Peak Incidence Research Articles

Paediatric oral and maxillofacial biopsies: A retrospective institutional archival study.

This is a retrospective cross-sectional study of oral and maxillofacial biopsies in paediatric population, up to 16 years of age from 1991 to 2021. This study aimed to investigate the frequency, demographic and clinicopathological characteristics of paediatric biopsies according to the diagnosis categories of the main tertiary centre in Malaysia. A total of 17294 histopathological reports from Diagnostic Oral Pathology Unit between 1991 and 2021 were retrieved. One thousand eleven histopathological reports that fulfilled the inclusion and exclusion criteria were included. Information of interest was extracted from histopathological reports. The lesions were categorised into 10 diagnosis categories. Descriptive and correlation analysis were performed. Paediatric oral and maxillofacial biopsies accounted for 5.9% of the total biopsies received. The peak incidence of diagnosis was in age range of 12 to 16 years old and mean age of 11.6 years old (±3.5), with female preponderance. The most common category of diagnosis was salivary gland pathology with mucocele (30%) being the most frequently diagnosed lesions. Lip and labial mucosa were the commonest site of occurrence. Specimen sizes smaller than 1 cm were the most common specimen diameter with mean size of 1.6 cm (±1.5). Age, site of occurrence and specimen size were statistically significant (P < 0.05) with paediatric oral and maxillofacial biopsies. This is a large-scale study of paediatric oral and maxillofacial biopsies of a tertiary centre over three decades. We hope this data is useful for chairside assessment and aids in diagnosis making.

Time trends in incidence of pilonidal sinus disease from 1996 to 2021: A Danish population-based cohort study.

Pilonidal sinus disease (PSD) is a common condition, but no data on disease occurrence exist outside highly selected settings. The aim of this study was to assess time trends in the incidence of PSD in a nationwide setting. Using data from nationwide Danish registries, we identified 48 247 patients recorded with diagnostic or surgical procedure codes representing PSD between 1996 and 2021. We stratified by sex and computed the age-adjusted and age-specific incidence rate, comparing 5-year intervals with the incidence rate ratio (IRR). The overall incidence of PSD increased from 26.1 to 39.6/100 000 person-years (PY) from the period 1996-2000 to the period 2016-2021 (IRR 1.52, 95% CI 0.78-2.94). The incidence increased from 35.8 to 56.9/100 000 PY (IRR 1.59, 95% CI 0.52-4.89) in male patients and from 16.4 to 22.5/100 000 PY (IRR 1.37, 95% CI 0.68-2.76) in female patients. The peak of age-specific incidence was 215.7/100 000 PY (95% CI 206.1-245.4) among 20-year-old men and 107.9/100.000 PY (95% CI 100.0-114.0) among 18-year-old women. Over the study period, the median age at first hospital contact decreased from 27 years [interquartile range (IQR) 22-34 years) to 25 years (IQR 20-34 years) in men but remained stable around 23 years (IQR 18-32 years) in women. However, for both sexes, the highest increase in incidence was seen in early adolescence. The incidence of PSD has increased significantly over the last decades. The increase is driven primarily by men and boys, with the highest increase in incidence seen in early adolescence. The increased burden of disease is not reflected in the literature, and more studies are warranted to understand the drivers of this development.

Seasonality of common respiratory viruses: Analysis of nationwide time-series data.

Understanding the seasonal behaviours of respiratory viruses is crucial for preventing infections. We evaluated the seasonality of respiratory viruses using time-series analyses. This study analysed prospectively collected nationwide surveillance data on eight respiratory viruses, gathered from the Korean Influenza and Respiratory Surveillance System. The data were collected on a weekly basis by 52 nationwide primary healthcare institutions between 2015 and 2019. We performed Spearman correlation analyses, similarity analyses via dynamic time warping (DTW) and seasonality analyses using seasonal autoregressive integrated moving average (SARIMA). The prevalence of rhinovirus (RV, 23.6%-31.4%), adenovirus (AdV, 9.2%-16.6%), human coronavirus (HCoV, 3.0%-6.6%), respiratory syncytial virus (RSV, 11.7%-20.1%), influenza virus (IFV, 11.7%-21.5%), parainfluenza virus (PIV, 9.2%-12.6%), human metapneumovirus (HMPV, 5.6%-6.9%) and human bocavirus (HBoV, 5.0%-6.4%) were derived. Most of them exhibited a high positive correlation in Spearman analyses. In DTW analyses, all virus data from 2015 to 2019, except AdV, exhibited good alignments. In SARIMA, AdV and RV did not show seasonality. Other viruses showed 12-month seasonality. We describe the viruses as winter viruses (HCoV, RSV and IFV), spring/summer viruses (PIV, HBoV), a spring virus (HMPV) and all-year viruses with peak incidences during school periods (RV and AdV). This is the first study to comprehensively analyse the seasonal behaviours of the eight most common respiratory viruses using nationwide, prospectively collected, sentinel surveillance data.

P01 Adult-onset chronic recurrent multifocal osteomyelitis – case series of four adult patients in Liverpool University Teaching Hospitals Foundation Trust

Abstract Introduction Chronic recurrent multifocal osteomyelitis (CRMO) is a rare inflammatory bone disorder. Classically known as a childhood disorder and diagnosis of exclusion, it characteristically presents with relapsing sterile bone inflammation affecting the metaphysis of lung tubular bones, shoulder girdle, clavicle, vertebral column or bony pelvis. Links with autoimmune conditions have been suggested. Evidence of adult-onset cases (age &amp;gt;18 at diagnosis) remains sparse and sporadic, with mostly individual case reports on searches. We present a case series of four patients with adult-onset CRMO in Liverpool, with varying responses to bisphosphonate treatment and no clinical features of SAPHO. Case description We list four cases of adult patients with CRMO. Case 1: 53-year-old female presented in 2023 with a 10 year history of on-off chest pain isolated to her sternum, and back pain since 2021. MRI confirmation of bone marrow oedema. Bone biopsy normal. Treated with zoledronate. MRI following treatment suggested some improvement but patient remained in pain. Case 2: 24-year-old female presented in 2019 to services with a 10 year history of worsening back pain. Medical background of asthma, type 1 diabetes mellitus, primary biliary cirrhosis and psoriasis. MRI suggestive of persistent pre-sacral soft tissue and sacral oedema since 2015. ANA, Anti-CCP, ENA and dsDNA were negative. Bone biopsy done was positive for inflammation. Pain improved with pamidronate. Case 3: 31-year-old male presented in 2022 with 14 years of relapsing pains and swelling in left clavicle and improvement with NSAIDs. Initially presented via orthopaedic services who arranged an MRI scan that demonstrated oedema of his left clavicle. Received zoledronate infusion with improvement in pain. Case 4: 45-year old-female presented in 2024 with eight year history of chronic right hip and right sacroiliac joint pain. Persistent lower back pain, central right sided with radiation down right knee to her knee. Examination showed tenderness over her lumbar spine and sacroiliac joints. PET-CT done showed avid uptake in L3/4, with subtle lucencies in left frontal bone, right femur and right sacrum. Treated as CRMO with pamidronate with a positive response. All patients received bisphosphonate therapy and varied response to treatment was seen. Two of the four patients had an excellent response with complete resolution of symptoms. One patient has had initial positive response to treatment with resolution of pain but is still planned for more bisphosphonate cycles. One patient had no response to treatment. Discussion Current literature searches describe CRMO mostly in the paediatric populace, with peak incidence aged 10. Most cases of CRMO are diagnoses of exclusion, hence leading to diagnostic delays as differentials such as malignancy, infection, and histiocytosis are first excluded. The Bristol review study suggested a mean time of 15 months to diagnosis in the paediatric populace. We highlight here our findings that CRMO can also present within the adult populace. Typically in adults when similar symptoms arise, SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) is considered as a differential. Our patients, whilst having features on imaging suggestive of bone inflammation, did not have any features of SAPHO syndrome. Our findings are corroborated by the Eurofever International Registry study that enrolled 485 patients and showed adult-onset disease in 6.3% of their cohort, accounting for 31 cases. Our patients were all treated with bisphosphonate therapies. Currently, bisphosphonate therapies are often agreed as a first line treatment approach. Some reports exist of beneficial effects in the use of corticosteroids, DMARDS - particularly sulfasalazine and methotrexate - and biologic treatments (anti-TNF agents), though no common consensus guideline for treatment of CRMO within the UK exist at the moment to our knowledge. We feel the varied clinical response of our patients highlights a need for more research to be targeted towards this area. Key learning points Learning points are as follows: • Few cases of adult-onset CRMO are reported in the UK. Most are single site case reports or case series of paediatric patients. • This cases series is the largest adult-onset cohort in Europe from a single hospital site. • Bisphosphonates are used first line - typically pamidronate. • Corticosteroids, DMARDs (SLZ/MTX) and biologic treatments (anti-TNF agents) have been reported to be effective in some single case reports. • Additional research is required for a national consensus guideline for the treatment of CRMO, including additional management options for those patients that fail first line treatment (bisphosphonate).

Use of Heber FERON as Part of the Treatment in Diffuse brain tumors: Report of Two Cases and Literature Review

Glioblastomas are the most common and malignant tumor among glial neoplasms (1). According to the Central Brain Tumor Registry of the United States (CBTRUS), the age-adjusted annual incidence rate of malignant primary brain tumors is 7.06/100,000 inhabitants and glioblastoma was 49.1% of them (2). It is characterized by being a fast-growing tumor, composed of a heterogeneous mixture of poorly differentiated astrocytic tumor cells, with pleomorphism, necrosis and vascular proliferation. According to the fifth classification of the World Health Organization, this type of tumor does not present a mutation in the IDH gene and usually presents a mutation in the EGFR gene, a mutation of the TERT promoter, trisomy of chromosome 7 and monosomy of chromosome 10 (3). It can manifest at any age, but it mainly affects adults, with a peak incidence between 45 and 70 years (3).The failure of current therapeutic approaches (focusing on surgical resection followed by radiotherapy and chemotherapy) is due to the dissemination that occurs in these tumors. Gliomas are highly infiltrating neoplasms, with solitary tumor cells or clusters of neoplastic cells that migrate extensively throughout the brain. In addition, malignant gliomas are an important stimulator of angiogenesis in a physiological manner, and angiogenesis in turn, may be a significant component in the progression of glial tumors. (5)This situation shows that the population of patients with malignant gliomas does not have therapeutic options to prolong their life, for this reason these two cases are presented to whom a therapeutic option with HeberFERON was offered to patients with diffuse brain tumors with a poor prognosis, also evaluating its antitumor effect (Imaging).

Relevance of Thyroid Microcarcinoma and Its Diagnosis

Microcarcinoma is a thyroid gland cancer with a size of less than 1 cm. The aim: To determine the frequency of microcarcinoma among malignant pathologies of the thyroid gland based on fine-needle aspiration biopsies (FNAB) data. Materials and Methods: A retrospective analysis of 2490 FNAB data was conducted under ultrasound control from 2007 to 01.07. 2024 at the Ternopil Regional Clinical Hospital. FNAB results were categorized into four groups: the first group – non-diagnostic results, the second – suspicion of thyroid cancer, the third – thyroid cancer, and the fourth – benign lesions. After the Bethesda system was introduced, FNAB classifications were based on this system. Results: Thyroid cancer was diagnosed in 186 cases (7.5%). Among these, macrocarcinoma was identified in 152 cases (81.7%) and microcarcinoma in 34 cases (18.3%). The peak incidence of microcarcinoma is observed in the 40-50 age, with approximately 90% of patients being women. Microcarcinomas in solitary nodules were found in 16 cases (47%); among multinodular goiters in 18 cases (53%). In 8 cases (23.5%), microcarcinoma was associated with larger thyroid cancers (multifocal process) and in 4 cases (11.8%) with benign nodules. In 6 cases (17.7%), microcarcinomas were associated with nodules suspicious for cancer. Conclusions: Indications for FNAB should be guided by the identified sonographic characteristics (solid echostructure of the nodule; hypoechogenicity; vertical orientation of nodules; indistinct margins of the nodule; presence of microcalcifications; regional cervical lymphadenopathy with signs of malignancy).

How have respiratory tract infections changed in the post-covid era for children under 5 years?

Abstract Background Social distancing measures introduced in response to the covid-19 pandemic reduced transmission of all respiratory pathogens. Exposure to respiratory pathogens in early life affects future lung health. We aimed to describe changes in the incidence of respiratory tract infections (RTIs) in children &amp;lt;5 years in England in the post-pandemic era. Methods Population-based retrospective cohort study using electronic health records. We included all children aged &amp;lt;5 years registered with a primary care practice from April 2016 to March 2023. We compared monthly GP consultation rates for RTIs in the two post-pandemic years (April 2021 - March 2022 and April 2022 - March 2023) with corresponding months during pre-pandemic years (April 2016 - February 2020). Results There were 3 045 701 respiratory tract infections among 2 894 539 children &amp;lt;5 years registered with a GP practice during the study period. Pre-pandemic, monthly RTI rates varied from lows of 29.1 per 100 child-years in August to highs of 108.8 per 100 child-years in November. In 2021/22, monthly RTI rates were bimodal peaking in June and October, although the winter peak was lower than pre-pandemic years and mean monthly RTI rates were ∼15% lower overall. In 2022/23 mean monthly RTI rates remained ∼15% lower than pre-pandemic years, but there was a single peak in December 2022 of 117.6 RTIs per 100 child-years, exceeding the pre-pandemic winter peaks by 8.1%. Conclusions Overall, monthly RTIs in post-pandemic years were 15% lower than pre-pandemic years. However, there was a concerning peak in December 2022 that exceeded the winter peaks from previous years. Comparisons with national surveillance data suggest this peak reflects changes in RTI incidence, particularly among group A streptococcal infections, but this peak may also reflect changes in access to care or healthcare seeking behaviour. Continued monitoring of post-pandemic seasonal patterns will assist in planning for health service use. Key messages • Respiratory tract infections in children &amp;lt;5 years in post-pandemic years were 15% lower than pre-pandemic years, but winter peaks in incidence may be of greater magnitude in the post pandemic era. • Ongoing monitoring of patterns of respiratory tract infections in young children is important for future health service planning and delivery.

The epidemiology of type 1 diabetes mellitus in older adults.

Although type 1 diabetes mellitus (T1DM) is traditionally viewed as a youth-onset disorder, the number of older adults being diagnosed with this disease is growing. Improvements in the average life expectancy of people with T1DM have also contributed to the growing number of older people living with this disease. We summarize the evidence regarding the epidemiology (incidence, prevalence and excess mortality) of T1DM in older adults (ages ≥60 years) as well as the genetics, immunology and diagnostic challenges. Several studies report an incidence peak of T1DM in older adults of a similar size to or exceeding that in children, and population prevalence generally increases with increasing age. Glutamic acid decarboxylase antibody positivity is frequently observed in adult-onset T1DM. Guidelines for differentiating T1DM from type 2 diabetes mellitus in older adults recommend measuring levels of C-peptide and autoantibodies, including glutamic acid decarboxylase antibodies. However, there is no gold standard for differentiating T1DM from type 2 diabetes mellitus in people aged 60 years and over. As such, the global variation observed in T1DM epidemiology might be in part explained by misclassification, which increases with increasing age of diabetes mellitus onset. With a growing global population of older adults with T1DM, improved genetic and immunological evidence is needed to differentiate diabetes mellitus type at older ages so that a clear epidemiological picture can emerge.

Analysis of antibody dynamics in Chinese children aged 1-3 years after single-dose varicella vaccination: A 42 months prospective study

ABSTRACT In China, children aged 12 months receive only a single dose of the varicella vaccine and the incidence of varicella remains high. This study aims to evaluate the changes in immunity among children aged 1–3 years following a single dose of the varicella vaccine, providing a scientific basis for determining the optimal age for a second vaccination. This prospective cohort study employed glycoprotein enzyme-linked immunosorbent assay (gpELISA) for antibody detection. The changes in IgG antibody levels over time post-vaccination were analyzed using a restricted cubic spline (RCS) fitted binary logistic regression model. Varicella surveillance data were collected from the National Notifiable Disease Reporting System (NNDRS). Following a peak in varicella incidence in 2019, the incidence shifted toward older age groups. The cohort study results revealed a seropositivity rate of 100% in children during the 18 months post-vaccination, which subsequently declined to 71.6% by the 42 months. The geometric mean concentration (GMC) decreased from 307.6mIU/mL to 115.2mIU/mL. Additionally, 14 children contracted varicella during the follow-up period, resulting in a breakthrough rate of 2.85%. RCS analysis indicated that antibody levels fell below the protective threshold 18.69 months post-vaccination, with a non-linear decline in the odds ratio(OR) of maintaining antibody concentrations ≥ 50mIU/mL(p < .001, Pnonlinear ≤ 0.001). This study demonstrates that the long-term protective efficacy of a single dose of the varicella vaccine diminishes over time in children, underscoring the necessity of implementing a two-dose vaccination strategy. The findings provide scientific evidence for determining the optimal timing for administering the second dose of the vaccine.

ONYCHOMATRICOMA, A RARE NAIL TUMOR

Abstract Introduction/Objective Nail apparatus tumors are rare and can pose diagnostic challenges. Onychomatricoma (also called onychomatrixoma) is a rare tumor first described in 1992. It is a benign biphasic fibroepithelial tumor of the nail. It has been reported in Caucasians, often in females with a peak incidence in the fifth decade of life. Rare cases are also reported in children. The common location is in the fingernail (75%), presenting with yellowing of the nail plate (xanthonychia) and thick longitudinal band. Cutaneous horn, melanonychia, nail bleeding, and nail deformity with or without bony extension can also be seen. Histologic findings show increased nail thickness surrounded by a layer of Malpighian epithelium. The fibroepithelial tumor shows hyperplasia of two components including onychogenic epithelium and mesenchymal stroma. Methods/Case Report A 65-year-old Vietnamese female presented with longstanding dark yellowish ridging discoloration, thickening and nail plate deformity of the left fourth fingernail with appearance of onychomycosis. However, KOH mount and fungal cultures of the nail plate were negative for fungal microorganisms. There was no history of pain, trauma, or prior treatment. Microscopic analysis of transverse and longitudinal sections of the nail shows a biphasic neoplasm that penetrates the nail plate with multiple digitations. There was deep finger-like epithelial cell strands that form anastomosis as well as invaginations into the dermis. Characteristic filiform projections are lined by onychogenic epithelium composed mostly of basal and supra-basal cells that lack granular and corneum layers. The stroma was hypercellular and fibrillary with spindle-shaped fibroblastic cells, and a deep layer with dense collagen. Immunohistochemical stains of the lesion show diffuse expression for CD10 and CD34 in the stroma and negativity for Periodic Acid Schiff staining. Results (if a Case Study enter NA) N/A Conclusion While most of the literature on onychomatricoma has been reported in Caucasian population, little is known about this tumor in non-Caucasians. This case report of onychomatricoma in a Vietnamese woman contributes to the emerging literature of this rare nail apparatus tumor in non-Caucasian population. Clinical and histopathologic correlation is important to achieve prompt and correct diagnosis since delay would result in nail dystrophy and deformity.

Distal radius fractures and distal ulna fractures among adults in a southern China county during the 11-year-period 2010 to 2020.

Most distal radius fractures are associated with distal ulnar fractures. However, there is still a lack of consensus on the incidence of different types of distal ulnar fractures among adults in China. Therefore, we analyzed the incidence of distal radial fractures with and without associated distal ulnar fractures among adults in a southern China county from 2010 to 2020. Registry data of 2333 patients (2351 sides) with a distal radius fracture from 2010 to 2020 underwent evaluation, encompassing parameters such as age, sex, distal radius fracture classification, fracture side, and distal ulnar fracture classification. Distal radial fractures were classified according to the AO/OTA classification. Distal ulnar fractures were examined using the Q-modifier classification. 1719 females (73.68%) and 614 males (26.32%) were included in the study. Compared to men, the incidence of distal radial fractures accompanying distal ulnar fractures in women was approximately 2.8 times higher. Additionally, 49.81% of distal radius fractures were associated with fractures of the distal ulna, while 46.44% were associated with fractures of the ulnar styloid. The most common fracture type was that of the ulnar styloid Q1 (93.73%). The mean age of female patients was 61.71 ± 12.13, while male patients had an average age of 50.63 ± 14.86. The Q1 type was the most common type of distal ulnar fracture. We also found that more females (age range: 50 years or older) had type C distal radius fractures compared to males. However, type B fractures were observed more frequently in males than in females (range: 18-49 years). Osteoporosis was believed to be the main cause of fractures in women aged >50 years old. Moreover, the peak incidence of radius fractures in males was lower than in females in different age groups.

Temporal distribution characteristics of hand, foot and mouth disease in Beijing, 2008-2023

Objective: To analyze the temporal distribution characteristics of hand, foot and mouth disease (HFMD) in Beijing and provide reference evidence in HFMD prevention and control. Methods: The monthly incidence data of HFMD in Beijing from 2008 to 2023 were collected from Notifiable Disease Management Information System of the Chinese Information System of Disease Control and Prevention, and the epidemiological characteristics of HFMD were analyzed by the methods of time series seasonal decomposition graph, concentration degree, and circular distribution.The WPS office software 2019 was used to clean the data, Python software 3.12 was used to analyze and make statistical charts. Results: The monthly incidence fluctuation of HFMD in Beijing from 2008 to 2015 was higher than that from 2016 to 2022. From 2016 to 2022, the fluctuation range of monthly incidence showed a gradually decreasing trend.From 2008 to 2015, the concentration (M) was 0.58, indicating a relatively strong seasonality; the mean angle (α) calculated by the circular distribution method was 174.95°, and the mean angle standard deviation (s) was 60.43°. The annual incidence peak occurred on June 27, and the incidence peak period was from April 27 to August 27. From 2016 to 2019 and 2023, the M was 0.57, indicating a relatively strong seasonality. The α was 228.05°, and s was 61.44°. The annual incidence peak occurred on August 20, and the incidence peak period was from June 18 to October 21. From 2020 to 2022, the M was 0.42, indicating a seasonality, the α was 238.27° and s was 76.35°. The annual incidence peak occurred on July 15, and the incidence peak period was from June 14 to November 14. The α of 2008-2015, 2016-2019 and 2023, and 2020-2022 were tested by the Watson-Williams method and the difference was statistically significant (F=33 443.09, P<0.001). In 2023, the M was 0.77, indicating a strong seasonality. The incidence peak occurred on September 16, and the incidence peak period was from August 5 to October 28. Conclusions: The seasonality of HFMD in Beijing was obvious from 2008 to 2023, and the incidence peak day and peak period overall had rearward shifts. It is necessary to strengthen the comprehensive analysis of the distribution characteristics at different dimensions and the comprehensive prevention and control in key areas, places, and populations during the peak incidence period.

Microbiology, induction, and management practices to mitigate lameness caused by bacterial chondronecrosis with osteomyelitis in broiler chickens

Bacterial chondronecrosis with osteomyelitis (BCO) lameness is the most prevalent skeletal disorder in poultry, implicated by the inherent risk of the high growth rate of modern broilers. The non-synchronization of massive body mass accretion vs maturation of the structural bone induces vulnerability to bone microfracture and immunosuppression, leading to bacterial necrosis in the skeletal and thoracic vertebral bones, leg paralysis, and eventual death. BCO lameness also imposes animal welfare issues and confers food safety risks. A study in 20 broiler farms in Australia recorded 28% BCO lesions of the necropsied birds, while a study in commercial flocks in Europe reported 19% moderate-to-severe lameness symptoms. The high incidence of lameness in commercial broiler farms reduces production value and leads to a huge economic loss in the poultry industry. Managing BCO lameness in broiler poultry is more challenging than that of other species because the peak of lameness incidence emerges at the marketing age of broilers. Moreover, curative treatment of the affected broilers is arduous due to their larger populations but shorter production cycles. Thus, condemnation of clinically lame birds has been a common practice in broiler farms to prevent the transmission of highly contagious BCO throughout the broiler populations. This practice decreases the production value and increases the economic forfeits. Therefore, presenting intervention measures for managing and controlling BCO in broiler poultry is necessary. Knowledge of etiological agents, pathogenesis, detection, and experimental lameness models to evaluate the efficacy of the intervention measures is highly important in presenting approaches to mitigate BCO lameness. Thus, this review focuses on microbiology studies of BCO, models of creating experimental lameness, and intervention measures mitigating BCO lameness in broiler chickens.

Epidemiology and clinical characteristics of acute viral gastroenteritis in 350 paediatric patients hospitalised between 2019 and 2022 in the Military Institute of Medicine – National Research Institute in Warsaw, Poland: a single-centre retrospective analysis

Introduction and objective: Acute gastroenteritis, a common childhood illness worldwide, manifests with symptoms including fever, abdominal pain, vomiting, and diarrhoea. It is highly contagious, with transmission occurring through contaminated water, food, or poor hygiene. Globally, 1.7 billion cases of diarrhoeal diseases are diagnosed annually, causing approximately 525,000 deaths among children under the age of five. Dehydration caused by diarrhoea is a primary cause of hospitalisation, particularly in developing countries. Aim: Analysis of the aetiology, frequency, and seasonal distribution of viral pathogens responsible for acute gastroenteritis in children hospitalised between 2019 and 2022 at the Military Institute of Medicine – National Research Institute in Warsaw, Poland. Materials and methods: Medical records of patients aged 0 to 18 diagnosed with rotavirus, norovirus, and adenovirus-induced acute gastroenteritis were analysed. The pathogens had been identified with reliable immunochromatographic tests. Exclusion criteria encompassed bacterial infections, dietary errors, and inflammatory conditions. Data examined included age, gender, aetiology of gastroenteritis, seasonality, duration of hospitalisation, and clinical symptoms (diarrhoea, vomiting, fever, abdominal pain, and dehydration). Laboratory results such as white blood cell count, C-reactive protein, electrolyte levels, and organ function markers were also evaluated. Results: Data from 350 children hospitalised between 2019 and 2022 were analysed. The highest number of hospitalisations occurred in 2019 and 2022, with fewer cases in 2020–2021, likely reflecting the impact of the COVID-19 pandemic. Most patients were between 6 and 12 months old. Rotavirus infection commonly presented with fever, vomiting, diarrhoea, and dehydration. Adenovirus and mixed infections were associated with slightly higher C-reactive protein levels, while rotavirus infections showed mildly elevated aspartate aminotransferase levels. Haematocrit, blood urea nitrogen, creatinine, and electrolyte levels were similar across all cases. Conclusions: Our analysis showed that rotavirus was the most frequent cause of acute viral diarrhoea in children, followed by norovirus and adenovirus, with mixed infections being the least common. The peak incidence occurred in autumn and winter, except in 2021, reflecting changes in the dynamics of infections related to the coronavirus pandemic. Biochemical findings were not sufficiently characteristic to infer the aetiology of the disease.

The Epidemiology of Thyroid Eye Disease in Olmsted County, Minnesota, 2005-2020.

Objective: To describe the epidemiology of thyroid eye disease (TED). Methods: A population-based cohort of all Olmsted County, Minnesota, residents who had newly diagnosed TED between January 1, 2005, and December 31, 2020, was identified through the medical diagnostic index of the Rochester Epidemiology Project. Individuals aged 18 years and older were included. Incidence rates and point prevalence were calculated. Baseline disease characteristics and progression of disease were described. Results: We identified 83 incident patients, of whom 75 (90.4%) were female. The overall age and sex adjusted incidence for the U.S. population were 5 cases/100,000 person-years. Females had higher incidence (8.9 cases/100,000 person-years) compared with men (1 case/100,000 person-years). The distribution of peak incidence rates by 5-year age groups differed between male and female, in which females had peak incidence rates in the age groups 60-64 years and 80-84 years (18.3 cases and 18 cases/100,000 person-years, respectively), while male had peak incidence rate in the age group 70-74 years (5.7 cases/100,000 person-years). No clear trend was identified for the yearly incidence between 2005 and 2020. The overall estimated point prevalence per 100,000 was 65 (CI, 53.3-78.7). Prevalence was 114.5 (CI, 92.6-139.9) for females and 13.8 (CI, 6.8-24.6) for males (p < 0.001). Factors associated with disease progression were severity of soft tissue involvement (hazard ratio [HR] 7.7; CI, 2-29.8) and presence of diplopia (HR 2.5, CI, 1.2-5.1). Conclusions: Incidence rates for TED remained stable over the past two decades, yet lower than that in the previous study from our population. Females continue to have the peak incidence rate a decade earlier than males, and the majority of disease burden is present after the age of 50 years. Appropriate resources should be devoted to furthering education, management, and research into this condition.

7427 Cellular Senescence As A Pro-Tumorigenic Process And Therapeutic Target In Adrenocortical Carcinoma

Abstract Disclosure: L. Smith: None. K. Warde: None. S. Haston: None. J. Martinez-Barbera: None. K. Basham: None. Adrenocortical carcinoma (ACC) is a rare, yet highly aggressive malignancy that arises in the adrenal cortex. Advanced age is a major risk factor for ACC, with the peak age incidence between 50 and 60 years old. Older individuals above age 50 also have significantly worse survival outcomes. A better understanding of how aging contributes to the development and progression of ACC will uncover new treatment strategies. A major hallmark of aging is the systemic accumulation of senescent cells. While senescent cells have been implicated in various age-related diseases, including cancer, their role in ACC remains poorly understood. ACC tumors from older patients have an enrichment of senescence-associated gene signatures. Moreover, advanced ACC patients are treated with etoposide, doxorubicin, and cisplatin (EDP), which are chemotherapies that induce senescence. While EDP offers short-term benefit in some patients, more than half will progress within 6-months. We hypothesize that the accumulation of senescent cells that arise after EDP treatment are ultimately tumor-supportive long-term. As a result, we postulate that the use of senolytic compounds that clear away senescent cells after EDP treatment will lead to improved survival outcomes for ACC patients. We developed a new ACC mouse model that provides a window to study the role of senescence in ACC tumor progression and treatment. Our model is based on adrenal specific loss of ZNRF3, which is a Wnt inhibitor that is frequently inactivated in human ACC tumors. Despite early adrenal hyperplasia, we showed that Znrf3 conditional knockout (cKO) mice do not develop adrenal tumors until 18-months of age, which corresponds to the peak age incidence in humans. Additionally, the adrenals of Znrf3 cKO mice show a robust senescence activation phenotype that precedes adrenal tumorigenesis. We hypothesize that the accumulation of senescent cells is pro-tumorigenic long-term. To test our hypothesis, we combined Znrf3 cKO mice with a newly established mouse model that enables selective ablation of senescent cells (ZKO-FDR mice). Ongoing aging studies will determine whether the removal of early and late senescent cells in ZKO-FDR mice reduces adrenal tumorigenesis. Further, we established new primary tumor cell lines from aged ZKO-FDR mice. These cell lines will facilitate testing of the pro-tumor mechanisms of senescence. Additionally, they will permit the removal of senescent cells, both genetically and pharmacologically with senolytics, as a new treatment strategy in ACC. Overall, this project aims to investigate the pro-tumor biology of age- and therapy-induced senescence in ACC. Results from these studies will advance our understanding of senescence in cancer and aid in the development of new therapeutic strategies for ACC, including senolytics. Presentation: 6/2/2024

Evaluation of new-onset BK viruria in post-renal transplant recipients by quantitative PCR

BackgroundThe BK polyomavirus infection poses a substantial challenge for organ transplant recipients due to immunosuppression, resulting in BK virus-associated nephropathy (BKVAN) and a considerable risk of graft loss. Screening and prompt decrease of immunosuppression are essential for averting these consequences. We examined the frequency of BK viruria (viral load in urine) among post-renal transplant recipients, along with its association with age, viral load, and the timing of viral reactivation. MethodsThe prospective cohort study was conducted at the Tertiary Care Hospital in Rawalpindi over a 12-month period, from January 1 to December 31, 2023. Urine specimens from 108 renal transplant recipients were collected and analysed for BK viruria every three months during the follow-up assessments. DNA extraction was performed using TANbead extractor, and amplification was carried out with Bio-Rad CFX-96 thermal cycler using Sacace TM amplification kit. Data was analysed using SPSS version 27. ResultsIn the cohort of 108 renal transplant recipients, BK viruria was detected in 16.7 % of cases. There was a higher prevalence of BK viruria in females (20 %) than males (16 %). The majority of positive cases were within the 41–60 years age group (61.1 %). Most of the patients (66.6 %) had viral loads below 1 million copies/ml. BK viruria was predominantly detected during the third quarter (between 7 and 9 months) post-transplant. The Chi-square test was applied between age and viral load, showing a significant association (p = 0.01). Similarly, gender and viral load also showed a significant relationship (p = 0.019). ConclusionThe study showed the frequency of 16.7 % of BK viruria in our small cohort after renal transplantation during the initial 12 months post-transplant. Age of recipients correlated with viral load and time of viral reactivation: middle-aged recipients had higher viral loads. BK viruria increased progressively over the initial nine months, with peak incidence in the third quarter post-transplant.

Inflammatory bowel disease uncovered in fecal immunochemical test positive patients in a Canadian provincial colon cancer screening program

Inflammatory Bowel Disease (IBD) is a chronic inflammatory condition that usually affects younger adults but has a second incidence peak in the older population. Although diagnosis of IBD is driven by symptoms, some patients are asymptomatic and incidentally discovered while participating in colon screening program (CSP). We aimed to identify the incidence and outcome of IBD in fecal immunochemical test (FIT) positive patients in the British Columbia CSP. We conducted a retrospective chart review of patients who had colonoscopies for positive FIT and were found to have colitis based on endoscopic and histological assessment. Of 93,994 patients who underwent screening colonoscopy for positive FIT between 2009 and 2017, 608 (0.6%) were found to have colitis. From 11 CSP sites, 191 patients met the inclusion criteria. 58 patients (30.4%) were diagnosed with ulcerative colitis, 109 (57.1%) with Crohn’s disease (CD), and 24 (12.6%) with IBD unclassified. 124 patients (64.9%) received treatment, of which 34 (17.8%) received biologics and 4 (2.1%) required surgery. Our study demonstrated a clinically significant incidence of IBD, with novel finding of CD predominance, within a Canadian provincial CSP. Further research is needed to guide management of older patients with varying rates of IBD progression after incidental diagnosis.

Systemic Lupus Erythematosus, An Unusual Presentation: A Case Report In Azal Hospital, Sana’a, Yemen

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder characterized by various clinical presentations and potential involvement of multiple organ systems; it exhibits a significant female predominance, with a peak incidence of middle-aged individuals. In this article, we report a case of a 19 years old female patient who presented with fever, headache, fatigue and neck stiffness. Initial investigations revealed a normal white blood cell count (WBC) with neutrophilia, leading to a diagnosis of bacterial meningitis. The patient responded to antibiotic and analgesic treatment. However, subsequent development of arthritis and skin lesions raised suspicion of systemic lupus erythematosus, which was confirmed by positive anti-dsDNA and antinuclear antibody (ANA) tests.

OTHR-09 EPIDEMIOLOGY OF BRAIN TUMORS IN ZIMBABWE

Abstract OBJECTIVE Brain tumors, while rare, cause significant morbidity and mortality across all ages. This study was done to help understand the age and sex distribution of the common brain cancers diagnosed in Zimbabwe. METHODS A retrospective descriptive analysis was done of the epidemiology of brain tumor cases presenting over the past 5years at a single center in Zimbabwe. RESULTS The Total number of brain tumor cases attended to during this period was 162. Of these, 26% (42cases) were meningiomas, while 18.3% (30cases) were pituitary tumors. 12% (20cases) were posterior fossa tumors. 35 cases (22%) were unclassified brain tumors. Other brain tumors which were noted were glioma (8), craniopharyngioma (4), ependymoma (3), lymphoma (2) as well as confirmed metastatic disease (6). Meningiomas had a male to female ratio of 1:2, with a peak incidence of 40-50years (35%) whilst pituitary tumors had a 1:1 male to female ratio with 54% presenting between 30-50years. Posterior fossa tumors are most common in children and adolescents, with 53% of the cases presenting below the age of 20. They have a 1:1 ratio between males and females. CONCLUSION Most brain tumors had an equal distribution between males and females with the exception of meningioma which have a 1:2 male:female ratio. In the young and adolescents posterior fossa tumors are the commonest, with pituitary tumors and meningiomas being more common between 30-50years.