Exploring chemical space, scaffold diversity, and activity landscape of spleen tyrosine kinase active inhibitors

This study aims to comprehensively characterize 576 inhibitors targeting Spleen Tyrosine Kinase (SYK), a non-receptor tyrosine kinase primarily found in haematopoietic cells, with significant relevance to B-cell receptor function. The objective is to gain insights into the structural requirements essential for potent activity, with implications for various therapeutic applications. Through chemoinformatic analyses, we focus on exploring the chemical space, scaffold diversity, and structure-activity relationships (SAR). By leveraging ECFP4 and MACCS fingerprints, we elucidate the relationship between chemical compounds and visualize the network using RDKit and NetworkX platforms. Additionally, compound clustering and visualization of the associated chemical space aid in understanding overall diversity. The outcomes include identifying consensus diversity patterns to assess global chemical space diversity. Furthermore, incorporating pairwise activity differences enhances the activity landscape visualization, revealing heterogeneous SAR patterns. The dataset analysed in this work has three activity cliff generators, CHEMBL3415598, CHEMBL4780257, and CHEMBL3265037, compounds with high affinity to SYK are very similar to compounds analogues with reasonable potency differences. Overall, this study provides a critical analysis of SYK inhibitors, uncovering potential scaffolds and chemical moieties crucial for their activity, thereby advancing the understanding of their therapeutic potential.

Attitude Towards Sustainability in Dentistry: The Evidence From Riyadh City, Saudi Arabia

OBJECTIVES

The field of dentistry is characterised by its substantial energy consumption and resource utilisation, resulting in a notable ecological footprint. Thus, sustainability in dentistry is an important but underresearched concern. The influence of public pressure on sustainability has been extensively studied across other industries; nevertheless, there is a dearth of research examining its impact on the dental sector specifically in Saudi Arabia. The current study conducted the first-ever survey in Saudi Arabia to investigate the prevailing attitudes with regard to sustainable dentistry amongst the general population of the country.

METHODS

This was an online cross-sectional observational survey conducted in Riyadh, Saudi Arabia. A self-administered online questionnaire was distributed to adults aged 18 years and older, of both genders, from March to April 2023. The study obtained appropriate ethical approval.

RESULTS

Participants expressed a positive attitude with regard to sustainable dentistry and demonstrated their openness regarding compromising in terms of time, convenience, cost, and even the appearance of their teeth in order to minimise the environmental impact resulting from dental procedures. It is also evident that a correlation exists between gender-associated beliefs and proenvironmental behaviour, particularly in the context of sustainable dentistry and related environmental intentions in Saudi Arabia.

CONCLUSIONS

The findings of this study represent an important complement to the existing sustainability knowledge and understanding in dentistry, which will be helpful for policymakers as well as dental professionals to develop or modify policy, regulation, and professional curriculum.

Ultrasound simulation training to meet the 2021 Royal College of Radiologists' curriculum for radiology trainees: South East London experience

AIM

To enhance ultrasound teaching delivery to radiology trainees using a simulation course matched to the 2021 Royal College of Radiologists (RCR) curriculum.

MATERIAL AND METHODS

An ultrasound simulation training course was designed for specialty trainees (ST) 1 in radiology, which was based on the 2021 RCR curriculum and covered the top ultrasound training priorities. The course was piloted initially on two occasions in a 1-day format to the August 2021 and the March 2022 ST1 intake trainees. Based on the feedback, a comprehensive 4-day course was developed and delivered between October and December 2022 for the August 2022 ST1 intake, funded by Health Education England. The outcomes measured were subjective trainee feedback using numerical scores and free text.

RESULTS

All King's College Hospital NHS Foundation Trust radiology ST1 trainees from the August 2021 to the August 2022 intake participated in ultrasound simulation training. The training matched the RCR curriculum and increased the trainees' confidence and competency in medical ultrasound.

CONCLUSIONS

Ultrasound simulation training can be successfully delivered to ST1 trainees to match the 2021 RCR curriculum and enhance training in medical ultrasound for radiologists.

The impact of state paid sick leave policies on weekday workplace mobility during the COVID-19 pandemic

OBJECTIVES

This study aimed to evaluate whether the Families First Coronavirus Response Act (FFCRA) modified the association between pre-existing state paid sick leave (PSL) and weekday workplace mobility between February 15 and July 7, 2020.

STUDY DESIGN

This was a longitudinal, observational study.

METHODS

The 50 US states and Washington, D.C., were divided into exposure groups based on the presence or absence of pre-existing state PSL policies. Derived from Google COVID-19 Community Mobility Reports, the outcome was measured as the daily percent change in weekday workplace mobility. Mixed-effects, interrupted time series regression was performed to evaluate weekday workplace mobility after the implementation of the FFCRA on April 1, 2020.

RESULTS

States with pre-existing PSL policies exhibited a greater drop in mobility following the passage of the FFCRA (β = -8.86, 95% confidence interval: -11.6, -6.10, P < 001). This remained significant after adjusting for state-level health, economic, and sociodemographic indicators (β = -3.13, 95% confidence interval: -5.92, -0.34; P = .039).

CONCLUSIONS

Pre-existing PSL policies were associated with a significant decline in weekday workplace mobility after the FFCRA, which may have influenced local health outcomes. The presence of pre-existing state policies may differentially influence the impact of federal legislation enacted during emergencies.

POS0756 DETERMINANTS OF HEALTH-RELATED QUALITY OF LIFE (HR-QoL) ACROSS THE SPECTRUM OF SYSTEMIC AUTOIMMUNE RHEUMATIC DISEASES: RESULTS FROM THE LEAP COHORT

Background

Poor health-related quality of life (HR-QoL) is recognised in patients with established connective tissue diseases (CTDs), however it is not clear how it affects patients with undifferentiated CTD (UCTD) which has traditionally been associated with a mild or more benign profile.

Objectives

To investigate HR-QoL in patients affected with a variety of CTDs (including UCTD) using the SF-36 questionnaire; and secondly, to review demographic and clinical factors predictive of a poor HR-QoL

Methods

The Lupus Extended Autoimmune Phenotype (LEAP) cohort is a multicentre prospective study of patients with a CTD. Rheumatologist diagnosis was used to classify patients into four groups: systemic lupus erythematosus (SLE), primary Sjögren’s syndrome (pSS), UCTD, and (combined because of low numbers) those with an idiopathic inflammatory myopathy (IIM), systemic sclerosis (SSc) or overlap syndrome. The SF-36 quality of life questionnaire was completed at enrolment and includes eight domains: physical function (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE) and mental health (MH) which range from 0 to 100, with higher scores reflecting better HR-QoL. Physical (PCS) and mental component score (MCS) were calculated for each group, with a score below 50 representing a worse HR-QoL compared to the general UK population. Predictors for poor HR-QoL was chosen a priori, then tested using linear regression adjusted for age, gender and ethnicity. All statistical analysis was performed using STATA v14, with results expressed as beta coefficients with 95% confidence intervals (95%CI).

Results

Data were collected from 309 patients (280 [90.6%] women, with a mean [SD] age of 48.9 [12.9] years) from three UK rheumatology centres. The majority of patients were Caucasian (n=235, 76.1%). By rheumatologist diagnosis, 115 (37.2%) had SLE, 56 (18.1%) pSS, 72 (23.3%) UCTD and 66 (21.4%) SSc, IIM or an overlap syndrome. Patients with UCTD, pSS and SSc/IIM spectrum disorders had a shorter median disease duration (3.8, 3.7 and 6.1 years respectively) compared with patients with those with SLE (11.0 years), p<0.001. Previous steroid and immunosuppressant use was highest in patients with SLE and SSc/IIM spectrum disorders (p<0.001). The most affected domains include VT, GH and BP (Figure 1), and the PCS is more impaired compared with the MCS, with similar scores across disease groups. Agnostic of disease group, factors associated with a lower PCS include increasing age (beta -0.15 [95%CI -0.26, -0.06], p=0.008), prednisolone use (-3.1 [-6.05, -0.19], p=0.037), c-reactive protein (-0.09 [-0.62, -0.10], p=0.007), fatigue (-2.00 [-3.79, -0.22], p=0.028), and sicca syndrome (-4.70 [-7.66, -1.74] p=0.002), and these remained significant in a multivariate model.

Figure 1.

radar diagrams of eight SF-36 domains, and MCS and PCS boxplots. SLE; systemic lupus erythematosus; UCTD, undifferentiated CTD; pSS, primary Sjögren’s syndrome; IIM, idiopathic inflammatory myopathy; SSc, systemic sclerosis; PF, physical function; RP, role physical; BP, bodily pain; GH, general health; VT, vitality; SF, social functioning; RE, role emotional; MH, mental health

Conclusion

Patients with UCTD exhibit similar impairment in physical components of HR-QoL compared with other established CTDs, despite perceived differences in disease severity. This study highlights sicca syndrome, fatigue, and steroid burden as key targets for improving HR-QoL in patients across the spectrum of CTDs.

Disclosure of Interests

Sarah Dyball Grant/research support from: UCB and Eli Lilly, John Reynolds: None declared, Ariane Herrick Speakers bureau: Janssen, Consultant of: Arena, Boehringer-Ingelheim, Camurus, CSL-Behring, and Gesynta, Grant/research support from: Gesynta, Hector Chinoy Speakers bureau: UCB, Biogen, Consultant of: Novartis, Eli Lilly, Orphazyme, Astra Zeneca, Grant/research support from: Eli Lilly and UCB, Sahena Haque: None declared, Sophia Naz: None declared, Ellen Bruce: None declared, Ian N. Bruce Speakers bureau: AstraZeneca, GSK and UCB, Consultant of: AstraZeneca, Eli Lilly, GSK, Merck Serono, UCB and ILTOO, Grant/research support from: Genzyme/Sanofi, GSK, Roche and UCB, Ben Parker Speakers bureau: Eli Lilly and Roche, Consultant of: Fresenius-Kabi and AbbVie, Grant/research support from: Genzyme/Sanofi and GSK

Peer-Assisted skills learning in structured undergraduate medical curriculum: An experiential perspective of tutors and tutees

Background and Aims

: This study aims to evaluate the implication of peer-assisted learning model adopted in students' clinical skills training from the perspective of tutees and tutors at the end of a peer-tutored clinical skills program and peer tutors themselves.

Subjects and Methods

This cross-sectional study was conducted in the Faculty of Medicine, Bursa Uludag in between January and March 2018. Following the clinical skills training, a questionnaire designed to assess the views of tutees and peer tutors was filled out on a voluntary basis by 159 tutees and 43 tutors. The statistical analysis of the collected and processed data was analyzed by using IBM SPSS 23.0 statistical program. The statistical significance level was maintained as α = 0.05.

Results

According to the Likert scale, satisfaction with the tutors and the educational environment was high in general. The 2^nd term tutees provided more negative feedback compared to other terms. Among all the terms, the most positive answers were provided by the 3^rd term students. Although the tutors found themselves fully skilled in communication with colleagues, there were striking differences between the tutors in the 5^th and 6^th terms of providing a good role model for pre-clinical terms students.

Conclusion

Considering peer assisted learning (PAL)'s positive responses from this study, the adoption of PAL has been started to be used as a supplementary teaching method for the clinical skills training at the Faculty of Medicine, Bursa Uludag University. PAL is considered a successful education model since it is cost-efficient for undergraduate medical training and improves the professional skills of both teacher and learner students. It can be availed of as an alternative method in medical faculties where especially the number of academic members is insufficient.

Estimation of Serum Fibrinogen in Males with Type 2 Diabetes

The patient with diabetes mellitus (DM) and its complication is increasing in our country and all over the world. Fibrinogen is a renowned factor of progressive atherosclerotic lesions and a predictor of cardiovascular events. Level of fibrinogen is increases in patients with diabetes mellitus (DM) may accelerate thromboembolic risk for cardiovascular disease (CVD). This study was carried out to assess plasma fibrinogen level in subjects with type 2 diabetes mellitus. It was a cross sectional analytic study and conducted in the Department of Physiology, Dhaka Medical College, Dhaka, Bangladesh from July 2013 to June 2014. A total number of 200 adult male subjects were selected with age ranging from 40-60 years. Among them, 100 subjects with type 2 diabetes mellitus were included in the study group (Group B) and 100 healthy subjects with same age range were considered as controls (Group A) for comparison. The subjects were selected from BIRDEM hospital Dhaka and personal contact from different areas of Dhaka city on the basis of exclusion and inclusion criteria. The study parameter was plasma fibrinogen level, and was measured in the Department of Microbiology and Immunology of BIRDEM hospital, Dhaka, Bangladesh. The data were collected and recorded in pre-designed structured questionnaire by the researcher herself. For statistical analyses unpaired Student's 't' test and Pearson's correlation coefficient (r) test were performed as applicable using SPSS for windows version 19.0. In this study plasma fibrinogen level was significantly (p<0.001) higher in the study group than that of control group. From this study, it may be concluded that estimation of plasma fibrinogen level might be beneficial for prediction of future cardiovascular risk in adult diabetic male.

168 Innovation Surgical Leadership: Future Directions

Aim

Which theories, concepts and frameworks have been evidenced for surgical innovation in leadership in the United Kingdom, European Union, and the United States of America?

Method

Systematic scoping synthesis of literature will be employed where appropriate theories, concepts and frameworks will be identified. Drawing upon broader literature on leadership innovation in surgery further examples will be utilised within surgery. s and full- text articles will be used and reviewed for relevance to the research question against an inclusion and exclusion criteria.

Results

The theories of innovative leadership in surgery are broad and non-specific. It demands a professionalism, competence, teamwork, and motivation. Upon comparison of the three country/region profiles there are strong similarities but present differences. It is paramount to understand and underpin these theories in order to foster the future of innovation in surgery. Surgery is fast evolving and developments in leadership must evolve with it. Within innovation, leadership skills must be harnessed including experience and observation. It is through an interprofessional team that surgeons must collaborate in order to provide optimum results and to permit the profession to evolve.

Conclusions

Innovation and surgery are symbiotic, and the next generation of surgical leaders must foster an environment where this is possible to cultivate. Programmes across these country profiles must ensure innovative leadership is present through good mentorship, coaching, team empowerment and feedback. Future directions must be put in place in post -graduate surgical training programmes to ensure that patient care is optimised as the primary objective.

408 Blood Parameters as an Early Indicator of Complications Following Oesophagogastric Resection

Aim

Oesophageal and gastric cancers are the eighth and fifth most prevalent cancers with a high degree of morbidity and mortality. Oesophagogastric resections are associated with a high degree of complications postoperatively. Complications following resection are associated with poorer hospital recovery, recurrence of cancer, readmission to hospital and increased mortality. A study was carried out to examine if there was an association between post-operative bloods and the development of complications.

Method

Data was collected from theatre logbooks, Integrated Clinical Environment (ICE) and clinical portal. Patients undergoing oesophagogastric resection for gastric and oesophageal cancer between October 2010 and November 2014 were included. Complications were organised using the Clavien Dindo classification. Data was analysed using the Student’ T test and Chi-Squared test. A P-value of 0.05 was classed as being statiscally significant.

Results

94 patients met the inclusion criteria for this study. 55 patients (58.5%) underwent Oesophagectomy, 18 (19.1%) total gastrectomy and 21 (22.3%) partial gastrectomy. A significant association was seen between development of complications and higher Day 5 White Cell count (WCC) (p = 0.048), lower Day 2–5 Albumin (Day 2 Albumin p = 0.038) and higher Day 2–5 C Reactive Protein (CRP) (Day 2 CRP p&lt;0.001).

Conclusions

This study suggests Albumin, CRP and WCC may be used to predict postoperative complications in patients undergoing oesophagogastric resections for malignancy. Changes in the blood parameters present as early as day 2 postoperatively and can highlight patients who require closer monitoring, allowing earlier re-intervention if required.

COVID-19 pandemic related excessive electronic media exposure and mental health in Saudi Arabia

OBJECTIVE

Due to the continued spread of COVID-19 and the emergence of novel mutated viral variants, families all over the world are experiencing wide-ranging stressors that threaten not only their financial well-being but also their physical and mental health. The present study assessed the association between excessive electronic media exposure of pandemic-related news and mental health of the residents of Ha'il Province, Saudi Arabia. The present study also assessed the prevalence of perceived stress, fear of COVID-19, anxiety, depression, and loneliness due to COVID-19-related restrictions in the same population.

MATERIALS AND METHODS

A total of 490 residents of Ha'il Province participated in a cross-sectional online survey during a two-month period (March to April 2021). A validated 38-item self-report survey was used to collect the data.

RESULTS

Significant associations were reported between excessive electronic media exposure and the prevalence of perceived stress (χ2=140.56; p<.001), generalized anxiety (χ2=74.55; p<.001), depression (χ2=71.58; p<.001), COVID-19-related fear (χ2=24.54; p<.001), and loneliness (χ2=11.46; p<.001). It was also found that participants without depressive symptoms were 0.28 times less likely to have been exposed to excessive electronic media exposure (AOR: 0.28; C.I. 0.16-0.48; p<.001). Similarly, participants with no stress/mild stress were 0.32 times less likely to have been exposed to excessive electronic media exposure (AOR: 0.32; C.I. 0.19-0.52; p<.001).

CONCLUSIONS

The findings of the present study suggest an urgent need for educational resilience programs (online and in-person) for susceptible individuals (females, unemployed, urban residents, etc.). Such programs would help them to develop skills to cope with the psychological impact of the COVID-19 pandemic.

891 Fasting Times in Trauma List Patients

Introduction

To reduce the risk of regurgitation and aspiration of gastric contents, patients are to fast before anaesthesia. However, prolonged periods of fasting have been found to be unnecessary and potentially harmful. Our aim was to compare pre-operative fasting times in trauma patients against the AAGBI (Association of Anaesthetists of Great Britain and Ireland) guidelines and highlight areas for improvement. The AAGBI recommends minimum fasting periods of:

Method

50 patients were audited in each cycle. Data were collected prospectively using questionnaires in the initial audit and by interviewing patients in the re-audit. Patients in ITU and those with dementia were excluded. Questions included fasting instructions given, time of the last meal and drink (including kind of drink), IV fluids administration. Anaesthetic notes were checked for time of induction of anaesthesia.

Results

Average time fasted for food was 17.09 hours and 9.32 hours for water. In the re-audit, average time fasted was 16.43 hours for food and 5.27 hours for water. All the patients received information as to when they could eat or drink until. None of them was told ‘midnight’.

Conclusions

Although there was an improvement, this was still beyond the guidelines. The results highlighted the importance of regularly reviewing the fasting status throughout the day in order to achieve the standard.

414 Informed Consent for Neck of Femur Fracture Surgery During the Covid-19 Pandemic: An Evidence-Based Approach

Background

Surgical intervention for neck of femur fractures continues to be prioritised during the Covid-19 pandemic. However, there remains a lack of clarity for clinicians during the consent process. This study quantifies additional perioperative risks for Covid-19 positive patients undergoing neck of femur fracture surgery and establishes an evidence-based framework for facilitating informed consent during the Covid-19 pandemic.

Method

259 patients undergoing neck of femur fracture surgery in four hospitals at the epicentre of the United Kingdom’s first wave of Covid-19 were recruited. 51 patients were positive for Covid-19. Predefined outcomes were recorded in a 30-day postoperative period.

Results

Odds of intensive care admission were 4.64 times higher (95% CI 1.59-13.50, p = 0.005) and odds of 30-day mortality were 3 times higher (95% CI 1.22-7.40, p = 0.02) in Covid-19 positive patients. 74.5% of Covid-19 positive patients suffered post-operative complications. 35.3% of Covid-19 positive patients developed lower respiratory tract infection with 13.7% progressing to acute respiratory distress syndrome. 9.8% of Covid-19 positive patients experienced symptomatic thromboembolic events with a 3.9% incidence of pulmonary emboli.

Conclusions

The implications of Covid-19 on the informed consent process for neck of femur fracture surgery are profound. Covid-19 positive patients should be consented for increased risk of postoperative complications (including lower respiratory tract infection, acute respiratory distress syndrome and thromboembolic events), longer inpatient stay, increased frequency of intensive care admission and higher risk of mortality.

Variants of SARS-CoV-2, their effects on infection, transmission and neutralization by vaccine-induced antibodies

OBJECTIVE: The current study reviewed Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) variants for their effects on infection, transmission and neutralization by vaccine-induced antibodies. MATERIALS AND METHODS: The research articles for the current study were searched over PubMed, Google Scholar, EMBASE and Web of Science online databases. The keywords used were: (("SARS-CoV-2" OR "COVID-19") AND ("mutation" OR "variant") AND ("death" OR "hospitalization" OR "infection" OR "transmission") AND ("antibody" OR "neutralize" OR "vaccine")). A total of 333 research articles were retrieved through online-database search. These articles were further scrutinized for their relevancy. Additionally, searches were performed to find the latest relevant information over Google search engine and relevant news browsers. Finally, around 35 germane articles were considered for scripting the current report. RESULTS: The mutations have changed amino acids at key positions in spike protein viz. S477N, E484K, Q677H, E484Q, L452R, K417T, K417N and N501Y. These mutations are relevant for different characteristics and are present in newly evolved strains of SARS-CoV-2 like E484K in B.1.526, B.1.525, P.2, B.1.1.7, P.1 and B.1.351. Mutations have increased the immune escape potential leading to 3.5-6.5-folds decrease in neutralization of antibodies (Pfizer and Moderna vaccines). The variant, B.1.617 circulating in India and many other countries (double variant) having E484Q and L452R mutations, has raised the infection rate and decreased the neutralization capacity of the vaccine-induced antibodies. Deadly K417N+E484K+N501Y triplet mutations found in B.1.351 and P.1 have increased the transmission ability of these strains by 50% leading to greater COVID-19 hospitalization, ICU admissions and deaths. CONCLUSIONS: The new SARS-CoV-2 variants have compromised the neutralization potential of the currently used vaccines, but still, they have considerable efficacy to reduce infection and mortality.

Graphical Abstract

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Photodiagnostic services in the UK and Republic of Ireland: a British Photodermatology Group Workshop Report

BACKGROUND

Photodiagnostic investigations are essential for the accurate diagnosis of abnormal cutaneous photosensitivity and provide important information for the management of patients with photodermatoses (cutaneous photosensitivity disorders). Although photodiagnosis has been undertaken since the early 1970s, specialist services in the United Kingdom (UK) and Republic of Ireland are limited and there is no formal guidance on diagnostic approach. Indeed, there is a limited literature in this area of methodology and diagnostic practice.

OBJECTIVES

The primary objective was to undertake a British Photodermatology Group Workshop to review the role and activities of specialist centres in the UK and Republic of Ireland in order to ascertain whether there were consensus practices. Secondary objectives were to identify key priorities for service, training and research.

METHODS

An initial detailed survey review of current activities was undertaken prior to the Workshop and data from this survey were used to inform discussion at the Workshop, which was attended by key photodermatology experts from the UK and Republic of Ireland.

RESULTS/CONCLUSIONS

We have undertaken a detailed review of current Photodiagnostic Services in the UK and Republic of Ireland and report on our findings from the 12 centres and we have identified key areas of consensus practice. This is an important step in the process of standardising and optimising procedures and protocols and defining minimum clinical standards for photodiagnostic investigations, which are of such diagnostic importance in Dermatology.

Phytochemicals induce apoptosis by modulation of nitric oxide signaling pathway in cervical cancer cells

OBJECTIVE

Nitric Oxide (NO) is produced by NO synthases (NOS) and is a key signaling molecule that regulates tumorigenesis, both aiding and alleviating it. Elevated NO levels are cytotoxic to cancer cells, making NOS an important target for cancer treatment. In the present study, the modulatory effects of the phytochemicals, quercetin, sulforaphane, genistein, and epigallocatechin-3-gallate on NO pathway and apoptosis were shown in HeLa cervical cancer cells.

MATERIALS AND METHODS

Fluorescent microscopy and flow cytometry were used to assess apoptosis. A Griess assay was used to quantitatively measure NO, quantitative PCR array was used to assess the expression levels of genes involved in the NO signaling pathway, and immunocytochemistry was used to determine NOS protein expression. The functional association among the modulated genes was evaluated using network biology analysis, gene set enrichment, and KEGG pathway analysis.

RESULTS

Treatment with the phytochemicals elevated NO levels in HeLa cells and modulated various genes involved in nitric oxide biosynthesis, superoxide metabolism, and oxidative stress, including NOS1, NOS2, NOS3, ALOX12, and SOD2, with a concomitant increase in NOS2 and NOS3 protein expression levels; also, the phytochemicals were found to induce apoptosis.

CONCLUSIONS

These results suggest that the phytochemical-induced cell death is partially attributed to the activation of the NO pathway and upregulation of pro-oxidant ROS generators. Further experimental studies are required to explore this mechanistic association of NO signaling pathway activation and induction of apoptosis in other types of cancer.

643 Near-Peer Surgical Teaching for Junior Doctors: A 16-Month Retrospective Analysis

Introduction

Surgical departments across the UK are having to mitigate service demands, budget constraints and changes to work patterns with their statutory duty to provide high-quality training and education. Securing consultant-led teaching has also become increasingly difficult leading to the rise of near-peer teaching. We evaluate the long-term effectiveness of near-peer surgical teaching for junior doctors.

Method

We developed a rolling 12-week trainee-led didactic surgical education programme for Foundation doctors and Core Surgical Trainees. Junior doctors delivered teaching to peers with registrar input; session and supervision feedback was recorded using 5-point scales and free-text responses.

Results

42 junior doctors responded to our end-of-programme feedback surveys covering December 2018 to April 2020. The overall programme (8.83±1.08/10), relevance (4.62±0.58/5), presentation quality (4.60±0.50/5) and supervisor knowledge (4.81±0.40/5) were rated highly by respondents. Attendees also reported significant improvements in subject knowledge (3.72±0.92/5 to 4.50±0.56/5, P &lt; 0.0001), clinical confidence, presentation and teaching skills.

Conclusions

Our near-peer teaching programme addressed the educational needs of junior doctors and developed their presentation and organisational skills. Supervision and input from registrars facilitated discussion and reinforced key concepts. The success of this programme highlights the role that trainees can play in designing, developing, and leading an effective surgical teaching programme.

Paederus Dermatitis: A severe reaction to Charlie’s kiss

Paederus dermatitis is a very painful vesicular condition which is caused by the extremely potent toxin “Pederin” released from an insect calledPaederusfuscipes but commonly known as Charlie.A 26 years old woman presented with a sudden onset of neuralgia, arthralgia of left jaw, fever, nausea and fatigue with generalized pain radiating to the neck and lower jaw as well as itch-like sensation on their left arm associated with acute inflammation which began 24-48 hours prior. The patient refused to go to the hospital due to the current pandemic situation but instead updated us daily on her conditions with photographic changes of the arm until complete resolution of symptoms. This case report accounts for the daily sequential changes experienced by a patient after severe reaction to an exposure of pederin with photographs of the affected site. While the painful lesion and all systemic conditions resolved spontaneously over time, a scar was left to mark the unpleasant period. Bangladesh Journal of Medical Science Vol.20(2) 2021 p.459-462

Sagittal Jaw Relationship of Different Types of Cleft and Non-cleft Individuals

To investigate whether the craniofacial sagittal jaw relationship in patients with non-syndromic cleft differed from non-cleft (NC) individuals by artificial intelligence (A.I.)-driven lateral cephalometric (Late. Ceph.) analysis. The study group comprised 123 subjects with different types of clefts including 29 = BCLP (bilateral cleft lip and palate), 41 = UCLP (unilateral cleft lip and palate), 9 = UCLA (unilateral cleft lip and alveolus), 13 = UCL (unilateral cleft lip) and NC = 31. The mean age was 14.77 years. SNA, SNB, ANB angle and Wits appraisal was measured in lateral cephalogram using a new innovative A.I driven Webceph software. Two-way ANOVA and multiple-comparison statistics tests were applied to see the differences between gender and among different types of clefts vs. NC individuals. A significant decrease (p < 0.005) in SNA, ANB, Wits appraisal was observed in different types of clefts vs. NC individuals. SNB (p > 0.005) showed insignificant variables in relation to type of clefts. No significant difference was also found in terms of gender in relation to any type of clefts and NC group. The present study advocates a decrease in sagittal development (SNA, ANB and Wits appraisal) in different types of cleft compared to NC individuals.

The Assessment of 3D Digital Models Using GOSLON Yardstick Index: Exploring Confounding Factors Responsible for Unfavourable Treatment Outcome in Multi-Population Children With UCLP

To evaluate dental arch relationship (DAR) using GOSLON Yardstick and also to explore the association between multiple factors (age, gender, UCLP types, UCLP side, Family history of cleft, family history of Class III malocclusion, techniques of cheiloplasty, techniques of palatoplasty) and DAR in children unilateral cleft lip and palate (UCLP) in different populations. Two hundred fifty-five laser scanned 3D digital models (LS3DM) of UCLP children (5-12 years) from Malaysia, Bangladesh, and Pakistan were included. The intra- and inter-examiner agreements were evaluated by kappa statistics, to compare the GOSLON mean score between the populations and to explore the responsible factors that affect DAR, one way ANOVA, and crude logistic regression analysis was used, respectively. The mean GOSLON score was 2.97; 3.40 and 3.09 in Malaysia, Bangladesh, and Pakistan, respectively. Twenty seven, 40, and 30 subjects were in unfavourable (category rating 4 and 5) groups in Malaysia, Bangladesh, and Pakistan, respectively. A significant association was found between techniques of palatoplasty (p = 0.03; p = 0.04 and p = 0.04 in Malaysia, Bangladesh, and Pakistan, respectively) and unfavourable DAR. Different cheiloplasty techniques (p = 0.04) and gender (p = 0.03) also exhibited noteworthy associations with unfavourable DAR in the Bangladeshi population. Bardach techniques of palatoplasty were significantly associated with unfavourable DAR in all three populations. Moreover, male UCLP and modified Millard techniques of cheiloplasty were also associated with unfavourable DAR in the Bangladeshi population.

Impact of COVID-19 on the cerebrovascular system and the prevention of RBC lysis

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) uses Angiotensin- converting enzyme 2 (ACE2) receptors to infect host cells which may lead to coronavirus disease (COVID-19). Given the presence of ACE2 receptors in the brain and the critical role of the renin-angiotensin system (RAS) in brain functions, special attention to brain microcirculation and neuronal inflammation is warranted during COVID-19 treatment. Neurological complications reported among COVID-19 patients range from mild dizziness, headache, hypogeusia, hyposmia to severe like encephalopathy, stroke, Guillain-Barre Syndrome (GBS), CNS demyelination, infarcts, microhemorrhages and nerve root enhancement. The pathophysiology of these complications is likely via direct viral infection of the CNS and PNS tissue or through indirect effects including post- viral autoimmune response, neurological consequences of sepsis, hyperpyrexia, hypoxia and hypercoagulability among critically ill COVID-19 patients. Further, decreased deformability of red blood cells (RBC) may be contributing to inflammatory conditions and hypoxia in COVID-19 patients. Haptoglobin, hemopexin, heme oxygenase-1 and acetaminophen may be used to maintain the integrity of the RBC membrane.

Mean Platelet Volume in Type 2 Diabetes Male

The patient with diabetes mellitus and its complication is increasing in our country and all over the world. Altered platelet morphology and function have been reported in patient with DM. Mean platelet volume has been suggested as a newly emerging and independent risk marker for atherothrombosis and cardiovascular disease. The present study was carried out to assess the mean platelet volume in subjects with type 2 diabetes mellitus. The present study was a cross sectional analytic study and conducted in the Department of Physiology, Dhaka Medical College, Dhaka, Bangladesh from July 2013 to June 2014. A total number of 200 adult male subjects were selected with age ranging from 40 to 60 years. Among them, 100 subjects with type 2 diabetes mellitus were included in the case (Group B) and 100 healthy subjects with same age range were considered as control (Group A) for comparison. The subjects were selected from BIRDEM hospital Dhaka and personal contact from different areas of Dhaka city on the basis of exclusion and inclusion criteria. The study parameter was mean platelet volume and was measured in the Department of Hematology of BIRDEM hospital, Dhaka. The data were collected and recorded in pre-designed structured questionnaire by the researcher herself. For statistical analyses unpaired Student's 't' test was performed as applicable using SPSS for windows version 19. In this study, mean platelet volume was significantly (p<0.001) higher in the case group than that of control group. Therefore, estimation of mean platelet volume might be beneficial for prediction of future cardiovascular risk in adult diabetic male.

AB1345-HPR THE MULTIDISCIPLINARY FOOT CLINIC: A SERVICE EVALUATION PROJECT

Background:

Patients with rheumatological foot disease are an overlooked population, and it was noted locally that these patients received a fragmented service; attending multiple appointments for the management of one clinical issue. This led to delays in treatment; significant inter-departmental correspondence and variations in the peri-operative management of disease modifying anti-rheumatic drug (DMARD) and biologic therapies. To remedy this a foot multidisciplinary (MDT) clinic was established, including input from rheumatology, orthopaedic surgery, specialist rheumatology podiatry and physiotherapy. The outcomes from the foot MDT clinic have been analysed in this service evaluation project.

Objectives:

To evaluate the outcomes of the multidisciplinary foot MDT clinic, with particular reference to concordance to the British Rheumatology Society (BSR) guidelines on peri-operative medicine guidelines.

Methods:

Data was collected retrospectively across all clinics from January 2017 to February 2019. Clinic letters were obtained, and data was collected using a standardised data collection sheet. Data was collected on patient demographics, rheumatological diagnoses, treatment outcomes from the foot MDT, appropriateness of peri-operative plan and post-operative complications. No data was available on these outcomes prior to the advent of the foot MDT clinic.

Results:

Data from 12 clinics was analysed (n=40). Patients had a median age of 66 years (IQR 27.5 years); 65% of patients were female and 35% of patients were male. The commonest rheumatological foot disease seen was rheumatoid arthritis (67%), followed by psoriatic arthritis (15%). All patients were treated with biologic or non-biologic DMARDs. Treatment outcomes were as follows: 27.5% were offered surgical treatment; 10% were offered intra-articular (IA) injections under ultrasound guidance; 10% were offered IA injections under general anaesthetic; 25% underwent specialist rheumatology podiatry, and the remaining 30% elected for a conservative approach after careful consideration of treatment options. Of those who were offered surgical treatment, 72% of patients were provided with a peri-operative plan which accorded with British Rheumatology Society (BSR) guidelines. Of those whom underwent surgery, one patient’s surgical treatment was complicated by a post-operative infection; however, the peri-operative DMARD/biologic plan was not felt to be contributing factor.

Conclusion:

The foot MDT clinic provides a comprehensive review of rheumatological foot conditions, with readily available access to a full range of treatment options. Co-location of all relevant professionals allows for real-time interdepartmental communication; shared decision making between clinicians and patients; avoids multiple appointments; reduces uncertainty with peri-operative planning as well as providing a cost-effective and efficacious service. Discrepancies in the peri-operative plan for medicines arose when the treating orthopaedic surgeon was not present in clinic. In these cases, the plan for surgical treatment was made outside of this clinic, without input from the treating rheumatologist. To improve concordance with BSR peri-operative medicine guidelines, it is recommended that all treatment decisions are made during the clinic, allowing input from all relevant partners. Informal feedback from patients commended the foot MDT, this shall be formalised through further qualitative data.

Disclosure of Interests:

None declared

OP0094 EULAR-ACR 2019 CLASSIFICATION CRITERIA FOR SLE: CAN WE CLASSIFY USING LABORATORY TESTS ALONE?

Background:

The EULAR-ACR 2019 (EULAR19) classification criteria for systemic lupus erythematosus (SLE) were developed to improve the sensitivity and specificity of previous criteria. Notably, both the EULAR19 and existing SLICC-SLE 2012 (SLICC12) criteria can classify patients as having SLE by the presence of immunology and haematological abnormalities in the absence of any signs or symptoms.

Objectives:

To validate the EULAR19 criteria, with comparison to existing criteria, in a large cohort of patients with an established systemic autoimmune rheumatic disease (SARD).

Methods:

We recruited 227 adult patients who were ANA positive with ≥1 clinical feature suggestive of a SARD, from three hospitals in the North West of England. Clinician diagnosis was used as gold standard; we then applied the EULAR19, SLICC12 and the ACR-SLE 1997 (ACR97) criteria.

Results:

Of the 227 patients recruited, by clinician diagnosis, 89 patients (36%) had SLE, 43 (17%) primary Sjögren’s (pSS), 62 (25%) undifferentiated CTD (UCTD), 25 (10%) systemic sclerosis (SSc) and 8 (3%) an inflammatory myositis. The characteristics of these patients and the breakdown of the EULAR19 criteria are outlined in figure 1.

Figure 1.

Baseline characteristics and classification criteria compared across five SARD diagnoses.

The sensitivity and specificity of the EULAR19 is similar to ACR97 (sensitivity 84% (95% CI 75-91%) vs. 87% (95% CI 78-93%) and specificity 78% (95% CI 70-84%) vs. 76% (95% CI 68-83%) respectively). The SLICC12 criteria by contrast are more sensitive (94% (95% CI 87-98%)) and less specific (61% (95% CI 52-69%)) in this cohort.

Figure 2 illustrates patients with a clinician diagnosis of SLE or UCTD who meet each of the classification criteria. Of the 89 patients with a clinician diagnosis of SLE, 39 (44%) patients would have sufficient points to meet EULAR19 criteria on blood test results alone in the absence of clinical symptoms. Four pSS patients and 4 UCTD patients would also meet EULAR19 criteria from positive blood results alone.

Figure 2.

Venn diagrams illustrating patients with SLE and UCTD who meet the EULAR19, ACR97 and SLICC12 classification criteria. No criteria refers to the patients not meeting any of the three SLE classification criteria.

Conclusion:

These results suggest that the EULAR19 criteria perform comparably to the ACR97 criteria when applied to an established cohort of SARDs. Similar to SLICC12, it is possible to classify patients as having SLE using the EULAR19 criteria by haematological and other laboratory tests. To what extent haematological abnormalities can be potentially used as the sole ‘clinical criteria’ needs consideration.

SLE n=89pSS n=43UCTD n=62SSc n=25Myositis n=8Female N (%)82 (92)42 (98)53 (85)24 (96)8 (100)Age, mean (SD) /years44 (13)52 (12)47 (13)60 (9)53 (7)Disease duration, mean (SD) /years12 (10)6 (5)5 (7)9 (11)3 (3)SLE classification criteriaEULAR SLE 2019, N (%)75 (84)10 (23)20 (32)1 (4)0ACR SLE 1997, N (%)77 (87)9 (21)21 (34)2 (8)1 (13)SLICC SLE 2012, N (%)84 (94)15 (35)33 (53)4 (16)2 (25)EULAR-ACR 2019 criteriaConstitutional, N (%)10 (11)2 (5)1 (2)01 (13)Neuropsychiatric, N (%)3 (3)01 (2)1 (4)0Mucocutaneous, N (%)71 (80)13 (30)27 (44)2 (8)2 (25)Serosal, N (%)13 (15)1 (2)2 (3)00Musculoskeletal, N (%)52 (58)14 (33)22 (35)3 (12)3 (38)Renal, N (%)30 (34)001 (4)0Haematological, N (%)44 (49)12 (28)10 (16)3 (12)0Antiphospholipid antibodies, N (%)43 (48)7 (16)17 (27)4 (16)0Low complement, N (%)48 (54)10 (23)10 (16)3 (12)1 (13)Anti-Sm, N (%)19 (21)2 (5)4 (6)1 (4)0Anti-dsDNA, N (%)50 (56)8 (19)12 (19)01 (13)

Disclosure of Interests:

Sarah Dyball: None declared, John Reynolds: None declared, Eoghan McCarthy: None declared, Sahena Haque: None declared, Ariane Herrick: None declared, Hector Chinoy: None declared, Ellen Bruce: None declared, Ben Parker Grant/research support from: GSK and Sanofi Genzyme, Consultant of: GSK, AstraZenaca, UCV, Abbvie, Pfizer, BMS, Celltrion, Ian N. Bruce Grant/research support from: Genzyme Sanofi, GSK, and UCB, Consultant of: Eli Lilly, AstraZeneca, UCB, Iltoo, and Merck Serono, Speakers bureau: UCB

Cubic crystals in an x-ray polarization-splitting geometry

Hexagonal and cubic crystals contain paired sets of internal planes that reflect the linearly polarized components of certain x rays into two separate, perpendicular directions. For the cubic crystals, two distinct crystal orientations provide the same polarization-splitting geometry. One of the orientations may have advantages for plasma spectroscopy by suppressing unwanted reflections. This paper demonstrates the two orientations with a germanium crystal and K characteristic lines from copper and zirconium.

Comparison of High Density Lipoprotein Cholesterol Level in Second and Third Trimester of Pregnancy in Mymensingh, Bangladesh

Pregnancy is accompanied by changes in the maternal lipoprotein metabolism that may serve to satisfy the nutritional demands of the fetus in addition to the energy requirements of the mother. Early pregnancy is considered the anabolic phase, characterized by increased hepatic production of triglycerides and enhanced removal of triglycerides from the circulation, resulting in an increased deposition of fat in maternal adipose tissue. Late pregnancy is referred to as the catabolic phase, the release of free fatty acids from adipocytes is enhanced due to both relative insulin resistance and stimulation of hormones. Although it is known that cholesterol rises in pregnancy, at present it is not routinely measured or treated. However, a growing body of evidence from animal and human studies suggests adverse consequences of high cholesterol levels in pregnancy. High lipid profile, a major factor behind atherosclerosis may leads to unconsciousness. To avoid such problems during pregnancy this longitudinal study was carried out in the department of Biochemistry, Mymensingh Medical College in co-operation with the Department of Obstetrics and Gynecology, Mymensingh Medical College Hospital and Community Based Medical College Hospital, Bangladesh from July 2011 to December 2012 to compare the changes in high density lipoprotein cholesterol level during 2nd and 3rd trimester of pregnancy. A total of one hundred subjects were participated in this study comprising of second and third trimester of pregnancy. All subjects were made to fast overnight at least for a minimum of 8 hours. Blood samples were taken and analyzed by enzymatic colorimetric kit method. Pregnancy has been found to be associated with changes in lipid profile and this differs with each trimester. The average results were analyzed with respect to each pregnancy for the whole group. The study proves that serum High Density Lipoprotein (HDL) cholesterol increases in second trimester (48.71±7.61mg/dl) than third trimester (47.01±7.45mg/dl) of Pregnancy. So, Lipid profile estimation and monitoring should be made as a part of routine investigation during antenatal period.

Periodic Assessment of Peri-implant Tissue Changes: Imperative for Implant Success

AIM

The aim of this study was to evaluate the changes in the peri-implant hard and soft tissues and implant stability and to assess the correlation of bone loss and peri-implant probing depth with implant stability.

MATERIALS AND METHODS

Twenty-one patients with implants were included in this study and implants were assessed by resonance frequency analysis (RFA). Bone levels of the implants were assessed by measuring mesial and distal bone levels from the periapical radiograph, and soft tissue was assessed from probing depth using a periodontal probe. Implants were assessed for stability and probing depth at pre-loading, at 3 months and 6 months post-loading. RFA and probing depth were statistically compared from different time points. Correlation of probing depth and marginal bone loss with implant stability was also determined.

RESULTS

The average change in implant stability quotient (ISQ) measurements from pre-loading to 6 months post-loading was found to be statistically significant (p <0.005). The average probing depth reduced from 1.767 mm at pre-loading to 1.671 mm at post-loading 3 months, and 1.600 mm at post-loading 6 months. At 6 months of function, radiographic examination yielded 0.786 mm mesial bone loss and 0.8 mm distal bone loss. It was found to be statistically significant (p <0.005) but within an acceptable range. No significant correlation was found between implant stability and bone loss; and implant stability and probing depth.

CONCLUSION

The study revealed an increasing trend in implant stability values with the time that indicates successful osseointegration. Increasing mean values for mesial and distal bone loss were also found.

CLINICAL SIGNIFICANCE

The success of dental implants is highly dependent on the quality of bone and implant-bone interface, i.e., osseointegration. The most important factors that influence the survival rate of an implant is initial stability. The present study found the changes in the peri-implant hard and soft tissues and implant stability. This article, while being a prospective study, may show the evidence of successful osseointegration by increasing trend in implant stability (RFA) values with time which can help to the clinician in the long-term management of implants.

Treatment of Angle class I malocclusion with severe crowding by extraction of four premolars: A case report

Aims: To correct the Angle class I malocclusion with crowding via four premolar extractions.Presentation of case:A 19-year-old Malaysian female presented with the bimaxillary protrusion, crowding, high canines, midline deviation and edge-to-edge anterior bite. Upper lateral incisors were palatalized and in crossbite interactions with the opposite teeth.Discussion: Treatment was initiated using fixed orthodontic appliances followed by four 1st premolar extractions in both arches. Case was finished with good inter cuspation of the upper and lower teeth. Molars were finished in a Class I relationship with canine guidance, and ideal overjet and overbite were obtained.Conclusion: Successful finishing of a case with beautiful smile, obtained proper overjet and overbite, corrected cross bite, midline shifting and the improved soft tissue profile.Bangladesh Journal of Medical Science Vol.17(4) 2018 p.683-687

Outcome of Surgery in Chronic Inactive Mucosal Otitis Media

Chronic otitis media is a common condition seen in patients attending the otorhinolaryngology Department. The discharging ear presents the otologists with the dilemma of operating on it or not. The aim of the this cross-sectional observational study was to find out the outcome of surgery in chronic inactive mucosal otitis media and was conducted on 62 patients of either sex in the age group of 15-60 years in the Department of ENT and Head Neck surgery, Shaheed Suhrawardy Medical College Hospital (ShSMCH), Dhaka, Bangladesh From July 2015 to January 2016. Pre and post operative hearing assessment was done with pure tone audiometry (PTA). Post operative graft status also noted. All the information's were recorded in the fixed protocol. Collected data were classified, edited, coded and entered into the computer for statistical analysis by using updated computerized program SPSS-19. Among 62 cases the mean age were 36.79±10.33 in chronic inactive mucosal otitis media. Majority of the study population were in age group of between 15-25 in this group of which was 16(51.6%). Male were 36(58.06) and 26(41.94) were female. All patients presented with history of otorrhoea in this group, 52(83.87%) had hearing impairment in chronic inactive mucosal otitis media, 30(48.39%) involved in right ear and 26(41.94%) involved in left ear and 06(9.68%) in both ear in chronic inactive mucosal otitis media. Majority of perforation were medium in size in this group of which was 30(48.39%). anterior perforation was 24(38.71%), posterior perforation 28(45.16%) and subtotal 10(16.13%) in chronic inactive mucosal otitis media. Sixty two (100%) cases underwent myringoplasty. Post-auricular approach used in most of operation in this group of which was 60(96.77%). Preoperative air conduction threshold 32(51.61%) were in between 31-45 dB in myringoplasty group (p<0.05) that was statistically significant. Postoperative air conduction threshold 30(48.39%) were between 16-30 dB in myringoplasty group (p<0.05) that was statistically significant. Difference between preoperative and postoperative air conduction threshold mean difference was 11.38 dB and 36.75±5.84 and 25.37±7.46 respectively (p<0.001) in myringoplasty group. Hearing gain was 42(67.74%) in myringoplasty (p>0.05) that was not statistically significant. Graft uptake in myringoplasty was 52(83.9%). Graft failure in myringoplasty was 10(16.1%). post operative complication was tinnitus in 12(19.35%) cases in myringoplasty. Success rate was more in case of posterior perforation than anterior and subtotal perforation in both chronic inactive mucosal otitis media which was 92.86%. Success rate was more in case of medium size perforation than subtotal perforation in chronic inactive mucosal otitis media which was 86.67%. Success rate was (100%) in small perforation in this group. From this study it can be concluded that myringoplasty is a valid treatment modality for chronic inactive mucosal otitis media to achieve an intact tympanic membrane and to gain hearing.

A perceptual evaluation of speech disorders in children with repaired unilateral cleft lip and palate in Hospital UniversitiSains Malaysia

Aims and objective: The purpose of this cross sectional study was to determine the types and severity of speech disorders in children with repaired unilateral cleft lip and palate (UCLP) in Hospital Universiti Sains Malaysia (Hospital USM) and describe the inter- and intra-judge reliability of perceptual evaluation of speech disorders using GOS.SP.PASS’98 and five-point rating scale. Four children with repaired UCLP with ages ranging from 8 years old to 12 years old were included in this study. Prior to data collection, participants were contacted through telephone call from the list of patients with UCLP obtained Combined Cleft and Craniofacial Deformity Clinic (Combined clinic) in Hospital USM, Kelantan from year 2013-2015 as well as from clinical records from the database of the Record Unit of Hospital USM from year 2003-2015. Following strict inclusion criteria participant has been selected. After that, history taking was first conducted with the participant’s parents, followed by collection of participant’s speech sample and finally concluded with oral motor examination.Results: Fifty percent of the speeh samples obtained from data collection were then duplicated for use in inter-rater and intra-rater reliability investigations. Exact agreement and kappa values were used for reliability measures. Seventy-five percent (3/4) participants exhibited speech disorders and 25% (1/4) participant had no evidence of speech disorder. The type of speech errors that occurred the most in the three participants were glottal articulations (39%), while the least speech errors includedlateralizations/lateral articulations (2%), backing to velar (1%), pharyngeal articulations (1%,) active nasal fricatives (1%) as well as nasal realizations of fricatives (1%). The severity of speech disorder ranged from some occurrences to occurring always or almost alwaysin the participants. Inter-judge reliability showed poor to slight agreement while intra-judge reliability revealed almost perfect agreement.Conclusion: The results obtained from this study were more or less similar to other studies conducted on the speech outcome of individuals with repaired UCLP.It is important that referrals be made to speech-language pathologists (SLPs) to evaluate the individuals’ speech outcomes even though surgical intervention has been provided to them to ensure a comprehensive management for the individual.Bangladesh Journal of Medical Science Vol.17(3) 2018 p.470-478

A phase II study of temsirolimus added to low-dose weekly carboplatin and paclitaxel for patients with recurrent and/or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC)

Background

Activating events along the PI3K/mTOR pathway are common in head and neck squamous cell carcinomas (HNSCC), and preclinical studies suggest additive or synergistic effects when combining mTORC1 inhibitors with carboplatin and paclitaxel chemotherapy.

Patients and methods

In this single-institution phase II study, the combination of temsirolimus 25 mg, carboplatin AUC 1.5, and paclitaxel 80 mg/m2 administered on days 1 and 8 of a 21-day cycle was evaluated in 36 patients with recurrent and/or metastatic (R/M) HNSCC. The primary end point was objective response rate after two cycles of treatment. Secondary end points include the safety and tolerability profile and overall survival. Correlative studies with exome mutational analysis were performed in pre-treatment biopsy samples from 21 patients.

Results

Fifteen (41.7%) patients had an objective response, which were all partial responses, and 19 (52.3%) patients had stable disease as best response. The two patients who were designated as 'non-responders' were removed from study prior to two cycles of treatment, but are included in the efficacy and safety analyses. The median duration on study was 5.3 months and the median progression-free survival and overall survival were 5.9 months (95% confidence interval, 4.8-7.1) and 12.8 months (95% confidence interval, 9.8-15.8), respectively. The most common grade 3 and 4 adverse events were hematologic toxicities. Three (3.8%) patients developed neutropenic fever on study. Three of four patients with PIK3CA mutations experienced tumor regressions, and responses were also seen in patients with other genetic alterations in the PI3K/mTOR pathway.

Conclusion

The combination of temsirolimus with low-dose weekly carboplatin and paclitaxel appears to have meaningful clinical efficacy in the treatment of R/M HNSCC. This regimen has a relatively high response rate compared to other treatments evaluated in R/M HNSCC, and potential associations with genetic alterations in the PI3K/mTOR pathway should be further explored.

A perceptual evaluation of resonance disorders in children with repaired unilateral cleft lip and palate in Hospital UniversitiSains Malaysia

Background: In most literature regarding speech outcomes in children with repaired cleft lip and palate (CLP), exhibited resonance disorders despite having surgical repair. However, the types and severity of the resonance disorders vary from one individual to another. Thus, perceptual evaluation is important to determine the speech outcomes in individuals with repaired cleft lip and palate.Aim: The aim of this cross sectional study was to determine the types and severity of resonance disorders of children with repaired unilateral cleft lip and palate (UCLP) and describe the inter- and intra-rater reliability of perceptual evaluation of resonance disorders using GOS. SP.PASS’98. Four children with repaired UCLP in Hospital USM with ages ranging from 8 years old to 12 years old was included in this study. During data collection, history taking was first conducted, then participants’ speech sample was collected and lastly oral motor examination was conducted.Results: 50% of the speech sample was then duplicated for inter- and intraexaminer reliability investigations. Exact agreement and kappa values were used for reliability measures. Seventy five percent (75%) (3/4) participants exhibited hypernasality as the type of resonance disorder and 25% (1/4) participant had no evidence of hypernasality or any other types of resonance disorder. No other types of resonance disorders such as hyponasality, mixed resonance or cul-de-saq was noted in the participants. The severity of hypernasality ranged from mild to severe in the participants. Inter-rater reliability showed fair to almost perfect agreement and intra-rater reliability revealed almost perfect agreement.Conclusion: The results obtained from this study was more or less similar to our other studies conducted on the speech outcome of individuals with repaired UCLP. Although surgical intervention has been provided to these individuals, it is important that referrals be made to SLPs to evaluate their speech outcomes. This is to determine a proper management for the individual.Bangladesh Journal of Medical Science Vol.17(2) 2018 p.282-289

Treatment Outcome of Bangladeshi UCLP Patients Based on Both Phenotype and Postnatal Treatment Factors using Modified Huddart Bodenham (mHB) Index

OBJECTIVE

To evaluate the dental arch relationship (DAR) of nonsyndromic unilateral cleft lip and palate (UCLP) and to explore the various phenotype and postnatal treatment factors that are responsible for poor DAR.

DESIGN

Retrospective study.

SETTING

School of Dental Science, Universiti Sains Malaysia.

SUBJECTS

Eighty-four Bangladeshi children with nonsyndromic UCLP who received cheiloplasty and palatoplasty.

MAIN OUTCOME MEASURES

Dental models were taken at 5 to 12 years of age (man: 7.69), and dental arch relationships were assessed using modified Huddart/Bodenham index (mHB) by two raters. Kappa statistics was used to evaluate the intra- and interexaminer agreements, chi-square was used to assess the associations, and logistic regression analysis was used to explore the responsible factors that affect DAR.

RESULTS

The total mHB score (mean [SD]) was -8.261 (7.115). Intra- and interagreement was very good. Using crude and stepwise backward regression analysis, significant association was found between positive history of class III (P = .025, P = .030, respectively) and unfavorable DAR. Complete UCLP (P = .003) was also significantly correlated with unfavorable DAR.

CONCLUSION

This multivariate study suggested complete type of UCLP and positive history of class III had a significantly unfavorable effect on the DAR.

Spatially resolved single crystal x-ray spectropolarimetry of wire array z-pinch plasmas

A recently developed single-crystal x-ray spectropolarimeter has been used to record paired sets of polarization-dependent and axially resolved x-ray spectra emitted by wire array z-pinches. In this measurement, two internal planes inside a suitable crystal diffract the x-rays into two perpendicular directions that are normal to each other, thereby separating incident x-rays into their linearly polarized components. This paper gives considerations for fielding the instrument on extended sources. Results from extended sources are difficult to interpret because generally the incident x-rays are not separated properly by the crystal. This difficulty is mitigated by using a series of collimating slits to select incident x-rays that propagate in a plane of symmetry between the polarization-splitting planes. The resulting instrument and some of the spatially resolved polarized x-ray spectra recorded for a 1-MA aluminum wire array z-pinch at the Nevada Terawatt Facility at the University of Nevada, Reno will be presented.

Challenges in culture-negative cases of Madurella mycetomatis: A case report re-accentuating PCR as an essential diagnostic tool

Identification of dematiaceous fungi responsible for black-grain mycetoma has remained cumbersome and time consuming for years leading to delayed diagnosis and thereby increased agony to patients. Moreover, difficult morphology of some of these fungi demanding enough expertise for species identification in addition to culture-negativity has often led to misdiagnosis and hence inapt treatment to the patients. We report the identification of Madurella mycetomatis from culture-negative black granules discharged from foot nodular lesions of a 27 years old male using PCR followed by sequencing of the internal transcribed spacer region. The patient's lesions were successfully treated using a combination of itraconazole (200mg) and terbinafine (250mg), confirming our diagnosis. Our case study proves the clinical value of PCR as the best, rapid and accurate diagnostic method for the identification of Madurella mycetomatis and related fungi, particularly in culture-negative cases.

The 67P/Churyumov-Gerasimenko observation campaign in support of the Rosetta mission

We present a summary of the campaign of remote observations that supported the European Space Agency's Rosetta mission. Telescopes across the globe (and in space) followed comet 67P/Churyumov-Gerasimenko from before Rosetta's arrival until nearly the end of the mission in September 2016. These provided essential data for mission planning, large-scale context information for the coma and tails beyond the spacecraft and a way to directly compare 67P with other comets. The observations revealed 67P to be a relatively 'well-behaved' comet, typical of Jupiter family comets and with activity patterns that repeat from orbit to orbit. Comparison between this large collection of telescopic observations and the in situ results from Rosetta will allow us to better understand comet coma chemistry and structure. This work is just beginning as the mission ends-in this paper, we present a summary of the ground-based observations and early results, and point to many questions that will be addressed in future studies.This article is part of the themed issue 'Cometary science after Rosetta'.