Adequate Response Research Articles

Rabies post-exposure prophylaxis: a retrospective analysis of timing of initiation and antibody responses in a Belgian cohort.

BackgroundWe aimed to determine the timeliness of rabies post-exposure prophylaxis (PEP) and the proportion of individuals with an adequate antibody response post-PEP among those attending the Belgian national reference center. MethodsRetrospective analysis of patient records who attended our center from 2018-2023. Delay was defined as rabies immunoglobulin (RIG) and vaccine initiation beyond 2 calendar days after exposure. Antibodies were measured by rapid fluorescent focus inhibition test (RFFIT) after PEP in high-risk exposures. A titer ≥0.5 IU/ml was considered adequate. ResultsWe reviewed 317 patient records. Among individuals with inland exposure (n=103), 85% timely received PEP. Among travelers exposed abroad (n=214), administration of RIG and vaccine initiation were timely in 30% and 50% of cases, respectively. An adequate antibody response was detected in 99.5% (195/196) individuals. ConclusionSubstantial PEP delays among travelers were observed. The robust antibody responses suggest that routine serological follow-up is not necessary for all patients.

Determinants in disaster preparedness of nurses in the Azores

Abstract Background Disasters are situations of complexity and unpredictability, increasingly frequent and more destructive. They require rapid and effective action from different teams from different contexts, with preparation and qualifications for an adequate response to victims, recovering the environment, and restoring living conditions, and nurses play a significant role in these events. Understanding the level of preparedness of nurses for disasters is fundamental for defining the competency framework in the disaster management cycle. Objectives To analyze the preparation of nurses in the Azores for a catastrophe. Methods A cross-sectional study was performed with 160 nurses from the Azores. The questionnaire validated for the Portuguese population “Disaster Preparedness Evaluation Tool (DPET ®): Preparation of nurses in the face of a catastrophe” was applied. It was approved by the Ethics Committee. Results More than half of respondents (n = 137, 71%) indicated that they were not fully prepared to respond to disasters, while 29% (n = 46) acknowledged that they felt adequately prepared. Of the 160 respondents, only 20% (n = 30) participated in the development of emergency plans and only 14% (n = 22) participated in the creation of emergency plans that contribute to improvements at the local level. Training through simulation training was cited as important in disaster preparedness (n = 129, 78%). Discussion The present study identified little involvement of RAA nurses in preparing emergency plans and less than half feel poorly prepared in responding to a catastrophe. This finding is consistent with studies by Baker, Alamri, & Aboshaiqah (2019) and Emaliyawati et al. (2021). Conclusions This study was conducted in a region prone to natural disasters. It is vital to invest in the training of these professionals throughout the disaster cycle so that they can contribute to reducing the impact that the catastrophe will have on the individual/family and community. Key messages • Strengthening capabilities through regular disaster training based on effective information. • Low participation in the development of emergency plans that contribute to improvements at the local level.

A scenario study on disaster preparedness behaviours

Abstract Europe has faced several crises over recent years, including the COVID-19 pandemic and the war in Ukraine. Additionally, the climate crisis has led to an increase in the occurrence of extreme weather events and natural disasters. Getting citizens on board when it comes to being prepared for the changing risk landscape in the EU is essential in building societal resilience. The importance of the population’s preparedness to deal with disasters has also been underlined by the Commission’s identification of the Union Disaster Resilience Goals (2023/C 56/01). One of these goals focuses on increasing risk awareness and the adoption of risk prevention and preparedness measures among the population. Research has shown that simply advising people of potential risks in their region is not necessarily sufficient to motivate them to prepare. Yet, preparation is key to an adequate responses in emergency situations and improving preparedness may thus be a powerful tool to support the population’s ability to respond in times of crisis. The EC JRC’s Competence Centre on Behavioural Insights will present a study conducted in five member states (N = ∼1000 per country), which investigates the effect of envisioning a disaster situation, and therefore explicitly eliciting personal affectedness, on individuals’ self-reported preparedness intentions and preparedness behaviours. The study uses multiple measures for intentions and preparedness behaviours, including click-through to external information and an incentivised preparedness game.

A UTILIZAÇÃO DE BIOMATERIAIS EM PROCEDIMENTOS CIRÚRGICOS ODONTOLÓGICOS

Sustainable practices are necessary in all areas, and in dentistry, this need is becoming increasingly present. Thus, new materials and materials become important in this process. Among these materials, biomaterials stand out. Biomaterials are natural or synthetic materials used in contact with biological systems whose purpose is to repair or replace tissues, organs or functions of the organism, with the aim of maintaining or improving the patient's quality of life. This literature review aims to examine and demonstrate the application of biomaterials, highlighting them as a viable option in dentistry. Currently, in dentistry, three categories of biomaterials stand out: metals, polymers and ceramics, with the use of Nile tilapia skin in dentistry being considered an innovation. Biomaterials must present physical and biological properties compatible with the host's biological tissues, in order to stimulate an adequate response from them. As demonstrated, the use of biomaterials in surgical procedures becomes necessary. Biomaterials, their use and innovations, as highlighted throughout this literature review, emerge as a fundamental tool in promoting quality, efficiency and sustainability in oral health services.

Psychopathological Profile of Patients with Moderate-to-Severe Plaque Psoriasis and Its Correlation to DLQI: Results from a Prospective, Monocentric Clinical Study

Background: Psoriasis is associated with a high psychological burden and comorbidities, such as depression and anxiety. The aim of this study was to evaluate the psychopathological profile of patients with moderate-to-severe plaque psoriasis under systemic treatment and to explore the association between DLQI and alexithymia, depression, and other psychopathological disorders. Methods: In this monocentric, prospective clinical study, 104 adult patients with moderate-to-severe plaque psoriasis were evaluated according to the disease severity (measured by PASI) influence of psoriasis on their quality of life (measured by DLQI) and their psychopathological profile (measured by the BDI, TAS-20, and SCL-90 questionnaires). Results: The psoriasis patients exhibited high levels of psychopathological symptoms, particularly for depression, obsessive-compulsive behavior, somatization, interpersonal sensitivity, and anxiety. More than half of the psoriatic patients (56.7%) were diagnosed with minimal depression, 26.9% with mild depression, and 16.3% with moderate or severe depression. The symptoms of possible and confirmed alexithymia were present in 19.2% and 15.4% of the patients, respectively. The patients with alexithymia appeared to experience a more significant impact on their QoL. Specifically, the percentage of patients with alexithymia/possible alexithymia who had a DLQI of ≥2 was 77.8% vs. 51.5% in those without alexithymia. Conclusions: Our study illuminates the intricate connection between the disease severity and psychological components that impact the QoL of patients with moderate-to-severe plaque psoriasis. It is advised that clinicians adopt a comprehensive approach to managing psoriasis, which involves addressing both the physical symptoms of the condition and the psychological impact. In cases of patients with a DLQI of ≥2, despite adequate clinical responses, evaluating the possible coexistence of general psychopathology is recommended.

Novel Cancer Therapeutics: Perioperative Implications and Challenges.

Since the introduction of immunotherapy and targeted therapies, patients not only have adequate tumoral response to these treatments, but their quality of life has improved due to milder toxicities. However, due to their wide mechanisms of action, the toxicity profile for these therapies is broad, can have an insidious onset, and their recognition can be challenging. Rarely, some of these toxicities can cause significant morbidity if not diagnosed early and lead to intensive care unit (ICU) admission and death. Anesthesiologists are likely to encounter not only a wide spectrum of these toxicities but also a wide range of severity. In some cases, they could be the first to make the diagnosis and therefore need to be prepared to rapidly assess, establish differentials, perform a diagnostic workup, and evaluate the impact the toxicity could have on the patients' care during the perioperative period. In this article, we set to review toxicities of novel cancer therapies such as checkpoint inhibitors and targeted therapies, that could present in the perioperative setting. This article will help as a guide for anesthesiologists to recognize their clinical presentation, the approach to their diagnosis, and their impact on patient care.

Transient Analysis of Flow Unsteadiness And Machine Instabilities In a Centrifugal Compressor at Surge and Second Quadrant Operation

Abstract Instabilities in turbomachinery operation originate from intrinsic flow unsteadiness, sudden variations of operating conditions, and interactions with the surrounding system, affecting both system stability and machine reliability. The flow unsteadiness, presenting a characteristic behaviour, requires a deep understanding of the underlying flow fundamentals, a careful analysis using advanced experimental methods and a clear distinction on how the system might lead to instabilities. The identified approach addresses deep surge and second quadrant characterization. The analysis presented here benefits from the responsiveness and flexibility of the experimental test rig, fine tuning of the system layout, the instrumentation installation, and the transient tests procedure. The main focus area is the time-frequency analysis of flow and pressure signals at transients, thus providing a proper reconstruction of flow mechanisms and instability evolution. Valuable techniques include: short-time fast Fourier transform, wavelet analysis, and Wigner-Ville distribution; coherence between flow and pressure, to trace waves propagation, is considered too. These, presented outlining their strengths and weaknesses, are evaluated considering real time field applicability with regards to computational resources too. The experimental campaigns and data processing are presented, with a test matrix covering a wide range of parameters, including system layout and surge volume size, rotational speeds, flow rates ranging from nominal point to full second quadrant operation. These data are vital for system modeling validation for a full compressor-system digital twin. Results indicate the importance of ensuring reliable data acquisition and analysis, with adequate instrumentation range, accuracy, synchronization, responsiveness and positioning.

Influence of Tendering Process on Performance of County Governments in Kenya

Procurement is essential to every organization, serving as a platform for all stakeholders to come together and discuss their needs and goals related to purchasing. The study aimed to explore factors influencing the tendering processes of County Governments in Kenya, focusing specifically on Siaya County Government. The study was guided by three objectives, to examine supplier selection criteria on performance of county Governments in Kenya, to establish the influence of Ethical Practices in Tendering processes on performance of county Governments in Kenya, to investigate the influence of automation processes of Tendering processes on performance of county Governments in Kenya, and to establish moderating effect of government policy on Public procurement And Disposal Act on performance of County Governments in Kenya. The research utilized a Descriptive Research Design approach to gather pertinent information. The study involved Census Sampling in which all 74 participants from different management levels and ad hoc committee members within the department. Questionnaires were used as the main data collection instruments. Data was gathered through the distribution of questionnaires to the chosen participants by means of pick and drop. respondents of 66% were received and were completed accurately, demonstrating an adequate response rate. The statements of the problem mainly focused on major issues facing the tendering procedures and analyzes their influence on organizational performance. The study findings show that Supplier selection criteria Mean of 4.002 and standard Deviation of 0.1428 the highest score amongst the key performance indicators was quality with mean of 4.29 and standard deviation of 0.097 showing highly significant to supplier selection criteria. Ethical practices in Tendering Mean of 4.012 Standard deviation of 0.097, of highest score in key performance indicators was Integrity with mean of 4.468 and standard deviation of 0.097. its shows that highly significant to Ethical practices, Automation of Tendering mean of 4.093 standard deviation of 0.148 highest amongst the key performance indicators was E informing with mean 4.224 and standard deviation 0. 147 shows highly significant to Automation. Moderating variable Mean of 4.094 standard deviation of 0.136 highest score among st key performance indicators of quality 4.306 standard deviation of 0.114 shows highly significant to Moderating variable and all the variables were critical to the performance of County Governments in Kenya. The study recommends that there is need to enormously implement procurement policies which encourage tendering, in order to enhance performance

A new opportunity for N-acetylcysteine. An outline of its classic antioxidant effects and its pharmacological potential as an epigenetic modulator in liver diseases treatment.

Liver diseases represent a worldwide health problem accountable for two million deaths per year. Oxidative stress is critical for the development of these diseases. N-acetyl cysteine (NAC) is effective in preventing liver damage, both in experimental and clinical studies, and evidence has shown that the pharmacodynamic mechanisms of NAC are related to its antioxidant nature and ability to modulate key signaling pathways. Here, we provide a comprehensive description of the beneficial effects of NAC in the treatment of liver diseases, addressing the first evidence of its role as a scavenger and precursor of reduced glutathione, along with studies showing its immunomodulatory action, as well as the ability of NAC to modulate epigenetic hallmarks. We searched the PubMed database using the following keywords: oxidative stress, liver disease, epigenetics, antioxidants, NAC, and antioxidant therapies. There was no time limit to gather all available information on the subject. NAC has shown efficacy in treating liver damage, exerting mechanisms of action different from those of free radical scavengers. Like different antioxidant therapies, its effectiveness and safety are related to the administered dose; therefore, designing new pharmacological formulations for this drug is imperative to achieve an adequate response. Finally, there is still much to explore regarding its effect on epigenetic marker characteristics of liver damage, turning it into a drug with broad therapeutic potential. According to the literature reviewed, NAC could be an appropriate option in clinical studies related to hepatic injury and, in the future, a repurposing alternative for treating liver diseases.

Adaptive responses of heart rate regulation during functional tests with breath holding

BACKGROUND: Synchronization of biorhythms in living organisms is of particular interest to researchers from the standpoint of adaptation theory. AIM: To study the characteristics of the response of regulatory influences on heart rhythm during tests with voluntary breath holding during inhalation and exhalation. MATERIAL AND METHODS: The study sample included 21 randomly selected students (9 males, 12 females) aged 20.64±1.14 years with body weight 67.19±12.98 kg, height 172.29±7.63 cm. All subjects were divided into three groups (I, II, III) according to the classification by N.I. Shlyk (2009), which is based on the predominance of central or autonomic circuits of heart rhythm regulation. A fivefold sequential ECG recording was conducted using the hardware-software complex “Varicard 3.0” with the subject seated after a five-minute rest: 1 — baseline state; 2 — voluntary breath holding during inhalation; 3 — resting state; 4 — voluntary breath holding during exhalation; 5 — resting state. Using the “Varicard 3.0” system, a mathematical analysis of heart rhythm was performed, taking into account statistical parameters of heart rhythm and indices of spectral frequency analysis. RESULTS: During the period of breath holding, heart rate variability decreased, while at rest it increased in all groups. In group I, after a breath-hold test during the rest period, eutonia was observed according to spectral analysis (HF=LF). Statistical analysis in this group demonstrated an increase in the contribution of the parasympathetic component to heart rate variability (RMSSD, pNN50, SDNN, CV), signifying the prerequisites for increased heart rate variability. In group II, after breath-holding tests, a slight decrease in sympathetic activity was observed. A tense pattern of autonomic regulation was observed during the exhalation breath-hold test, which may indicate a reduced functional state of the regulatory systems. Group III was characterized by a sharp increase in sympathetic activation in the test with breath holding during inhalation, followed by a soft correction during breath holding during exhalation, which can be regarded as an adequate response of the body to the load. At rest, after the test, the regulation pattern returned to the original one with a moderate predominance of parasympathetic activity and, accordingly, a more favorable level of heart rate variability for the body. CONCLUSION: Adaptive reactions of the heart rate variability are manifested by an increase in sympathetic activation, which, subsequently, during normal breathing, is replaced by a compensatory activation of the parasympathetic division of the autonomous nervous system. Although reactions are unidirectional, the severity can vary across the groups.

Feasibility of neoadjuvant chemotherapy for bulky early stage to stage IIIB cervical cancer in Uganda

IntroductionExternal beam radiotherapy (EBRT) became unavailable in Uganda from February 2016 to November 2017. Following resource stratification guidelines, an alternative treatment strategy was developed. MethodsBulky early stage to Stage IIIB patients received at least 3 cycles of neoadjuvant chemotherapy (NAC). Surgery was performed if adequate response was achieved and adjuvant therapy given for high risk factors. Chemotherapy versus supportive care was advised in unresectable disease. NAC protocol completion was defined as receiving at least 3 cycles of NAC followed by either surgery, chemotherapy and/or radiation, or best supportive care. The purpose of this study was to determine the completion rate of NAC and assess the adverse events associated with treatment. Data were collected through retrospective chart review. ResultsFrom February 2016 to November 2018, 53 evaluable patients were identified. 86.8% (46/53) of patients presented in Stage IIB or higher. The completion rate of the NAC protocol was 75.5% (40/53). 94.3% (50/53) received platinum-taxane combination. 7.6% (4/52) grade 3 adverse events occurred related to chemotherapy, all hematologic. 18.8% (10/53) patients underwent surgery with 2 aborted cases due to metastatic or inoperable disease. No adverse events related to surgery were reported. 5 patients underwent adjuvant therapy after surgery due to high risk factors or incomplete pathology findings. 26 patients received adjuvant radiation (3 brachytherapy, 23 EBRT after it became available). Reported side effects related to radiation included vaginal fibrosis and skin reactions. ConclusionIn this limited-resource setting, majority of patients completed a NAC treatment strategy for cervical cancer with acceptable toxicities.

COVID-19 Vaccine-induced antibody response to BNT162b2 mRNA in frontline healthcare workers

The emergence of SARS-CoV-2, the virus causing COVID-19, has resulted in a pandemic that has disrupted all sectors of society. Less than a year after the sequencing of the virus’s genome, emergency use authorization for the BNT162b2 vaccine was requested. The aim of this study was to evaluate the response to the BNT162b2-mRNA COVID-19 vaccine in frontline workers from two hospitals in Colombia. Nasopharyngeal swabs were collected for the molecular detection of SARS-CoV-2 using real-time PCR, and blood samples were taken to assess seroconversion using qualitative and quantitative IgA, IgG, and IgM test kits. The study was conducted at a high-complexity healthcare institution in Bucaramanga, Colombia. 245 people were included in the first round and 129 in the second. SARS-CoV-2 molecular tests were conducted by RT-qPCR, and peripheral blood samples were collected to measure IgG, IgM, and IgA. The main outcome was to establish natural infection and the antibody response induced by the vaccine. The entire population was tested at two fixed times with RT-PCR tests and antibody level measurements approximately 4 and 8 months after receiving the second vaccine dose. 62 (25.3%) and 35 (14.3%) participants had a history of positive PCR in the first and second rounds, respectively. All positive cases showed elevated levels of all immunoglobulins, especially IgG. The average concentrations of IgA, IgM, and IgG at 90 days were 1149.5 U/mL (95% CI 828.2-1470.9); 320.3 U/mL (95% CI 218.4-422.3); and 9277.3 U/mL (95% CI 8989.2-9565.3). Frontline healthcare workers showed an adequate response to the BNT162b2 mRNA vaccine.

New Safety Feedback Control Design to Guarantee Adequate Frequency Performance in Microgrids

ABSTRACTSafety analysis of power systems is concerned with the system's ability to maintain critical variables within specified limits following a disturbance. Frequency control adequacy has become increasingly important as the system inertia decreases due to the increase in renewable energy penetration. Various controllers for inverters have been proposed to improve the system frequency response and few are capable to ensure the safety of the response. In this article, a diesel‐wind energy system is considered and modeled as a switching system between normal, faulted, and post‐fault modes. A safety feedback controller is designed as a supplementary signal for a wind turbine generator such that the speed of the diesel generator stays within a permissible range in the presence of a finite energy disturbance. Numerical results on the modified 33‐bus microgrid system obtained of the proposed novel approach indicate that the suggested control configuration can guarantee adequate frequency response without excessive conservativeness.

Evaluation of CMV T-cell Mediated Immunity in Children with CMV DNAemia After Allogeneic Hematopoietic Cell Transplantation

Abstract Background Cytomegalovirus (CMV) is among the most common infectious complications following allogeneic hematopoietic cell transplantation (allo-HCT). A commercially available CMV T-cell immune panel (CMV-TCIP, Viracor®), reported as percentages of CMV-specific interferon gamma releasing CD4 and CD8 cells (%CMV-CD4 or %CMV-CD8 IFN-γ), may be used to assess CMV cell-mediated immunity (CMV-CMI). However, the utility of this assay among pediatric allo-HCT recipients remains unknown. Methods A retrospective analysis among pediatric allo-HCT recipients (age ≤18 years) from 1/2020 to 11/2023 who developed CMV DNAemia and had CMV-TCIP testing was performed. Per institutional protocol, weekly quantitative plasma CMV PCR was performed until day +100. Clinically significant CMV infection (csCMVi) was defined as CMV viral load (VL) ≥500IU/ml and pre-emptive therapy (PET) was provided for csCMVi. The most frequent indications for CMV-TCIP testing were to evaluate CMV-CMI to inform the need of CMV virus-specific T-cell therapy (CMV-VST) in the setting of resistant/refractory CMV, to monitor CMV-CMI as a proxy of VST expansion post CMV-VST, or to evaluate the need of ongoing secondary antiviral prophylaxis. A %CMV-CD4 or %CMV-CD8 IFN-γ ≤0.2% was categorized as a poor response, whereas a result >0.2% was classified as an adequate response. Specimens with insufficient quality, high background, or discrepant results from %CMV-CD4 or %CMV-CD8 were classified as a discordant response. Demographics, underlying condition, HCT type, conditioning regimen, antiviral agents and use of VST, VL, and CMV-TCIP results were recorded. Descriptive and nonparametric statistics (median, interquartile range [IQR]) were used for analysis. Results Twenty-seven CMV-TCIP results from 10 unique allo-HCT recipients were analyzed. The median age at transplant was 8.5 years (IQR 2.75-14.3), predominantly for hematologic malignancy (70%). CMV donor/recipient (D/R) serostatus were D+/R+ (60%), D-/R+ (30%) and D+/R- (10%). CMV DNAemia developed post-HCT in 80% (8/10) with median onset of 4 days post-HCT (IQR 3-40) and 2 subjects had known DNAemia prior to HCT. Nine (90%) subjects were started on PET for csCMVi, whereas 1 (10%) received antiviral therapy when VL was <500IU/ml. The first CMV-TCIP was obtained at median of 112 days (IQR 42-130) post-HCT. Despite appropriate antiviral therapy, patients with a peak VL ≥500 IU/mL (obtained within 1 week before and after CMV-TCIP testing) demonstrated significantly lower absolute CD4 (median 12 vs. 198 cells/uL, p=0.02) and CD8 (median 79 vs. 443 cells/uL, p=0.04) counts and %CMV-CD4 IFN-γ (0.04% vs. 0.36%, p=0.02) compared to those with a peak VL <500 IU/mL. Conclusion Our results suggest that CMV-CMI, particularly %CMV-CD4 IFN-γ >0.2%, was observed concurrently with downward trending VL, and may serve as a proxy of VST expansion in patients receiving CMV-VSTs. Figure 1A. The distribution of peak VLs over time based on %CMV-CD4 and %CMV-CD8 IFN-γ are demonstrated in Figure 1B. CMV peak VLs were lower with TCIP testing results reported as adequate combined responses compared to those with poor combined responses. In five subjects (50%) who received CMV-VSTs as part of CMV therapy, increased %CMV-CD4 and %CMV-CD8 IFN-γ were observed post-infusion with an observed downward trend in VL.

Pneumococcal Serotype-Specific Antibodies in Children with Recurrent Oto-sinopulmonary Infections.

Low titers to pneumococcal vaccine are a frequent finding in pediatric patients with recurrent oto-sinopulmonary infections. To characterize the pre- and post-immunization antibody trend for each serotype included in the pneumococcal 13-valent conjugate vaccine (PCV13), in a cohort of pediatric patients with recurrent oto-sinopulmonary infections. This retrospective review identified 182 patients with recurrent oto-sinopulmonary infections (131 required an immune workup and 99 had low pneumococcal titers leading to a PCV13 vaccine booster). Baseline pneumococcal serotype-specific antibody titers at initial visit and 6 weeks after the vaccine booster were obtained. An adequate response to the pneumococcal conjugate vaccine was deemed to be a 4-fold increase over baseline and/or a post-immunization titer of 1.3 µg/ml or greater. Overall, PCV13 booster provided a significant improvement in the number of protective titers, increasing from 3.6 serotypes at baseline to 11.1 serotypes at 6 weeks (p < 0.001). This increase correlated with improved clinical outcomes (81% showed no signs of recurrent infection after the first booster and 94% after a second booster). Post-immunization antibody concentrations were significantly higher than at baseline for all serotypes (p< 0.05) and only 8, 9N, and 12F did not exhibit a greater than 4-fold increase (p> 0.05) 6 weeks following booster. There were no differences between patients at different ages in post-immunization titer levels for all serotypes. In pediatric patients with recurrent oto-sinopulmonary infections, an additional pneumococcal booster proved to be effective in the protection of these children against further infections, across all age groups.

'Monkeypox, where is your rage?': The racialization, sexualization, and securitization of global health

With the purposes of identifying the underlying challenges of global and public health governance of outbreaks, this paper explores three key themes that emerged in response to the 2022 mpox epidemic: the belated change of disease nomenclature from monkeypox to mpox; the classification of mpox as a sexually transmitted infection (STI); and the unpreparedness of health agencies to vaccinate impacted populations. The paper makes the case that, because of the global and public health tensions arising from racialized nomenclatures, sexualized classifications, biosecuritized borders, and monopolized vaccines, national and international agencies failed in providing an adequate and comprehensive response to the latest mpox pandemic, which contributed further to the pathologization of already vulnerable and stigmatized population groups.

8062 Uncommon Presentation of Multiple Myeloma as a Rapidly Growing Thyroid Goiter Initially Thought to be Hashimoto's Thyroiditis

Abstract Disclosure: M.S. Shah: None. S. Humayon: None. K.P. Sanu: None. C. Peñaherrera: None. We present a unique case of an 85-year-old female with rapidly growing anterior neck swelling and subclinical hyperthyroidism, initially suggestive of Hashimoto's thyroiditis. The goiter initially responded well to steroids but rebounded back in size despite two courses of prednisone. This prompted further diagnostic workup which revealed unexpected findings, ultimately leading to the diagnosis of multiple myeloma involving the thyroid parenchyma and lymph nodes. The patient had no history of thyroid disorders or recent upper respiratory tract infections. She exhibited sudden neck swelling, mild subclinical hyperthyroidism, and positive TPO antibodies. Initial fine needle aspiration suggested lymphoid tissue with Hurthle cell differentiation, raising suspicion of Hashimoto's thyroiditis. Flow cytometry supported this diagnosis, but the potential for a Hurthle cell neoplasm persisted. Prednisone temporarily reduced thyroid size, but disease recurrence necessitated surgical excisional and incisional biopsies. Subsequent biopsies revealed plasma cell neoplasms consistent with multiple myeloma. The pathologic report confirmed MYC rearrangement, indicative of multiple myeloma involvement in lymph nodes and thyroid tissue. Protein electrophoresis revealed two restricted bands migrating in the gamma globin region. The patient experienced subclinical hyperthyroidism that evolved into euthyroidism over a month. Incidental findings included non-invasive, low grade papillary urothelial carcinoma. Disease progression was evident in a follow-up PET/CT, prompting oncology consultation. The patient initiated Revlimid with chemotherapy. Levothyroxine was prescribed for postoperative hypothyroidism, with adjustments based on thyroid panel results. This case report illustrates the intricate diagnostic challenges posed by multiple myeloma masquerading as a thyroid disorder. The unexpected evolution of the disease, marked by MYC rearrangement and metastatic spread, emphasizes the need for heightened vigilance in managing such cases. Clinicians should consider alternative diagnoses when treatment efforts fail to provide adequate response. This will ensure timely and appropriate management in clinical practice. This report contributes valuable insights into the diagnostic complexities and multidisciplinary considerations for addressing similar presentations in endocrine and oncology settings. Presentation: 6/1/2024

8062 Uncommon Presentation Of Multiple Myeloma As A Rapidly Growing Thyroid Goiter Initially Thought To Be Hashimoto's Thyroiditis

Abstract Disclosure: M.S. Shah: None. S. Humayon: None. K.P. Sanu: None. C. Peñaherrera: None. We present a unique case of an 85-year-old female with rapidly growing anterior neck swelling and subclinical hyperthyroidism, initially suggestive of Hashimoto's thyroiditis. The goiter initially responded well to steroids but rebounded back in size despite two courses of prednisone. This prompted further diagnostic workup which revealed unexpected findings, ultimately leading to the diagnosis of multiple myeloma involving the thyroid parenchyma and lymph nodes. The patient had no history of thyroid disorders or recent upper respiratory tract infections. She exhibited sudden neck swelling, mild subclinical hyperthyroidism, and positive TPO antibodies. Initial fine needle aspiration suggested lymphoid tissue with Hurthle cell differentiation, raising suspicion of Hashimoto's thyroiditis. Flow cytometry supported this diagnosis, but the potential for a Hurthle cell neoplasm persisted. Prednisone temporarily reduced thyroid size, but disease recurrence necessitated surgical excisional and incisional biopsies. Subsequent biopsies revealed plasma cell neoplasms consistent with multiple myeloma. The pathologic report confirmed MYC rearrangement, indicative of multiple myeloma involvement in lymph nodes and thyroid tissue. Protein electrophoresis revealed two restricted bands migrating in the gamma globin region. The patient experienced subclinical hyperthyroidism that evolved into euthyroidism over a month. Incidental findings included non-invasive, low grade papillary urothelial carcinoma. Disease progression was evident in a follow-up PET/CT, prompting oncology consultation. The patient initiated Revlimid with chemotherapy. Levothyroxine was prescribed for postoperative hypothyroidism, with adjustments based on thyroid panel results. This case report illustrates the intricate diagnostic challenges posed by multiple myeloma masquerading as a thyroid disorder. The unexpected evolution of the disease, marked by MYC rearrangement and metastatic spread, emphasizes the need for heightened vigilance in managing such cases. Clinicians should consider alternative diagnoses when treatment efforts fail to provide adequate response. This will ensure timely and appropriate management in clinical practice. This report contributes valuable insights into the diagnostic complexities and multidisciplinary considerations for addressing similar presentations in endocrine and oncology settings. Presentation: 6/1/2024

Patient-Reported Outcome Measures for Pelvic Organ Prolapse: A Systematic Review Using the COnsensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) Checklist.

Patient-reported outcome measures (PROMs) are recommended to measure the impact of a health condition or intervention effectiveness as they aim to capture what is most meaningful to patients. Several PROMs are used to evaluate pelvic organ prolapse (POP)-related domains, yet the measurement properties of these instruments have not been fully explored with a rigorous analysis of the methodological quality and quality of evidence. To conduct a systematic review reporting on the measurement properties of PROMs used for the assessment of POP-related domains in accordance with the COSMIN guidelines. Five databases were searched from inception to December 2023. Studies were eligible if they involved (1) at least one group of female adults diagnosed with or presenting with symptoms of POP; (2) a self-reported outcome measure (PROMs, questionnaires) to evaluate POP-related domains; and (3) at least one measurement property. Methodological quality and measurement quality were assessed using the COSMIN risk of bias (ROB) checklist and the COSMIN criteria for good measurement properties. A total of 13 PROMs were included. The BIPOP had the lowest ROB for Content Validity. The POP-SS was the only PROM with sufficient evidence of adequate construct validity and responsiveness to be used in both surgical and conservative management settings. This original work identified a gap in evidence regarding the measurement qualities of identified PROMs used in the POP population.

A-080 Morning Cortisol for Rule-in and Rule-out of Adrenal Insufficiency in an Asian Population

Abstract Background Short ACTH stimulation (Synacthen) tests are performed to investigate for adrenal insufficiency. Previous work suggests that morning cortisol concentrations can be used to rule in or out adrenal insufficiency to avoid performance of a Synacthen test. This study aimed to determine the optimal cortisol concentration for rule-in or rule-out adrenal insufficiency based on 30-minute cortisol (COR30) for adequate response using the assay-specific cut-off from The Endocrine Society of Australia/The Australasian Association for Clinical Biochemistry and Laboratory Medicine/The Royal College of Pathologists of Australasia (ESA/AACB/RCPA) Harmonization of Endocrine Dynamic Testing - Adult (HEDTA), in an Asian population. Methods Synacthen tests performed at our institution from 2012-2024, with a baseline cortisol between 6 and 10 am (COR0(6-10)), were extracted from the laboratory database. Plasma cortisol concentrations were measured by Beckman Coulter DxI 800. Synacthen tests were classified as adequate or inadequate based on the Beckman Coulter specific HEDTA cut-off for COR30 of 420 nmol/L. Performance characteristics (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under receiver operator characteristic (AUROC) curve) of COR0(6-10) concentrations to predict adequate or inadequate response were calculated using Microsoft Excel. Results 4609 Synacthen tests were included, 77% of which had adequate Synacthen response. COR0(6-10) &amp;gt;300 nmol/L could exclude inadequate COR30 response with sensitivity 95%, specificity 48%, PPV 35%, NPV 97%; and COR0(6-10) &amp;gt;364 nmol/L had sensitivity 99%, specificity 29%, PPV 29%, NPV 99%. COR0(6-10) &amp;lt;155 nmol/L could rule-in inadequate COR30 response with sensitivity 53%, specificity 95%, PPV 76%, NPV 87%; and COR0(6-10) &amp;lt;97 nmol/L had sensitivity 35%, specificity 99%, PPV 91%, NPV 84%. AUROC of COR0(6-10) for adequate COR30 response was 0.86. If patients with COR0(6-10) &amp;lt;97 nmol/L and &amp;gt;300 nmol/L did not proceed to Synacthen testing, up to 46% of tests could be avoided, while keeping misclassification under 5%. Conclusions Morning cortisol cut-offs were determined for rule-in and rule-out of adrenal insufficiency in an Asian population. Patients with morning cortisol &amp;gt;300 nmol/L or &amp;lt;97 nmol/L may be able to avoid Synacthen testing unless there is a strong suspicion of clinical discordance. Such a testing strategy could significantly decrease the number of Synacthen tests while keeping misclassification to a minimum.