Common Treatment Modality Research Articles

Clinicopathologic profile of sinonasal neoplasia in Kano, Northwestern Nigeria: A 10-year single-institution experience.

Background:Sinonasal neoplasia comprises approximately 3% of all head-and-neck tumors. However, the incidence of these tumors may be greater in some parts of the world including Asia and Africa.Aim and Objective:The study aimed to review the clinical and histopathological pattern of sinonasal neoplasms in Kano, Nigeria.Materials and Methods:The records of patients managed for sinonasal neoplasia at the Department of Otorhinolaryngology, Aminu Kano Teaching Hospital, Kano, Nigeria, over a period of 10 years were reviewed. Information obtained from the case files included demographic characteristics, tumor characteristics, and clinical information. The data obtained were analyzed using SPSS version 23.Results:A total of 245 patients were reviewed with sinonasal neoplasms. Among these, 168 (68.57%) were males, with a sex ratio (M:F) of 2.18:1. The mean age was 40.2 ± 18.9 years. Malignant sinonasal neoplasm constituted 55.92%% of the sinonasal neoplasia, with peak age at the fifth decade. Squamous cell carcinoma was the most common histological subtypes seen in 50.36% of the patients. Inverted papilloma was the most common benign sinonasal neoplasia (42.59%). The most common symptom presented by the patients was nasal obstruction (77.55%), mostly presented within 6 months of onset of symptoms (63.67%), and farmers were the predominant (27.76%). The most common treatment modality was surgical extirpation (54%), and most of the patients presented with Stage IV disease (88%). The site of tumor was found to statistically correlate with the type of tumor among the patients (P ≤ 0.0001), whereas the type of tumor and site of tumor correlated significantly with the duration of symptoms before the presentation.Conclusion:Malignant sinonasal disease is the predominant sinonasal neoplasm in this environment, and most of the patients presented with advanced disease.

Treatment of localized prostate cancer and use of nomograms among urologists in the West Africa sub-region.

Introductionthere is a high incidence of prostate cancer among men of African descent. The disease tends to occur at an early age with a tendency to be aggressive. The objective was to determine the practice of urologists in the West African sub-region regarding treatment of localized prostate cancer, the use of nomograms and their perception of the usefulness of nomograms.Methodsthis was a cross-sectional study that involved urologists practicing in the West African sub-region attending urology and surgery conferences of the “Société Internationale d´Urologie”, West African college of surgeons and the Ghana association of urological surgeons. A structured questionnaire was used that sort to ascertain the treatment modalities used for localized prostate cancer and the use of nomograms in the sub-region. The study period spanned the years 2018 and 2019.Resultsfifty-six urologists practicing in eleven West African countries responded. Fifty percent had been in practice for less than 5 years. Sixty eight percent (38/56) had been involved in the treatment of localized prostate cancer. Radical prostatectomy was widely available and the treatment modality most used 94.7% (36/38). Nomograms was used by 57.9% of them (22/38) with the Partin tables being the most commonly used nomogram (34.2%). No Locally developed nomogram for treatment of localized prostate cancer was identified.Conclusionradical prostatectomy is the commonest treatment modality used for the management of localized prostate cancer in the West Africa sub-region. Majority of the urologists used nomograms with the Partin tables being the most used.

Frozen Shoulder: A Brief Review

Frozen shoulder, also known as adhesive capsulitis of the shoulder joint, is a very common and well-known entity in the field of pain medicine. The shoulder joint, being one of the most important and complex joint in the human body, gives much flexibility while compromising stability. But when flexibility is reduced, it causes much trouble and discomfort. Frozen shoulder is known for years but its definition, pathology, and treatment are yet to be standardized. In this article, there will be recapitulation of the anatomy, pathogenesis of frozen shoulder, and its correlation with clinical features in different stages, plus diagnosis of adhesive capsulitis on clinical examination as well as using advanced imaging techniques, will be discussed. The current available treatment modalities for frozen shoulder are also enumerated. Although newer imaging studies like arthrography, magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and ultrasound aid the diagnosis of frozen shoulder, clinical examination with exclusion of other pathology remains the mainstay and the most cost-effective way of diagnosis. The commonest treatment modality still being physiotherapy with some interventions; operative management is done only in very selected cases as the last option. Interventions like hydrodilatation of joint capsule and intraarticular platelet-rich plasma (PRP) have a very good role in management along with physiotherapy. It is recommended that ultrasound should be used routinely for the interventions in frozen shoulder.

Changing pattern of adult external abdominal hernias in Zaria

Background: External abdominal hernias are very common diseases encountered in surgical practice. A previous report from this centre 21 years ago documented the pattern of adult external abdominal hernias. However, there is an observed changing pattern. The aim of the study was to document the changing pattern, mode of presentation, treatment and outcome. Methods: It was a 5-year prospective study from January 2011 to December 2015. Adult patients with external abdominal hernia at our institution were studied. Information documented included patients' sociodemographic information, type of hernia, mode of presentation, treatment and outcome. Results: Six hundred and thirty-seven out of 4,083 patients with general surgical cases had external abdominal hernias (15.6%), with a male:female ratio of 3.1:1. The types of hernia were inguinal (451 [70.8%]), umbilical (83 [13.0%]), incisional (54 [8.5%]), epigastric (31 [4.9%]), femoral (14 [2.2%]) and others (4 [0.6%]). The common modes of presentation for inguinal hernias were simple (364 [80.7%]) and strangulated (42 [9.3%]). The most common mode of treatment for inguinal hernias was modified Bassini (265 [58.8%]). The common post-operative morbidities for groin hernias were wound infection (18 [3.9%]) and acute urinary retention (10 [2.2%]). The 3-year recurrence rate for groin hernias was 14 (3.0%). Mortality was three (0.5%) patients. Conclusion: The pattern of external abdominal hernias in our institution has changed with the descending order of occurrence as follows: inguinal, umbilical, incisional, epigastric and femoral. This is in contrast to previous reports where femoral was the second most common. Modified Bassini was the preferred method of repair of inguinal hernia due to its simplicity.

Systemic oxidative stress and antioxidant capacity in cancer patients

Various factors impact the outcome of patients with the diagnosis of cancer. Common treatment modalities of cancer, including surgery, radiation therapy and cytostatic agents, all lead to a systemic inflammatory reaction. In particular, this reaction is of physiological importance as it is crucial for patient recovery. However, in some patients, a self-perpetuating inflammatory response develops due to the presence of unfavorable risk factors, several of which are still unknown, but might lead to a worse disease prognosis. Inflammation has been intimately associated with oxidative stress, that is characterized by an imbalance between pro-oxidants, also termed reactive species, and antioxidants. Systemically, oxidative stress can be quantified by measuring thiols (R-SH, sulfhydryl compounds), which are considered to be regulatory nodes within the extracellular antioxidant network. Most importantly, thiol measurements in serum or plasma form a robust and powerful read-out of the in vivo reduction-oxidation (redox) status as thiols are highly redox-active and thus readily oxidized by circulating reactive species. Therefore, systemic quantification of thiols might be a valuable addition to the clinically available diagnostic and prognostic armamentarium as it is able to reliably capture the overall balance between oxidants and the antioxidant capacity of patients. In this review, we summarized the currently available literature on thiol levels as amendable markers for oxidative stress in patients with lung, prostate and colorectal cancer. Total thiols, native (free) thiols and disulfide levels are significantly altered in these patients compared to healthy individuals. In general, these findings indicate that the extracellular antioxidant capacity is severely affected in patients with these types of cancer. Moreover, lower thiol levels are associated with a lowered overall survival. Future research should focus on exploration of the clinical significance of thiols in cancer.

Plasmonic gel nanocomposites for detection of high energy electrons.

Radiation therapy is a common treatment modality employed in the treatment of cancer. High energy photons are the primary source of radiation but when administered, they leave an exit dose resulting in radiation damage to the adjacent healthy tissues. To overcome this, high energy electrons are employed in cases of skin cancer to minimize radiation induced toxicity. Despite these advances, measurement of delivered radiation remains a challenge due to limitations with existing dosimeters including labor intensive fabrication, complex read-out techniques and post-irradiation instability. To overcome these limitations, we have developed a novel colorimetric plasmonic gel nanocomposite for the detection of therapeutic levels of radiation delivered in electron beam therapy. The plasmonic nanocomposite consists of an agarose gel matrix encapsulating precursor gold ions, which are reduced to gold nanoparticles as a result of exposure to high energy electrons. The formation of gold nanoparticles renders a change in color to the agarose matrix, resulting in the formation of plasmonic gel nanocomposites. The intensity of the color formed exhibits a linear relation with the delivered electron dose, which can be quantified using absorbance spectroscopy. The plasmonic gel nanocomposites were able to detect doses employed in fractionated electron therapy, including in an anthropomorphic phantom used for planning radiation treatments in the clinic. Furthermore, the use of glutathione as a quenching agent facilitated qualitative and quantitative spatial mapping of the delivered dose. Our results indicate that the ease of fabrication, simplicity of detection and quantification using absorbance spectroscopy, determination of spatial dose profiles, and relatively low cost make the plasmonic gel nanocomposite technology attractive for detecting electron doses in the clinic.

30 Dementia and Falls

Abstract Cognitive impairment is a risk factor for falls and injury in older people. The profile of people with dementia reflects both physical and cognitive contributors to overall risk of falls. Over the years there have been a number of studies looking at falls and injury prevention in this high risk population. The approaches to intervention have varied with exercise being the most common modality of treatment. This presentation will unpack the role of cognition in postural stability and review the latest literature in the prevention of falls in older people with dementia. It will include presentation of data from a recently completed randomised controlled trial looking at a combined physiotherapy and occupational therapy intervention tailored to the participants’ cognitive abilities as well as pilot data looking at the feasibility of iPAD technology to deliver exercise to people with dementia in the home environment.

Prosthetic design related to peri-implant bone resorption in microvascular free fibular flap among patients with oral cancer: A retrospective clinical study

Statement of problemProsthetic rehabilitation is challenging after tumor excision in patients with oral cancer. Prosthetic parameters may be compromised because of the physical limitations of the oral cavity. Although microvascular free fibular flaps are a common treatment modality for mandibular reconstruction and allow the placement of dental implants, fibular resorption under long-term functional loading is still a controversial issue. Research focusing on how prosthetic design affects fibular resorption around dental implants in an oral cancer population is lacking. PurposeThe purpose of this retrospective clinical study was to correlate the success of implant-supported prostheses in microvascular free fibular flaps with occlusal force and fibular resorption around the implants 7 years after functional loading. Material and methodsThe T-Scan III was used to measure occlusal force in 13 participants with oral cancer. Forty-seven successful endosseous dental implants (Biomet 3i) under functional loading in the participants from 2010 to 2017 were analyzed retrospectively. Prosthetic design including fibular length, rehabilitated arch length, and crown-to-implant ratios was estimated from panoramic radiographs. The intergonial distance was used to calibrate the panoramic radiographs to enhance accuracy. To compensate for panoramic distortion, all parameters were represented as a ratio such as fibular length/mandibular width; implant-supported prosthesis length/mandibular dental arch length; implant-supported prosthesis length/maxillary dental arch length; and mandibular dental arch length/maxillary dental arch length. A generalized estimating equation was used for longitudinal analysis to estimate the impact of variables on fibular resorption around the implants. ResultsIncreased length of the implant-supported prostheses compared with maxillary and mandibular dental arch length significantly impaired the maximal occlusal force (P=.045 and P=.029). The crown-to-implant ratios in the fibular flaps were not correlated with fibular resorption around the implants under long-term functional occlusion (P>.05). The increased ratio of the implant-rehabilitated mandibular to maxillary dental arch length showed a statistically significant tendency to reduce fibular resorption around the implants (P=.007). ConclusionsCrown-to-implant ratios were not significantly correlated with maximal occlusal force or fibular resorption around dental implants. Increasing the length of the reconstructed mandibular implant-supported prosthesis in the fibular flap will reduce occlusal force. The rehabilitated mandibular dental length should be as long as the maxillary arch for optimum occlusal stress distribution to maintain the peri-implant fibula bone level.

Customizable Patient-Specific Cutting Guide for High Tibial Osteotomy

Abstract The paper is an interdisciplinary medical and engineering approach that aims to optimize the accuracy of the High Tibial Osteotomy surgical intervention. The axial deviations of the human inferior limb are presented in the first part of the paper. Without altering the shape of the bones, these deviations cause the wear of the knee’s articular cartilage by gonarthrosis. One of the most common and effective treatment modalities for eliminating axial deviations is High Tibial Osteotomy. Because the surgical procedure involves 3D spatial bone cutting, the accuracy of the procedure and thus the success of the operation and the recovery of the patient is dependent on the execution of these cuts. Within this paper, a specialized device is proposed that makes it possible to guide the surgical saw and to accurately perform the correction angles. In the last part of the paper, customization possibilities and fabrication of the main elements of the cutting device using Additive Manufacturing processes are presented.

Non-Surgical Periodontal Therapy - Evidence and Opinion.

Effective non-surgical periodontal therapy is fundamental to achieve and maintain periodontal health, particularly in individuals who are susceptible to periodontitis. This article aims to highlight current evidence and published guidance, together with personal insights and suggestions from the author's clinical experience to help with management of patients utilising this common treatment modality.

Primary Ocular Lymphoma: A SEER Database Analysis of Patterns of Involvement and Outcomes

BACKGROUND: Malignant lymphomatous involvement of the eye and its surrounding structures is a rare phenomenon. Due to the unique location, non-specific symptomatology, limitations for invasive procedures, physician experience, and significant effect on the quality of life related to vision, it poses many challenges in the diagnosis and management. Ocular involvement can be primary or secondary in lymphoma. Primary ocular lymphoma, based on its clinical and pathological characteristics, has been divided into 2 main groups: those involving the orbit and adnexal tissues including lacrimal gland, conjunctiva and cornea and, those affecting intra-ocular structures mainly vitreous and retina. We aim to evaluate the SEER database to assess patterns and outcomes in patients with primary ocular involvement with lymphoma. METHODS: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients (≥18 years) diagnosed with primary ocular lymphomas between 1975 and 2016. B-cell and T-cell lymphomas with stage I disease and primary site labeled as ocular (orbital, retina, conjunctiva, cornea, choroid, ciliary, lacrimal gland) were included. Treatment effect (surgery, radiation, systemic therapy) was analyzed when available.Overall survival (OS) was estimated using the Kaplan-Meier method and compared using the Log-Rank test. Cox proportional hazards models were used for adjusted survival analyses. RESULTS: We identified 3610 patients with primary lymphoma of the eye and adnexa. The median age was 66 years (18-103). 70% of the patients were Caucasians, followed by Hispanic (10%). Slight female preponderance was noted (55%). Most common site of involvement was orbit (n = 2063; 57%) followed by conjunctiva (n = 986; 27.3%). 8% (n = 292) of the patients were noted to have bilateral involvement. MALT (n = 2208; 61.2%) was the most common histology followed by DLBCL (n = 576; 16%) and follicular lymphoma (n = 519; 14.4%). Other histologies were rare (see Table 1). Most common treatment modality was radiation (n = 2117; 58.6%). Systemic therapy was utilized in only about 25% of the patients. Radiation treatment was associated with improved survival HR = 0.44 (0.23-0.83 95%CI, p = 0.01). Interestingly, patients that received systemic therapy had worse survival in univariate analysis (p<0.05) but was not significant in multivariate analysis. Site-specific survival suggested conjunctiva had the best median OS (19 years [16.3 - 21.7 95% CI]), followed by orbital and lacrimal gland involvement (median OS 12 years [10.92-13.23 95% CI]) - Figure 1. Retina (median OS 1.9 years) and choroid/ ciliary body (median OS 6.3 years) involvement were associated with shorter survival (p<0.05). DISCUSSION: Ocular lymphoma is a rare occurrence. Overall MALT was the most common subtype followed by DLBCL and FL. Very few instances of Burkitt's lymphoma, T-cell, and CLL were identified. Site-specific data in our subset, albeit with low numbers, suggest worse survival in the ciliary body and choroid similar to what is seen within vitreoretinal involvement. Due to small numbers in our subset, this requires confirmation in a larger dataset to identify potential change in management similar to primary vitreoretinal lymphoma, which is now recognized and managed as primary CNS lymphoma. Patients receiving systemic therapy showed a trend towards worse survival, which may be explained by a selection bias for more aggressive disease. Our study highlights the small but relevant prevalence of primary ocular lymphomas and reports the interesting observation of different survival patterns based on the site of involvement. Disclosures Yazbeck: Celgene: Membership on an entity's Board of Directors or advisory committees; Gilead Sciences: Research Funding; Seattle Genetics: Membership on an entity's Board of Directors or advisory committees.

Autophagy as one of the most important strategies for the treatment of tuberculosis; Mini-review

Cancer is defined as uncontrolled cell division, which could spread or invade various tissues. There are more than 200 types of cancer, including breast, skin, lung, colon, and prostate cancer, and lymphoma, the symptoms and indications of which vary depending on the type of tissues. Cancer has several treatments with different applications. For instance, chemotherapy, radiation therapy, surgery or their combination are common treatment modalities for cancer. However, a complete cure for cancer has not been achieved yet. On the other hand, novel drugs for cancer treatment are not efficient due to the ability of cancer cells to develop resistance against chemotherapeutic agents. Recently, natural compounds have been reported to improve the efficiency of cancer treatment. Polyunsaturated fatty acids (PUFAs) are natural compounds that could be used as dietary supplements in cancer patients. PUFAs are classified into two main categories, including n-3 and n-6 PUFAs. According to the literature, n-3 PUFAs exert protective effects against cancer through the induction of apoptotic pathways and suppressing cell proliferation, while n-6 PUFAs cause tumor formation by inducing cell growth and proliferation. Using PUFAs in combination with chemotherapeutic agents is considered to be an effective approach to the treatment of cancer patients through increasing cancer cell death. This review aimed to discuss the interactive effects of the structure and function of PUFAs on cancer and cell processes through various signaling pathways.

Acne in aesthetics: a common skin condition and the practitioner's role in helping

This article will provide a general overview of the pathophysiology of acne presentations that may be seen in aesthetic practice, as well as common problems associated with acne. Some of the common treatment modalities that can be used in aesthetic practice will then be discussed. By doing this, the author hopes that aesthetic practitioners will be more confident and more able to manage clients with this potentially debilitating condition.

PMD12 UNDERSTANDING THE ECONOMIC IMPACT OF THERAPEUTIC PLASMA EXCHANGE: A SINGLE INSTITUTION STUDY IN PUNE, INDIA

Therapeutic plasma exchange (TPE) is a procedure that removes large volume of plasma from a patient. Through the bulk removal and replacement of plasma, pathogenic substances that cause underlying disease such as antibodies, endotoxins, circulating immune complexes and cholesterol-containing lipoproteins were removed. It is a common treatment modality in management of various renal, hematological and neurological diseases. Plasma exchange can be performed using centrifugal (c) or membrane (m) filtration method. This study assessed the cost associated with these techniques from public payer perspective. TPE utilization and cost data were collected from nephrology department, Deenanath Mangeshkar Hospital, Pune, India. A cost benefit analysis model was created on Excel spreadsheet using micro-costing approach with the following cost component; device acquisition, maintenance, consumables, venous access, replacement fluids, labor. Data on procedure efficiency and clotting frequency were sought from published literatures. Clotting was defined as requiring filter replacement to continue procedure. The model assumed similar clinical outcome in these techniques. Sensitivity analysis was conducted with increase number of TPE procedures on centrifugal technique. A total of 166 TPE procedures were performed annually; membrane (90%) and centrifugal (10%). In the sensitivity analysis, converting 90% mTPE to cTPE, cost per procedure for centrifugal and mTPE was estimated at USD 261 (INR 18,117), rounded to nearest integer, and USD 371 (INR 25,763), respectively. Plasma exchange with membrane technique cost the payer additional USD 110 (INR 7,646) for each TPE procedure. Additional savings of USD 29 (INR 2000) was expected for each cTPE procedure with peripheral access. The projected annual cost savings with predominant use of centrifugal technique was USD 33,210 (INR 2,305,392). The economic evaluation between these two plasma exchange methods showed centrifugal TPE had a better cost benefit than membrane TPE.

Surveillance Imaging After Curative Intent Therapy for Lung Cancer

Abstract • Brief description of lung cancer history, screening, and prognosis. • Discussion of curative intent treatment modalities including various types of systemic therapies, radiotherapy, and surgical resection. • Review of the complications associated with common treatment modalities. • Brief overview in defining treatment response to definitive therapy. • In depth review of the current clinical evidence and practices as well as upcoming modalities for surveillance imaging after curative intent lung cancer treatment.

Coenzyme Q10 mitigates ionizing radiation-induced testicular damage in rats through inhibition of oxidative stress and mitochondria-mediated apoptotic cell death

Radiotherapy is a common treatment modality for cancer patients; however, its use is limited by decreasing the probability of fertility in male cancer survivors. Therefore, this study aimed to define the capability of coenzyme Q10 (CoQ10), a potent stimulator of mitochondrial function, in attenuating ionizing radiation (IR)-induced spermatogenesis impairments. Male Sprague Dawley rats were exposed to a single dose of ϒ-rays (10 Gy) and/or treated with CoQ10 (10 mg/kg, orally, for 2 consecutive weeks). IR mediated irregular seminiferous tubules, which were emerged with typical morphological characteristics of apoptosis, and nuclear condensation, while CoQ10 significantly preserved the testicular structure and maintained spermatogenesis, which was displayed by higher levels of serum estradiol and testosterone. CoQ10 remarkably augmented sperm count, motility, and viability while diminished the rate of sperm-defects relatively to their counterparts after IR exposure. CoQ10 modulations in reproductive parameters were underpinned by attenuating IR-induced oxidative stress as evidenced by decreasing lipid peroxidation and increasing the antioxidant enzymes glutathione peroxidase and glutathione-s-transferase activities, and glutathione level. Supporting the involvement of CoQ10 in the anti-apoptotic response, the reduced mRNA expression levels of p53, Puma, and Bax accompanied by the increased Bcl-2 mRNA expression were observed. Subsequently, CoQ10 ameliorated the mitochondria dependent apoptotic pathway through diminishing Bax/Bcl-2 ratio, caspase-3 protein expression, and DNA fragmentation in testes of irradiated rats. Taken together, our findings showed that CoQ10 conserved against IR-induced steroidogenesis disruption through subsiding mitochondria-mediated oxidative stress injury in germinal cells.

Surgical management of benign prostatic obstruction: 20-year population-level trends.

Benign prostatic obstruction (BPO) due to histological benign prostatic hyperplasia is highly prevalent among older men. Despite widespread use of medical therapy, surgical treatment remains a mainstay in the management of BPO. We sought to characterize trends in the surgical management of BPO in Ontario, Canada. We performed an interrupted time-series analysis using segmented regression among men aged 18 years and older undergoing surgical treatment for BPO between January 1, 1994 and December 31, 2014 in Ontario, Canada. The passage of time was considered the primary exposure. The primary outcome was the proportion of all BPO surgeries performed using each of the following modalities: transurethral resection of the prostate (TURP), endoscopic laser prostatectomy, open/laparoscopic prostatectomy, and others. We identified 136 459 men who underwent BPO surgery between 1994 and 2014. The annual age-adjusted rate of BPO surgery declined significantly over time (24 to 10 per 10 000 population in 1994 and 2014, respectively). From 1994-2001, there were no significant changes in the distribution of BPO surgical modalities, with TURP the most common throughout (97.2% and 97% in 1994 and 2001, respectively). From 2002-2014, there was a significant decline in the use of TURP (92.1% to 76.9%; p=0.027) with a corresponding increase in the use of endoscopic laser prostatectomy (3.5% to 21.9%; p=0.0008). This study demonstrates a shift in the management of BPO, with increasing use of endoscopic laser prostatectomy, beginning in 2002. However, TURP remains the most common treatment modality.

Evaluation and management of diabetic foot according to Wagner’s classification

Aims and Objectives: To re-evaluate role of Wagner’s classification in the Study and Management of diabetic Foot in patient admitted to tertiary care hospital. Materials and Methods: This hospital based observational study was conducted in the department of General Surgery at tertiary care hospital from July 2017 to August 2018. This study included 47 cases of Diabetic foot patients in which management protocol according to Wagner’s Classification was studied. Data was collected from hospital records which includes history, physical examination, investigations, treatment and follow up at discharge was collected.Results: The most common age of presentation in patients with diabetic foot lesion was between 41-60 yrs. In this study, out of 47 patients, 32 patients (68.1%) were male and 15 patients (31.9%) were female. The most common site was foot in 29 patients (61.7%). Out of 47 cases studied, 28 cases were having history of trauma, which account for 59.6% of the total cases. Amputation was the most common treatment modality. In this study of 47 patients, 11 patient required local debridement after initial surgery. Out of 47 cases; 42 patients ulcers were healed, 5 patients ulcer were not healed (4%).Conclusion: Diabetic patients have always suffered from complication affecting the lower limbs. Foot infection and subsequent amputation of lower extremities are the most common cause of hospitalization among diabetic foot patients. Prevention strategy including patient’s education in foot care, prophylactic skin and nail care, and footwear reduces the risk of foot ulceration and lower limb amputation by 25%.

1077 Liver Cancer in Ethiopia: Presentation, Prognosis, and Therapy

INTRODUCTION: Sub-Saharan Africa exposes one of the largest burdens of morbidity and mortality from Hepatocellular carcinoma (HCC). However, there is little information about HCC presentation and outcomes form the region. In this study we describe clinical characteristics and therapeutic approach to HCC in a single center in Ethiopia. METHODS: We retrospectively evaluated clinical charts of individuals that presented with HCC at a major referral clinic in Addis Ababa, Ethiopia from 2016 to 2018. Diagnosis of HCC was performed via biopsy or imaging criteria as established by AASLD guidelines. Survival was determined as date of last visit, and calculated in days from initial diagnosis visit. Those individuals with initial and last visit of less than seven days were removed from survival analysis. Mann-Whitney test was used for survival assessment. RESULTS: Forty-six cases are reported. The median age was 54 years (IQR 45-62) and 50% were females. Forty-one percent of individuals had hepatitis B (HBV) as underlying liver disease, 45% had hepatitis C (HCV) and the rest were classified as “other”. There was no association between region of origin and HBV-related HCC. Seventy-eight percent (N:36) of cases had evidence cirrhosis on presentation. Median age of HCC diagnosis was 54 years (IQR 45-62) in all patients and 48 years (IQR 19-38) in those infected with HBV. Median tumor size was 6.5cm (IQR 4.5-6.9) and median MELD score was 12 (IQR 8-17). The median survival in the entire cohort was 68 days (IQR 17-334). The most common treatment modalities were trans-arterial chemoembolization (TACE, 16%), Sorafenib (18%) and Palliative care (31%), with median survival being 351, 94 and 27 days, respectively. There was no correlation between MELD score and survival at 6 months. Twenty percent of all individuals were treated with sorafenib (N:9). Median survival in this group was 92 days (IQR 24-121), despite almost all of them having AFP >400ng/ml. Interestingly, a neutrophil-to-lymphocyte ratio (NLR) of < 2.5 correlated with better survival (109 days vs 68 days for those with NLR >2.5, P = 0.01). CONCLUSION: We found younger diagnosis of HCC in individuals infected with HBV. The great majority of patients received non-curative therapy. A small sub-group of individuals showed a reasonable survival benefit with sorafenib.

EP1.01-57 Clinical Profile and Treatment Outcomes of NSCLC in Elderly Subjects with Poor Performance Status from India

Elderly population and subjects with poor performance status (PS) are generally excluded from Lung cancer (LC) trials evaluating various treatment modalities, and their outcome is unclear. Herein, we report the clinical profile, treatment and overall survival (OS) of elderly non-small cell LC (NSCLC) subjects with poor PS. We retrospectively reviewed our database (from Jan 2016-Dec 2017) to identify NSCLC subjects aged ≥65 years and having an Eastern cooperative oncology group PS (ECOG-PS) ≥2 at presentation. Demographic profile, treatment details, PS after treatment and OS (as on 15th November 2018) were retrieved. We also report the incidence of grade 3 or 4 adverse events (AE) following chemotherapy. 122 patients with a median (interquartile range [IQR]) age of 72.5 (65-88) years were included. Majority were men (86.1%) and smokers (79.5%). ECOG-PS was 2, 3 and 4 in 64.8%, 27.9% and 7.4% patients. Squamous cell carcinoma (53, 43.4%) and adenocarcinoma (51, 41.8%) were the most common histologic subtypes. 69% had TNM (8th edition) stage IV (A in 41%, B in 28%) and 26% had stage III (IIIA 8%, IIIB 10% and IIIC in 8%). Chemotherapy with or without radiotherapy (86%), tyrosine kinase inhibitors (6%) and immunotherapy (1%) were the common treatment modalities, while 10 patients did not receive any treatment. In whom response could be assessed (n=61), the best response achieved was partial response in 38%, stable disease in 49%, complete response in 5% and progressive disease in 8%. Of the subjects undergoing chemotherapy (n=102), 33 experienced grade 3 or 4 AE and 14 subjects had to discontinue chemotherapy before 4 cycles. ECOG PS improved to 0/1 in 22 (19.6%) subjects who underwent any form of treatment. The median survival of the study cohort was 250 days. On a multivariate analysis, the presence of brain metastases was associated with poor OS (HR [95% CI] 7.6 [1.4-41.6]) Most of the Elderly patients with NSCLC and poor PS had an advanced stage at presentation. Majority tolerate chemotherapy well and some have an improvement in their PS. The presence of brain metastases is associated with a poor survival.