Cent Of Cases Research Articles

McFine: python-based Monte-Carlo multi-component hyperfine structure fitting

Abstract Modelling complex line emission in the interstellar medium (ISM) is a degenerate, high-dimensional problem. Here, we present McFine, a tool for automated multi-component fitting of emission lines with complex hyperfine structure, in a fully automated way. We use Markov chain Monte Carlo (MCMC) to efficiently explore the complex parameter space, allowing for characterising model denegeracies. This tool allows for both local thermodynamic equilibrium (LTE) and radiative-transfer (RT) models. McFine can fit individual spectra and data cubes, and for cubes encourage spatial coherence between neighbouring pixels. It is also built to fit the minimum number of distinct components, to avoid overfitting. We have carried out tests on synthetic spectra, where in around 90 per cent of cases it fits the correct number of components, otherwise slightly fewer components. Typically, Tex is overestimated and τ underestimated, but accurate within the estimated uncertainties. The velocity and line widths are recovered with extremely high accuracy, however. We verify McFine by applying to a large Atacama Large Millimeter/submillimeter Array (ALMA) N2H+ mosaic of an high-mass star forming region, G316.75-00.00. We find a similar quality of fit to our synthetic tests, aside from in the active regions forming O-stars, where the assumptions of Gaussian line profiles or LTE may break down. To show the general applicability of this code, we fit CO(J = 2-1) observations of NGC 3627, a nearby star-forming galaxy, again obtaining excellent fit quality. McFine provides a fully automated way to analyse rich datasets from interferometric observations, is open source, and pip-installable.

Cauda equina syndrome in the emergency department: a 2-year retrospective review

Cauda equina syndrome if a rare but life-changing clinical condition inwhich pressure is exerted on the group of nerve roots known collectivelyas cauda equina.It was first described in 1934. It has an incident ranging from 2.7 to4.0 per 100,000.It is more common in women with a mean age of 42 years.It can lead to loss of control of pelvic organs and legs, with a risk ofpermanent loss of sensory and motor control in the area supplied by thecauda equina.The setting for the study was the emergency department in a LargeUrban Teaching Hospital. A Retrospective Chart Review over 2 yearsfrom January 2022 to December 2023 was conducted. Adult patientsaged 18 years and over presenting with suspected cauda equina syndrome(CES) were included. We found a CES prevalence of 0.07% of all EDattendances or 74 per 100,000. There was a female preponderance of70% versus 30% male. A total of 74% of cases were aged between 24and 65 years at one peak, and a spike after the age of 75 years. Mostcases (92%) were managed conservatively. A total of 100 patients (68%)were admitted or transferred, while 32% were discharged. A total of 140patients (95%) met the National Institute for Health and Care Excellence(NICE) red flag symptoms. In conclusion, CES is rare (< 0.5% of ED presentations). There was anage peak between 25 and 65 years, with a spike after the age of 75 years.It has a large female preponderance in keeping with the observation fromother studies. Ninety five per cent of cases in our cohort met the NICEred flag criteria. Most cases were managed locally and conservatively.

Hematoma Block Verses General Anesthesia For Close Reduction And Percutaneous Pinning Of Distal Radius Fractures In Elderly Patients

Objective: The objective of our study is to compare two techniques used for analgesia, hematoma block and general anaesthesia, in patients presented with a fracture of the distal radius in the trauma centre of Aziz Bhatti Shaheed Hospital Gujrat. Methods: Our study was conducted at the Trauma Centre of Aziz Bhatti Shaheed Hospital Gujrat from January 2021 to April 2023. All the patients having distal radius fractures who met the inclusion criteria were included in our study. The patients were placed into two groups, A and B. All the patients were treated by close reduction and percutaneous pinning. The analgesia method used in group A was Hematoma block while in group B was general anesthesia. Data was analyzed using SPSS. Results: 156 patients met the inclusion criteria. The mean age was 61.3 ± 6.6 years. These patients were placed in two groups, A and B, of 78 patients each. There was significantly less pain intensity at 2 and 6 hours after the procedure in the hematoma block group (P < 0.001). Duration for manipulation did not differ significantly between the two groups. Duration for surgery was significantly shorter for the hematoma block group (P 0.02). In 100 per cent of cases, anatomical reduction was achieved in both groups. Conclusion: Hematoma block used as analgesia for the management of fractures of the distal radius in elderly patients is a more effective and safe method than general anaesthesia in emergency trauma centres. Keywords: Hematoma block, distal radius fracture, elderly.

Çocukluk çağı Kronik ve Persistan Lenfadenopatilerin Ultrason ve Laboratuvar Veriler eşliğinde Öngörülebilirliği; Bir Çocuk Hematoloji-Onkoloji Polikliniği Deneyimi

Aim:
 Lymphadenopathies occupy an important part of pediatric hematology-oncology practice. More than 95 per cent of cases are known to be reactive, and infection-related. Lymphadenopathies are followed up at 1-3-6 month intervals, and the process requires ultrasound follow-up. Our study aimed to compare the persistent and non-persistent cases.
 Results: In our study, lymphadenopathy cases (n=93) admitted to our pediatric haematology-oncology outpatient clinic between 2022-2023 were examined and diagnosed; reactive lymph nodes (n=76)(81. 7%), infectious mononucleosis (n=9)(9. 7%), tuberculosis (n=1)(1%), lymphoma (n=2)(2%), benign cytology (n=2)(2%). Mean age ± standard deviation (SD); 8. 2±4. 4, number of girls; 42 (45. 2%). The median time to resolution of acute (n=8)(8. 6%), subacute (n=26)(28%), chronic (n=59)(63. 4%) lymphadenopathy was 1 [5-155] week. Cases with and without ultrasonographic disappearance of lymphadenopathy were compared; the mean hemoglobin value (g/dL) (12. 7±1. 4 vs. 12. 3±1. 2, respectively) (p=0. 047) and platelet value (x10³/mm³) (334. 2±108. 012 vs. 288. 4±89. 5, respectively) (p=0. 047) were higher and the presence of hilar vascularity on ultrasonography (76% vs. 98. 1%) (p=0. 001) was LOWER in those who disappeared compared to those who did not disappear. There was no correlation between hypoechoic lymph node, indistinct border, necrosis, fatty hilus, perinodal cortical vascularity, cortical thickening, presence of lymph node in more than one region and non-loss of lymph node.
 Conclusion: In conclusion, it has been shown that in the presence of lymphadenopathy, elevated hemoglobin and platelets, together with the presence of hilar vascularity, may be predictive findings in the failure of the lymph node to disappear.
 Key words: lymphadenopathy, ultrasonography, haemoglobin, platelets, childhood

Forecasting disease trajectories in critical illness: comparison of probabilistic dynamic systems to static models to predict patient status in the intensive care unit

ObjectiveConventional prediction models fail to integrate the constantly evolving nature of critical illness. Alternative modelling approaches to study dynamic changes in critical illness progression are needed. We compare static risk...

When Does Lethal Repression Fail? Unarmed Militancy and Backfire in Bolivia, 1982–2021

AbstractRepressive state violence, intended to tamp down collective mobilisation, sometimes inspires greater participation by protesters. When popular and/or elite reactions cause the repressing party to concede, civil resistance scholars define the failure of state repression as ‘backfire’. Some have proposed that movements’ nonviolent discipline is essential to backfire. This article demonstrates that movements that practise ‘unarmed militancy’ – forceful, combative tactics less damaging than armed violence – can also succeed through backfire, achieving policy concessions and even presidential resignations, and presents a qualitative comparative analysis of the outcomes of 48 protest events with multiple deaths in Bolivia between 1982 and 2019, and a case-based analysis of how either movements or repressors prevailed. Movements that confronted deadly repression succeeded in 57–8 per cent of cases. Whether or not protesters engaged in lethal defensive violence did not affect their likelihood of success. However, state repression of guerrillas and paramilitary groups, and during polarised partisan conflicts, was consistently successful. Current understandings of backfire need to be reconsidered in light of successful unarmed militant protest in Bolivia and numerous other locations worldwide.

Gender and justice: The status of women in Ottoman courts

AbstractThis paper studies legal disparities between men and women in a patriarchal framework. Throughout history, women have confronted discrimination in matters of inheritance, property ownership, and various other legal rights. We examine the consequences of legal discrimination for women's differential engagement and success within legal conflicts, using data from Ottoman courts in the early nineteenth century. The results show that women were parties to approximately 30 per cent of cases, with a modest gender gap of around eight to ten percentage points in terms of plaintiff win rates. The gap varied across courts and types of cases, consistent with gender disparities in legal knowledge and trial stakes in patriarchal societies. Notably, when litigating against male defendants, the disparity was more pronounced in provincial courts (Konya and Kütahya), as opposed to courts in the capital city (Galata and Üsküdar). Similarly, while the gender gap was greater in property and probate cases than those involving personal crimes and commercial exchange, the gap was reversed in family matters. The analysis suggests that a significant portion of the gender gap in litigation success can be attributed to disparities in evidence presentation (witness testimonies, written documents and legal opinions).

In-hospital outcomes predictors and trends of redo sternotomy aortic root replacements: insights from a UK registry analysis.

Redo sternotomy aortic root surgery is technically demanding, and the evidence on outcomes is mostly from retrospective, small sample, single-centre studies. We report the trend, early clinical results and outcome predictors of redo aortic root replacement over 20 years in the United Kingdom. We retrospectively analysed collected data from the UK National Adult Cardiac Surgery Audit (NACSA) on all redo sternotomy aortic root replacements performed between 30th January 1998 and 19th March 2019. We analysed trends in the volume of operations, characteristics of hospital survivors vs. non-survivors, and predictors of in-hospital outcomes. During the study period, 1,107 redo sternotomy aortic root replacements were performed (median age 59, 26% of patients were females). Eighty-four per cent of cases (N = 931) underwent a composite root replacement, 11% (N = 119) had homograft root replacement and valve-sparing root replacement was performed in 5.1% (N = 57) of cases. There was a steady increase in the volume of redo sternotomy root replacements beyond 2006, from an annual volume of 22 procedures in 2006 to 106 procedures in 2017. Hospital mortality was 17% (n = 192), postoperative stroke or TIA occurred in 5.2% (n = 58), and postoperative dialysis was required in 11% (n = 109) of patients. Return to the theatre for bleeding/tamponade was required in 9% (n = 102) and median in-hospital stay was 9 days. Age >59 (OR: 2.99, CI: 1.92-4.65, P < 0.001), recent myocardial infarction (OR: 6.42, CI: 2.24-18.41, P = 0.001) were associated with increased in-hospital mortality. Emergency surgery (OR: 3.95, 2.27-6.86, P < 0.001), surgery for endocarditis (OR: 2.05, CI: 1.26-3.33, P = 0.001), salvage coronary artery bypass grafting (OR: 2.20, CI: 1.37-3.54, P < 0.001), arch surgery (OR: 2.47, CI: 1.30-3.61, P = 0.018) and aortic cross-clamp longer than 169 min (OR: 2.17, CI: 1.00-1.01, P = 0.003) were associated with increased risk of mortality. We found no effect of the centre or surgeon volume on mortality (P > 0.05). Redo sternotomy aortic root replacement still carries significant morbidity and mortality and is sporadically performed across surgeons and centres in the UK.

Whole-body MRI with diffusion-weighted imaging as an adjunct to18 F-fluorodeoxyglucose positron emission tomography and CT in patients with suspected recurrent colorectal cancer.

The aim was to explore how findings of whole-body MRI including diffusion-weighted imaging (DW-MRI) compared to the routine diagnostic workup with CT and/or 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT in patients with suspected recurrent colorectal cancer (CRC). This was an exploratory retrospective analysis of 55 patients with a clinical suspicion of recurrent CRC who underwent DW-MRI following CT and/or FDG-PET/CT. Two readers in consensus interpreted all clinical imaging reports and converted each described lesion into a confidence score (1 = definitely benign to 5 = definitely malignant). DW-MRI findings were compared to the most recent previous CT or PET/CT. Any discrepant or additional DW-MRI findings were documented and compared with histology and/or clinical follow-up (if available). Whole-body MRI including diffusion-weighted imaging (DW-MRI) resulted in discrepant/additional findings in 26/55 (47%) cases; 23/37 (62%) compared to previous CT and 3/18 (17%) compared to previous PET/CT. These included 10 cases where DW-MRI converted previously inconclusive CT (n = 8) or PET/CT (n = 2) findings into a conclusive diagnosis, one where it contradicted a previous CT diagnosis of recurrence, five where DW-MRI diagnosed recurrent disease not previously reported on CT and 10 cases where DW-MRI detected additional lesions compared to CT (n = 9) or PET/CT (n = 1). Eighty-eight per cent of cases with discrepant/additional findings concerned patients with recurrent/metachronous peritoneal metastases. In total, DW-MRI resulted in 42 discrepant/additional lesions; the DW-MRI diagnosis was correct in 76% of these lesions and incorrect (false positive) in 7%. In the remaining 17%, no standard of reference was available. This explorative study suggests that DW-MRI may be of added value to patients with a clinical suspicion for recurrent CRC, in particular to identify patients with peritoneal metastases. DW-MRI mainly has potential as a 'problem-solver' in patients with inconclusive or negative findings on previous imaging (in particular CT) and to detect additional disease sites in patients already diagnosed with recurrent disease.

Systematic review and meta-analysis of laryngeal reinnervation techniques in adults with unilateral and bilateral vocal fold palsies.

To evaluate the outcomes of reinnervation techniques for the treatment of adult unilateral vocal fold paralysis and bilateral vocal fold paralysis. A literature review was conducted in the Embase and Medline databases in English, with no limitations on the publication date. The outcome parameters of interest included visual, subjective perceptual, acoustic, aerodynamic analysis and electromyography. A meta-analysis with a random-effects model and inverse variance was calculated. The systematic Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach resulted in 27 studies, totalling 803 patients (747 unilateral cases and 56 bilateral cases). Thyroid cancer and/or surgery had caused unilateral vocal fold paralysis in 74.8 per cent of cases and bilateral vocal fold paralysis in 69.6 per cent of cases. Statistically significant improvements in patients were observed for voice, deglutition and decannulation (bilateral vocal fold paralysis). Meta-analysis of 10 reinnervation techniques was calculated for the maximum phonation time of 184 patients. Reinnervation was shown to improve voice, swallowing and decannulation, but studies lacked control groups, limiting generalisability. Larger studies with controls are needed.

Novel Work on Collection of Tracheo-bronchial Aspirates in Pneumonic Cattle

Routine diagnosis of pulmonary disorders in bovines by physical examination, hematology and radiography is not sufficient to establish confirmatory diagnosis. Tracheo-bronchial aspirates (TBA) can be used as a reliable sample for the diagnosis of lower respiratory tract affections in cattle. Percutaneous tracheo-bronchial aspirate sampling was performed in 173 standing conscious cattle using two types of catheters. Fifty four cows were sampled with Large Animal transtracheal wash Kit (MILA International, Inc. USA) and 119 with infant feeding tube. Cytologic analysis of TBA smears was performed to assess the diagnostic utility of samples. Diagnostic samples were obtained in 87.8 per cent cows (152/173). Sampling using commercial catheter and infant feeding tube retrieved diagnostic samples in 90.7 per cent and 86.6 per cent of cows, whereas repeated infusions were required in 61.2 per cent and 78.7 per cent of cases, respectively. None of the cows exhibited complications post sampling. Infant feeding tube (7 Fr) with 10 G steel introduction catheter was effectively used in the collection of TBA and was comparable with commercial catheter. Present communication reports first systematic study on collection of TBA by percutaneous method in adult pneumonic cattle.

‘Inner world’ of luminal HER 2-negative metastatic breast cancer: Efficacy of ribociclib in different intrinsic subtypes

The heterogeneity of breast cancer (BC), which determines various clinical scenarios of the disease, is still inaccessible to our understanding. Heterogeneity is based primarily on intrinsic subtypes of breast cancer, determined using genomic tests. Currently, four intrinsic subtypes are generally recognized: luminal A and B, HER-enriched (HER2-E) and basal-like. HER2-E subtype in luminal HER-negative (ER+HER–) breast cancer accounts for 11–22 per cent of cases. The efficacy of a combination of hormone therapy (HT) and the CDK4/6 inhibitor ribociclib in the HER2-E subtype was evaluated in a large exploratory analysis of MONALEESA-2, -3, and -7 trials. The gain in progression-free survival (PFS) and overall survival (OS) from the addition of ribociclib to HT was observed in all intrinsic subtypes, except for basal-like, and reached maximum in HER2-E subtype: Ribociclib increased the median PFS to 16.4 months from 5.5 months on HT (HR = 0.389; p &lt; 0.0001) and median OS to 40.3 months from 29.4 months (HR = 0.600; p = 0.0180). The significant frequency of occurrence of the HER2-E subtype in ER+HER-BC, the low efficiency of monoHT in this subtype is another argument in favor of prescribing combination therapy in early lines. Information about the intrinsic subtype not only brings us closer to understanding tumor heterogeneity, but may also become a significant factor in determining treatment tactics in the future.

Optimal job scheduling to minimize total tardiness by dispatching rules and community evaluation chromosomes

In traditional scheduling, job processing times are assumed to be fixed. However, this assumption may not be applicable in many realistic industrial processes. Using the job processing time of real industrial processes instead of a fixed value converts the deterministic model to a stochastic one. This study provides three approaches to solving the problem of stochastic scheduling: stochastic linguistic, stochastic scenarios, and stochastic probabilistic. A combinatorial algorithm, dispatching rules and community evaluation chromosomes (DRCEC) is developed to generate an optimal sequence to minimize the tardiness performance measure in the scheduling problem. Thirty-five datasets of scheduling problems are generated and tested with the model. The DRCEC is compared to the Genetic Algorithm (GA) in terms of total tardiness, the tendency of convergence, execution time, and accuracy. The DRCEC has been discovered to outperform the GA. The computational results show that the DRCEC approach gives the optimal response in 63 per cent of cases and the near-optimal solution in the remaining 37 per cent of cases. Finally, a manufacturing company case study demonstrates DRCEC's acceptable performance.

Financial inclusion and tax effort in sub-Saharan Africa: the role of institutional quality

Addressing growth challenges in developing countries requires mobilising domestic resources in the face of declining external financing. This paper explores the effects of financial inclusion on tax efforts in sub-Saharan Africa, conditioned by institutional quality. To do this, a finite mixture model that takes into account the potential presence of unobserved heterogeneity was estimated based on a sample taken from 43 countries over the 1996–2019 period. Tax effort scores were constructed using several stochastic frontier models. The results show that the impact of financial inclusion on tax efforts differs across country groups. For example, financial inclusion stimulates tax effort in sub-Saharan Africa in 93.8 per cent of cases and inhibits tax effort in only 6.2 per cent of cases. These results are robust to several sensitivity tests. This paper highlights the need for countries in sub-Saharan Africa to improve access to financial systems by increasing mobile banking coverage and accessibility and reducing financial services costs. These countries should also look to capitalise on the benefits of financial inclusion by protecting political rights and fighting corruption.

A retrospective study investigating the management, risk factors, and outcomes of patients diagnosed with Clostridioides difficile infection

AbstractBackgroundThe rate of clostridioides difficile infection (CDI) in Australia has increased by more than 8% between 2016–2018. This can be attributed to multiple factors including an ageing population, widespread antibiotic and proton‐pump‐inhibitor usage.AimThe aim of this study was to investigate the management, risk factors and outcomes for CDI to identify strategies to reduce its incidence.MethodA single‐centre retrospective audit was completed using medical records for patients admitted to a 250‐bed regional Queensland hospital with CDI in 2020–2021. Data surrounding CDI management for each patient was analysed against the Therapeutic Guidelines. This study was approved by The Prince Charles Hospital Human Research Ethics Committee (Reference No: LNR/HREC/QPCH/81287).ResultsThere were 72 cases with CDI during the study timeframe. Recent antibiotic prescription, proton‐pump‐inhibitor (PPI) use and antibiotic allergy labels were common. Thirty‐five per cent of cases were treated appropriately. Eight per cent died, and nine per cent had relapsed CDI within 12 weeks of diagnosis. Common gaps found in the results included inappropriate selection of antibiotics based on the severity of disease and lack of documentation surrounding CDI cases left untreated.ConclusionThere are multiple opportunities for pharmacists to improve the care of patients with CDI which range from promoting guideline adherence, influencing prescriber antibiotic selection based on disease severity, prompting review of PPIs upon CDI diagnosis and prompting provider follow‐up of CDI laboratory results pending at the point of patient discharge. The results of this study have prompted antimicrobial stewardship service review of all CDI admissions at the study site and indicates the need for a larger multiple‐site study to raise awareness of CDI risk factors and severity criteria.

BG06 Beyond keratin: when simplex is not so simple

Abstract Epidermolysis bullosa simplex (EBS) is a heterogeneous, congenital, mucocutaneous fragility syndrome, characterized ultrastructurally by cleavage within the basal keratinocyte. Seventy-five per cent of cases are attributable to mutations in KRT5 and KRT14, the vast majority of which are dominant negative mutations, resulting in impaired keratin intermediate filament dynamics within the basal layer of the epidermis. The presenting phenotype, including extracutaneous manifestations and overall severity, is often closely linked to the underlying genetic mutation; however, genotype–­phenotype correlation is poorly resolved in a minority of cases, and there is an approximately additional 15% of patients in whom genetic abnormalities are not identified. However, recent advances in next-generation sequencing technologies have expanded the mutational database. We describe two cases of EBS with rare underlying mutations and distinct clinical phenotypes. A 46-year-old man presented with widespread blistering primarily affecting his hands, feet, elbows and knees since childhood. He had unaffected, consanguineous parents and one of his three siblings was affected. Other presenting features included dystrophic nails, focal plantar keratoderma, truncal mottled pigmentation and large areas of hypopigmentation on the back. We considered a diagnosis of ‘EBS with mottled pigmentation’, but the autosomal recessive mode of inheritance and dystrophic nails were atypical. DNA whole-exome sequencing (WES) and bidirectional Sanger sequencing revealed a novel homozygous PLEC mutation [c.94dupG p.(Ala32GlyfsTer3)]. Pathogenic PLEC variants are known to cause autosomal dominant EBS, the Ogna type (MIM131950), autosomal recessive EBS with muscular dystrophy (MIM226670) and autosomal recessive EBS with pyloric atresia (MIM612138). To date, our patient has not manifested any signs of progressive muscle weakness, but the presenting age can vary. The second patient was a 30-year-old woman who presented with blistering on her flexures, feet, hands and friction sites since the age of 4 months. She had unaffected, consanguineous parents and eight unaffected siblings. WES and confirmatory bidirectional Sanger sequencing identified a homozygous nonsense mutation in DST [c.3370C&amp;gt;T p.(Gln1124Ter)]. DST encodes the epithelial isoform of bullous pemphigoid antigen-1, present in the skin, muscle and neuronal tissues. Only 11 patients with DST mutation-induced EBS have been reported to date. The cutaneous phenotype is reported to be blisters, postinflammatory dyspigmentation, scarring, nail dystrophy, keratoderma and hyperhidrosis. If the affected exon is present in neuronal isoforms and neuronal tissue, neurological symptoms are expected. Unlike the patient reported elsewhere who harbours exactly the same mutation, our patient has reported no neurological issues to date. These cases highlight the importance of unravelling genotype–phenotype correlation in rare autosomal recessive forms of EBS, with possible implications for future prognosis and management.

BI07 Outcomes of oral squamous cell carcinoma following haematopoietic stem cell transplantation

Abstract Haematopoietic stem cell transplant (HSCT) recipients are at increased risk of malignancies, including cancers of the oral cavity, with a reported observed-to-expected ratio of 10.7, accounting for 14% of all solid tumours following HSCT. We report 10 cases of oral squamous cell carcinoma (SCC; 2016–2022) in HSCT recipients from a single tertiary centre [nine men and one woman; median age at diagnosis 52 years (range 27–66)]. Thirty per cent were ex-smokers and 10% current smokers. Prior to HSCT, 50% had reduced intensity conditioning, 40% had myeloablative conditioning and 10% had both. Eighty per cent were recipients of sibling allografts and 20% were recipients from matched unrelated donors. Ninety per cent had a history of chronic graft-versus-host disease (GVHD), with affected sites including the mouth (n = 6), skin (n = 6), eyes (n = 5), lungs (n = 4), kidneys (n = 3) and liver (n = 1). Forty per cent had active severe manifestations of oral GVHD. Treatments used for oral GVHD included topical immunosuppression (n = 5), oral immunosuppression (n = 6) and extracorporeal photopheresis (ECP; n = 2). Median latency from HSCT to oral SCC diagnosis was 10 years (range 4–22). At the time of SCC diagnosis, 20% were not taking immunosuppressants, 20% were being treated with topical corticosteroids and 50% with oral immunosuppression, and one patient was recently treated with ECP. Examination findings at SCC diagnosis included induration, ulceration, tenderness, bleeding, hyperkeratosis, speckling and lymphadenopathy (n = 1). Fifty per cent were asymptomatic. In 40% of cases, a previous biopsy showed hyperplastic or dysplastic changes. The commonest sites of SCC were the tongue (n = 4) and buccal mucosa (n = 3). The disease stage (TNM) at presentation ranged from T1N0M0 to T4N2M0. Sixty per cent of cases were T3 or T4 and 40% had nodal involvement. Management included radical surgical resection in 90% of cases; 10% received adjuvant radiotherapy and 10% chemoradiotherapy. One patient with an SCC on the lower lip underwent resection using Mohs micrographic surgery. Median duration of follow-up for the cohort was 0.8 years (range 0.4–5.7) with a 50% mortality rate. In our cohort, median survival following oral SCC diagnosis was 0.8 years (range 0.4–5.0) and SCC-specific mortality was 30% (n = 3). We report the largest UK case series, to the best of our knowledge, of oral SCC post-HSCT. The data show a long latency from HSCT to the onset of oral SCC, highlighting the importance of regular, active oral surveillance by haematologists, dermatologists, oral specialists and dentists. This follow-up is recommended irrespective of the severity of GVHD and length of iatrogenic immunosuppression. Intensive surveillance is indicated in groups at higher risk with a history of chronic oral GVHD.

BT06 Using artificial intelligence to triage skin cancer referrals: outcomes from a pilot study

Abstract Artificial intelligence (AI) is a rapidly emerging field in dermatology, aimed at delivering efficient and effective patient care. To date, there is a lack of substantial evidence for the use of this technology in a clinical setting. However, the pandemic era has placed significant pressures on dermatology services, specifically the skin cancer clinics at our trust, which has experienced a 30% increase in demand compared with prepandemic levels. A novel solution for urgent referrals was to test the use of AI teledermatology software using a UK Conformity Assessed marked Class IIa Medical Device (and therefore regulated by the Medicines and Healthcare products Regulatory Agency). Appropriate cases are selected and booked for a teledermatology appointment at one of our four community-based hubs. Clinical and dermoscopic images, together with a short questionnaire, are uploaded to the software by a healthcare assistant. The AI immediately assesses the dermoscopic images of the lesion, and those cases identified as benign are discharged back to the general practitioner (GP), following a safety check by a consultant dermatologist employed by the AI provider. The trust dermatology consultants have chosen to further triage all cases suspected to be nonbenign. Patients with suitable small lesions at low-risk sites receive a telephone appointment to discuss surgery and obtain consent. Those with precancerous lesions can be discharged back to the GP with management advice. Low-risk basal cell carcinomas case are transferred to a routine pathway. Selected cases may be referred directly to other teams. The pilot started in March 2022 and now processes 5–600 cases per month at four photography hubs. To date, 19% of cases have been discharged back to the GP with a benign diagnosis. A further 15% of cases have been discharged back to the GP by the trust dermatologists, giving an overall discharge rate of 34%. Ten per cent of patients have received a telephone call to take consent for biopsy, and 2% have been referred directly to another speciality. Thirteen per cent of cases have been triaged to a routine pathway, and 38% of patients have required an urgent face-to-face appointment with a dermatologist. The trust has seen &amp;gt; 90% 2-week wait referrals within 2 weeks in the last two quarters. Since the introduction of this AI teledermatology service, we have seen a 62% reduction in the number of patients requiring an urgent face-to-face appointment with a dermatologist. Ongoing audit work is focused on the safety, acceptability and cost-effectiveness of this pathway, and will shape decision-making in the ongoing use of this technology both locally and across the UK.

DP05 (P53) Incidence of Merkel cell carcinoma in the Republic of Ireland (1994–2019)

Abstract Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine cutaneous malignancy most commonly observed in those aged over 65 years. Merkel cell carcinoma is twice as common in males as in females and is 25 times more common in those with fair skin than in those with darker skin types. Solid organ transplant recipients have a 24-fold increased risk of developing MCC. There was a 95% increase in the incidence of MCC in the USA from 2000 to 2013, with further increases predicted. The aim of this study was to investigate the trends of incidence of MCC in the Republic of Ireland. Age-standardized rates were calculated using the 2013 European standard population. There were 447 histologically confirmed MCCs diagnosed between 1994 and 2019. Forty-nine per cent of cases (n = 220) were in males. Median age was 80 years (range 15–19 to 95+). The median age for males was 78 years and the median age for females was 82 years. On average, there were seven cases of MCC diagnosed annually between 1994 and 1998 vs. 27 cases of MCC annually diagnosed between 2015 and 2019—almost a quadrupling of case numbers. The age-adjusted incidence rate of MCC for both male and females is detailed in Table 1. Previous literature has indicated that MCC is twice as common in males than in females. Our cohort differed in that there was a slight female predominance in patients diagnosed with MCC. This is in keeping with published literature from Northern European groups, which have also demonstrated a female predominance in MCC. While the absolute number of MCC diagnosed in Ireland has increased in both males and females, the age-adjusted incidence rate is increasing in males, but there has not been a significant change in females. Other Northern European groups have also demonstrated an increase in the incidence of MCC in males that was not observed in females. This study adds to the body of epidemiological data on MCC. Table 1Age-adjusted incidence rates of Merkel cell carcinoma (MCC)Cases of MCCAge-standardized rate (per 100 000 person-years)SE95% confidence intervalMales 1994–1999230.520.130.27–0.77 2000–2004210.370.080.21–0.53 2005–2009350.790.150.50–1.08 2010–2014661.190.160.88–1.50 2015–2019751.050.120.81–1.29Females 1994–1999260.360.070.22–0.50 2000–2004440.670.100.47–0.87 2005–2009540.790.110.57–1.01 2010–2014450.570.090.39–0.75 2015–2019580.650.090.47–0.83

P53 Incidence of merkel cell carcinoma in the Republic of Ireland (1994–2019)

Abstract Merkel cell carcinoma (MCC) is a rare, aggressive, neuroendocrine cutaneous malignancy most commonly observed in those aged over 65 years. MCC is twice as common in males as in females and is 25 times more common in those with fair skin than in those with darker skin types. Solid organ transplant recipients have a 24-fold increased risk of developing MCC. There has been a 95% increase in the incidence of MCC in the USA from 2000 to 2013, with further increases predicted. The aim of this study was to investigate the trends of incidence of MCC in the Republic of Ireland. Age-standardized rates were calculated using the 2013 European standard population. There were 447 histologically confirmed MCCs diagnosed between 1994 and 2019. Forty-nine per cent of cases (n = 220) were in males. Median age was 80 years (range 15–19 to 95+). The median age for males was 78 years and the median age for females was 82 years. On average, there were seven cases of MCC diagnosed annually between 1994 and 1998 vs. 27 cases of MCC annually diagnosed between 2015 and 2019—almost a quadrupling of case numbers. The age-adjusted incidence rate of MCC for both male and females is detailed in Table 1. Previous literature has indicated that MCC is twice as common in males than in females. Our cohort differed in that there was a slight female predominance in patients diagnosed with MCC. This is in keeping with published literature from Northern European groups, which have also demonstrated a female predominance in MCC. While the absolute number of MCC diagnosed in Ireland has increased in both males and females, the age-adjusted incidence rate is increasing in males, but there has not been a significant change in females. Other Northern European groups have also demonstrated an increase in the incidence of MCC in males that was not observed in females. This study adds to the body of epidemiological data on MCC.Table 1Age-adjusted incidence rates of Merkel cell carcinoma (MCC)Cases of MCCAge-standardized rate (per 100 000 person years)SE95% confidence intervalMales1994–1999230.520.130.27–0.772000–2004210.370.080.21–0.532005–2009350.790.150.50–1.082010–2014661.190.160.88–1.502015–2019751.050.120.81–1.29Females1994–1999260.360.070.22–0.502000–2004440.670.100.47–0.872005–2009540.790.110.57–1.012010–2014450.570.090.39–0.752015–2019580.650.090.47–0.83