Extensive History Research Articles

Timing of inopressor initiation in patients with acute myocardial infarction complicated by cardiogenic shock

Abstract Introduction Inotropes and vasopressors (inopressors) are commonly used in the treatment of acute myocardial infarction complicated by cardiogenic shock (AMICS). The characteristics of patients subjected to early or late initiation of inopressors are not yet described, and the impact of timing on outcomes remains uncertain. Purpose This retrospective real-world data study aims to identify patient-, treatment-, and outcome characteristics of AMICS patients treated with early- or late initiated inopressors. Methods The Netherlands Heart Registration (NHR) prospectively records baseline, procedural, and outcome data for PCI patients. Between 2017-2021, additional retrospective data on CS patients were collected by fourteen Dutch hospitals. Patients were categorized based on the timing of inopressor initiation, either early (pre PCI) or solely late (at the cathlab or within 24 hours after PCI). Patients presenting with an out of hospital cardiac arrest were excluded. Missing data were imputed through multiple imputation (30x). Multivariable logistic regression analysis was performed to evaluate the association between the timing of inopressor initiation and 30-day mortality, adjusting for univariate significant confounders among variables known at admission. Results A total of 956 consecutive CS patients were included of whom 418 (43.7%) and 538 (57.3%) patients were subjected to early and late initiation of inopressors respectively. The most frequently used drug in both groups was noradrenaline. At baseline, patients in the early initiation group were younger (67.4 vs. 70.0 years, p <0.001), presented with a lower mean arterial pressure (MAP) (72.5 vs. 76.3, p = 0.048) and higher lactate (4.2 vs. 3.6, p = 0.012), and presented with a NSTEMI more often (36.0% vs. 14.2%, p <0.001). They also had a higher prevalence of previous myocardial infarction (33.9% vs. 22.9%, p <0.001) and previous CABG (14.3% vs. 6.2%, p <0.001). Moreover, 30-day mortality rates were higher in the early initiated group (48.6% vs. 37.6%, pLogrank <0.001). After multivariate adjustment for age, admission MAP and lactate, early inopressor initiation remained independently associated with 30-day mortality (OR 1.44, 95%-CI 1.08-1.98) compared to late initiation. Conclusion In this Dutch cohort of CS patients undergoing PCI, baseline- treatment- and outcome characteristics differed between patient categories receiving either early or late initiated inopressors. Patients who were subjected to early initiated inopressors were younger, presented with worse hemodynamics, had a more extensive cardiovascular medical history and higher 30-day mortality rates. The results of this study reemphasize the importance of identifying patients who benefit from inopressors.30-day mortality late vs. earlyTable patient characteristics

Complicated thermo-chemical heterogeneity of the mantle transition zone beneath the Philippine Sea Plate revealed by SS precursors investigation

The Philippine Sea Plate (PSP), a region renowned for its intricate history of multi-stage subduction and back-arc extension, encounters difficulties in elucidating its deep seismic structure, primarily due to the sparse distribution of seismic stations. This study uses over 44,086 traces of SS precursors collected from >1,000 seismic stations over 10–20 years period, to image the mantle transition zone (MTZ) beneath the PSP. With the curvelet denoising technique, we provide high-resolution maps of the depths of the 410 km (D410) and 660 km (D660) discontinuities and the thickness of the MTZ. Notably, we demonstrate a 10–35 km MTZ thickening extending from the West Philippine Basin to the Shikoku Basin, which may be associated with the thermal effect and dehydration of stagnated slabs in the MTZ. Furthermore, the reflection gap and multiple reflectors were both observed in D410 and D660 beneath the Mariana Trench, which suggests that the vertically subducted Pacific plate transports substantial water and non-olivine components into the MTZ in this area. Additionally, a ∼10–25 km MTZ thinning with an abnormally shallow D660 has been observed beneath the Parece Vela Basin and Caroline Plate in the southern PSP, suggesting the potential existence of thermal upwelling from a secondary plume, which may be possibly the tree branch of the Caroline mantle plume in MTZ. Our results provide new seismological constraints on present and past mantle dynamics in and around the PSP.

A woman with mycosis fungoides, vitiligo, and a new hand nodule.

A 70-year-old African American female with a history of stage IV mycosis fungoides in remission presented with a gradually enlarging, red, ulcerated nodule on her right dorsal hand. The lesion was biopsied, and it showed intraepidermal proliferation with cytologic atypia and increased vasculature in the papillary dermis. Immunohistochemical staining indicated a yes-associated protein 1 (YAP1) rearrangement, confirmed by RNA sequencing, revealing a YAP1::MAML2 (mastermind-like transcriptional coactivator 2) fusion. The lesion was diagnosed as an eccrine porocarcinoma (EPC). The occurrence of EPCs following radiotherapy or trauma has been documented. This case highlights the importance of considering EPCs in patients with extensive skin treatments and immunosuppression history.

A rare and underestimated cause of anion gap metabolic acidosis in a pediatric patient

Abstract Recognized causes of anion gap metabolic acidosis include methanol, uremia, diabetic ketoacidosis, propylene glycol, isoniazid, iron, lactic acidosis, ethylene glycol, and salicylates, which is taught as the mnemonic, MUDPILES. While this mnemonic can be a useful learning tool, it is important to consider other, atypical causes. Here, we present the case of a 9-year-old male patient with a complex medical history, including trisomy 21 and Lennox-Gastaut syndrome who presented to the emergency department (ED) in hypotensive shock. Upon admission, he was noted to have a distended abdomen, evidence of acute pancreatitis and possible sepsis. Of note, his initial labs revealed an anion gap of 30.1 mmol/L, a whole blood lactate of 4.4 mmol/L, a pH of 7.2, and a normal pCO2, indicting an anion gap metabolic acidosis. Importantly, methanol, ethylene glycol, ketones, and salicylates were not detected, and renal function was normal. However, he did have an extensive medication history, including several antiepileptic drugs (AEDs). Over the coming weeks, he recovered from the acute pancreatitis, but developed fluid overload, electrolyte derangements (hypernatremia and hypokalemia), a worsening metabolic acidosis with an anion gap up to 54.6 mmol/L, and hyperammonemia (plasma NH3 of 232 μmol/L). At this point, the metabolism team was contacted for concerns regarding the rising ammonia levels, which subsequently responded to a combination of lactulose and Rifaximin. An inborn error of metabolism (IEM) was considered, and plasma amino acid analysis was performed (Waters Acquity MassTrak AAA solution) but was not diagnostic. Notably, the patient developed a significantly elevated gamma glutamyl transpeptidase (GGT) up to 4088 U/L, suggesting glutathione depletion, however, transaminases and alkaline phosphatase were normal. The laboratory was contacted by the metabolism providers for other possible causes of metabolic acidosis and it was suggested that the patient undergo urine organic acid testing. Urine specimens were analyzed using gas chromatography/mass spectrometry (GC/MS) (Aligent system). The results were notable for marked excretion of pyroglutamic acid (5-oxoproline), which is typically associated with acetaminophen, however, the patient’s acetaminophen levels were less than 5 μg/mL, indicating another, atypical cause of increased pyroglutamic acid. In this case, vigabatrin, an anticonvulsant known to cause glutathione depletion and secondary pyroglutamic aciduria was suspected, and subsequently withdrawn. The patient was also started on a trial of N-acetylcysteine (NAC) to replenish glutathione, which resolved the pyroglutamic aciduria and anion gap, and corrected the metabolic acidosis. This case highlights the importance of recognizing pyroglutamic acid as a rare cause of anion gap metabolic acidosis, even in the setting of normal acetaminophen levels, and the importance of organic acid testing in the work-up of such patients. Wider use of the mnemonic GOLD MARK, where the “O” stands for oxoproline, may help in the differential diagnosis of anion gap metabolic acidosis.

Seven Identities Co-existing, A Noteworthy Manifestation of Complex Childhood Trauma: A Case Report

Background Childhood trauma increases the risk for psychiatric disorders such as Dissociative Identity Disorder (DID), Other Specified Dissociative Disorder (OSDD), Depersonalisation/Derealisation disorder (DDD), Post-Traumatic Stress Disorder Dissociative Type (D-PTSD), and Borderline Personality Disorder (BPD). Children who experience prolonged stress, trauma, or abuse during developmental years of growth and change have a wide range of outcomes. Case Presentation We report a case of a 22-year-old female with a significant history of physical abuse and sexual assault who initially presented to the hospital for suicidal ideation with a stated plan. During the patient’s stay at the hospital, we encountered two of the six alternate identities of the patient. The patient revealed she experiences all 7 identities (her true self plus 6 alters) in parallel, recalls the events of each alter, and can intermittently switch between identities; all rare features of dissociative disorders. Conclusion Given our patient’s extensive history of trauma, previous psychiatric diagnoses, and current dissociative presentation, we conclude that a diagnosis of OSDD and defence mechanisms of dissociation and regression may be appropriate. The patient was discharged with clomipramine for Obsessive-Compulsive Disorder and mood, lurasidone for mood, mirtazapine for mood, insomnia, and appetite stimulation, clonidine for nightmares and Postural Orthostatic Tachycardia Syndrome (POTS), fludrocortisone for POTS, gabapentin for Generalized Anxiety and fibromyalgia, and levothyroxine for hypothyroidism, and counselled to follow up with an outpatient therapist specialising in trauma. This case highlights the impact that childhood physical, sexual, and emotional trauma can have on one’s psychiatric presentation and the complexity of diagnosing dissociative presentations in an inpatient psychiatry setting.

Some Applications of Hericium erinaceus Mushrooms: A Review

The Lion's Mane mushroom, which has the scientific name Hericium erinaceus, can be defined as a medicinal fungus type. For very long time, it has been utilized in the conventional medicine in Asia for a variety of purposes. In the past few years, there had been a great deal of interest directed towards potential benefits to the health, which could be provided by this unique type of mushroom in particular, when it comes to the treatment of various diseases. The concentration will be focused on examining the way that Hericium erinaceus as well as its bioactive elements could be utilized for therapeutic purposes within the area od disease control. This review states the possible Hericium erinaceus advantages in cases that are related to some health issues, such as metabolic problems, gastrointestinal diseases, neurodegenerative disorders, and immune system problems. In addition to that, the present paper discusses the work that is used for providing the therapeutic effects. It is stated that some of the characteristics of the Hericium erinaceus include having anti-inflammatory, neuro-protective, anti-oxidant, and immune-modulatory effects. Even though more studies are needed for detailed understanding of all the mechanisms that are involved in its activities, presenting evidences that strongly suggest possible Hericium erinaceus uses as one of the natural cures for a variety of illnesses, it is known as well in some cases as lion's mane mushroom, which fungus type that comes with extensive history and many potential advantages. As a result of its distinctive morphology, including bio-active compounds, in addition to its conventional uses have combined to the generation of much interest in a variety of areas. More research is needed for full understanding of the way that it works for the therapeutic applications and its potential implementations in the area of nutrition, cooking, and medicine. The cultivation of Hericium erinaceus might be viewed as an activity of conservation and business production.

Deciphering the multi- partite mitochondrial genome of Crataegus pinnatifida: insights into the evolution and genetics of cultivated Hawthorn

Flowering plant (angiosperm) mitochondrial genomes are remarkably dynamic in their structures. We present the complete mitochondrial genome of hawthorn (Crataegus pinnatifida Bunge), a shrub that bears fruit and is celebrated for its extensive medicinal history. We successfully assembled the hawthorn mitogenome utilizing the PacBio long-read sequencing technique, which yielded 799,862 reads, and the Illumina novaseq6000 sequencing platform, which producing 6.6 million raw paired reads. The C. pinnatifida mitochondria sequences encompassed a total length of 440,295 bp with a GC content of 45.42%. The genome annotates 54 genes, including 34 that encode proteins, 17 that encode tRNA, and three genes for rRNA. A fascinating interplay was observed between the chloroplast and mitochondrial genomes, which share 17 homologous sequences sequences that rotal 1,933 bp. A total of 134 SSRs, 22 tandem repeats and 42 dispersed repeats were identified in the mitogenome. Four conformations of C. pinnatifida mitochondria sequences recombination were verified through PCR experiments and Sanger sequencing, and C. pinnatifida mitogenome is more likely to be assembled into three circular-mapping chromosomes. All the RNA editing sites that were identified C-U edits, which predominantly occurred at the first and second positions of the codons. Phylogenetic and collinearity analyses identified the evolutionary trajectory of C. pinnatifida, which reinforced the genetic identity of the hawthorn section. This unveiling of the unique multi-partite structure of the hawthorn mitogenome offers a foundational reference for future study into the evolution and genetics of C. pinnatifida.

7630 Incidental Calvarial Brown Tumor in an ESRD patient with seizures

Abstract Disclosure: K.N. Pereira: None. V. mehta: None. S. Sekaran: None. M. Renzu: None. Brown Tumor [BT], also known as Osteitis fibrosa cystica [OFC], is a rare tertiary manifestation of hyperparathyroidism [HPTH]. BT commonly affects the maxilla/mandible, long bones and spine and presents as lytic bone lesions on imaging. Among the crania-facial bones, the maxilla, palate, temporal bone, nasal cavity, orbital bone and paranasal sinuses are affected. We describe a case of a 37 year old African-American female with extensive medical history including ESRD on hemodialysis who initially presented to the hospital with hypertensive emergency in the setting of 1 week of missed dialysis. During her presentation, she had an unexplained seizure which led to further workup with imaging. CT head revealed findings suspicious of renal osteodystrophy as well as a discrete lucency at the calvarial vertex suggestive of a brown tumor. Endocrinological studies were noted to have very high PTH levels with hypercalcemia, hyperphosphatemia and vitamin D deficiency indicative of tertiary hyperparathyroidism. Based on her clinical presentation, labs and imaging, her bone disease including BT and pathologic fractures, was deemed to be due to tertiary hyperparathyroidism in the setting of ESRD, which were not amenable to surgical intervention. Extensive literature review did not reveal any reported BTs in the calvarial vertex. This case emphasizes on the holistic approach to diagnosis of BTs and underlines that fact that BT can occur in any cortical bone including unusual presentation sites like the calvarial vertex. Presentation: 6/3/2024

Exploring the Role of Folklore in Sustaining Cultural Tourism in Meghalaya

Meghalaya, known for its colourful customs, extensive oral history, and breathtaking scenery, has emerged as a major destination for cultural tourism in Northeastern India. The region's identity is fundamentally shaped by the rich history of customs, rituals, and folklore upheld by its indigenous groups, which are predominantly the Khasi, Garo, and Jaintia tribes. In Meghalaya, cultural tourism has grown to be a substantial industry, drawing tourists from both home and abroad who are interested in learning more about the distinctive traditions, celebrations, artwork, folklore storytellers, and way of life of the local tribes. This study explores the function of cultural tourism in Meghalaya, emphasizing how it advances sustainable tourism, cultural heritage preservation, and socioeconomic development. The state’s cultural tourism revolves around festivals, traditions, and folklore, these celebrations provide guests with the excitement of Meghalaya's dynamic culture as ancient myths, stories, songs, enchanting festivals, and traditional ceremonies, which play a vital role in supporting and advancing cultural tourism and provides an unforgettable adventure into the core of indigenous heritage. Furthermore, the study looks at how folklore tourism gives local people the chance to become more economically empowered through guided storytelling and ensuring the preservation of tourism centred around the folklore stories of Meghalaya which is crucial for sustaining the strong cultural legacy of its native communities, providing tourists with a more profound link to the ancient traditions and intriguing legends of the region.

8216 When calcium makes you breathless, exploring hypocalcemia-induced bronchospasm

Abstract Disclosure: K.N. Pereira: None. V. Sundaram: None. H.S. Sreemantula: None. When calcium makes you breathless, exploring hypocalcemia-induced bronchospasm Hypocalcemia, characterized by low levels of serum calcium, is an uncommon yet potentially life-threatening condition with various clinical manifestations. This case report delves into an unusual manifestation of hypocalcemia-induced bronchospasm in a 54-year-old male with an extensive medical history, including chronic kidney disease, insulin-dependent type 2 diabetes mellitus, hypertension, hyperlipidemia, ascending aortic aneurysm and hyperthyroidism. Despite multiple interventions in the emergency department like nebulized bronchodilators and intravenous steroids, his 4 day misery of respiratory distress persisted. Physical exam was notable for tachypnea, audible wheezing, and accessory muscle use for respiration. Work up was negative for infectious and pulmonary causes including asthma or chronic obstructive pulmonary disease. However, his laboratory results unveiled severe hypocalcemia (calcium: 5.7 mg/dL), elevated creatinine (Cr: 5.90), and blood urea nitrogen (BUN: 64), profound vitamin D deficiency with a 25-OH vitamin D level below 7 and elevated parathyroid hormone (PTH- 375.7). He was ultimately diagnosed with hypocalcemia-induced bronchospasm as intravenous calcium gluconate administration led to gradual respiratory improvement. This case highlights the necessity of considering hypocalcemia-induced bronchospasm in respiratory distress differentials, even in patients with concurrent asthma or COPD histories. The rarity of this presentation, coupled with the patient's complex medical history, underscores diagnostic challenges, necessitating a high index of suspicion. Timely hypocalcemia assessment and calcium replenishment are vital in averting mortality linked to this unusual manifestation. Clinicians must exercise caution to prevent misinterpreting symptoms as asthma or COPD exacerbation, as this could lead to potentially fatal outcomes. Presentation: 6/1/2024

8075 Euglycemic Diabetic Ketoacidosis Associated With Cocaine Use

Abstract Disclosure: N.N. Solanki: None. A.N. Kiani: None. M. Feldman: None. Euglycemic diabetic ketoacidosis (EDKA) is characterized by increased anion gap metabolic acidosis, ketonemia or ketonuria, and normal blood glucose levels (<200 mg/dL). Due to the absence of hyperglycemia, it commonly presents as a diagnostic and therapeutic dilemma. EDKA is commonly associated with decreased caloric intake, sodium-glucose cotransporter-2 (SGLT-2) inhibitors, recent use of insulin, heavy alcohol consumption, chronic liver disease, glycogen storage disorders, and drug-induced intoxication. Cocaine use is a lesser-known etiology for EDKA. We present a case of a 64-year-old female with a history of type 2 diabetes mellitus who presented with complaints of decreased oral intake for two days secondary to nausea and vomiting and productive cough for one week, along with cocaine use. Despite an extensive history of diabetes and no recent SGLT-2 inhibitor use, her labs were consistent with euglycemic DKA. Her imaging and further investigations revealed respiratory syncytial virus pneumonia. The patient was initially managed for starvation ketoacidosis with fluid resuscitation with no improvement in acidosis and later treated with DKA protocol with rapid correction of her anion gap metabolic acidosis. This case highlights the challenges associated with diagnosing and treating EDKA. Early initiation of DKA protocol should be considered in diabetic patients presenting with euglycemia with high anion gap metabolic acidosis with a clinical picture of starvation and cocaine use. Presentation: 6/3/2024

Using RS and GIS for risk management of natural disasters consequences: The case of cultural heritage in Jinan city, China

The preservation of cultural heritage is confronted with significant challenges due to its extensive history and the increasing impact of climate change, particularly natural disasters. Instead of solely investing resources in post-disaster restoration efforts, implementing a proactive risk-management strategy for natural disasters is a more effective approach. This study introduces an analytical and evaluative methodology grounded in remote sensing (RS) and geographic information systems (GIS) to bridge the existing gap in understanding natural disaster risks to cultural heritage sites in Jinan, China. By leveraging a combination of RS data and established methodologies such as the Soil Conservation Service Curve Number, Maximum entropy, and the Revised Universal Soil Loss Equation, we conducted an in-depth analysis of the risks posed by various disasters including floods, landslides, earthquakes, and erosion. Furthermore, GIS and the Analytic Hierarchy Process were utilized to facilitate the risk assessment. Detailed disaster risk maps based on these assessments were produced. Our findings revealed that approximately 28.95 % of Jinan's cultural heritage sites face moderate to severe risks from natural disasters. Cultural heritage sites in Changqing District, Gangcheng District, and Laiwu District are particularly vulnerable to such calamities. These outcomes serve as crucial references for enhancing the safeguarding and management of cultural heritage, while informing disaster prevention and mitigation strategies in Jinan.

Exploring the Potential of Moringa Oleifera Phytochemicals as Inhibitors of Dipeptidyl Peptidase-4 (DPP-4) in Diabetes Mellitus: A Molecular Docking Approach

Abstract Diabetes mellitus (DM) is a global health concern characterized by chronic hyperglycemia due to defects in insulin secretion, insulin action, or both. Type 2 diabetes (T2DM), the most prevalent form, is largely driven by obesity and a sedentary lifestyle, contributing to over 95% of diabetes cases worldwide. The current treatment regimens for T2DM, including Dipeptidyl Peptidase-4 (DPP-4) inhibitors, aim to enhance insulin secretion but are often associated with adverse side effects. This has intensified the search for natural, safer alternatives with comparable efficacy. Moringa oleifera, a highly valued plant with an extensive history in traditional medicine, has shown promising antidiabetic properties. This research explores the potential of Moringa oleifera-derived phytochemicals as natural DPP-4 inhibitors using in-silico molecular docking techniques. The study identifies and evaluates the binding affinities of these phytochemicals to the DPP-4 enzyme, aiming to predict their inhibitory potential and minimal side effects, thereby contributing to the development of novel, safer hypoglycemic drugs. The results indicate the compounds’ potential as effective DPP-4 inhibitors with promising hypoglycemic properties. Specifically, piceatannol exhibited the highest binding affinity of -7.9 kcal/mol, whereas vanillic acid had the lowest at -5.7 kcal/mol. This study underscores the potential of Moringa oleifera as a natural, safer alternative in the development of novel anti-diabetic drugs, contributing to the growing body of research on plant-based therapeutics for diabetes management.

Trauma History in a Medium-Secure Adult Male Forensic Mental Health Setting

Forensic services have shifted their focus to the importance of forensic practice becoming more trauma informed. Trauma exposure is pervasive in forensic mental health populations and has been found to negatively impact the course of severe mental illness (SMI) and increase risk of violence. This study aimed to explore the trauma histories of adult male inpatients in a medium-secure psychiatric hospital, and examine childhood and adulthood trauma as predictors of diagnoses, self-harm, suicidality, hospital re-admissions, substance use, and nature of offense. The case files of 85 male patients in a medium secure unit in the UK were reviewed. Eighty-seven percent of patients had a schizophrenia diagnosis and 86% had extensive trauma histories, the most common trauma type being physical violence in childhood (44.7%). One patient had a PTSD diagnosis. Logistic regressions demonstrated that cumulative childhood and adulthood trauma significantly increased the odds of self-harm. Cumulative childhood trauma exposure was found to decrease the likelihood of having a schizophrenia diagnosis. There is a serious under-recognition of the extent and consequences of trauma exposure; trauma histories are likely greater than the findings of this study and existing literature suggests. Implications for clinical practice, trauma-informed care (TiC), and future research are proposed.

A descriptive overview of English-language publications in the field of Astronomy Education Research, 1898 to 2022

Discipline-based education research (DBER) takes the theories and methodologies of education research and applies them in the context of a specific discipline, in this example, astronomy. Research in the teaching and learning of astronomy has an extensive history; astronomy education research (AER), as its own separately defined field, is relatively new, stemming from the early to mid-1990s, as a separate track from physics education research (PER). By using a mixed-methods approach to textual analysis considering 2085 English language publications in the field, an order of magnitude larger than the previous largest overviews of the field, this study paints a rich picture of the landscape of AER over the timespan of a century from 1898 to 2022. This paper finds that AER authors started regularly publishing around 1970 and took off significantly in the 1990s with journal articles (~50%) and conference proceedings (~30%) being the most common method of publication. AER, in its early era, was largely a USA endeavour dominated by ASTRO101. This has changed over time and in recent years, the USA has dropped below 50\% of the worldwide AER publication production. “Celestial Motion”, “Instrumentation/Techniques”, and “Planetary Sciences (not Exoplanets)” are the most common content foci while a significant lack of local galactic and extragalactic education research is identified. AER has been heavily focussed on “Content Knowledge”, “Affective”, and “Engagement”. It is found that most articles tend to be general reporting of approaches or results (~43%) rather than full empirical research (~36%) while there is very little theoretical or historical research in AER yet. This overview, based on results input to an online database (istardb.org), provides a resource to researchers, educators, and other interested stakeholders allowing efficient ascertainment of previous research. This supports both researchers, allowing them to develop research questions at the cutting edge of the field, as well as practitioners, to inform their pragmatic approach based on latest research findings. We also present a set of recommendations and future outlook of the field of Astronomy Education Research.

Ultrasound-guided radial vein cannulation for general anesthesia in cases with difficult peripheral venous access: a report of two cases

BackgroundDespite advancements in ultrasonography, locating peripheral veins for catheter placement remains a challenge in patients with altered anatomy owing to multiple surgeries. Herein, we highlight the potential of using the radial vein as an alternative site for ultrasound-guided peripheral venous catheterization.Case presentationWe present two cases of patients with extensive surgical histories, including multiple abdominal surgeries, leading to difficult peripheral venous access. Traditional sites for peripheral venous catheterization were unsuitable due to vein narrowing or lack of visibility. In both cases, ultrasonography helped identify the radial vein as the only viable site for catheter placement. The patients underwent successful ultrasonography-guided catheterization of the radial vein without complications, facilitating medical management, including anesthesia induction and intraoperative monitoring.ConclusionsThe radial vein is a feasible and safe alternative for ultrasound-guided peripheral venous access in patients where traditional venous access sites are compromised.

Severe hypocalcaemia and hypophosphatemia following Denosumab administration in a multi-comorbidity patient

The case is presented of an elderly patient (DCP) with extensive medical history, including osteoporosis, who developed hypocalcaemia and hypophosphataemia whilst treated with denosumab, while prescribed concomitant calcium and vitamin D therapies. The management of this complex case involved a multidisciplinary team (MDT) approach, incorporating the patient’s wishes. It included discontinuation of denosumab and intravenous (IV) and oral mineral supplementation that yielded gradual amelioration of calcium and phosphate levels. This case demonstrates the importance of vigilant monitoring and appropriate management in patients receiving denosumab, particularly those with multiple comorbidities. It carries important considerations for using denosumab for osteoporosis treatment in patients with complex medical backgrounds. Ethical clearance waiver was granted by the Trust Research Ethics Committee on 18/01/2024.

B - 15 Symptom Presentation on the Neurobehavioral Symptom Inventory and Post Traumatic Stress Disorder Checklist for DSM-5 in a Cohort of Explosive Ordnance Disposal Veterans

Abstract Objective This preliminary research examined symptom differences on the Neurobehavioral Symptom Inventory (NSI) and Post Traumatic Stress Disorder Checklist DSM-5 (PCL-5) for Explosive Ordnance Disposal (EOD) and Non-EOD Veterans receiving care at the Washington DC-War Related Illness and Injury Study Center (DC-WRIISC) Veterans Administration Medical Center. EOD Veterans have extensive repetitive blast-exposure histories, exposure to environmental toxins, and operated under high-stress/allostatic load throughout their careers. Therefore, we aim to understand how these unique occupational exposures influence long-term health outcomes for EOD Veterans. Method Eligible participants (N = 39, Mage = 51 years (SD = 9.5 years); EOD, n = 21) completed comprehensive interdisciplinary evaluations, self-report questionnaires, were combat deployed, and experienced traumatic brain injury. Total and component scores for the NSI (affective, cognitive, somatic, vestibular, and validity-10) and PCL-5 (criterion B-E symptom clusters), and total score for the Holmes-Rahe Life Stress Inventory, (HRLSI) were included. Results Regression analysis revealed overall NSI severity was positively correlated to PCL-5 total scores for both groups (EOD: F(1,19) = 25.30, p < 0.001); (Non-EOD: F(1,16) = 25.48, p < 0.001). However, significant differences in symptom presentation were noted between groups. NSI Cognitive scores were positively correlated with PCL-5 component scores for Criterion B for EOD (F(3,17) = 8.40, p < 0.001) and Criterion E for Non-EOD (F(3,14) = 24.32, p < 0.001). Post-hoc analysis suggested stress/resiliency may further contribute to group differences (HRLSI; Non-EOD, F(2,12) = 33.96, p < 0.001). Conclusion DC-WRIISC Veterans often present with cognitive concerns and complex medical presentations. Our findings suggest the presence of unique symptom presentations that may improve diagnostic formulation, treatment planning, and engagement. These findings highlight the need for continued research examining the influence occupational exposures have on Veteran health.

Discovery and biological confirmation of a highly divergent Tacaribe virus in metatranscriptomic data from neotropical bats.

Clade B New World arenaviruses (NWA) include rodent-borne lethal hemorrhagic fever viruses, whereas Tacaribe virus (TCRV) stands out because of its detection in bats and its presumably low zoonotic potential. However, the bat association of TCRV was put into question by lethal experimental neotropical fruit bat infections and rare TCRV detection in bats. Scarce genomic data include near-identical viruses from Caribbean bats and ticks from the US sampled 50 years later. The prototype TCRV isolate used for experimental risk assessments has an extensive passage history in suckling mouse brains. Exploring the true genetic diversity, geographic distribution, and host range of bat-borne NWA is pivotal to assess their zoonotic potential and transmission cycles. We analyzed metatranscriptomic data for evidence of NWA identifying a highly divergent TCRV in bats and confirmed virus detection in original biological materials, supporting the association of TCRV with neotropical bats and warranting investigation of strain-associated TCRV pathogenicity.

EP354 - Acute pancreatitis – an unusual cause

Abstract Introduction Drugs are responsible for only 0.1%-2% of acute pancreatitis. Whilst the link between some drugs and pancreatitis is well-established, (steroids, azathioprine), we found only one previous case-report linking testosterone replacement therapy (TRT) to pancreatitis. We report a case of acute pancreatitis secondary to TRT. Case Report A 55-year-old man presented with history of upper abdominal pain. He denied alcohol/illicit drug use, no recent infection/changes to medication. His amylase was raised; CT scan confirmed acute pancreatitis. When interrogating his past medical history for a cause, we learned of his bilateral orchidectomy, radiotherapy and chemotherapy for seminoma in 1993, following which, he was on Testogel. He was managed conservatively, with success. Discussion Although drug-related causes of pancreatitis are uncommon, management is easy with identification/cessation of the causative agent. Therefore, a detailed medical history (including exposure to toxins and medication changes) is important. In our patient, an extensive surgical, medical and social history, CT and bloods excluded other main causes of acute pancreatitis i.e. alcohol, gallstones/infection, hypertriglyceridemia, toxins and trauma. The WHO database of “drugs suspected to cause pancreatitis” includes evidence from published literature, mostly case reports. Testosterone does not feature amongst the 525 drugs mentioned. Conclusion Our anecdotal evidence may provide a possible link between TRT and pancreatitis, however further research is needed to ascertain a definite causality. Reporting such potential links is important due to increased TRT use recently as treatment for female-to-male sex transition and young adults for performance enhancement, as well as remaining the primary treatment for hypogonadism.