaction and perception towards the skills acquired and a rubric to grade the research report and presentation. Also, students' final grades in the module were compared with that of the previous cohort who didn't conduct the research assignment.

RESULTS

Students' response rate to the questionnaire was 50%. 73.6% of students agreed that research enhanced critical evaluation of literature while 65.5% felt confident to further participate in research and 66.7% were satisfied about the whole research experience. Mean score of assignment was 84% for female students and 78% for male students. Grades of the current cohort in the endocrine module were significantly higher than that of the preceding cohort (78.7 ± 11 and 70.2 ± 13 respectively P< 0.001).

CONCLUSION

The current study pointed to the positive impact of implementing group research assignment within the undergraduate medical curriculum. Students were satisfied about the research exposure, agreed attaining some skills and got higher grades than preceding peers.

SAT0547 RADIOGRAPHIC IMAGING IN ASSESSMENT OF FLUOROSCOPIC GUIDED INJECTION OF RHEUMATOID ATLANTOAXIAL JOINT INFLAMMATION

Background:

Rheumatoid spondylitis is a feature of long-lasting Rheumatoid arthritis (RA) that is presented by neck pain, headache and sleep disturbance. Atlantoaxial joint (AAJ) is the commonest cervical spine joint that affected in patients with RA. When it is involved, it can be associated with dangerous complications. Magnetic Resonance Imaging (MRI) can be used for assessing the disease activity, the amount of cartilage destruction, associated cervical myelopathy and differentiating synovial fluid from inflammatory pannus (Taniguchi D, et al., 2008).

Objectives:

This study aimed to evaluate the efficacy of intra-articular steroid injection of inflamed AAJ in RA patients, regarding neck pain, headache and sleep quality using pre and post-interventions MRI.

Methods:

A prospective case control study. Patients with inflamed AAJ were recruited. Group 1 (AAJ group, n = 30), received intraarticular AAJ steroid injection, guided by fluoroscopy and Group 2 (control group, n = 30), received systemic steroids. Both groups were assessed with: Visual Analogue scale (VAS) for nocturnal neck pain and headache. Pittsburgh sleep quality index (PSQI) was used for sleep disturbance. Pre and post contrasts enhanced MRI interventions were done for both groups during the period of follow up (three months).

Results:

Nocturnal neck pain, headache and sleep disturbance have significantly decreased, during follow up visits (3 months), in AAJ group in comparison to the control group. The Pre-intervention nocturnal pain score was 60.3 ±17.1 in AAJ group & 58.5 ±17.9 in control group. Pain has significantly decreased after 2weeks in AAJ group with continuous improvement till 3 months’ post-intervention 6.9 ±4.65 & 51.26 ±10.54 respectively. The pre-intervention headache was 22.68 ±16.74 in AAJ group & 45.17 ±15.83 in control group decreased to 7.54 ±5.23 & 48.52 ±11.98 respectively post intervention. The percentage of patients who had sleep disturbance at baseline was 66.7% & 73.3% in AAJ and control groups respectively which has significantly decreased to 6.7% & 43.3% after 3 months. Regarding MRI, AAJ group hada statistical significant decreasein the percentage of patients with MRI synovial enhancement, inflammatorypannus,fibrosis and bone marrow edema in comparison to control group 3 months post intervention. All post-procedural side effects resolved within thmonth without further medical intervention, and no long-term sequelae were identified

Conclusion:

Fluoroscopic guided intra-articular steroid injection of inflamed atlantoaxial joints is considered a beneficial therapeutic option in rheumatoid arthritis patients regarding clinical and radiological assessments.

References:

[1]Taniguchi D, Tokunaga D, Hase H, et al. Evaluation of lateral instability of AAJ in RA using dynamic open-mouth view radiographs. Clin Rheumatol.2008 Jul. 27(7):851-7.

Disclosure of Interests:

None declared

THU0268 NEURO-DEVELOPMENTAL OUTCOME IN CHILDREN BORN TO MOTHERS WITH SLE AND APS

Background:

Systemic Lupus erythematosus and antiphospholipid disease are very common autoimmune diseases in women at reproductive age.

Objectives:

Evaluate the neuro-developmental outcome in children born to mothers with SLE or APS and to assess and characterize memory impairment in children’s born to mother with systemic lupus erythematosus or APS using children’s memory scale and the relation between tetrahydrobiopterin concentration range of children with developmental and neurological disorders.

Methods:

Women attending rheumatology clinics University of Asyut, SLE patients were eligible if they met the American College of Rheumatology (ACR) criteria for SLE and APL prior to pregnancy, and had at least one live birth following SLE diagnosis. Maternal history Data collected using a structured format that included medical and obstetric history. A detailed history of medication exposures and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) during pregnancy was obtained. Offspring history Medical and developmental histories of the offspring including antenatal, delivery, prenatal and pediatric histories, as child’s cognitive, physical or social maturity compared with established age-appropriate norms. Speech or hearing delays, diagnosis of attention- deficit hyperactivity disorder (ADHD), or any special educational needs (eg, occupational or speech therapy, behavioral counseling) was recorded. Assessment and characterization of memory impairment using children’s memory scale by neurologists. Tetrahydrobiopterin was measured by ELISA compared to children born to control healthy subjects of the same age and sex.

Results:

Data on 38 mothers and 60 offspring were analysed: ADHD was reported for 15 of 60 (25%) offspring. Recent memory delay was detected in 93% (14/15) Speech delay 40% (6/15). Maternal APS history was significantly associated with increased use special educational need among offsprings, including after adjustment for lupus anticoagulant (LA) positivity (39.4% for delays age >2 years; p<0.05). Anticardiolipin and anti-BETA2GP1 were not detected to be associated with delays. Recent memory delay was associated with increased Tetrahydrobiopterin level (P=0.01).

Conclusion:

The prevalence of neurodevelopmental abnormalities in children born to mothers with SLE or APS seems to be higher than normal population and more educational attention is important in these children, and need long-term follow-up.

Disclosure of Interests:

None declared

THU0453 THIRD OCCIPITAL NERVE RADIO-FREQUENCY UNDER FLUOROSCOPIC GUIDANCE IN MANAGEMENT OF CERVICOGENIC HEADACHE IN RHEUMATOID ARTHRITIS

Background:

Rheumatoid arthritis is a common type of autoimmune arthritis characterized by chronic inflammation. Cervical spine is often affected specially in long lasting disease

Objectives:

Evaluate efficacy of Third occipital nerve Radiofrequency under fluoroscopic guidance to treat refractory cervicogenic headache in RA patients.

Methods:

The current study was revised and approved from the local ethical committee of Faculty of Medicine; Assiut University, then registered in the clinical trials under the number ofNCT03852355. Inclusion criteria included, Patients who fulfilled the American College of Rheumatology (ACR) (2010) criteria for RA and suffering from upper neck pain and/or headache due to bilateral 3rd occipital nerve involvement, excluding other local cervical spine pathologies was confirmed by MRI and previously failed conservative treatment for at least three months prior to enrollment. Sixty adult patients were randomly assigned to one of the two studied groups Group 1 (RF, n = 30), received bilateral Third occipital nerve Radiofrequency under fluoroscopic guidance or Group 2 (control group, n = 30), received oral prednisolone 10 mg/day. The two groups were then followed-up with neck disability index (NDI), nocturnal neck pain VAS score and headache score every two weeks for three months. Sleep disturbance, sleep disability index were reassessed six months post intervention. Post interventional assessment was done by pain physician who were kept blind to the grouping process.

Results:

Neck disability index (1ry outcome), Nocturnal pain VAS, and severity of headache showed significant differences during the whole post-interventional study period. The patients in RF group demonstrated significant improvement of pain in comparison to baseline value over the whole six months with p-value < 0.001 as regard to the fore-mentioned three parameters. On the other aspect, the control group patients showed significant improvement in comparison to its baseline value after the 2nd, 12th and 24th weeks only as follows: (0.001,0.003, 0.003 for the NDI) (p values of 0.02,0.01, 0.01 for the nocturnal pain VAS), (0.001 0.009, 0.005 for the headache VAS severity.

Conclusion:

Radiofrequency of 3rd occipital nerve is effective in treatment of refractory cervicogenic headache in RA.

Disclosure of Interests: :

None declared

Differential effects of gender and patient background diversity on the changes in metabolic and biophysical profiles in people with type-2 diabetes from different ethnicities who fast during Ramadan (H1439); a prospective study from Qatar

OBJECTIVE

The 'PROspective Study of dose adjustment of multiple anti-diabetic therapy for Type-2 diabetic patients FASTing the Month of Ramadan aimed to assess the biophysical and metabolic effects of fasting during Ramadan, including HbA1c, weight, blood pressure and lipid profile.

STUDY DESIGN METHODS

We performed a prospective study of people with Type-2 diabetes who were on ≥3 drugs for lowering glucose before and after Ramadan of H1438 (May-June 2017) in Hamad Medical Corporation, Qatar. We enrolled 228 participants, of whom 181 completed the study and were included in the analysis.

RESULTS

There were 115 (63.5%) men and 66 (36.5%) women, mean age 53.6 ± 9.7 years and mean diabetes duration of 10 ± 6 years. Both HBA1c [7.8% (62 mmol/mol) vs. 7.6% (60 mmol/mol); p = 0.004]; and diastolic BP (75.7 ± 8.55 vs. 68.8 ± 23.1 mmHg, P = 0.001) improved significantly after Ramadan while there was an increase in total cholesterol (3.94 ± 0.89 mmol/l vs 4.11 ± 1.02 mmol/l; p = 0.008) and triglycerides (1.55 ± 0.72 mmol/l vs 1.71 ± 0.9 mmol/l; p = 0.012). Subgroup analysis showed that patients on sulphonylurea, South Asians and males had a significant reduction in both HBA1c and weight.

CONCLUSION

Patients with Type 2 diabetes who fast during Ramadan show an improvement in glycaemic control and diastolic blood pressure, but a worsening of total cholesterol and triglycerides, particularly those of South Asian origin and men.

Incidence of hypoglycaemia in patients with type-2 diabetes taking multiple glucose lowering therapies during Ramadan: the PROFAST Ramadan Study

Objective

To assess the incidence of hypoglycemia in people with type-2 diabetes mellitus (T2DM) on three or more anti-diabetic medications during Ramadan.

Study design methods

We have studied people with T2DM on three or more glucose-lowering drugs during Ramadan of H1438 (May-June 2017). The dose of each drug was adjusted according to a pre-specified protocol. The incidence of symptomatic or blood glucose confirmed hypoglycemia was recorded during the study.

Results

We enrolled 228 people with T2DM; 181 completed the study, and data on hypoglycaemia was available in 172 subjects. There were 115 males and 66 females, (mean age ± SD) 53.6 ± 9.7 years, diabetes duration 10 ± 6 yrs. The incidence of hypoglycaemia was 16.3% (28/172). Univariable logistic regression analysis showed that the risk of hypoglycaemia was increased in Arab subjects compared to Qatari; in those with longer duration of diabetes; and in those on four or more anti-diabetic medications compared to those on three anti-diabetic medications.

Conclusion

Despite the tailored advice, there is a high incidence of hypoglycemia in people with T2DM taking multiple glucose lowering therapies whilst fasting during Ramadan. Guidelines should address the increased complexity in anti-diabetic medications in patients who fast during Ramadan. Healthcare providers should individualize the modifications in anti-diabetic medications during Ramadan.