Center Department Research Articles

Comparison of Bioelectrical Impedance Analyser (BIA) with Dual-Energy X-ray Absorptiometry (DXA) Scan in Assessing the Body Composition of Adult Individuals with Type 2 Diabetes Mellitus

Abstract Introduction: Assessing the body composition is important in adult patients with type 2 diabetes mellitus to prevent and achieve optimum control during treatment. Bioelectrical impedance analysis (BIA), being a more affordable method of assessing the body composition, should therefore be compared with the gold standard dual-energy X-ray absorptiometry (DXA) to look for a correlation between the two and the potential of BIA to be used widely in this population. A cross-sectional observational study was conducted on 60 patients attending the endocrinology outpatient department (OPD) of a tertiary care centre in Kolkata, India. Methods: Body composition was measured by both BIA and DXA. Intra-class correlation (ICC) values were calculated between the two methods for fat mass and fat-free mass for three body mass index (BMI) groups and overall. Results: DXA and BIA correlated well for both fat mass and fat-free mass in the entire study population and in the non-overweight non-obese group (BMI <23) and the obese group (BMI ≥25). However, the overweight group (23 ≥BMI <25) did not correlate well with the above-mentioned parameters. Conclusion: We suggest interchangeable use of the two methods in the non-overweight non-obese (BM I <23) and obese (BMI ≥25) BMI groups of adult subjects with type 2 diabetes mellitus. However, the low correlation for all parameters in the overweight group points towards exercising caution when taking such measurements by BIA and planning a further study with a larger cohort of such individuals to better evaluate the said correlation.

Comparison of indirect cyanmethaemoglobin method and TrueHb haemometer point of care test with direct cyanmethaemoglobin (gold standard) method for strengthening anaemia detection at primary health care level

ABSTRACT Introduction: The most reliable indicator for anaemia diagnosis at the population level is haemoglobin (Hb) estimation. The direct cyanmethaemoglobin method is considered the gold standard method for haemoglobin estimation. However, for resource constraint areas like primary health care (PHC) level, either blood samples are transported on filter paper for Hb testing (indirect cyanmethaemoglobin method) in laboratory or point of care testing is commonly used. Therefore, a comparative analysis of haemoglobin estimation of direct with indirect cyanmethaemoglobin method and also with TrueHb (Wrig Nanosystems Pvt. Ltd.) haemometer was done to strengthen anaemia diagnosis at the PHC level. Materials and Methods: This was a cross-sectional study. A total of 90 participants above 9 years of age, who visited the outpatient department (OPD) of health centre, Kheri and gave consent were included. Comparative analysis was done between Hb concentration assessed by indirect cyanmethaemoglobin method and TrueHb haemometer device against the gold standard method. Results: The mean Hb value estimated by direct method, TrueHb haemometer and indirect methods (filter paper A, B and C) was 11.42 ± 1.59 g/dl, 11.52 ± 1.54 g/dl, 10.66 ± 1.52 g/dl, 9.84 ± 1.50 g/dl and 10.19 ± 1.62 g/dl, respectively. There was no significant difference found between the mean Hb concentration estimated by the direct method and the TrueHb haemometer device. However, there was a significant difference in mean Hb values between the direct method and the indirect method. Therefore, regression analysis was done to estimate the correction factor for the indirect method. Conclusion: TrueHb metre device gave promising results in comparison to the gold standard method and can be used if resource permits in PHC centres. Indirect methods of haemoglobin estimation can be an alternative in resource-constraint settings, specifically for surveys. However, further studies are required for the validation of the indirect method.

Characterizing trauma encounters among patients with language other than English preference at a level 1 trauma center's emergency department

AbstractObjectivesInjury‐related visits constitute a sizeable portion of emergency department (ED) visits in the United States. Individuals with language other than English (LOE) preference face barriers to healthcare and visits for traumatic injury may be the first point of contact with the healthcare system. Yet, the prevalence of traumatic injuries in this population is relatively unknown. Our objective was to characterize the prevalence and purpose of trauma encounters, and healthcare utilization, among a LOE cohort.MethodsWe conducted a retrospective chart review of LOE patients who presented for a trauma encounter at a level 1 trauma and emergency care center between January 1, 2019 and December 31, 2021. LOE participants were identified by utilization of video‐based language interpretive services. Variables evaluated included injury patterns and primary and subspeciality healthcare utilization. Quantitative analysis of categorical and continuous variables was performed.ResultsA total of 429 patients were included. Most patients presented for one trauma encounter and the majority spoke Spanish. The most common causes of injury were motor vehicle collisions (MVCs) (28.5%, n = 129), ground‐level falls (15.9%, n = 72), and falls from heights (14.2%, n = 64). Occupational injuries made up 27.2% of trauma encounters (n = 123) and only 12.6% (n = 54) of patients had a primary care visit.ConclusionOur findings highlight the need for increased research and attention to all causes of injury, especially MVCs and occupational injuries, among those with LOE preference. Results reaffirm an underutilization of healthcare among this population and the opportunity for trauma encounters as points of access to care.

Antibiotic prophylaxis in pediatric dog bite injuries: Infection rates and prescribing practices.

Pediatric dog bite injuries are a major public health concern and antibiotic prophylaxis is often prescribed due to concern about the development of infection. The Infectious Diseases Society of America recommends 3‒5 days of antibiotic prophylaxis for high-risk dog bites. The purpose of our study was to compare infection rates among patients receiving antibiotic prophylaxis and those who did not receive antibiotic prophylaxis. We conducted a retrospective cohort study of children aged 3 months to 17 years enrolled in the healthcare systems' affiliated accountable care organization (ACO). Eligible children with a dog bite injury presented at an urgent care center or emergency department between 2016 and 2019. We excluded children who were immunosuppressed or had bites that required closure by a surgeon. An electronic health record review was completed and ACO claims data were used to determine if a prescription was filled. Patients with an International Classification of Diseases (ICD)-10 code concerning for infection within 7 days of injury were recorded as having a bite infection. A total of 2653 non-immunosuppressed children presented for care of dog bite injuries and 672 children met eligibility criteria. Thirty-five children developed an infection of their injury. Of the 539 children who received antibiotic prophylaxis, 5.8% developed an infection and 3.0% of the 133 children who did not receive antibiotic prophylaxis developed an infection (p=0.28). The overall infection rate for pediatric dog bite injuries was 5.2%. In our single-center study, no difference in infection rates was found between those receiving and not receiving antibiotic prophylaxis.

Aesthetics treatment with injectable fillers in patients with cancer: Safety and quality of life during active antineoplastic therapy.

e23245 Background: Patients treated with antineoplastic treatment,commonly experience physical changes,secondary to the disease,weight loss,stress,and cancer therapy side-effects.Injectable fillers,offer effective and safe soft-tissue manipulations improving patients’ positive body image.While FDA-approved fillers are used in various medical settings,data on the safety and implications on quality of life(QOL)in oncology patients during active cancer therapy are limited.The study aimed to assess oncology patients' safety,QOL and both physician and patients’ perceived skin changes when fillers are used during active cancer therapies. Methods: The study was conducted at the Women's Cancer Center and Dermatology Department between 2021-2023.Female oncology patients treated with antineoplastic therapies completed a validated QOL questionnaire,dermatologist and patient self-evaluation,prior and following aesthetic intervention.Patients were randomly assigned to receive aesthetic treatments. Results: 127 female patients diagnosed with cancer,and treated at a single cancer center were included in the study.Patient mean age was 57 years.Patient diagnoses included breast,ovarian,uterine,cervical,and other cancers(58%, 22%,7%,5%,8%,respectively).31 (24%) patients were randomized to receive filler treatment.106(83%)patients were not treated with fillers,patients were either not randomized to filler treatments,or attributing their abstention to their cancer diagnosis,potential risks shared by other patients,or their treating oncologist.Patients receiving fillers were treated with chemotherapy,chemotherapy and biological agents,biological agents,hormonal therapies,immunotherapy,biological and hormonal therapy(39%,23%,10%,19%,6%,3%,respectively).3 independent dermatologists assessed improved aesthetic parameters following filler treatment,patients appeared less ill,sad,distracted.6-8 weeks post filler injections,there was a markedly improved QOL score,and noticeable positive skin changes by dermatologists and patients evaluation.Patients appeared less tired,angry,worried(45%,38%,35%,respectively).Most patients were satisfied following injections(81%) and planned future aesthetic treatments.More than half of the patients(55%)had no adverse events.Thirteen patients experienced minor dermal side effects (grade 1,42%).While 1 patient developed delayed inflammatory reaction 6-months post injection(grade 2,3%). Conclusions: Aesthetic treatment with filler injections while on anti-cancer treatment,with minimal side effects,statistically improved patient QOL and dermatological measures,enhanced dermatologist and patient sense of positive body image,demonstrating that injectable fillers can be safely recommended to patients receiving anti-neoplastic therapies.

A cancer center department of supportive oncology: Patient demographic characteristics.

e13518 Background: Supportive Oncology is critical to whole-person, modern cancer care. Our Department of Supportive Oncology (DSO) provides the following services: palliative medicine, senior oncology, integrative oncology, cancer survivorship, genetics, cancer rehabilitation, oncology nutrition, patient navigation, and psycho-oncology. Little is known on the patient population who access these services which makes program development difficult. We describe the key demographic variables in a Supportive Oncology Department (DSO) for age, payor, gender, language preference, and race across our health system, geographical locations, and DSO services. Methods: Patient encounters, as noted in the EMR, were analyzed in a Microsoft PowerBI (www.microsoft.com) database using visits from July 1, 2022 through December 31, 2023. Variables were pre-defined by the healthcare system. Descriptive statistics in grouped frequency distribution tables were used. Results: Female, White, English-speakers (respectively) were the top utilizers across our healthcare system (57%,62%,94%), the oncology service line (64%,69%,97%), and DSO (68%,68%,96%). By gender, females were predominant users (84%) of Integrative Oncology & Survivorship services. Males used Senior Oncology & Palliative Medicine most often of all DSO services (45%). Differences in race were noted in geography (Black urban 26% vs rural 18%). In DSO services, Black patients access for senior oncology/palliative medicine (combined) was highest at 26%. Lowest utilization for Blacks was psycho-oncology & genetics at 18 and 13% respectively. While the overall system had more managed care (55%), both the oncology service line and DSO had more Medicare and less Medicaid. DSO had more managed care (46%) than the service line (42%). In rural settings, DSO patients (39%) were more likely to be in managed care than those in the service line (34%). DSO had more patients in younger age groups (ages 45-64, 42%) than both the oncology service line (35%) and the health system (24%), regardless of urban/rural location. In both the health system and the oncology service line, younger patients were more likely to be in urban locations and older were more likely rural. For DSO services, younger patients (ages 18-44) were more involved in psychology (27%), genetics (26%), and integrative & survivorship care (19%). Older patients were more likely to utilize palliative medicine and senior oncology (ages > 65, 47%). Conclusions: This Supportive Oncology population reveals variation in service access related to demographic characteristics that can inform future program development. Important similarities and differences were noted compared to the wider oncology service line and health system. Age, gender, geographic, payor, and racial disparities may influence service utilization in Supportive Oncology.

Time Series Forecasting of Cardiovascular Mortality: Machine Learning Based on State Economic and Local Medical Data.

This study focuses on the complex interplay of healthcare, economic factors, and population dynamics, addressing a research gap in regional-level models that integrate diverse features within a temporal framework. Our primary objective is to develop an advanced temporal model for predicting cardiovascular mortality in Russian regions by integrating global and local healthcare features with economic and population dynamics. Utilizing a dataset from the Almazov Center's Department of Mortality Performance Monitoring, covering 94 regions and 752 records from January 1, 2015, to December 31, 2023, our analysis incorporates key parameters such as angioplasty procedures, population morbidity rates, Ischemic Heart Disease (IHD) and Cardiovascular Diseases (CVD) monitoring, and demographic data. Employing XGBoost and a regression model, our methodology ensures the model's robustness and generalizability.

Patient Outcomes Compared Between Admissions Coordinated by the Transfer Center and Emergency Department at a U.S. Tertiary Care Hospital.

Patient admissions at a U.S. tertiary care hospital occur via the emergency department (ED), or transfer center. We aim to compare the clinical outcomes of patients admitted from the ED to admissions coordinated by the transfer center. Admissions to Mayo Clinic Hospital, Rochester, MN, between July 2019 to June 2021 were identified in this retrospective study and categorized into two cohorts-transfer center and ED. The two cohorts were then matched for age, sex, admitting service, and Charlson Comorbidity Index. Univariate and multivariate analyses were performed to compare hospital length of stay (LOS), mortality, 30-day mortality, and 30-day readmissions between the two cohorts. 73,685 admissions were identified, of which 24,262 (33%) were transfer center admissions. In the matched cohorts (n = 19,093, each), in-hospital mortality (2.4% versus 1.9%), 30-day mortality (5.4% versus 3.9%), 30-day readmission (12.7% versus 7.2%), and LOS (6.4 days versus 5.1 days) were significantly higher ( P < 0.001) among the admissions coordinated by transfer center. A higher palliative care consultation rate (9.4% versus 6.2%, P < 0.001), and a lower proportion of home discharges home (76.2% versus 82.5%, P < 0.001) among transfer center admissions was observed. Similar findings were noted in multivariate analysis, even when adjusting for LOS. Transfer center admissions had higher in-hospital mortality, LOS, 30-day mortality, and 30-day readmission compared to ED admissions. This study also highlights new considerations for palliative care consultation before transfer acceptance, especially to avoid futile transfers. Additional studies analyzing factors behind the outcomes of transfer center admissions are required.

A Study on Prescription Pattern of Drugs in Orthopaedics Inpatient Department of Navodaya Medical College Hospital and Research Centre in Raichur

Background: Periodic evaluation of drug utilization pattern is necessary to promote rational drug use by. In orthopaedics practice, the prescribing pattern needs to be regularly monitored since many of the drugs prescribed carry untoward adverse effects. In this backdrop, the present study was conducted to explore the prescribing pattern in orthopaedics outpatient department (OPD) of Navodaya medical college hospital and research centre in Raichur. Methods: This is a prospective observational study conducted for 3 months, in Navodaya medical college hospital and research centre in Raichur, a 1000 bedded tertiary care rural based, teaching hospital. Total 100 patients were included in this study. Results: Total 1216 drugs were prescribed in 100 prescriptions. Average number of drugs per prescription was 7.34. Average duration of prescription was 9 days. Percentage of drugs prescribed by generic name was 29.7%. Percentage of encounter with an Antibiotic prescribed was 60.23% i.e. out of 100 prescriptions antibiotics were prescribed in 60. Percentage of encounter with an Injection prescribed was 60% which means out of 100 prescriptions, injectables were prescribed in 60. Percentage of drugs prescribed from National Essential Medicine List was 52.63%. Percentage of drugs prescribed from WHO model List was 32.46%. Diclofenac (14.25%) was most commonly prescribed drug. Incidence of polypharmacy was quite high in context of Analgesics. Almost 19% of prescriptions had 3 drugs. Orally prescribed Analgesics were 62.4%, Injectables 34% and Topical 3.6%. Conclusion: The study provides an insight into the prescribing pattern in orthopaedics in-patients. It highlights the importance of emphasizing rational drug prescribing and toward improving awareness of the physicians and medical students to the WHO recommended standards on prescribing indicators.

Evaluating the Impact of the COVID-19 Pandemic on Late-Canceled and No-Show Appointments at the Department of Neurological Surgery.

The coronavirus disease 2019 (COVID-19) pandemic resulted in unprecedented restrictions on the general public and disturbances to the routines of hospitals worldwide. These restrictions are now being relaxed as the number of vaccinated individuals increases and as the rates of incidence and prevalence decrease; however, they left a lasting impact on healthcare systems that is still being felt today. This retrospective study evaluated the total number of canceled or missed outpatient clinic appointments in a Neurological Surgery department before and after peak COVID-19 restrictions and attempted to assess the impact of these disruptions on neurosurgical clinical attendance. We also attempted to compare our data with the data from another surgical subspecialty department. We evaluated 32,558 scheduled appointments at the Loyola University Medical Center Department of Neurological Surgery, as well as 139,435 scheduled appointments with the Department of Otolaryngology. Appointments before April 2020 were defined as pre-COVID, while appointments during or after April 2020 were defined as post-COVID. Here, we compare no-show and non-attendance rates (no-shows plus late-canceled appointments) within the respective time range. Overall, we observed that before COVID-19 restrictions were put into place, there was an 8.9% no-show rate and a 17.4% non-attendance rate for the Department of Neurological Surgery. After COVID restrictions were implemented, these increased to 10.9% and 18.3%, respectively.Greater no-show and cancellation rates (9.8% in the post-COVID era vs 8.0% in the pre-COVID era) were associated with varying socioeconomic and racial demographics. African-American patients (2.56 times higher), new-visit patients (1.67 times higher), and those with Medicaid/Medicare insurance policies (1.48 times higher) were at the highest risk of no-show in the post-COVID era compared to the pre-COVID era.

Epidemiology, clinical characteristics, and associated cost of acute poisoning: a retrospective study.

Poisoning is a major public health issue and a leading cause of admission to the emergency department (ED). There is a paucity of data describing the epidemiology and cost of acute poisoning. Therefore, this study investigated the epidemiology, patterns, and associated costs of acute poisoning in emergency department of the largest tertiary care healthcare centre in Qatar. This study was a retrospective review of the health records of patients admitted to the ED due to poisoning between January 2015 and December 2019. Incidence, clinical characteristics, and costs associated with acute poisoning were assessed. Frequency and percentages were calculated for categorical variables and mean and SD for continuous variables. The relationship between sociodemographic characteristics and poisoning profile was assessed using the chi-square test. A micro-costing approach using the cost of each resource was applied for cost calculations. The incidence of acute poisoning was 178 cases per 100,000 patients. Females (56%) and children below 14 years (44.3%) accounted for the largest proportion. Most of the exposures were accidental involving therapeutic agents (64.2%). The mean length of hospital stay was found to be 1.84 ± 0.81 days, and most patients (76.6%) were discharged within the first 8 h. A statistically significant difference was found between age groups and type of toxin (χ2 = 23.3, p < 0.001), cause and route of exposure (χ2 = 42.2, p < 0.001), and length of hospital stay (χ2 = 113.16, p < 0.001). Admission to intensive care units had the highest cost expenditure (USD 326,008), while general wards accounted for the least (USD 57,709). Unintentional poisoning by pharmacological agents is common in infants and children. This study will assist in the development of educational and preventive programmes to minimise exposure to toxic agents. Further studies are required to explore the impact of medical toxicology services, and post discharge monitoring of poisoning.

Diagnostic performance of a point of care high-sensitivity cardiac troponin I assay and single measurement evaluation to rule out and rule in acute coronary syndrome.

About 10 million individuals in USA presented annually in the emergency department (ED) with chest pain or with signs and symptoms of acute coronary syndrome (ACS). The advent of point of care (POC) devices, able to measure high sensitivity troponin, are a very interesting tool in the ED setting for its rapid turnaround time (<10 min). The present study evaluates the diagnostic performance of the Atellica VTLi (Siemens) in real life setting using the clinical data derived from integrated diagnoses of emergency room staff and cardiologist and in comparison with standard laboratory hs-cTnT assay (Cobas 8000, Elecsys, Roche). 966 patients admitted to the emergency department of "G. Mazzini Hospital" in Teramo, Italy, from July 27, 2022, through June 09, 2023, were enrolled. The diagnostic performance of POC hs-cTnI was evaluated. An appropriate POC hs-cTnI threshold values <4 ng/L supplied a sensitivity and an NPV of 100 % (95 % CI: 99.5-100) in order to achieve rapid rule out for MI through asingle measurement at patient presentation in the ED. Furthermore, a derivation POC hs-cTnI concentration >54 ng/L provided a specificity of 97.2 % (95 % CI: 95.9-98.1) and a PPV of 43.5 % (95 % CI: 40.3-46.7) for ruling in MI. This platform showed comparable diagnostic performance for myocardial infarction to the central laboratory. Our data suggest the possible use of the Atellica VTLi hs-cTnI POC assay either in emergency department of urban medical centre, either in rural hospital for triage and patient management.

Reverse pupillary block, in contemporary scleral intraocular lens procedures.

To evaluate the frequency and anterior segment optical coherence tomography parameters of patients with scleral fixated intraocular lenses (IOL) and reverse pupillary block (RPB). Retrospective analysis at a tertiary care centre (Department for Ophthalmology and Optometry, Medical University of Vienna, Austria). We researched our records for patients who underwent scleral fixated IOL implantation from January 2018 till February 2023. Patients were included only if there was at least one adequate post-operative scan of anterior segment optical coherence tomography (AS-OCT) available. Initially, AS-OCT scans were assessed for IOL tilt and decentration employing a 3D scan and then later for anterior chamber angle (ACA), aqueous anterior chamber depth (AQD), pupil diameter and iris-IOL distance using the 2D scan at a 0° angle. Both an iris-IOL distance of 0 or less and an ACA of more than 70° were required to define an RPB. A total of 110 patients met the inclusion criteria, 41 were treated using the Carlevale, 33 the four flanged, 24 the Yamane and 12 the Scharioth technique, respectively. RPB was found in 32 patients (29%). Twenty patients with RPB were treated using YAG peripheral iridotomy, mean ACA decreased from 91.91° ± 13.77 to 61.02° ± 8.52, (p < 0.001), mean AQD decreased from 4.67 mm ± 0.47 to 4.31 ± 0.36 mm (p < 0.001) and mean iris-IOL distance increased from -0.09 ± 0.04 to 0.33 ± 0.30 (p < 0.001). RPB is found in a third of eyes who have undergone scleral fixated IOL implantation without iridectomy. YAG peripheral iridotomy is a potent option to treat RPB, and subsequently reduce the risk of iris chafing and secondary inflammation or glaucoma.

Breastfeeding Practices among Lactating Mothers in a City of South India

Introduction: Breast feeding is the first fundamental right of the child. It provides a unique biological andemotional basis for the health and development of the children. The world health organization recommends that breastfeeding be initiated within one hour of birth. Early initiation of breastfeeding provides benefits for both mother and the baby.Objectives: To assess the knowledge and attitude and practices about breast-feeding and complimentary feeding practices among lactating mothers attending Outpatient department (OPD) of tertiary care centre in a city of South India.Materials and Methods: It was a cross-sectional observational study done amongst post-natal mothers attending OPD in Sri Siddhartha Medical College, Tumkur between October to November 2022. Data collected was entered on Microsoft Excel spread sheet. Descriptive statistics and Chi –square test as test of significance were used. P value less than 0.05 was taken as statistically significant. Statistical software Epi Info software version 7.2.5 was used for the statistical analysis.Results: Data was collected from 104 post-natal mothers attending the OPD. All of them knew about importance of exclusive breast-feeding, colostrum feeding (100%). 99% of them knew breast feeding improves immunity. 95 (91%) of the participants were willing to continue breastfeeding up to two years and beyond. Only 16 (15.4%) mothers fed the baby on demand, others followed scheduled feeding like once in 1-2 hours, once in 2 to 3 hours.In our study 78.8% women started complimentary feeding at 6 months.Conclusion: Healthy breastfeeding practices have significant effect on mothers and infants. The breastfeeding knowledge and positive practices are optimal among mothers. Focused breastfeeding counselling and advice by the health workers with emphasis on correct technique can improve the positive breastfeeding practices.

Abstract LB221: Novel molecular targeted tumor targeted oncolytic peptide for the treatment of therapy resistant progressive neuroblastoma

Abstract Cancer treatments, particularly for solid tumors like neuroblastoma, often entail severe side effects, resistance, and the potential for secondary malignancies. To address these challenges, we explored an innovative approach employing tumor-targeting peptides. Recently, we unveiled the tumor evolution regulatory role of retinal-degeneration protein-3 (RD3) in therapy defying progressive tumors. Here in we investigated the therapeutic potential of RD3 peptides. Utilizing neuroblastoma, the most common cancer at infancy, as the tumor model, we investigated the delivery and therapeutic potential RD3 peptide. Five peptides representing unique regions, each with a C-terminal TAT tag for fluorescence and an N-terminal amide cap were developed. Peptide homing capabilities (Cell Tracking aasay) and relative potential in modifying metastatic state including invasion (Matrigel invasion assay), migration (scratch-wound assay), clonal expansion (LDTA) and tumorosphere formation (LDTA) was investigated utilizing patient derived clinical therapy defied progressive NB cells NB-EBc1 from adrenal mass and SK-N-FI from bone marrow. Whole genome RNA sequencing was performed using novogene (Illumina) platform. All peptides screened displayed tumor cell internalization and inflicted cell death at varying degrees. Among the five peptides investigated, two peptides (RD3 Pep-1 and RD3 Pep-3) profoundly inhibited cell proliferation, migration, invasion, and tumorosphere formation. A novel molecular targeted oncolytic peptide, validated through RNA sequencing, demonstrates promising efficacy for treating therapy-resistant progressive neuroblastoma. These outcomes uniquely highlight the therapeutic potential of RD3 peptides, offering a novel therapeutic candidate to counter therapy defying progressive disease. Further, the results defined the synergistic benefit RD3 peptide deliver with the current clinical maintenance therapy (GD2 immunotherapy for neuroblastoma). Together, these results identified a molecular targeted novel oncolytic peptide that could complement current standards of maintenance therapy for therapy defying progressive disease. Funding: This work was partially or in full, funded by Oklahoma Center for the Advancement of Science and Technology, OCAST-HR19-04; National Institutes of Health, NIH-P20GM103639 and; NIH-NCI- Cancer Center Support Grant P30CA225520 and Department of Defense DoD-CA210339. Citation Format: Dinesh Babu Somasundaram, Poorvi Subramanian, Sreenidhi Mohanvelu, Sheeja Aravindan, Natarajan Aravindan. Novel molecular targeted tumor targeted oncolytic peptide for the treatment of therapy resistant progressive neuroblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB221.

Pediatric Epistaxis-Effectiveness of Conservative Management.

Epistaxis is an emergency medical condition that sometimes requires admission to the emergency department. Pediatric epistaxis differs from epistaxis in the older population in terms of etiology, severity, and management. Our objective was to identify the distinctive features of pediatric epistaxis and determine the appropriate management. This was a retrospective study of 231 medical records of children (<18 years old) with epistaxis of a total of 1171 cases in the general population who presented to our medical center's emergency department between 2013 and 2018. Among 231 admissions, 10 children (4.3%) presented more than once. Male patients accounted for the majority of cases (64.5%), and the average age was 9.4 years. Two children were treated with aspirin because of cardiac valve disease. Anterior bleeding was detected in 101 cases (43.7%), whereas posterior origin was observed in 8 cases (3.5%). In 122 cases (52.8%), there was no active bleeding observed. Nose injury was the cause of epistaxis in 24 cases (10.4%), and 16 admissions (6.9%) followed nasal surgical interventions. Nineteen children (8%) had abnormal coagulation tests, and 7 patients (3%) received blood transfusions. Chemical cauterization was performed in 89 cases (39.3%), and anterior packing was needed in only 9 cases (3.9%). Nine children required hospitalization (3.9%), and 2 needed surgical intervention to control bleeding. Compared with the adult population, there were significantly fewer cases of active bleeding, recurrent epistaxis, anterior packing, or need for hospitalization in the pediatric population. Epistaxis is significantly less severe in the pediatric population, with only a few cases requiring major intervention. Endoscopic examination of the entire nasal cavity and routine coagulation tests are not mandatory unless there is a history of recurrent epistaxis, known coagulopathy, antiplatelet/anticoagulation therapy, or a suspicion of juvenile idiopathic angiofibroma. We suggest using absorbable packs, which offer advantages over cauterization or nonabsorbable packs.

Reappraisal of the Use of X-Rays in Acute Ankle and Midfoot Injuries. A Prospective Evaluation of the Ottawa Ankle Rules (OAR) in a Single Tertiary Trauma Centre

INTRODUCTION: Acute ankle and foot injuries commonly present to the emergency departments, often resulting in routine radiography referrals, despite the fact that less than 15% of cases exhibit clinically significant fractures. The OAR has been designed to reduce the number of unnecessary radiographs ordered for these patients. We evaluated the OAR for predicting ankle and midfoot fractures in a cohort of patients treated in a single tertiary trauma centre. MATERIALS AND METHOD: A prospective study was conducted in the emergency department and orthopaedic clinics of a tertiary trauma centre. 73 patients aged 18 years and older were recruited during a 12-month study period. Radiographs were performed for all patients after clinical evaluation findings were recorded. The main outcomes measured were sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios (positive and negative) of the OAR. RESULTS: 41 patients had ankle injuries, 21 around the midfoot, and 11 within both areas. In detecting ankle fractures, OAR had a sensitivity of 100%, a specificity of 73.68%, and a negative predictive value of 100% compared to the detection of midfoot fractures (100%, 84.61%, and 100%, respectively). The OAR had the potential of reducing radiographs by 42.47%. CONCLUSION: OAR is an accurate and highly sensitive tool to detect ankle and midfoot fractures. The implementation would lead to a significant reduction in the request for radiographs without missing any clinically significant fractures, thus, reducing costs, radiation exposures, and waiting times.

“Examining the link between tooth agenesis and papillary thyroid cancer: is there a risk factor?” Observational study

BackgroundMutations in one or multiple genes can lead to hypodontia and its characteristic features. Numerous studies have shown a strong genetic influence on the occurrence of hypodontia, and identified several genes, including AXIN2, EDA, FGF3, FGFR2, FGFR10, WNT10A, MSX1, and PAX9, that are directly associated with dental agenesis and carcinogenesis. The objective of this study was to investigate the occurrence and pattern of tooth agenesis, microdontia, and palatally displaced canine (PDC) in women diagnosed with papillary thyroid cancer (PTC), compared to a control group of women without any malignancy or thyroid disease.Materials and methodsThis case–control study was carried at the Department of Orthodontics, School of Dental Medicine University of Zagreb, and Department of Oncology and Nuclear Medicine Sestre Milosrdnice University Hospital Centre. The study involved a clinical examination and evaluation of dental status, panoramic X-ray analysis, and assessment of medical and family history of 116 female patients aged 20–40 with PTC, as well as 424 females in the control group who were of similar age.ResultsThe prevalence of hypodontia, microdontia, and PDC was statistically higher in women with PTC than in the control group. The prevalence rate of hypodontia was 11.3% in the experimental group and 3.5% in the control group. The experimental group showed a higher occurrence of missing upper lateral incisors, lower left central incisors, and all the third molars (except the upper left) compared to the control group. Women with PTC showed the prevalence of PDC significantly higher than the control group (3.5%, 0.7%, p = 0.002). The probability of hypodontia as a clinical finding increases 2.6 times, and microdontia occurs 7.7 times more frequently in women with PTC.ConclusionOur study suggests a possible link between odontogenesis and PTC. The absence of permanent teeth may increase the likelihood of PTC in women. Leveraging the age-7 orthopantomogram to identify women at high risk for PTC within a critical early detection window could significantly improve oral health outcomes and PTC prognosis through proactive interventions.

(126) Medicolegal Considerations for Patients Undergoing Urologic Surgical Interventions and the Development of an Audio-Recording Application for use During Genital Gender-Affirming Surgical Consultation

Abstract Introduction Patient recollection of details discussed during medical consultation is often limited (Figure 1a). For genital gender-affirming surgery (gGAS) consultations, lengthy discussions and deep contemplation surrounding surgical options are critical. Inadequate communication can result in patient complaints and medico-legal action, whereupon issues such as a lack of discussion or poor documentation can lead to medico-legal liability against the care provider and hospital system. As a result, strategies must be developed to ensure that information discussed during complex medical consultations are made available so patients can properly weigh out the care options presented. Objective 1) Assess medico-legal incidents in Urologic and surgical specialties in the UK, US, and a Californian quaternary care center, 2) evaluate the advantages and feasibility of offering audio-recordings of patient consultations, and 3) create a user-friendly smartphone app for recording healthcare consultations. Methods A literature review evaluated current evidence on medical liability claims in the UK and US was conducted. Additionally, our center's Department of Risk Management provided information pertaining to medico-legal cases against our institution. Separately, gGAS patients consented to audio-record their consultation. Copies were provided to patients and kept in their medical records. A follow-up survey assessed its usefulness, and based upon patient feedback, a smartphone application was developed. Results A PubMed search yielded 921 results on "medical malpractice claims" from 2013–2023. In Urologic Surgery, 32 papers addressed medical malpractice, with 2 providing data over the last 15 years. In the UK, 660 claims were made from 2010–2020, of which 8.2% were due to poor communication (37 = informed consent; 17 = lack of follow-up). In the US, from 2020–2022, 38.3% of Urologists faced at least one legal proceeding in their career, and 5.3% were sued within 1 year for any reason. Our institution's Department of Risk Management reported 32% of lawsuits were related to surgical care. Informed consent involved 8% of cases and had a component in 32%. The average financial settlement for medical malpractice was $125,000.00 USD, and trial costs averaged $75,000.00 USD. 50/71 patients completed an anonymized, online survey post-audio recording. Positive results were noted regarding recording quality, comfort whilst being recorded, and wishes for future consultation recordings (Figure 1b). In addition, most patients felt less anxiety, and had greater confidence in their treatment choice (Figure 1c) Based upon patient responses, we developed a smartphone App which records 90 minutes of audio, allows for file and hyperlink attachments to be sent to patients before immediately deleting all information (Figure 1d). Routine use of audio-recordings led to a reduction in patient queries to our office. Conclusions Routine audio recording of patient consultations provides significant benefits with minimal cost to providers. As per our institution's Office of Risk Management, it offers protection against medico-legal risks. Adequate discussion, good documentation and providing adjuncts for patients can help prevent a large proportion of medicolegal complaints in addition to optimizing patient care. Considering that patients face similar challenges across different disciplines and regions, a larger study (multi-center, international, multi-language) is warranted. Disclosure No.

Population Pharmacokinetics of Valproate in Children: The Importance of Total Daily Dose, Compliance and Co-Treatment

Abstract Valproate represents one of the most commonly used anticonvulsants worldwide, whose narrow therapeutic range and high potential for drug-drug interactions leads to pronounced intra- and inter-individual variability in plasma concentration and response. The aim of our study was to apply population pharmacokinetics analysis to comprehensively investigate and detect the most important factors affecting pharmacokinetics of valproate in Serbian children with epilepsy. This retrospective observational study was based on demographic and medical data retrieved from the medical records on epileptic patients treated with valproate at the pediatric department of the Clinical Centre, Kragujevac, Serbia. Valproate serum concentrations were obtained as a part of routine medical practice. Population pharmacokinetics analysis was performed by MonolixSuite 2019R1 (Lixoft, Antony, France) software, using one-compartment model with first order absorption and linear elimination. The study included 1642 valproate concentrations obtained from 232 patients, of which 201 (1420 concentrations) were included in the index set used for the modelling, while the other 31 (222 concentrations) were the validation set used for external validation of the final model. Covariate testing based on the whole index set revealed that only total daily valproate dose significanly affected the clearance of valproate: Cl (l/h)= 0.135×1.002DD. When only compliant patients were included, co-treatment with carbamazepine was shown to be of significance as well: Cl(l/h)=0.121×1.002DD×1.2CBZ. Our study demonstrated that valproate clearance correlates with total valproate daily dose. The influence of co-treatment with carbamazepine on valproate pharmacokinetics can be observed and used for clearance estimation only in compliant patients.