Neurocognitive evaluation using the International HIV Dementia Scale (IHDS) and Montreal Cognitive Assessment Test (MoCA) in an HIV-2 population

OBJECTIVES

We aimed to characterize neurocognitive impairment (NI) in an HIV-2 population using an observational cross-sectional study in four Portuguese hospitals.

METHODS

Adult HIV-2-infected patients were included. Montreal Cognitive Assessment Test (MoCA) and International HIV Dementia Scale (IHDS) scales were applied for screening of NI. Patient Health Questionnaire-9 (PHQ-9) and Instrumental Activities of Daily Living (IADL) scales were used for assessment of depression and functionality. A multivariate analysis was performed to assess for risk factors for NI.

RESULTS

Eighty-one patients were included, 50.6% of African origin (n = 41) and 49.4% of Portuguese origin (n = 40). The MoCA scale showed alterations in 81.5% of patients (100% of migrants vs. 62.5% of non-migrants, P < 0.001) and the IHDS scale showed alterations in 42%. Both scales were altered simultaneously in 35.8%. Variables independently associated with NI were age [odds ratio (OR) = 0.885] and migrant status (OR = 9.150).

CONCLUSIONS

Neurocognitive impairment (both scales altered) was present in 35.8%, which is comparable to what is described for HIV-1. The MoCA performed worse in the migrant population and might not be applicable in this setting.

Mid-position treatment strategy for locally advanced lung cancer: a dosimetric study

OBJECTIVE

The internal target volume (ITV) strategy generates larger planning target volumes (PTVs) in locally advanced non-small cell lung cancer (LA-NSCLC) than the Mid-position (Mid-p) strategy. We investigated the benefit of the Mid-p strategy regarding PTV reduction and dose to the organs at risk (OARs).

METHODS

44 patients with LA-NSCLC were included in a randomized clinical study to compare ITV and Mid-p strategies. GTV were delineated by a physician on maximum intensity projection images and on Mid-p images from four-dimensional CTs. CTVs were obtained by adding 6 mm uniform margin for microscopic extension. CTV to PTV margins were calculated using the van Herk's recipe for setup and delineation errors. For the Mid-p strategy, the mean target motion amplitude was added as a random error. For both strategies, three-dimensional conformal plans delivering 60-66 Gy to PTV were performed. PTVs, dose-volume parameters for OARs (lung, esophagus, heart, spinal cord) were reported and compared.

RESULTS

With the Mid-p strategy, the median of volume reduction was 23.5 cm3 (p = 0.012) and 8.8 cm3 (p = 0.0083) for PTVT and PTVN respectively; the median mean lung dose reduction was 0.51 Gy (p = 0.0057). For 37.1% of the patients, delineation errors led to smaller PTV with the ITV strategy than with the Mid-p strategy.

CONCLUSION

PTV and mean lung dose were significantly reduced using the Mid-p strategy. Delineation uncertainty can unfavorably impact the advantage.

ADVANCES IN KNOWLEDGE

To the best of our knowledge, this is the first dosimetric comparison study between ITV and Mid-p strategies for LA-NSCLC.

Evaluation of the sensitivity of the Express View function in the Mirocam® capsule endoscopy software

Background: A new computer algorithm called Express-View has recently been introduced by Mirocam, but data concerning its application and efficacy are scarce.Objective: To evaluate the lesion detection rate, per-patient sensitivity and the diagnostic accuracy using Express-View.Methods: All patients who performed CE between January 2018 and June 2019, whose indication was obscure gastrointestinal bleeding (OGIB) and with findings on CE, were included. Lesions identified in conventional reading were selected and considered as reference.Results: Eighty-nine patients were included, 50.6% male, with a mean age of 68.4 years-old (±12.3). The Express-View mode detected 85.5% of lesions previously detected by conventional reading (524 out of 613). There were 89 missed lesions, mainly erosions or ulcers (44.9%) and angioectasias (38.2%). The lesion detection rate was found to be lower in the jejunum and ileum compared to extra-small bowel locations and duodenum (p = .04). Although Express-View had a per-patient sensitivity for all lesions of 56.2% and a per-patient sensitivity for all clinically significant lesions of 83.1%, it achieved a diagnostic accuracy of 91%.Conclusions: The per-patient sensitivity for all lesions was shown to be below expectations, although the lesion detection rate, the per-patient sensitivity for all clinically significant lesions, and the diagnostic accuracy were shown to be higher.

P229 PillCamCrohn’sCapsule: the use of a panenteric capsule endoscopy in a Portuguese centre

Background

Crohn’s disease (CD) is a complex chronic inflammatory gastrointestinal condition with variable age of onset, disease location and behaviour. PillCamCrohn’sCapsule (PCC) was recently introduced as a new system composed of a two-headed capsule which allows an extensive coverage of the gastrointestinal (GI) tract. This panenteric capsule endoscopy plays an important role in the diagnosis and monitoring of CD patients and has the potential to reduce multiple procedures in CD, consequently increasing patients’ satisfaction. However, its role in clinical practice remains undefined due to limited data. A recent study in children demonstrated its importance ina treat-to-target approach and a randomised trial is currently under-recruiting in order to evaluate the likelihood of panenteric mucosal healing in CD patients treated with Vedolizumab. The authors present an analysis of the application of this system.

Methods

A cross-sectional analysis of SBC from patients with suspected or established CD was performed. Data were collected retrospectively. Patients performed 2L of polyethylene glycol (PEG) prior to PCC ingestion. After PCC ingestion, patients underwent sequentially: 2 boosters of sodium phosphate (NaP). The authors assessed: indication of PCC, bowel preparation, completeness (when the capsule was naturally excreted), Lewis and CECDAI scores and complications. Diagnosis confirmation and changes in stage disease were also evaluated.

Results

Eighteen patients (median age 43 years, 55.6% female, established CD in 83.3%) were included in the analysis. Indications were suspected CD (16.7%), definition of disease activity and extension (27.8%) and assessment of treatment response (44.4%). All procedures were complete and had an adequate bowel cleansing (Brotzqualitative excellent n = 1, Good n = 15, fair n = 2; Brotz quantitative median 9.5). 72.2% patients presented inflammatory lesions. In established CD median Lewis was 900 and CECDAI 8.5. PCCcorroborated the diagnosis in 1 of 3 patients with suspected CD and changed the staging of the disease in known CD in 13.3% (L1 to L3 n = 1 and B1 to B2 n = 1). No complications were reported including capsule retentions.

Conclusion

This preliminary study showed that PCC is an effective and safe tool to use in suspected or established CD patients. In our study, this method was more frequently used for assessment of treatment response. PCC could be of great advantage in our clinical practice since it provides a complete examination of mucosal healing of the gastrointestinal tract in a single procedure, helping physicians in disease management.

Successful everolimus therapy for SEGA in pediatric patients with tuberous sclerosis complex

PURPOSE

Tuberous sclerosis complex (TSC) is associated with hamartomatous growths including subependymal giant cell astrocytomas (SEGAs). Although, SEGAs are slow-growing glioneuronal tumors, they represent a significant cause of morbidity and mortality due to the risk of sudden death from acute hydrocephalus. Neurosurgical resection has been the mainstay of therapy, since radiotherapy and chemotherapy were proved inefficient in those tumors. Recent studies support the use of everolimus for subependymal giant cell astrocytomas associated with tuberous sclerosis and suggest it might represent a disease-modifying treatment for other aspects of tuberous sclerosis.

METHODS

We describe the clinical and radiological progression of three pediatric patients with definitive diagnosis of TSC and SEGA, which have been treated with everolimus.

RESULTS

Up to 34 % sustained SEGA decrease was observed in the three cases. All three patients have experienced seizure control and two of them have showed cognitive and behavioral improvement. Everolimus has been well tolerated by all. No severe adverse events have been observed to date.

CONCLUSION

Everolimus offers significant promise in treating SEGAs. Studies are required to explore optimal therapy duration and management upon discontinuing therapy.

First record of a whale shark Rhincodon typus in continental Europe

A whale shark Rhincodon typus was found in a set-net in southern Portugal in October 2011. This was the first record for continental Europe and represents an increase of the species' known range. Upwelling events and increase in sea-surface temperatures are possible reasons for this occurrence.

Solitary hemangioma of the small bowel disclosed by wireless capsule endoscopy

A nine-year-old child presented with melena and anemia. She had similar symptoms five months earlier and had undergone an extensive workup with upper gastrointestinal endoscopy and colonoscopy, both normal and 99m-Tc-RBC-scintigraphy which was positive in the right lower quadrant. This time, capsule endoscopy was performed and disclosed an hemangioma with a dark spot suggesting recent bleeding in the ileum. The lesion was resected. Pathological examination revealed a transmural cavernous hemangioma. Small bowel hemangioma is a rare disease. Its diagnosis is extremely difficult and is usually obtained during surgery. Capsule endoscopy is an endoscopic technique that can improve preoperative diagnosis, as reported in the present case.