Fecal Test Research Articles

Assessing the Efficacy of a Modified Triple Drug Regimen Supplemented with Mastic Gum in the Eradication of Helicobacter pylori Infection

Abstract Introduction/Objective Helicobacter pylori (H. pylori) is a bacterium that infects the stomach and small intestine. It is known to be the main cause of gastritis and peptic ulcers. The infection is common worldwide, with a prevalence rate of 50% in many countries. Eradication of H. pylori infection is crucial, as failure to do so can lead to serious complications such as gastric cancer. Treatment for H. pylori infection involves a combination of antibiotics, proton pump inhibitors (PPIs), and bismuth compounds. However, due to the emergence of antibiotic resistance, there is a need for alternative treatments. Methods/Case Report This study had been a randomized controlled trial involving 180 patients with H. pylori infection. The patients had been divided into two groups: Group A received the standard triple-drug regimen (clarithromycin, amoxicillin, and omeprazole), while Group B received the triple-drug regimen along with mastic gum. The treatment duration was 14 days for both groups. Baseline demographics and clinical characteristics had been collected for all patients. The presence of H. pylori infection had been confirmed by a urea breath test and fecal antigen test. Results (if a Case Study enter NA) This study has investigated the effects of mastic gum on H. pylori infection. In a randomized controlled trial of 180 H. pylori-positive patients, mastic gum was found to be effective in eradicating the bacteria in 83 of 90 patients (92.2%) who received the supplementation Group B received the triple-drug regimen along with mastic gum, compared to only 57 of 90 patients (63.3%) in the group A (p < 0.001). Thus, a randomized controlled trial of 90 patients with H. pylori infection found that combination therapy of mastic gum and a triple-drug regimen resulted in a significantly higher eradication rate (92.2%) compared to a triple-drug regimen only (63.3%). Conclusion The current study investigated the adding mastic gum to the standard triple-drug regimen can improve the eradication rate of H. pylori infection. This could potentially offer an alternative treatment option for patients with H. pylori infection, especially those with antibiotic resistance. Applying the mastic gum has approved its effectiveness, and it could reduce the reliance on antibiotics and minimize the risk of resistance development.

673. Sniffing Out Adherence: Evaluation of a Clostridioides difficile guideline at a Tertiary Academic Medical Center

Abstract Background Tufts Medical Center’s (TMC) Antimicrobial Stewardship Team (AMT) in collaboration with gastroenterology (GI) developed an institutional treatment algorithm to guide appropriate inpatient management of Clostridioides difficile infection (CDI). The CD treatment algorithm was revised in April 2022 to reflect updated national clinical practice guidelines and disseminated to TMC providers. Our study aimed to assess provider compliance to TMC’s CD treatment algorithm. Methods A retrospective study of adult patients hospitalized from April 15, 2022 to October 31, 2022 and tested for CD was conducted. We collected patient demographics, white blood cell count, serum creatinine (SC), length of stay, CD treatment, Infectious Diseases (ID) & GI consult, occurence of severe CDI (defined as white blood cell > 15 K/uL or SC > 1.5 mg/dL), occurrence of recurrent CDI, and immunocompromised status (defined by having had organ or bone marrow transplant, receiving immunomodulatory therapy or chronic steroids). A 2-step Clostridioides difficile (CD) testing algorithm was used. For CD toxin A/B & glutamate dehydrogenase antigen (GDH) indeterminate results, reflex to nucleic amplification test (NAAT) was performed only with AMT approval. Results A total of 111 inpatients had CD toxin/GDH stool testing; 70 (63%) positive and 41 (37%) indeterminate. Of patients who had an indeterminate CD toxin/GDH, none had subsequent CD NAAT testing, and none receive CDI treatment. Of the others, 81 (73%), 23 (21%), and 7 (6%) were diagnosed with non-severe, severe, and fulminant CDI, respectively. The overall adherence to the institutional CD treatment algorithm was 58% (figure 1). More patients were appropriately treated with oral vancomycin (11, 65%) compared to those who were appropriately treated with fidaxomicin (9, 24%). Guidance adherence was (3) 38% among patients who had one or more recurrent episodes of CD, and none received suggested ID or GI consultation for additional CDI treatment consideration. Conclusion Adherence to institutional CD treatment algorithm was low. This study highlights opportunities to improve prescription of first line CDI therapy, especially among patients who are at higher risk for recurrence. Disclosures Maureen Campion, PharmD, BCIDP, Shinoigi: Speaker

2071. Strongyloides stercoralis Testing in a Hospital in Bronx, NYC; A 3-year Experience

Abstract Background Once a parasitic infection limited to tropical/subtropical regions, as international travel and immigration continues to rise, Strongyloidiasis is now a disease also prevalent in non-endemic regions, including the United States. Its disease spectrum spans from an asymptomatic infection to a hyper-infection syndrome, predominantly in patients with HTLV-1 and/or on steroids, where it can be deadly if not recognized early. Methods Retrospective descriptive study describing patients who tested positive for Strongyloides stercoralis between 2019-2023 at Jacobi Medical Center, a safety net hospital in Bronx, NYC. Patients were diagnosed with a serum recombinant immunodiagnostic antigen from S. stercoralis-specific larvae. Results 108 patients were included; the mean age was 53.7+/-16 years, 63% were male. The most common place of birth was Latin America, Caribbean, Mexico in descending order. Prolonged steroid use (more than 1 week) reported by 7.4% and 8.3% had been exposed to chemotherapy/cytotoxic drugs. 92.5% of individuals were asymptomatic. Reason for testing was eosinophilia in 56.5% and migrant screening in 36.1%. The remaining (8%) patients were tested for diarrhea, urticaria and abdominal pain. Infectious diseases performed 76% of testing while primary care tested 15%. Mean time from immigration was 19.9 years. Stool testing was performed in 60 patients; larvae were seen 21.7% of these. Eosinophilia (abs >500/uL) was found in 70.4% of cases. Of the 29.6% w/o eosinophilia, 64.6 % of individuals reported an outdoor toilet. Ivermectin was given to 98% of cases. Conclusion Most cases were asymptomatic and identified on screening. Eosinophilia was seen in 2/3 of cases of strongyloidiasis, but 1/3 did not have eosinophilia. Larvae were reported in 21% of patients who had a stool for O/P underscoring the importance of establishing this diagnosis with serology. In patients without eosinophilia, strongyloidiasis should be considered if living conditions in country of birth put them at risk. As expected, patients had been in the US for many years prior to testing and only 15% of patients were screened by primary care. Increased awareness of the disease must be encouraged, especially amongst primary care physicians. Disclosures All Authors: No reported disclosures

595. Recovery of Clostridioides difficile Isolates from Cary-Blair Transport Medium Compared to No Transport Medium

Abstract Background Surveillance of C. difficile infection (CDI), one of the most common U.S. healthcare-associated infections, is essential to inform public health response, characterize strains causing disease, and describe changes in strain prevalence over time. The U.S. CDC’s Emerging Infections Program (EIP) has conducted active CDI surveillance, including culturing of C. difficile from a convenience sample of stool samples from cases, since 2009. Cary-Blair transport medium (CBTM) is used by some clinical laboratories for stool testing, but little is known about its impact on the recovery of C. difficile from culture. Methods We performed a cross-sectional study of the recovery of C. difficile isolates from C. difficile positive stools received 10/2021 – 10/2022 from Colorado and Georgia EIP sites. Stools were collected and stored within CBTM or within no transport medium per site protocols and subsequently frozen. Frozen samples were thawed and inoculated on taurocholate-cycloserine-cefoxitin-fructose agar plates (TCCFA) for recovery. Specimens from which C. difficile was not recovered on TCCFA plates were subjected to alcohol shock to enhance the recovery rates. We compared the recovery rates of C. difficile from stools in CBTM and stools in no transport medium. Results We cultured 825 stools from Colorado and Georgia, recovering C. difficile from 81.5% of stools. Overall, 412 (49.9%) stools were in CBTM and 413 (50.1%) were stools in no transport medium. Of those with known testing data, 410/410 (100%) CBTM stools vs 371/407 (91.2%) non-CBTM stools were C. difficile positive by PCR test (p< 0.01). Colorado stools accounted for 78% of the CBTM specimens. We recovered C. difficile on TCCFA plates from 59% (244/412) of stools in CBTM compared to 84% (348/413) in no transport medium (p< 0.01). After including alcohol shock results, C. difficile was recovered from 72% of CBTM stools, and 91% from stools in no medium (p< 0.01). Conclusion Cary-Blair transport medium may limit the recovery of C. difficile from culture and impact the ability to detect emerging strains. A large parallel study is needed to determine if these findings are reproducible and if stool collection methods should be standardized to maximize the recoverability of C. difficile by culture. Disclosures Andrew M. Skinner, MD, Academy for Continued Healthcare Learning: Honoraria|American Society of Healthcare Pharmacists: Honoraria|Ferring Pharmaceuticals: Honoraria|MJH Life Sciences: Honoraria Dale N. Gerding, MD, Destiny Pharma,: Advisor/Consultant|Sebela Pharma: Advisor/Consultant

Interpreting pathology test result values with comparators (< , >) in Electronic Health Records research: an OpenSAFELY short data report.

Numeric results of pathology tests are sometimes returned as a range rather than a precise value, e.g. "<10". In health data research, test result values above or below clinical threshold values are often used to categorise patients into groups; however comparators (<, > etc) are typically stored separately to the numeric values and often ignored, but may influence interpretation. With the approval of NHS England we used routine clinical data from 24 million patients in OpenSAFELY to identify pathology tests with comparators commonly attached to result values. For each test we report: the proportion returned with comparators present, split by comparator type and geographic region; the specific numeric result values returned with comparators, and the associated reference limits. We identified 11 common test codes where at least one in four results had comparators. Three codes related to glomerular filtration rate (GFR) tests/calculations, with 31-45% of results returned with "≥" comparators. At least 90% of tests with numeric values 60 and 90 represented ranges (≥60 and ≥90 respectively) rather than exact values. The other tests - four blood tests (Nucleated red blood cell count, Plasma C reactive protein, Tissue transglutaminase immunoglobulin A, and Rheumatoid factor), two urine tests (albumin/microalbumin) and two faecal tests (calprotectin and quantitative faecal immunochemical test) - were returned with "≤" comparators (29-86%). Comparators appear commonly in certain pathology tests in electronic health records. For most common affected tests, we expect there to be minimal implications for researchers for most use-cases. However, care should be taken around whether results falling exactly on clinical threshold values should be considered "normal" or "abnormal". Results from GFR tests/calculations cannot reliably distinguish between mild kidney disease (stage G2, 60-<90) versus healthy kidney function (90+). More broadly, health data researchers using numeric test result values should consider the impact of comparators.

Clinical performance study of a fecal bacterial signature test for colorectal cancer screening.

The fecal immunochemical test (FIT) is the most widely used test for colorectal cancer (CRC) screening. RAID-CRC Screen is a new non-invasive test based on fecal bacterial markers, developed to complement FIT by increasing its specificity. The test was previously clinically evaluated in FIT-positive patients (>20 μg of hemoglobin/g of feces, "FIT20"), in which it reduced the proportion of false positive results by 16.3% while maintaining most of FIT20's sensitivity. The aim of this study was to compare the sensitivity and specificity of a CRC screening program using RAID-CRC Screen in addition to FIT20 as a triage test in a European screening population undergoing screening colonoscopy with a CRC screening program with FIT20 alone in the same cohort. A cohort of 2481 subjects aged > 55 years from the German screening colonoscopy program was included. The colonoscopy findings were used as the gold standard in calculating the diagnostic capacity of the tests and included 15 CRC and 257 advanced neoplasia cases. RAID-CRC Screen added to FIT20 provided the same sensitivity as FIT20 alone (66.7%) in detecting CRC and a significantly higher specificity (97.0% vs. 96.1%, p<0.0001). The positive predictive value was 11.9% when using RAID-CRC Screen and 9.5% with FIT20 alone, and the negative predictive value was 99.8% in the two scenarios. For advanced neoplasia detection, the use of RAID-CRC Screen yielded significantly lower sensitivity than with FIT20 alone (17.5% vs. 21.8%, p = 0.0009), and the overall specificity was significantly higher when using RAID-CRC Screen compared with FIT20 alone (98.2% vs. 97.8%, p = 0.0039). Our findings confirm the results obtained in previous clinical studies in a CRC screening setting, showing the potential of RAID-CRC Screen to increase the overall specificity of FIT-based screening.

Cancer Screening Disparities Before and After the COVID-19 Pandemic

Breast, cervical, and colorectal cancer-screening disparities existed prior to the COVID-19 pandemic, and it is unclear whether those have changed since the pandemic. To assess whether changes in screening from before the pandemic to after the pandemic varied for immigrants and for people with limited income. This population-based, cross-sectional study, using data from March 31, 2019, and March 31, 2022, included adults in Ontario, Canada, the country's most populous province, with more than 14 million people, almost 30% of whom are immigrants. At both dates, the screening-eligible population for each cancer type was assessed. Neighborhood income quintile, immigrant status, and primary care model type. For each cancer screening type, the main outcome was whether the screening-eligible population was up to date on screening (a binary outcome) on March 31, 2019, and March 31, 2022. Up to date on screening was defined as having had a mammogram in the previous 2 years, a Papanicolaou test in the previous 3 years, and a fecal test in the previous 2 years or a flexible sigmoidoscopy or colonoscopy in the previous 10 years. The overall cohort on March 31, 2019, included 1 666 943 women (100%) eligible for breast screening (mean [SD] age, 59.9 [5.1] years), 3 918 225 women (100%) eligible for cervical screening (mean [SD] age, 45.5 [13.2] years), and 3 886 345 people eligible for colorectal screening (51.4% female; mean [SD] age, 61.8 [6.4] years). The proportion of people up to date on screening in Ontario decreased for breast, cervical, and colorectal cancers, with the largest decrease for breast screening (from 61.1% before the pandemic to 51.7% [difference, -9.4 percentage points]) and the smallest decrease for colorectal screening (from 65.9% to 62.0% [difference, -3.9 percentage points]). Preexisting disparities in screening for people living in low-income neighborhoods and for immigrants widened for breast screening and colorectal screening. For breast screening, compared with income quintile 5 (highest), the β estimate for income quintile 1 (lowest) was -1.16 (95% CI, -1.56 to -0.77); for immigrant vs nonimmigrant, the β estimate was -1.51 (95% CI, -1.84 to -1.18). For colorectal screening, compared with income quintile 5, the β estimate for quntile 1 was -1.29 (95% CI, 16 -1.53 to -1.06); for immigrant vs nonimmigrant, the β estimate was -1.41 (95% CI, -1.61 to -1.21). The lowest screening rates both before and after the COVID-19 pandemic were for people who had no identifiable family physician (eg, moving from 11.3% in 2019 to 9.6% in 2022 up to date for breast cancer). In addition, patients of interprofessional, team-based primary care models had significantly smaller reductions in β estimates for breast (2.14 [95% CI, 1.79 to 2.49]), cervical (1.72 [95% CI, 1.46 to 1.98]), and colorectal (2.15 [95% CI, 1.95 to 2.36]) postpandemic screening and higher uptake of screening in general compared with patients of other primary care models. In this cross-sectional study in Ontario that included 2 time points, widening disparities before compared with after the COVID-19 pandemic were found for breast cancer and colorectal cancer screening based on income and immigrant status, but smaller declines in disparities were found among patients of interprofessional, team-based primary care models than among their counterparts. Policy makers should investigate the value of prioritizing and investing in improving access to team-based primary care for people who are immigrants and/or with limited income.

Giardia lamblia Diagnosed During Upper Gastrointestinal Endoscopy: Clinical Manifestation, Histopathologic Findings and the Association With Celiac Disease.

Giardia lamblia may be found incidentally during upper gastrointestinal (GI) endoscopy, including when biopsies are taken for celiac disease (CeD) diagnosis. We aimed to study the clinical presentation and histopathology of G. lamblia and determine its association with CeD. A retrospective case series of pediatric patients diagnosed with G. lamblia based on intestinal biopsies between January 1999 and January 2023. Baseline data; demographics, symptoms, celiac serology, stool testing, macroscopic and histopathologic findings. Follow-up data; treatment and repeated celiac serology. Of 38 patients with G. lamblia , 15 (39.5%) were female, mean age of 6.7 (±4.8 SD) years. Clinical symptoms; GI 19/38 (50%), growth retardation and/or iron deficiency anemia 8/38 (21.1%) or a combination 11/38 (28.9%). Celiac serology was positive in 13/38 (34.2%). Duodenal endoscopic findings; normal (n = 23, 60.5%), nodularity (n = 12, 32.4%), erosions in 2 (5.4%) and scalloping in 1 (2.7%). Histopathology; normal villi 24/38 (63.2%), villous shortening with increased intraepithelial lymphocytes (IEL) 5/38 (13.2%), isolated IEL 3/38 (7.9%) and duodenitis in 6/38 (15.8%). Children with positive CeD serology were younger (4 vs. 8.1 years, P = 0.019), had fewer GI symptoms (23.1% vs. 64%, P = 0.017) and a higher rate of villous shortening with increased IEL (38.5% vs. 0, P < 0.001) versus children with negative serology. On follow-up, metronidazole treatment was recommended to all but was documented to be given in 22/38 (57.9%). Among the 13 children with positive CeD serology, serology normalized in 10 (77%). G. lamblia is a rare histopathologic finding in children. It may be an incidental finding in CeD or may cause false positive celiac serology.

Developing Patient-Refined Messaging for Follow-Up Colonoscopy After Abnormal Fecal Testing in Hispanic Communities: Key Learnings from Virtual Boot Camp Translation.

Colorectal cancer (CRC) is a leading cause of cancer death in the US. Screening by fecal immunochemical test (FIT) is a strategy to lower CRC rates. Unfortunately, only half of patients with an abnormal FIT result complete the follow-up colonoscopy, an essential component of screening. We used virtual Boot Camp Translation (BCT), to elicit input from partners to develop messaging/materials to motivate patients to complete a follow-up colonoscopy. Participants were Hispanic, ages 50 to 75 years, and Spanish-speaking. All materials were developed in English and Spanish. The first meeting included expert presentations that addressed colorectal health. The two follow-up sessions obtained feedback on messaging/materials developed based on themes from the first meeting. Ten participants attended the first meeting and eight attended the follow-up sessions. The two key barriers to follow-up colonoscopy after abnormal FIT noted by participants were (a) lack of colonoscopy awareness and (b) fear of the colonoscopy procedure. We learned that participants valued simple messaging to increase knowledge and alleviate concerns, patient-friendly outreach materials, and increased access to health information. Using virtual BCT, we included participant feedback to design culturally relevant health messages to promote follow-up colonoscopy after abnormal fecal testing among Hispanic patients served by community clinics.

Provider- and System-Level Barriers and Facilitators to Colonoscopy and Multi-Target Stool DNA for Colorectal Cancer Screening in Rural/Remote Alaska Native Communities.

The Alaska Tribal Health System is working to increase colorectal cancer (CRC) screening among Alaska Native people, who experience the highest CRC rates in the world. This study examined CRC screening provider- and system-level barriers and facilitators from the perspective of healthcare providers serving Alaska Native people in rural/remote communities. A total of 28 provider (physicians, advanced practice, and Community Health Aides/Practitioners) interviews were held from 1 February to 30 November 2021. Colonoscopy provider-level barrier themes included time, competing priorities, and staffing, while system-level barriers included travel costs, weather, and the COVID-19 pandemic. Multi-target stool DNA (mt-sDNA) barrier themes included test viability and unfamiliarity, and previous stool tests experiences. For both tests, limited medical record reminders was a major barrier. Facilitator themes for both tests included community outreach, cultural competency and patient navigation, and clinic/system improvements. In-depth interviews with tribal health providers showed that adding mt-sDNA testing may help address system-level colonoscopy barriers such as waitlists and travel costs, but other barriers remain. Further research is needed into patient barriers and facilitators, as well as the effectiveness of integrating mt-sDNA into a geographically dispersed tribal health system to reduce cancer disparities and build equity in CRC prevention among Alaska Native people.

Improving Colorectal Cancer Screening in a Regional Safety-Net Health System over a 10-Year Period: Lessons for Population Health.

Despite national policy efforts to increase colorectal cancer (CRC) screening, rates in vulnerable populations remain suboptimal. Many types of interventions have been employed, but their impact on improving population-level rates of CRC screening over time is uncertain. Assess the impact of 10years of different in-reach and outreach strategies to improve CRC screening and identify factors associated with being screen up-to-date (SUTD). Observational cohort study. Patients aged 50-74years from 12 community-based primary care clinics in an integrated, regional safety-net health system. Multiple system-level interventions were implemented over time (visit-based electronic health record [EHR] reminders, quality measurement, annual preventive service letters, and mailed fecal immunohistochemical stool tests [FIT]). CRC SUTD rates by calendar year among those with a primary care (PC) visit in the prior 1 and 3years and their multivariable correlates. The sample included 31,786-40,405 patients/year. In 2011, mean age was 58.9, 63.9% were women, 37.0% were Hispanic, 39.3% Black, 16.8% White, and 6.6% Asian/Other, and 60.5% were uninsured/Medicaid. Three-quarters of patients had ≥ 1 PC visit in the prior year. Lower-intensity interventions (EHR reminders, quality measurement, annual prevention letters) had limited impact on SUTD rates (2-3% rise). Implementing system-wide mailed FIT increased rates from 51.2 to 61.9% among those with a PC visit in the past year (40.5 to 46.8% with a PC visit ≤ 3years). Stopping mailed FIT due to COVID wiped out these gains. Higher screening rates were associated with the following: older age; female; more comorbidities, PC clinic visits, and prior FITs; and better insurance coverage. Hispanics had the highest SUTD rates followed by Asians, Blacks, and Whites (p < 0.05). Implementation of a system-wide mailed FIT program had the greatest impact on SUTD rates. Lower-intensity interventions (EHR reminders, quality measurement, and patient letters) had limited effects.

Evaluation of anthelmintic resistance in Oklahoma beef cattle herds and assessment of composite sampling for herd level fecal egg count reduction testing

Beef cow-calf producers submitted fecal samples for fecal egg count reduction (FECR) tests. Anthelmintic administration practices were not controlled, and producers were encouraged to follow standard procedures for each herd. Fecal egg counts (FEC) were determined using the Wisconsin method with alimit of detection of 1 egg per gram (EPG). Inclusion criteria included a pretreatment FEC of 25 EPG. A FECR of ≤ 90% was considered indicative of resistance. Seventeen herds submitted a total of 19 sample sets. All major classes of anthelmintics were represented except for levamisole. Injectable, pour-onand oral as well as original label and generic products were represented. Sample sets from 3 herds were excluded from the final analysis based on inadequate pretreatment FEC. Of the 16 sample sets included in the final analysis, 13 exhibited resistance based on the arithmetic mean of individual FECR tests (FECRT). In addition to individual FEC, composite samples for each herd were created using 1 gram of feces from each animal. Four grams of each composite sample were used to determine a composite FEC. Composite samples from 13 herds were included in the final analysis and 11 of 13 exhibited resistance. There was complete agreement between the individual and composite samples for the detection of resistance. Based on the results of this small survey, apparent anthelmintic resistance appears to be widespread in beef cow-calf herds in Oklahoma. Composite sampling appears to be an effectivemethod for detection of herd level resistance.

Qualitative Interviews to Add Patient Perspectives in Colorectal Cancer Screening: Improvements in a Learning Health System.

Health systems are interested in increasing colorectal cancer (CRC) screening rates as CRC is a leading cause of preventable cancer death. Learning health systems are ones that use data to continually improve care. Data can and should include qualitative local perspectives to improve patient and provider education and care. This study sought to understand local perspectives on CRC screening to inform future strategies to increase screening rates across our integrated health system. Health insurance plan members who were eligible for CRC screening were invited to participate in semi-structured phone interviews. Qualitative content analysis was conducted using an inductive approach. Forty member interviews were completed and analyzed. Identified barriers included ambivalence about screening options (e.g., "If it had the same performance, I'd rather do home fecal sample test. But I'm just too skeptical [so I do the colonoscopy]."), negative prior CRC screening experiences, and competing priorities. Identified facilitators included a positive general attitude towards health (e.g., "I'm a rule follower. There are certain things I'll bend rules. But certain medical things, you just got to do."), social support, a perceived risk of developing CRC, and positive prior CRC screening experiences. Study findings were used by the health system leaders to inform the selection of CRC screening outreach and education strategies to be tested in a future simulation model. For example, the identified barrier related to ambivalence about screening options led to a proposed revision of outreach materials that describe screening types more clearly.

Using diagnostics in supporting sustainable worm control in horses

Anthelmintic resistance in horses is an ongoing problem. Changes in methods of worming – from group worming to testing individual horses and worming appropriately – are important to help prevent any further resistance developing. There are various methods to test for worm burdens in horses, including faecal egg counts, blood tests and saliva tests. This article discusses these methods in relation to specific species of gastrointestinal parasites, in addition to how pasture management can be used to help maintain low levels of resistance.

Diagnostic accuracy of faecal elastase-1 test for the diagnosis of pancreatic exocrine insufficiency: A systematic review and meta-analysis

Diagnostic accuracy of faecal elastase-1 test for the diagnosis of pancreatic exocrine insufficiency: A systematic review and meta-analysis

Are we missing pancreatic exocrine insufficiency in ‘at-risk’ groups? Prospective assessment of the current practice and yield of faecal elastase testing in patients with diabetes mellitus, HIV and/or high alcohol intake

There is cumulative evidence that pancreatic exocrine insufficiency (PEI) is under-recognised and can occur in patients with ‘at-risk’ conditions. Thus, we aimed to assess the current practice and yield of requesting faecal elastase (FEL-1), an indicator of PEI, in patients with ‘at-risk’ conditions. We prospectively recruited patients attending secondary care clinics with diabetes mellitus (DM), people living with HIV (PLHIV) and inpatients admitted to hospital with high alcohol intake (HAI). All patients underwent testing with FEL-1. Those patients with PEI (FEL-1 <200 μg/g) were contacted and offered a follow-up review in gastroenterology clinic. In total, 188 patients were recruited (HAI, n=78; DM, n=64; and PLHIV, n=46). Previous FEL-1 testing had not been performed in any of the patients. The return rate of samples was 67.9% for patients with HAI, 76.6% for those with DM and 56.5% for those with PLHIV. The presence of PEI was shown in 20.4% of patients with DM, 15.4% of patients with PLHIV and 22.6% in those with HAI. Diarrhoea and bloating were the most reported symptoms in followed-up patients with low FEL-1 (31.8% and 22.7% of patients, respectively). Follow-up computed tomography (CT) scans in those patients with PEI identified chronic pancreatitis changes in 13.6% and pancreatic atrophy in 31.8% of patients. These results suggest that there is a lack of testing for PEI in ‘at-risk’ groups. Our findings also suggest that using FEL-1 to test for PEI in patients with DM, PLHIV and HAI has a significant impact, although further studies are required to validate these findings.

Analysing the colorectal cancer screening patterns during the COVID-19 pandemic and their effects on patient outcomes.

40 Background: In Canada, colorectal cancer (CRC) ranks as the third most prevalent cancer and second leading cause of cancer mortality (1). The potential to prevent a significant proportion of colorectal cancers and associated mortality through effective screening is widely acknowledged (Han-Mo Chiu, 2021). Notably, fecal immunohistochemistry testing (FIT) has led to improved early detection of CRC (2). However, FIT screening was suspended in Canada in the initial phase of the COVID-19 pandemic response. Specifically, in Ontario, the collection of FIT samples was suspended between March 23rd, 2020 and August 26th, 2020 (3). During this 3-month period, an estimated 540,000 Canadians would have participated in screening, as indicated by OncoSim, a microsimulation model for cancer (4). The primary objective was to evaluate the consequences of screening cessation, through comparison of asymptomatic and symptomatic CRC diagnoses at the Windsor Regional Cancer Centre in Windsor, Ontario. Methods: A retrospective chart review was performed for patients admitted to the Windsor Regional Cancer Centre of Windsor Regional Hospital between December 2016 and June 2021. Demographic data, risk factors for CRC, cancer operability status, and the presence of symptoms at diagnosis of CRC were recorded. Results: 771 patient charts were reviewed and 77 (10%) were excluded due to duplication or insufficient chart data. Of the remaining 694 patients, 545 (79%) were classified as the pre-COVID group (December 2016 to February 2020) and 149 (21%) as the COVID group (March 2020 to June 2021). We found a 2.5% increase in symptomatic diagnoses of CRC in patients diagnosed after March 2020 (pre-COVID group vs. COVID group). However, we did not observe a significant difference in proportion of inoperable CRC cases between groups. Conclusions: The observed trend of symptomatic diagnoses of CRC underscores the importance of FIT screening for early CRC detection and the need for increased catch-up screening to mitigate the potential risks and mortality associated with CRC screening interruptions. For this, it is presumed that a population of patients exists who would have tested positive through FIT screening but instead presented symptomatically at a later stage of the disease. It is also important to note that our study data did not extend beyond June 2021, so we could not capture the complete impact of FIT cessation. (1) Canadian Cancer Statistics, 2021. (2) Zauber, 2015. (3) Ontario Health, 2021. (4) StatCan, 2021.

CLINICAL AND IMMUNOLOGICAL ASPECTS OF BRONCHIAL ASTHMA WITH ATOPIC DERMATITIS IN CHILDREN

This article presents the results of a clinical and immunological examination of 68 children with allergic bronchial asthma and 22 children with atopic dermatitis. The purpose of the work is to determine the concentrations of IgA, IgM, IgG to identify clinical and immunological features in the blood serum of children with allergic asthma and AD and to identify clinical and immunological features in groups of these patients. Methods. At the allergy department of the VDOCH, 68 children with allergic asthma and 22 children with AD aged from 4 to 14 years (of which 53 boys and 37 girls) were examined. All children were examined clinically and laboratory (complete blood count, general urine test, biochemical blood test, nasal swab for eosinophils, stool test for helminth eggs, scraping for enterobiasis), and a carefully collected medical history. Results and conclusions: Taking into account the number of acute respiratory infections in the history, we identified significant differences in these groups of patients (p = 0.017). The concentrations of IgA, IgM, IgG in the blood serum of the examined patients were determined using an enzyme-linked immunosorbent assay (ELISA). We found that 33.8% of children with asthma and 36.4% of children with atopic dermatitis have low IgA levels. We also determined low IgG concentrations in more than half of the examined patients both in the group with bronchial asthma and in the group with atopic dermatitis (58.8% and 59.1%, respectively), which, in combination with low levels of other immunoglobulins, can be regarded as transient immunodeficiency in children.

Evaluation of Fecal Egg Count Tests for Effective Control of Equine Intestinal Strongyles.

The American Association of Equine Practitioners strongly advocates evidence-based intestinal strongyle control in horses. It recommends targeted treatment of all heavy egg shedders (>500 eggs per gram (EPG) of feces), while the low shedders (0-200 EPG) are left untreated. As 50-75% of adult horses in a herd are low shedders, preventing them from unnecessary anthelmintic exposure is critical for tackling resistance. There are various fecal egg count (FEC) techniques with many modifications and variations in use, but none is identified as a gold standard. The hypothesis of the study was that the diagnostic performance of 12 commonly used quantitation methodologies (three techniques with four variants) differs. In this regard, method comparison studies were performed using polystyrene beads as proxy for intestinal strongyle eggs. Mini-FLOTAC-based variants had the lowest coefficient of variation (CV%) in bead recovery, whereas McMaster variants had the highest. All four variants of Mini-FLOTAC and the NaNO3 1.33 specific gravity variant of modified Wisconsin followed a linear fit with R2 > 0.95. In contrast, the bead standard replicates for modified McMaster variants dispersed from the regression curve, causing a lower R2. The Mini-FLOTAC method seems less influenced by the choice of floatation solution and has better repeatability parameters and linearity for bead standard recovery. For FEC tests with high R2 (>0.95) but that underestimated the true bead count, a correction factor (CF) was determined to estimate the true count. Finally, the validity of CF was analyzed for 5 tests with R2 > 0.95 to accurately quantify intestinal strongyle eggs from 40 different horses. Overall, this study identified FEC methodologies with the highest diagnostic performance. The limitations in standardizing routine FEC tests are highlighted, and the importance of equalization of FEC results is emphasized for promoting uniformity in the implementation of parasite control guidelines.

Molecular characterization of Strongyloides stercoralis in Mazandaran Province, North of Iran

Strongyloides stercoralis is a parasitic nematode that lives in the mucosa of the small intestine and causes strongyloidiasis in humans. Mazandaran is one of the endemic areas of this parasite in Iran. For detecting S. stercoralis larvae in stool samples various types of techniques such as PCR technique have been used. The present study was conducted to determine the molecular characteristics of S. stercoralis collected from residents of Mazandaran, northern Iran. From April to September 2017, a number of 2195 samples of human feces were collected from different regions of Mazandaran province. First, all stool samples were tested using the formalin-ether method. Then, S. stercoralis positive stool samples and 300 random samples were selected for molecular study. A set of primer pairs for conventional PCR was used in a PCR reaction to amplify the mitochondrial cytochrome c oxidase subunit 1 (Cox1) gene. To confirm the results of PCR, positive samples were sent for sequencing. The sequence was compared with reference sequences from GenBank. Phylogenetic relationships of the Cox1 gene of S. stercoralis inferred by the maximum likelihood algorithm. According to our results, in the stool test with the formal ether method, 21 stool samples (0.95%) were found to be positive for S. stercoralis and 162 samples (38.7%) were positive for other parasites . All 21 positive samples were confirmed as S. stercoralis by PCR method. The sequence of the samples overlapped 99% with S. stercoralis in the Genbank. Our results showed that conventional PCR could detect all samples that were microscopically positive.