Mary's Hospital Research Articles

Atypical neonatal cutaneous myiasis: A diagnostic challenge mimicking pustular rash in a resource-limited setting.

Neonatal cutaneous myiasis is a rare disease in newborns. Although it is unlikely, the level of suspicion for this condition should be high, especially in tropical regions. Treatment may deviate from the standard approach when necessary, and chemical debridement can be considered, particularly for smaller lesions. Ultimately, clinical judgment plays a key role in decision-making. Myiasis is the infestation of the skin of a mammal by larvae or maggots. The skin is the most affected organ. However, it can also affect other organs of the body. Gasterophilus and Hypoderma are two flies that produce creeping myiasis, a type of cutaneous myiasis our patient had. The infestation is common in Sub-Saharan Africa and most especially among rural dwellers. We report on a case of a 7-day-old term neonate who reported to St. Mary's Hospital Lacor, a Private-not-for-Profit hospital situated in the Northern region of Uganda, who was admitted as a case of neonatal sepsis with a focus on the skin initially, however, while on the ward was eventually diagnosed with Cutaneous Myiasis. The management plan included chemical debridement with Hydrogen peroxide, IV antibiotics, and other supportive therapies, and the neonate was ultimately discharged home after 9 days in the NICU. This case report aims to inform healthcare workers of the importance of heightening the index of suspicion of myiasis for neonates who present with sudden-onset rash that can resemble pustules and be mistaken for a pustular rash. Additionally, chemical debridement, in this case, underscores the importance of an innovative approach to managing cutaneous myiasis in resource-limited settings. Mass education and awareness programs focusing on proper hygiene practices, safe handling of newborns, and early recognition of symptoms can help mitigate the risk of myiasis.

Crestal approach for maxillary sinus augmentation in individuals with limited alveolar bone height: An observational study.

In cases where the bone presence is <4 mm, the lateral approach is typically the first approach considered. Nevertheless, for patients who prefer minimally invasive procedures or wish to reduce postoperative discomfort, the crestal approach is a viable option. The objective of this study was to investigate the potential of crestal sinus augmentation for achieving adequate bone in individuals with residual bone measuring <3 mm. The study comprised 11 participants (63.6 ± 10.9 years of age) who were treated at Seoul St. Mary's Hospital between 2021 and 2023 and received crestal approach sinus augmentation due to insufficient bone density of <3 mm using the crestal approach kit. Pre-augmentation and post-augmentation cone-beam computed tomographic images were analyzed using the imaging software to measure vertical bone height, bucco-palatal width, and mesio-distal width. Before the intervention, the height of the vertical bone was 2.1 ± 0.5 mm, while the width from buccal to palatal was 10.6 ± 2.9 mm, and the width from mesial to distal was 9.9 ± 1.2 mm. Following the intervention, these measurements increased to 8.8 ± 0.9 mm, 12.2 ± 2.2 mm, and 10.2 ± 1.2 mm, respectively. The change in height of the vertical bone was 6.7 ± 1.0 mm, in bucco-palatal width was 1.6 ± 1.4 mm, and in mesio-distal width was 0.3 ± 0.4 mm. The results revealed a significant rise in the height of the vertical bone and bucco-palatal width. Crestal sinus augmentation has been demonstrated to be a highly effective approach for achieving an adequate quantity of bone in patients with residual bone <3 mm. Nonetheless, further observation is required to evaluate the long-term prognosis of the procedures.

Summer Surgical Elective in Hong Kong

I completed a surgical elective with the Department of Plastic and Reconstructive Surgery in Queen Mary Hospital, Hong Kong Special Administrative Region (SAR), China. I was taught a great deal of surgical knowledge by the team and was inspired as I witnessed the life-changing operations they performed. The experience was professionally and culturally enriching and has cemented my desire to pursue surgery as a career to improve the lives of my future patients. In this article, I will discuss how I secured this elective and my personal experience during the elective. Additionally, I will briefly discuss some differences I observed between the healthcare systems in Hong Kong and Ireland, including different scopes of surgical practice, residency training, and also the similar challenges faced by both public healthcare systems.

Laparoscopic adrenalectomy performed with the Endo GIA™ Stapler as an easy and safe approach.

The purpose of this study was to determine whether the application of the Endo GIA™ Stapler (Medtronic, Dublin, Ireland) could be helpful in the dissection of adrenal tumors in complicated cases. We retrospectively reviewed the records of patients who underwent laparoscopic adrenalectomy between 2012 and 2022 at the College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea (Seoul, Republic of Korea). We adopted the Endo GIA™ Stapler (Medtronic) to seal vessels around adrenal gland and separate adrenal gland completely when it was difficult to perform meticulous dissection and isolation with laparoscopic instruments. Thirteen patients who underwent laparoscopic adrenalectomy with Endo GIA™ staplers were reviewed and compared with 45 other patients who underwent laparoscopic adrenalectomy without Endo GIA™ staplers. There were no statistical differences between the two groups in demographic, tumor-related, and diagnostic variables. Surgical outcomes such as margin involvement, bleeding, operation duration, rate of conversion to open surgery, blood transfusion, complications, and recurrence were not different between the two groups. In our experience, applying of the Endo GIA™ Stapler (Medtronic) in laparoscopic adrenalectomy is a feasible and acceptable approach.

Multidisciplinary care to optimise pregnancy outcomes among Jehovah’s Witness: Case series over fifteen years in a tertiary teaching hospital

ObjectiveTo assess the obstetric and neonatal outcomes of Jehovah’s Witness (JW) mothers and the willingness to accept blood products after multidisciplinary management. Study DesignA retrospective case-control study was conducted at Queen Mary Hospital from 2005 to 2020. Delivery records of pregnant women who identified themselves as JW were reviewed. The immediate next age-matched non-JW patient in the booking register was assigned as control. ResultsA total of 96 subjects were identified within the study period (48 JW and 48 non-JW age-matched patients). The haemoglobin levels of JW and non-JW were similar at booking, 28 weeks of gestation, pre-delivery and postnatal day 2. JW mothers were more likely to receive iron supplements in the antenatal period than the control group (27.1 % vs. 6.3 %, p = 0.01) despite the similar rate of antenatal anemia in both groups (4.2 % vs. 4.2 %, p = 1.00). There were no differences in mode of delivery, total blood loss at delivery, rate of primary postpartum haemorrhage, gestational age at delivery, birth weight, and Apgar score at 1 and 5 min between JW and non-JW. There were no maternal deaths, hysterectomy or admissions to the adult intensive care unit in either group. Six JW women accepted packed cell transfusion at the initial consultation and did not receive multidisciplinary care. The remaining 42 JW women had consultant obstetric and anesthesiologist review before delivery. After multidisciplinary consultation, two (4.8 %, 2/42) accepted blood transmission and 11 (26.2 %, 11/42) accepted some components of blood. The remaining 29 (69 %, 29/42) women refused all blood products. ConclusionJW patients who received multidisciplinary care achieved comparable pregnancy and neonatal outcomes to the normal population. Antenatal iron supplement was more common among pregnant JW despite the similar rate of antenatal anemia compared with the non-JW women. 12.5% of JW women agreed packed cell transfusion at the initial consultation and a further 27.1% of JW women agreed to some forms of blood products after multidisciplinary counseling.

Long-Term Kidney Outcome of Lupus Nephritis by Renal Response Status

IntroductionLimited evidence exists that clinical trial treatment response criteria predict long-term outcomes in Asian patients with lupus nephritis (LN). MethodsThis retrospective analysis of prospectively collected data from the Hong Kong Queen Mary Hospital Cohort categorized adults with biopsy-proven LN (Class III, IV, V, or mixed [III±V, IV±V]) after standard treatment for 2 years (2Y) post biopsy and immunosuppression induction according to modified primary efficacy renal response (mPERR: estimated glomerular filtration rate [eGFR] ≥60 ml/min/1.73 m2 or ≤20% below biopsy value AND urine protein:creatinine ratio [uPCR] ≤0.7) and modified complete renal response (mCRR; eGFR ≥90 ml/min/1.73 m2 or ≤10% below biopsy value AND uPCR ≤0.5). Associations between 2Y mPERR/mCRR status and long-term kidney survival and mild chronic kidney disease (CKD) or worse (Stage ≥3) were assessed. ResultsOf the 176 Chinese patients, 64.2% achieved mPERR and 43.8% achieved mCRR at 2Y post biopsy. After mean follow-up of 15.3 years, significantly higher proportions of mPERR and mCRR responders versus non-responders achieved long-term kidney survival (mPERR: 85.8% vs 71.4%; p=0.029; mCRR: 92.2% vs 71.7%; p<0.001). mPERR and mCRR achievement was associated with adjusted risk reductions for kidney non-survival of 60% (p=0.034) and 86% (p<0.001), respectively. Adjusted risk for mild CKD or worse (Stage ≥3) was 82% (p=0.013) and 87% (p=0.012) lower for mPERR and mCRR responders, respectively, versus non-responders. ConclusionsIn Chinese patients with LN, mPERR and mCRR at 2Y post biopsy predict superior long-term kidney outcomes and lower CKD progression risk.

Use of Two Pain Assessment Tools to Improve Pain Recognition in Post Stroke Patients: A Quality Improvement Project

Abstract Background Post stroke patients can suffer from a variety of complex pain syndromes. These are often associated with decline in function, cognitive impairment, impaired quality of life and mood disturbances. Pain identification can be challenging in this population, due to stroke deficits that impair communication, and associated medical conditions that can affect the patient’s ability to self-report pain. This Quality Improvement (QI) project aims at implementing two pain assessment tools to support clinicians assess pain in a structured manner, and thereby improve pain management. Methods An initial audit was performed to identify whether post stroke pain (PSP) was being recorded in a reliable manner in St Mary's hospital. A pain assessment proforma was then designed, incorporated in the admission proforma and rolled-out for use. This included two pain assessment tools: the Numerical Pain Scale for patients who could self-report pain, and the Abbey Pain Scale for patients with communication difficulties. A second audit was performed to analyse the compliance to documentation and a qualitative evaluation of its use was also conducted in semi-structured staff interviews. Results The first audit showed pain being under reported with only 25% of patients having formal pain assessment documented on admission. The second audit showed improvement in pain assessment with 72.7% pain documentation. Qualitative evaluation revealed staff expressing challenges with pain identification in post stroke patients and viewed the proforma as a useful prompt. Limitations to the use of observational tools included time constraints, lack of familiarity with tools and potential inaccuracy of scores. Conclusion Identification of PSP is key to optimising treatment, and hence improving function and quality of life of stroke patients. This QI project shows that the use of pain assessment tools, in combination with detailed clinical assessment can help pain assessment. Clinician awareness and continuous training are required to support this challenging task.

Comparing the effect of sedation with dexmedetomidine and propofol on sleep quality of patients after cardiac surgery: A randomized clinical trial.

Sleep quality is the main concern of patients after cardiac surgery. We compared the effect of two routinely used sedatives on the sleep quality of patients admitted to the intensive care unit (ICU) after cardiovascular surgery. It is a prospective, controlled, randomized clinical trial. A total of 120 patients, after cardiac surgery were enrolled. During extubating, patients were randomized into two groups: 60 patients received an infusion of dexmedetomidine (precede; 0.5 μg/kg/h), and 60 patients received 50 μg/kg/min propofol for 6 hours. Baseline characteristics were compared between the groups. The patients completed the St. Mary's Hospital Sleep Questionnaire, and the scores were compared between the groups. The groups were not different in terms of demographics, underlying diseases, smoking/drug abuse/alcohol, number of vessels involved, history of non-cardiac surgery, and mean levels of serum parameters (P>0.05). Most of the medications used were similar between the groups (P>0.05), except calcium channel blockers (more frequently used in the propofol group [P=0.027). The details of surgery were not statistically significant different (P>0.05); but, the mean volume of platelet received after the surgery was higher in propofol group (P=0.03). The propofol group had less problems with last night's sleep (0 vs 0.1±0.66), felt more clear-headed (4.9±0.6 vs 4.68±0.58, were more satisfied with their last night's sleep (52.1% vs 47.9%), but spent more time getting into sleep (0.38±1.67 vs 0 ) (P<0.5). The sleep quality of patients under the influence of propofol seemed to be better than dexmedetomidine after cardiac surgery.

Identification and evaluation of a serum microRNA panel to diagnose colorectal cancer patients.

Screening plays a crucial role in the early detection of colorectal cancer, greatly reducing mortality rates. The objective of this study was to identify a non-invasive diagnostic method utilizing serum microRNA expression for the diagnosis of colorectal cancer patients. The study consisted of three stages. In the first stage, 129 patients with colorectal cancer and 129 normal subjects were recruited as the training set for the development of a blood miRNA panel. The second stage involved recruiting 200 patients from each group as the validation cohort. Finally, a blinded study was conducted in the third stage, with 260 patients recruited to determine the predictive value of our miRNA panel. Serum samples were prospectively collected from colorectal cancer patients and normal subjects between 2017 and 2021 at Queen Mary Hospital in Hong Kong. Quantitative PCR was utilized to detect the serum levels of candidate microRNAs, and a multiple linear regression model was employed to formulate a serum microRNA panel for diagnosing colorectal cancer patients. The performance of the panel was evaluated using ROC analysis. Our study showed that the values of three pairs of serum microRNAs, namely miR-106b-5p/miR-1246, miR-106b-5p/miR-16 and miR-106b-5p/miR-21-5p, exhibited statistically significant differences between colorectal cancer patients and normal subjects. A serum microRNA panel formulated from these three pairs of microRNAs demonstrated high accuracy in diagnosing colorectal cancer patients from normal subjects, with an AUC of approximately 0.9. The serum miRNA test proved to be a feasible and promising non-invasive biomarker for the diagnosis of colorectal cancer patients in comparison to normal subjects.

Effects of Flaxseed on Perimenopausal Symptoms: Findings From a Single-Blind, Randomized, Placebo-Controlled Study.

Background Flaxseed contains many phytoestrogens that share structural similarities with endogenous estrogens. It has beneficial properties that improve hormonal effects that may influence chronic disorders. Objective This study aims to evaluate the impact of flaxseed supplementation on perimenopausal syndrome symptoms and serum polyphenol metabolites enterodiol (ED) and enterolactone (EL). Methods Recruitment of 145 perimenopausal women from Queen Mary's Hospital OPD in K.G.M.U. Lucknow, India, was done for this single-blind randomized placebo-controlled experiment, considering inclusion and exclusion criteria. We randomly divided subjects into two groups using a computer-generated random number table. The intervention group A received 10 grams of flaxseed powder, while the placebo group B received 10 grams of roasted wheat flour for a continuous three months. We measured their demographic characteristics,menopausal symptoms score using the modified Kupperman's index (KI),the menopause rating scale (MRS), and the menopause-specific quality of life (MENQOL) intervention questionnaire. Moreover, using high-performance liquid chromatography (HPLC), biochemical parameters (ED, EL) were assessed both at baselineand after three months. For the statistical analysis, Statistical Product and Service Solutions (SPSS, version 24; IBM SPSS Statistics for Windows, Armonk, NY) was employed. Result The study involved 123 individuals, with 22 subjects losing out during follow-up. From baseline to follow-up comparison, the intervention group demonstrated an average percentage decline in the final score of the KI, MRS, and MENQOL intervention questionnaire of -47.25%, -54.05%, and -50.39%, respectively, while the placebo group demonstrated an average percentage decline of -3.83%, -4.91%, and -7.92%, respectively. From baseline to follow-up, ED and EL levels increased by 2.81-fold and 8.55-fold in the intervention group and decreased by 0.25-fold and 0.27-foldin the placebo group. Conclusion Following three months of supplementation, the intervention group showed substantially lower menopausal symptoms (p < 0.001), and ED and EL levels were considerably higher (p < 0.001). Therefore, flaxseed might ameliorate the symptoms associated with perimenopause.

Drug retention of biologic and targeted synthetic disease-modifying antirheumatic drugs in Korean patients with seropositive rheumatoid arthritis.

The aim of this study was to compare the short- and long-term retention rates of biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) in Korean patients with seropositive rheumatoid arthritis. This study was conducted with 1,538 treatment courses of 1,063 patients, including adalimumab (n = 332), etanercept (n = 369), infliximab (n = 146), abatacept (n = 152), tocilizumab (n = 299), tofacitinib (n = 136), and baricitinib (n = 104), in patients with seropositive rheumatoid arthritis who started b/tsDMARD treatment between 2008 and 2020 at Seoul St. Mary's Hospital. Discontinuation 1 and 3 years after the first prescription of each drug was investigated. Kaplan- Meier estimates of time to discontinuation were calculated to compare the difference in drug retention rate for each drug. Patient-level predictors of drug discontinuation were evaluated using a Cox proportional hazards model. The overall 1-year drug retention rate was from 60.1% for adalimumab to 90.0% for tofacitinib in the b/tsDMARD-naïve group, and from 55.2% for infliximab to 84.8% for tofacitinib in the b/tsDMARD-experienced group. The 3-year drug retention rate was from 36.9% for infliximab to 86.5% for tofacitinib in the b/tsDMARD-naïve group, and from 31.0% for infliximab to 65.4% for tocilizumab in the b/tsDMARD-experienced group. Drug discontinuation appeared to be affected by specific types of b/tsDMARDs. Tocilizumab and tofacitinib are less commonly discontinued compared to tumor necrosis factor-α inhibitors at 1 and 3 years. Specifically, tofacitinib in the b/tsDMARD-naïve group and tocilizumab in the b/tsDMARD-experienced group showed the highest 3-year retention rates.

The impact of bronchiectasis and its severity on long-term renal outcomes.

<sec><title>INTRODUCTION</title>While bronchiectasis is associated with adverse cardiovascular outcomes, data regarding its impact on long-term renal outcomes is lacking.</sec><sec><title>METHODS</title>We reviewed bronchiectasis patients followed up at Queen Mary Hospital in 2017 and examined their clinical/renal outcomes in the subsequent five years. The relationships between the severity of bronchiectasis as defined by FACED (FEV1, Age, Chronic colonisation, Extension, Dyspnoea) scores and adverse renal outcomes were evaluated.</sec><sec><title>RESULTS</title>A total of 315 bronchiectasis patients were included. Seventy-five patients (23.8%) showed renal progression. Baseline FACED score showed a positive correlation with renal progression over 5 years of follow-up (adjusted odds ratio [aOR] 1.30 (95% CI 1.083-1.559, P = 0.005). Patients with moderate-to-severe bronchiectasis (FACED score ≥3) showed an increased risk of renal progression (aOR 1.833, 95% CI 1.082-3.106; P = 0.024) and more rapid decline in estimated glomerular filtration rate than those with mild disease (-4.77 ± 4.19 mL/min/1.73 m²/year vs. -3.49 ± 3.94 mL/min/1.73 m²/year; P = 0.006). Patients who developed renal progression had a higher risk of death (adjusted hazard ratio [aHR] 3.056, 95% CI 1.505-6.206; P = 0.002) and subsequent rates of hospitalisation (1.56 ± 2.81 episodes/year vs. 0.60 ± 1.18 episodes/year; P < 0.001) compared to those without renal progression.</sec><sec><title>CONCLUSIONS</title>Progressive renal function deterioration is prevalent among bronchiectasis patients, and the severity of bronchiectasis is a robust predictor of renal progression.</sec>.

Glycated albumin may have a complementary role to glycated hemoglobin in glucose monitoring in childhood acute leukemia.

Glycated hemoglobin (HbA1c) as a glycemic index may have limited value in pediatric patients with acute leukemia as they often present with anemia and/or pancytopenia. To address this issue, we evaluated the usefulness of glycated albumin (GA) as a glycemic monitoring index in pediatric patients with acute leukemia. Medical records of 25 patients with type 2 diabetes mellitus (T2DM), 63 patients with acute leukemia, and 115 healthy children from Seoul St. Mary's Hospital, The Catholic University of Korea, were retrospectively investigated for serum GA, HbA1c, and fasting blood glucose (FBG) levels, along with demographic data. GA, HbA1c, and FBG levels did not differ between the control and acute leukemia groups. In the T2DM group, positive correlations were observed among GA, HbA1c, and FBG (P<0.01). Although GA level was not associated with the HbA1c level in the control group, GA and HbA1c levels showed a positive correlation in the acute leukemia group (P=0.045). Regression analysis revealed GA and HbA1c levels to be positively correlated in the acute leukemia and T2DM groups even after adjusting for age, sex, and body mass index z-score (P=0.007, P<0.01). GA may be a useful complementary parameter to HbA1c for glycemic monitoring in pediatric patients with acute leukemia, similar to its use in patients with T2DM.

Validation of diagnostic coding for chronic obstructive pulmonary disease in an electronic health record system in Hong Kong.

Electronic health record databases can facilitate epidemiology research regarding diseases such as chronic obstructive pulmonary disease (COPD), a common medical condition worldwide. We aimed to assess the validity of International Classification of Diseases, 9th Revision (ICD-9) code algorithms for identifying COPD in Hong Kong's territory-wide electronic health record system, the Clinical Data Analysis and Reporting System (CDARS). Adult patients diagnosed with COPD at all public hospitals in Hong Kong and specifically at Queen Mary Hospital from 2011 to 2020 were identified using the ICD-9 code 496 (Chronic airway obstruction, not elsewhere classified) within the CDARS. Two respiratory specialists reviewed clinical records and spirometry results to confirm the presence of COPD in a randomly selected group of cases. During the study period, 93 971 and 2479 patients had the diagnostic code for COPD at all public hospitals in Hong Kong and specifically at Queen Mary Hospital, respectively. Two hundred cases were randomly selected from Queen Mary Hospital for validation using medical records and spirometry results. The overall positive predictive value was 81.5% (95% confidence interval=76.1%-86.9%). We also developed an algorithm to identify COPD cases in our cohort. This study represents the first validation of ICD-9 coding for COPD in the CDARS. Our findings demonstrated that the ICD-9 code 496 is a reliable indicator for identifying COPD cases, supporting the use of the CDARS database for further clinical research concerning COPD.

MRI T2w Radiomics-Based Machine Learning Models in Imaging Simulated Biopsy Add Diagnostic Value to PI-RADS in Predicting Prostate Cancer: A Retrospective Diagnostic Study.

Currently, prostate cancer (PCa) prebiopsy medical image diagnosis mainly relies on mpMRI and PI-RADS scores. However, PI-RADS has its limitations, such as inter- and intra-radiologist variability and the potential for imperceptible features. The primary objective of this study is to evaluate the effectiveness of a machine learning model based on radiomics analysis of MRI T2-weighted (T2w) images for predicting PCa in prebiopsy cases. A retrospective analysis was conducted using 820 lesions (363 cases, 457 controls) from The Cancer Imaging Archive (TCIA) Database for model development and validation. An additional 83 lesions (30 cases, 53 controls) from Hong Kong Queen Mary Hospital were used for independent external validation. The MRI T2w images were preprocessed, and radiomic features were extracted. Feature selection was performed using Cross Validation Least Angle Regression (CV-LARS). Using three different machine learning algorithms, a total of 18 prediction models and 3 shape control models were developed. The performance of the models, including the area under the curve (AUC) and diagnostic values such as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were compared to the PI-RADS scoring system for both internal and external validation. All the models showed significant differences compared to the shape control model (all p < 0.001, except SVM model PI-RADS+2 Features p = 0.004, SVM model PI-RADS+3 Features p = 0.002). In internal validation, the best model, based on the LR algorithm, incorporated 3 radiomic features (AUC = 0.838, sensitivity = 76.85%, specificity = 77.36%). In external validation, the LR (3 features) model outperformed PI-RADS in predictive value with AUC 0.870 vs. 0.658, sensitivity 56.67% vs. 46.67%, specificity 92.45% vs. 84.91%, PPV 80.95% vs. 63.64%, and NPV 79.03% vs. 73.77%. The machine learning model based on radiomics analysis of MRI T2w images, along with simulated biopsy, provides additional diagnostic value to the PI-RADS scoring system in predicting PCa.

Low Absolute Lymphocyte Count Correlates with Lymph Node Metastases and Worse Survival of Patients with Gastric Cancer.

Several studies have found that the absolute lymphocyte (ALC) or neutrophil count predicts the survival of patients with solid tumors, and that the neutrophil-to-lymphocyte ratio and the prognostic nutritional index are useful markers of gastric cancer prognosis. However, it remains unclear whether the ALC is prognostic of lymph node (LN) metastasis in patients with gastric cancer. In this study, we aimed to explore the impact of ALC on prognosis and distinctive clinical characteristics in patients with gastric cancer. The medical records of patients with gastric adenocarcinomas who underwent radical gastrectomy with curative intent at Seoul St. Mary's Hospital and Yeouido St. Mary's Hospital between January 2010 and December 2017 were reviewed. Of these, 4149 patients for whom preoperative white blood cell, neutrophil, and lymphocyte counts were available were enrolled. In all 4149 patients, ALC gradually decreased as the pN stage increased. Those with an ALC of less than 1360 cells/μL were defined as a low-ALC group, and advanced cT and cN stages were the strongest risk factors for LN metastasis in both univariate and multivariate analyses; undifferentiated tumor histology and a low ALC were also significant risk factors. Patients of all stages in the ALC-low group exhibited poorer prognoses. The ALC-low group also exhibited a higher recurrence rate in a greater proportion of LNs. In patients with gastric cancer, as the preoperative ALC decreases, the incidence of LN metastasis increases. A low ALC is associated with a high recurrence rate, particularly in LNs.

Dietary diversity, undernutrition, and predictors among pregnant adolescents and young women attending Gulu University teaching hospitals in northern Uganda.

Undernutrition has deleterious consequences to both the mother and the unborn child, significantly contributing to maternal and neonatal morbidity and mortality. We assessed dietary diversity, the prevalence, and predictors of undernutrition among pregnant adolescents and young women (PAYW) attending antenatal clinic (ANC) at two large teaching hospitals in northern Uganda. Between 12th June 2023 to 27th October 2023, we conducted a facility-based, cross-sectional study at Gulu Regional Referral Hospital (GRRH) and St Mary's Hospital Lacor (SMHL), both in Gulu district, Uganda. We recruited PAYW aged 15-24 years attending ANCs. Sociodemographic and clinical characteristics of the study participants were collected using a pre-tested, semi-structured questionnaire. Undernutrition was defined as a mid-upper arm circumference (MUAC) of < 23 cm. Modified Poisson regression analysis was performed to determine factors independently associated with undernutrition. Data analyses was performed using STATA version 17.0. A p<0.05 was considered statistically significant. A total of 324 participants, with a mean age of 21.2±2.2 years were enrolled. About 62.0% (n = 201) of the participants dewormed during pregnancy. The prevalence of undernutrition was 12.7% [n = 41]. Prevalence was higher among participants who maintained pre-pregnancy diet (adjusted prevalence ratio [aPR] = 2.27, 95% Confidence Interval [CI]: 1.26-4.05, p = 0.006), those who did not receive nutritional education (aPR = 2.25, 95% CI: 1.21-4.20, p = 0.011) and consumption of non-green leafy vegetables (aPR = 4.62 95% CI: 1.64-13.01, p = 0.004). The prevalence of undernutrition was lower among participants who consumed milk and milk products (aPR = 0.44 95% CI: 0.24-0.81, p = 0.009) and among those who consumed fish and seafood compared to those who did not (aPR = 0.45 95% CI: 0.20-1.00, p = 0.050). About 1 in 8 of PAYW attending GRRH or SMHL had undernutrition, particularly those who lacked education about feeding habits during pregnancy and limited access to milk and milk products, fish and seafoods. We recommend health workers to offer timely education of pregnant adolescent and young women mothers about good feeding habits during pregnancy, appropriate monitoring of weight gain and physiological changes during pregnancy.

Impact of Tumor Size on Prognosis in Differentiated Thyroid Cancer with Gross Extrathyroidal Extension to Strap Muscles: Redefining T3b.

The prognostic significance of tumor size in T3b differentiated thyroid cancer (DTC) remains debated and underexplored. This study aimed to examine the varying impact of T3b based on tumor size, analyzing disease-specific survival, disease-free survival, and overall survival. A retrospective review of 6282 DTC patients who underwent thyroid surgery at Seoul St. Mary's Hospital from September 2000 to December 2017 was conducted. T3b was classified into three subcategories, T3b-1 (≤2 cm), T3b-2 (2-4 cm), and T3b-3 (>4 cm), using the same size criteria for T1, T2, and T3a. T3b-1 showed no significant difference in disease specific survival compared to T1, and both disease-free and disease-specific survival curves were sequentially ranked as T1, T3b-1, T2, T3a, T3b-2, and T3b-3. The modified T category, reclassifying T3b-1 as T1, demonstrated superior staging performance compared to the classic T category (c-index: 0.8961 vs. 0.8959 and AUC: 0.8573 vs. 0.8518). Tumors measuring 2 cm or less within the T3b category may require downstaging, and a modified T category could improve the precision of prognostic staging compared to the current T category.

Effects of cold and hot temperatures on the renal function of people with chronic disease.

This study investigated the effects of hot and cold temperature on the renal function of people with chronic diseases, such as diabetes, hypertension, and chronic kidney disease, using large-scale clinical data. We used retrospective cohort data from the Clinical Data Warehouse of the Seoul St Mary's Hospital, which contains clinical, diagnostic, laboratory, and other information about all patients who have visited the hospital since 1997. We obtained climate data from the Automated Synoptic Observing System of the Korea Meteorological Administration. The heat index was used as a measuring tool to evaluate heat exposure by indexing the actual heat that individuals feel according to temperature and humidity. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. To investigate changes in renal function trends with heat index, this study used generalized additive mixed models. Renal function decreased linearly with increasing heat index after approximately 25°C, which was considered the flexion point of temperature. A linear decrease in the eGFR was observed with the effects of 0 to 5 lag days. Although there was a correlation observed between the decrease in eGFR and temperatures below -10°C, the results did not indicate statistical significance. The results of our study provide scientific evidence that high temperatures affect the renal function of people with chronic diseases. These results can help prevent heat-related morbidity by identifying those who are more likely to develop renal disease and experience worsening renal function.

P-116 Relationship between exposure in equilibration solution pre-vitrification for human collapsed blastocysts and miscarriage rate in ART treatments

Abstract Study question To explore the relationship between equilibration time pre-vitrification of human collapse blastocyst and clinical pregnancy and miscarriage rate in patients undergoing ART treatments Summary answer The miscarriage rate was significantly lower in the group with a short equilibration time of 7-8 minutes compared to the group of 9-10 minutes What is known already The introduction of vitrification represents one of the most important advancement in ART. However, protocols currently applied to cryopreserve human embryos still have some weak points that might be improved. A critical aspect is represented by the high concentration of cryoprotectants (CPAs) used during the vitrification and some of this CPAs might impact negatively cellular metabolism and function. Thus, this study investigated whether a shorter time in the equilibration solution before vitrification of artificially collapsed blastocysts might have an impact on survival and pregnancy outcomes, as well as live birth rate and risk of miscarriage in patients undergoing ART. Study design, size, duration This prospective study was performed at the Centre for Reproductive Medicine, Haikou Mary Hospital, China from March 2018 to May 2022. Informed consent for experimentation with human subjects was obtained before the patients start the ovarian stimulation. Female age &amp;lt;35 years, and causes of infertility included male factors, female infertility, and unexplained infertility. Following the fresh embryo transfer, supernumerary good quality blastocysts ≥ 2, according to Gardner’s score were vitrified and allocated as discussed below Participants/materials, setting, methods The study included a total of 831 expanded blastocysts, which were divided into two groups according to the equilibration time before vitrification: group (A) 7-8 minutes (413); and group (B) 9-10 minutes (418). Expanded blastocysts (grade 3 or more) were artificially shrunk by applying one or two laser pulses. Patients were included in the study only when at least two blastocysts were available for vitrification, in order to be allocated one in each group Main results and the role of chance Results: A total of 831 vitrified-warmed blastocysts were analysed in this study, of which 825 survived at the warming step (99.3%: 825/831). All surviving blastocysts were transferred in 585 embryo transfers. Overall, the clinical pregnancy rate per transfer was CPR: 68.5% (401/585), and live birth and miscarriage rates: 61.0% (357/585) and 11.0% (44/401). No significant differences were observed between the two groups regarding the mean age of patients, the average number of blastocysts transferred, the basal FSH, BMI, and infertility duration. Results show the same survival rate after warming for group A (99.3%) and group B (99.3%), as well as similar CPR (A: 69.1% versus B: 68.0%).The live birth (A: 63.8% versus B: 58.3%) and multiple gestation rates (A: 20.8% versus B: 23.5%) were comparable in the two groups. When analysing the overall miscarriage rate, data displayed a statistically significant difference (P &amp;lt; 0.05) in favour of group A (7.6%) compared to group B (14.2%). There were no differences between the two groups concerning the prevalence of male babies (A: 57.1% and B: 55.4%), average gestational length (A: 38.67±1.37 versus B: 38.33±1.21), preterm birth rate (A: 19.2% versus B: 20.6%), and birth weight (A: 2.95±0.58 versus B: 3.05±0.63 kg). Limitations, reasons for caution This is not a randomized controlled trial, it is a prospective observational cohort study aiming to calculate the effect of a shorted ES time on the risk of miscarriage. Also, potential confounding factors due to the heterogeneous nature of the sample investigated may impair the validity of our conclusions. Wider implications of the findings Results demonstrate that a shorter equilibration time resulted in optimal survival, clinical pregnancy, and live birth rates compared to exposure to ES for 9-10. Thus, suggesting that a longer exposure to the ES is not needed, and might negatively effect cellular metabolism and function, increasing the risk of miscarriage. Trial registration number Not applicatione