Prior Screening Research Articles

Characterizing the Blood-Stage Antimalarial Activity of Tafenoquine in Healthy Volunteers Experimentally Infected With Plasmodium falciparum.

The long-acting 8-aminoquinoline tafenoquine may be a good candidate for mass drug administration if it exhibits sufficient blood-stage antimalarial activity at doses low enough to be tolerated by glucose 6-phosphate dehydrogenase (G6PD)-deficient individuals. Healthy adults with normal levels of G6PD were inoculated with Plasmodium falciparum 3D7-infected erythrocytes on day 0. Different single oral doses of tafenoquine were administered on day 8. Parasitemia and concentrations of tafenoquine and the 5,6-orthoquinone metabolite in plasma/whole blood/urine were measured and standard safety assessments performed. Curative artemether-lumefantrine therapy was administered if parasite regrowth occurred, or on day 48 ± 2. Outcomes were parasite clearance kinetics, pharmacokinetic and pharmacokinetic/pharmacodynamic (PK/PD) parameters from modelling, and dose simulations in a theoretical endemic population. Twelve participants were inoculated and administered 200 mg (n = 3), 300 mg (n = 4), 400 mg (n = 2), or 600 mg (n = 3) tafenoquine. The parasite clearance half-life with 400 mg or 600 mg (5.4 hours and 4.2 hours, respectively) was faster than with 200 mg or 300 mg (11.8 hours and 9.6 hours, respectively). Parasite regrowth occurred after dosing with 200 mg (3/3 participants) and 300 mg (3/4 participants) but not after 400 mg or 600 mg. Simulations using the PK/PD model predicted that 460 mg and 540 mg would clear parasitaemia by a factor of 106 and 109, respectively, in a 60-kg adult. Although a single dose of tafenoquine exhibits potent P. falciparum blood-stage antimalarial activity, the estimated doses to effectively clear asexual parasitemia will require prior screening to exclude G6PD deficiency. Clinical Trials Registration. Australian and New Zealand Clinical Trials Registry (ACTRN12620000995976).

Underscreening, Overscreening, and Guideline-Adherent Cervical Cancer Screening in a National Cohort

ABSTRACT Cervical cancer screening is highly effective in reducing incidence and mortality of cervical cancer. Recommended cervical cancer screening involves cytology alone every 3 years between the ages of 21 and 29 years and with either human papillomavirus (HPV) testing alone or HPV plus cytology cotesting every 5 years or cytology alone ever 3 years for individuals of average risk between the ages of 30 and 65 years. Overscreening may result in subsequent overtreatment and increased costs, whereas underscreening may lead to lack of repeat testing after abnormal cytology or HPV test and increased incidence of preventable cervical cancer. This retrospective study aimed to identify high-risk individuals who require more frequent screening and to examine rates of underscreening, overscreening, and guideline-adherent screening among women of average risk for cervical cancer. Data were obtained on women aged 21 to 64 years with continuous insurance coverage between 2014 and 2019 from the IBM MarketScan Commercial Claims and Encounters Database (MarketScan). Claims data were examined for low- and high-risk conditions, where low risk was defined as having undergone a hysterectomy, and high risk was defined as the presence of 1 or more conditions requiring more frequent screening including abnormal screening history, HIV-positive status, and solid organ transplant. Among average-risk women, underscreened was defined as Papanicolaou (Pap) tests recorded at <3.5- to 5-year intervals or HPV testing or cotesting at <5.5-year intervals, and overscreened as Pap tests recorded at <2.5-year intervals or HPV testing or cotesting at 2.5- to 4.5-year intervals. Logistic regression was used to determine the association between women's demographic and clinical characteristics and the odds of receiving appropriate screening, underscreening, and overscreening. A total of 1,872,809 women were identified and included in the analysis, of whom 401,746 (22%) did not qualify for routine screening. Of these, 72,684 (4%) had evidence of hysterectomy without a cancer diagnosis, and 329,062 (18%) required more frequent screening due to high-risk medical conditions or prior screening abnormalities. A total of 1,471,063 women (79%) qualified for routine screening; however, 373,368 (25%) of them had no record of screening during the study time frame. Of the 278,938 women (19%) screened with Pap tests alone, 15% received guideline-adherent screening, 44% were underscreened (screened >3.5- to 5-year interval), 41% were overscreened (2.5- to 4.5-year interval), and 3% were severely underscreened (<5-year interval). Of the 493,028 women (33%) screened with HPV/Pap cotesting, 44% were guideline-adherent, 51% were overscreened, 33% were severely overscreened (<2.5-year interval), and 5% were underscreened. Logistic regression revealed women aged 30 to 39 years were more likely to receive guideline-adherent screening than other age groups (odds ratio [OR], 0.72, 0.87, and 0.71, with 95% confidence intervals [CIs] of 0.70–0.73, 0.86–0.88, and 0.70–0.72 for women aged 20–29, 40–49, and 50–64 years, respectively). Women with 1, 2, or 3 comorbidities had higher odds of appropriate screening compared with women with no comorbidities (OR, 1.18 [95% CI, 1.16–1.19], 1.15 [1.13–1.16], and 1.11 [1.09–1.13], respectively). Each additional gynecological visit was associated with lower odds of guideline-adherent screening (OR, 0.78; 95% CI, 0.78–0.78), whereas each preventive care visit was associated with higher odds of guideline adherence (OR, 1.06; 95% CI, 1.05–1.06). The results of this study demonstrated that nearly 1 in 5 women had high-risk conditions necessitating more frequent screening and that only 1 in 5 average-risk women were screened according to guidelines, with high rates of underscreening particularly among women 50 years and older.

Military Sexual Trauma Among Women Veterans Using Veterans Health Administration Reproductive Health Care: Screening Challenges and Associations with Post-Military Suicidal Ideation and Suicide Attempts.

Military sexual trauma (MST) is highly prevalent among women veterans. Research among MST survivors has focused on individuals receiving care in specific settings, such as mental health services. There is a dearth of knowledge regarding MST prevalence and associations in other settings commonly accessed by women veterans, including reproductive healthcare settings. We examined MST prevalence (overall, by MST type and extent of underreporting) and associations with suicidal ideation and suicide attempts, among women veterans accessing Veterans Health Administration (VHA) reproductive health care. Our sample included 352 post-9/11 women veterans who used VHA reproductive health care in Fiscal Year (FY) 2018 and participated in a cross-sectional survey. Approximately 68.7% screened positive for MST, including 44.9% who reported experiencing military sexual assault. Notably, 30.8% reported MST on the survey, but had a negative MST screen for their most recent MST screen in their VHA medical record. Both military sexual harassment and assault were associated with increased prevalence of experiencing suicidal ideation following military service; however, a significant association among military sexual harassment, past-month suicidal ideation, and post-military suicide attempts was not detected. Military sexual assault was uniquely associated with past-month suicidal ideation and post-military suicide attempts. As MST and underreporting are highly prevalent among women veterans using VHA reproductive health care, rescreening for MST within this population is essential. A trauma-informed approach is recommended irrespective of prior MST screening results and may facilitate suicide prevention in this population. Addressing barriers to MST disclosure and preventing MST and its sequelae remain critical.

Comprehension of premarital screening and genetic disorders among the population of Riyadh

ObjectivePremarital, unfortunately, does not cover all possible genetic diseases, such as deafness and congenital heart diseases, diabetes mellitus, and hypertension, nor does it cover unknown genetic mutations that may cause severe defects in subsequent generations. However, the Saudi population has limited knowledge regarding premarital screening tests, which do not detect all genetic disorders or diseases. Hence, we aimed to explore the knowledge and attitudes among the population of Riyadh toward premarital screening. MethodsA cross-sectional observational study was conducted with a self-administered designed questionnaire. The survey included questions regarding sociodemographic data, genetics, genetic testing, and premarital screening. All data were entered and analyzed in the statistical package SPSS version 22. ResultsA total of 385 participants responded to the questionnaire, and good knowledge among most participants was significantly associated with education level (p < 0.001), sex (p < 0.001), and prior screening (p = 0.001). The overall attitude was positive toward premarital screening, and significant associations of sex and social/marital status with a positive response to premarital screening were observed. ConclusionKnowledge and attitudes among the population of Riyadh toward premarital screening must be improved through national awareness programs. In light of our results, a need exists to provide more information and education regarding screening. Further studies must be conducted in urban areas to investigate the level of satisfaction with existing programs.

Selected Articles from This Issue

During the COVID-19 pandemic, many colorectal cancer-related procedures were suspended, with unclear implications for colorectal cancer mortality. In this study, van den Puttelaar and colleagues used observed data and simulation modeling to estimate the impact on colorectal cancer outcomes, clinical resources, and associated tradeoffs, for longer versus shorter recovery periods to catch up procedures. The authors estimate that the disruptions may cause 4,200 to 14,400 excess colorectal cancer deaths in the US in the next 20 years, depending on the assumed extent of disruption, length of recovery period, and resources used. These estimates may help inform strategies to mitigate the broader impact of the COVID-19 pandemic or future crises.Christopher and colleagues used a data-driven approach to identify exercise trajectories over the adult life course and examined how these trajectories were associated with colon cancer risk within the NIH-AARP Diet and Health Study. Adults maintaining moderate-to-high amounts of exercise consistently throughout adulthood had a lower risk of colon cancer. Being inactive early in adulthood but increasing exercise participation by midlife was also suggestive of a lower risk. These findings are aligned with the current physical activity recommendations and add new evidence that promoting physical activity at all stages of the adult life course is needed for population-based colon cancer prevention.Few empirical data are available for older adults on the absolute risk of colorectal cancer and its associated mortality in the context of prior screening. Dalmat and colleagues address this evidence gap with estimates from a large population of screen-eligible adults ages 76 to 85 years who had a negative colonoscopy ten years ago. Estimates of cumulative incidence and mortality were 1.29% (95% CI: 1.02–1.61%) and 0.46% (95% CI: 0.30–0.70%), respectively, in eight years following screening eligibility date, after accounting for competing risk of death from another cause. Patients were approximately 90 times more likely to die from another cause than colorectal cancer, which may be an important context for older adults’ decision making.Nicotine metabolism significantly influences nicotine dependence. The goal of this study, by Perez-Paramo and colleagues, was to examine the impact of genetic variants in nicotine metabolizing enzyme genes on urinary levels of nicotine metabolites. Functional deficiency of cytochrome P450 2A6 caused multiple changes in nicotine metabolites in smokers’ urine. Genetic polymorphisms in multiple functional metabolizing enzyme genes showed a significant impact on urinary levels of many nicotine metabolites. These data suggest that multiple genes in several pathways are involved in the metabolism of nicotine, which may influence nicotine dependence and smoking behavior.

Cancer screening behaviors and preferences among women in southern India

IntroductionIn 2020, India’s cancer cases were estimated at 1.32 million (International Agency for Research on Cancer et al., 2020) and were predicted to double by 2040 (Smith and Mallath, 2019). MethodsStarting in March 2019, we recruited 211 adult women in the Trivandrum area of India who had an outpatient office visit within the past 6 months to participate in a structured survey. We identified the study population from the Gokulam Medical College and four peripheral centers. Two trained interviewers collected survey information from the participants, including information on breast, oral, and cervical cancer screening eligibility, history, recommendations, and screening initiation. For analysis, we stratified the sample into two groups by age: a priority screening group, aged 30–65 (n = 132), and an overall group, containing the entire sample, aged 19–85 (n = 211). Results14.22% of respondents in the overall group and 14.39% in the priority screening group reported receiving a prior cancer screening. Among women who had not received cancer screening, the most common reasons were "no provider recommendation” (42.18%) and not knowing they needed to be screened (40.76%). Most women estimated their risk of developing cancer to be “very low” (64.93%), although the vast majority also believed early detection could improve cancer outcomes (84.83%). Among those who had not been screened for cancer, 61.61% overall and 65.15% in the priority screening group responded that they would undergo all eligible cancer screenings if recommended by their provider. The figure jumps to 79.62% in the overall group and 77.27% in the priority screening group if additional respondent-identified barriers to screening were addressed. ConclusionProvider recommendations can be used to mitigate the suboptimal screening uptake and late-stage diagnosis that exacerbate the mortality and economic burden due to cancer in India. Policy summaryThis study finds that provider recommendations can shape the trajectory of outcomes by increasing cancer screening among women.

WITHDRAWN: Strong Dual Antipolymerase/Antiexonuclease Actions of Some Aminothiadiazole Antioxidants: A Promising In-Silico/In-Vitro Repurposing Research Study against the COVID-19 Omicron Virus (B.1.1.529.3 Lineage)

Currently, nitrogen-containing heterocyclic virucides take the lead as top options for treating the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and their escorting disease, the coronavirus disease 2019 (COVID-19). But unfortunately, the sudden emergence of a new strain of SARS-CoV-2, the Omicron variant and its lineages, complicated matters in the incessant COVID-19 battle. Goaling the two paramount coronaviral-2 multiplication enzymes RNA-dependent RNA polymerase (RdRp) and 3'-to-5' exoribonuclease (ExoN) at synchronous times using single ligand is a quite effective new binary avenue to restrain SARS-CoV-2 reproduction and cease COVID-19 progression irrespective of the SARS-CoV-2 strain type, as RdRps and ExoNs are vastly conserved in all SARS-CoV-2 strains. The presented in-silico/in-vitro research winnowed our own small libraries of antioxidant nitrogenous heterocyclic compounds, inspecting for the utmost convenient drug candidates expectedly capable of effectively working through this dual tactic. Computational screening afforded three promising compounds of the antioxidant 1,3,4-thiadiazole class, which were named ChloViD2022, Taroxaz-26, and CoViTris2022. Subsequent biological examination, employing the in-vitro anti-RdRp/anti-ExoN and anti-SARS-CoV-2 assays, exclusively demonstrated that ChloViD2022, CoViTris2022, and Taroxaz-26 could efficiently block the replication of the new lineages of SARS-CoV-2 with considerably minute anti-RdRp and anti-SARS-CoV-2 EC50 values of about 0.18 and 0.44 μM for ChloViD2022, 0.22 and 0.72 μM for CoViTris2022, and 0.25 and 0.78 μM for Taroxaz-26, in the order, overtaking the standard anti-SARS-CoV-2 drug molnupiravir. These biochemical findings were optimally presupported by the results of the prior in-silico screening, suggesting that the three compounds might potently hit the catalytic active sites of the virus's RdRp and ExoN enzymes. Furthermore, the perfect pharmacophoric features of ChloViD2022, Taroxaz-26, and CoViTris2022 molecules make them typical dual inhibitors of SARS-CoV-2 replication and proofreading, with their relatively flexible structures eligible for diverse forms of chemical modification. In sum, the current important results of this thorough research work exposed the interesting repurposing potential of the three 2-amino-1,3,4-thiadiazole ligands, ChloViD2022, Taroxaz-26, and CoViTris2022, to effectively conflict with the vital biointeractions between the coronavirus's polymerase/exoribonuclease and the four essential RNA nucleotides, and, accordingly, arrest COVID-19 disease, persuading the relevant investigators to quickly begin the three agents' comprehensive preclinical and clinical anti-COVID-19 assessments.

Single nucleotide polymorphism in the genomic target affects the recombination efficiency of CRISPR/Cas9-mediated gene editing in zebrafish

The CRISPR/Cas9 gene editing tool is becoming increasingly popular in the scientific community as one of the most efficient gene editing tools because of its high specificity and precision in targeted mutagenesis. A typical CRISPR system includes two components: a single guide RNA (sgRNA or gRNA) and a CRISPR associated endonuclease (Cas9). In CRISPR, the specificity of the Cas9 protein in cleaving the target DNA is decided by the homology of the spacer sequence, particularly the seed sequence (8–10 bases at the 3′ end of the spacer sequence) and any mismatch in the seed sequence abolishes the target cleavage and the subsequent generation of indels. Here, using Poly (A)specific ribonuclease (PARN) as an example in zebrafish, we show that the presence of single nucleotide polymorphism (SNP) in the sgRNA target, particularly in the seed sequence, affects the Cas9 activity resulting in a reduced recombination efficiency of CRISPR. Thus, while selecting target sites, prior screening for SNPs in the chosen targets across different wild-type lines/strains could be one of the easiest and effective ways of avoiding reduced recombination efficiency of CRISPR-mediated gene editing in zebrafish.

Review article on endocrine diseases during pregnancy

Pregnancy is the period where a woman undergoes several physical and hormonal changes in accordance to the growth of the fetus. Wide alteration in the levels of hormones from the normal values affect the state of gestation and the growth of the baby. Especially the most commonly encountered disorders like pregnancy induced thyroid disorder effects the neuro development of the baby whereas gestational diabetes makes mode of delivery complex. Hormonal imbalance can be investigated by haematological findings like thyroid stimulating hormone (TSH), T3 and T4 tests to identify thyroid disorders whereas HbA1C, Random blood sugar(RBS), fasting random blood sugar(FRBS) , post prandial blood sugar (PPBS) and oral glucose tolerance test (OGTT) to screen gestational diabetes. Apart form these there are some uncommon hormonal pregnancy disorders like cushing syndrome, conns syndrome, congenital adrenal hyperplasia, adrenal insufficiency. These complexes can be rectified up to certain extent by diagnosing them before hand thereby implementing life style changes, dietary changes and taking medications. Therefore, prior screening of the diseases is important in supress further complications in pregnancy and to have healthy progeny.

Older women testing positive for HPV16/18 on cervical screening and risk of high-grade cervical abnormality.

In Australia's HPV-based cervical screening program, we previously showed that risk of histological high-grade abnormality at 1year post screening decreased with age in women with oncogenic HPV. In this study, we followed 878 HPV16/18 positive women aged 55 years and over for up to 3 years post screening test, to determine the proportion with histological high-grade abnormality (HGA, incorporating high-grade squamous intraepithelial abnormality (HSIL), adenocarcinoma in situ (AIS), squamous cell carcinoma (SCC) and adenocarcinoma) and to correlate risk of HGA with liquid-based cytology result and with prior screening history. HGA was detected in 7.8% at 1year and 10.0% at 3 years, with no significant difference (P=.136), despite the number of women with follow-up information significantly increasing from 82.9% to 91.0% (P < .0001). The proportion of HPV16/18 positive women with HGA at 3 years was highest in those with an HSIL cytology result (79.0%) and lowest in those with negative cytology (6.2%). Women with an adequate screening history had fewer HGA than such women with inadequate prior screening (6.6% vs 16.0%, P=.001) or with a history of an abnormality (6.6% vs 14.4%, P=.001). HPV16/18 infection in women over 55 years may have a different natural history from that in younger women, in whom HGA are more common after HPV16/18 detection. In HPV-based cervical screening programs, management algorithms for screen-detected abnormalities based on risk stratification should include factors such as age, screening history and index cytology result, so that women receive appropriate investigation and follow-up.

Co-segregation analysis and functional trial in vivo of candidate genes for monogenic diabetes

IntroductionThe aim of this study was to perform familial co-segregation analysis and functional trial in vivo during mixed meal tolerance test (MMTT) of novel variants in diabetes candidate genes.Research design...

Use Trends and Recent Expenditures for Cervical Cancer Screening–Associated Services in Medicare Fee-for-Service Beneficiaries Older Than 65 Years

Since 1996, the US Preventive Services Task Force has recommended against cervical cancer screening in average-risk women 65 years or older with adequate prior screening. Little is known about the use of cervical cancer screening-associated services in this age group. To examine annual use trends in cervical cancer screening-associated services, specifically cytology and human papillomavirus (HPV) tests, colposcopy, and cervical procedures (loop electrosurgical excision procedure, cone biopsy, and ablation) in Medicare fee-for-service beneficiaries during January 1, 1999, to December 31, 2019, and estimate expenditures for services performed in 2019. This population-based, cross-sectional analysis included health service use data across 21 years for women aged 65 to 114 years with Medicare fee-for-service coverage (15-16 million women per year). Data analysis was conducted between July 2021 and April 2022. Proportion of testing modalities (cytology alone, cytology plus HPV testing [cotesting], HPV testing alone); annual use rate per 100 000 women of cytology and HPV testing, colposcopy, and cervical procedures from 1999 to 2019; Medicare expenditure for these services in 2019. There were 15 323 635 women 65 years and older with Medicare fee-for-service coverage in 1999 and 15 298 656 in 2019. In 2019, the mean (SD) age of study population was 76.2 (8.1) years, 5.1% were Hispanic, 0.5% were non-Hispanic American Indian/Alaska Native, 3.0% were non-Hispanic Asian/Pacific Islander, 7.4% were non-Hispanic Black, and 82.0% were non-Hispanic White. From 1999 to 2019, the percentage of women who received at least 1 cytology or HPV test decreased from 18.9% (2.9 million women) in 1999 to 8.5% (1.3 million women) in 2019, a reduction of 55.3%; use rates of colposcopy and cervical procedures decreased 43.2% and 64.4%, respectively. Trend analyses showed a 4.6% average annual reduction in use of cytology or HPV testing during 1999 to 2019 (P < .001). Use rates of colposcopy and cervical procedures decreased before 2015 then plateaued during 2015 to 2019. The total Medicare expenditure for all services rendered in 2019 was about $83.5 million. About 3% of women older than 80 years received at least 1 service at a cost of $7.4 million in 2019. The results of this cross-sectional study suggest that while annual use of cervical cancer screening-associated services in the Medicare fee-for-service population older than 65 years has decreased during the last 2 decades, more than 1.3 million women received these services in 2019 at substantial costs.

In-depth Retrospective Review of Originally Negative Screening Mammograms from Women with Confirmed Breast Cancer.

We aim to contribute to the assessment of the screening performance in Flanders (Belgium) and to identify valuable mammograms for subsequent studies and training. Initially negative prior screening mammograms (sMx) of 210 women with confirmed breast cancer detected by the Flemish screening programme between 2011-2013 were reviewed by a highly experienced radiologist. The review of the prior sMx was performed in three steps: 1) only prior mammograms available; 2) with index sMx (=subsequent positive sMx) present; 3) with index sMx and clinical information present. The radiological review yielded 94 (45%) mammograms 'without suspicious lesions', 77 (37%) 'with minimal signs in at least one breast', and 39 (19%) 'with clearly visible tumours'. In univariate analyses, the reclassification of prior sMx was significantly associated with the date of the prior sMx, the need for a third reader for arbitration, image quality and the detector system used (computed radiography versus direct readout digital radiography), and it was not associated with the interval between screening rounds, age at prior sMx, breast density, or tumour characteristics (<T2 versus ≥T2, in situ versus invasive). In multivariate analyses, the date of the prior sMx (p = 0.001), need for arbitration (p = 0.001) and image quality (p < 0.001) remained significantly associated with the reclassification. This retrospective review reclassified 19% of the sMx as clearly visible tumours. With this, the Flemish screening programme performs in accordance with similar studies. The sMx reviewed in this study, form a valuable set of mammograms for training and further research.

Abstract 10856: Artificial Intelligence-Guided Screening for Atrial Fibrillation Using the Electrocardiogram in Sinus Rhythm

Introduction: Prior AF screening trials demonstrated low yield, highlighting the need for more targeted approaches. An AI algorithm was developed to identify ECG signatures of AF risk during normal sinus rhythm, which has been validated in diverse external populations. Hypothesis: An AI-guided, targeted screening approach could improve the diagnosis of AF. Methods We conducted a pragmatic decentralized trial to prospectively recruit patients with stroke risk factors but no prior AF. The AI algorithm was applied to the ECGs performed in routine practice and divided patients into high- or low-risk groups. The primary endpoint was AF lasting ≥ 30 seconds on a subsequent 30-day continuous cardiac rhythm monitor. In a secondary analysis, trial participants were 1:1 propensity score-matched to real-world controls derived from the eligible but unenrolled population. Results A total of 1,003 patients from 40 U.S. states completed the study, with a mean age of 74 [SD 8.8] years. Over a mean of 22.3 days of continuous monitoring, AF was detected in 6 (1.6%) of low-risk patients and 48 (7.6%) of high-risk patients (OR 4.98 [2.11-11.75], p&lt;0.001). Compared to usual care, AI-guided AF screening was associated with increased detection of AF (high-risk group: 4.2% vs. 11.1%, p&lt;0.001; low-risk group: 0.9% vs. 2.4%, p=0.12) over a median follow-up of 10 months. Conclusions A prospective pragmatic study found that the AI a can risk-stratify a relatively uniform population (i.e., older adults at risk for stroke) to detect AF during short-term cardiac monitoring. Furthermore, when compared with usual care, AI-guided cardiac monitoring was associated with increased AF detection. As such, an AI-guided AF screening approach, leveraging existing EHR data and infrastructure, could be effective, patient-centered, and massively scalable, thereby reducing unnecessary health utilization and diagnosis-related anxiety (Clinicaltrials.gov: NCT04208971).

Evaluation of the Functional Status of the Posture Control System in Children with Detected Disorders in Body Posture.

Screening tests for body posture defects and abnormalities conducted over the past several decades have revealed a significant and constantly increasing problem of health risks in children. A sedentary lifestyle, which is considered to be the primary cause, can result in proprioceptive disorders leading to postural instability. The aim of the study was to find the correlation between the level of proprioceptive control and the number of postural disorders. The study involved a representative group of 1090 children aged 8-10 years, from randomly selected primary schools. Subjects who scored from 1 to 5 points in a prior postural screening test were qualified for the examination of the postural control system. The examination of the postural control system was carried out using an electronic station enabling assessment of postural stability and proprioception. A single leg stance test showed that the number of postural disorders does not significantly impact proprioceptive control. Proprioceptive control was found to significantly increase with the age of the children, and girls presented significantly better proprioceptive control in relation to the boys in each age group.

Prevalence, incidence and mortality of hypertrophic cardiomyopathy based on a population cohort of 21.9 million in China

There are limited studies on the prevalence and incidence of clinically diagnosed hypertrophic myocardiopathy (HCM) and its mortality in the Chinese population, and the projected population burden of HCM over the next decades. We collected data on HCM and its mortality from the Beijing Municipal Health Commission Information Center (BMHCIC) database and estimated the prevalence and incidence based on the whole Beijing population. Calculation of population trends was performed using annual percentage change (APC) and average annual percentage change (AAPC). Finally, future HCM incidence was built by modelling projection of HCM to the next decades using Poisson regression analysis and Gray Model 1,1(GM [1,1]). The prevalence of HCM was 0.0069% (95%CI, 0.0065–0.0072%; N = 1343) in 2010, rising to 0.076% (95% CI, 0.074–0.077%; N = 16,616) in 2019, and the incidence of HCM was 6.85 per 100 000 person-year in 2010, rising to 11.76 per 100 000 person-year in 2019. Males had higher prevalence and incidence of HCM than females. The APPC for the rising incidence of HCM was 5.8% and the expected numbers will double increase in 2029 by assuming the same increase trend as the last decades. HCM had increased annual incidence of HF (APPC: 8.4, 4.4–12.6, p < 0.05), and relatively stable annual incidence of mortality (APPC: 1.2%, − 2.3% to 4.8%, p > 0.05) during the studied period. Males had lower mortality (2.70% vs. 4.20%, p < 0.001) than females. The calculated HCM prevalence was much lower compared to prior screening studies from 2004, although the predicted HCM incidence would double over the next decades. HCM was associated with a stable risk of mortality during the studied period.

Young Age on Starting Prostate-specific Antigen Testing Is Associated with a Greater Reduction in Prostate Cancer Mortality: 24-Year Follow-up of the Göteborg Randomized Population-based Prostate Cancer Screening Trial

BackgroundThe risk of death from prostate cancer (PC) depends on age, but the age at which to start prostate-specific antigen (PSA) screening remains uncertain. ObjectiveTo study the relationship between risk reduction for PC mortality and age at first PSA screening. Design, setting, and participantsThe randomized Göteborg-1 trial invited men for biennial PSA screening between the ages of 50 and 70 yr (screening, n = 10 000) or no invitation but exposure to opportunistic PSA testing (control, n = 10 000). InterventionRegular versus opportunistic PSA screening or no PSA. Outcome measurements and statistical analysisWe modeled the nonlinear association between starting age and the absolute risk reduction in PC mortality in three settings: (1) intention-to-screen (randomized arms); (2) historical control (screening group and 1990–1994 registry data); and (3) attendees only (screening attendees and matched controls). We tested whether the effect of screening on PC mortality depends on the age at starting screening by comparing survival models with and without an interaction between trial arm and age (intention-to-screen and attendees only). Results and limitationsYounger age on starting PSA testing was associated with a greater reduction in PC mortality. Starting screening at age 55 yr approximately halved the risk of PC death compared to first PSA at age 60 yr. The test of association between starting age and the effect of screening on PC mortality was slightly greater than the conventional level of statistical significance (p = 0.052) for the entire cohort, and statistically significant among attendees (p = 0.002). This study is limited by the low number of disease-specific deaths for men starting screening before age 55 yr and the difficulty in discriminating between the effect of starting age and screening duration. ConclusionsGiven that prior screening trials included men aged up to 70 yr on starting screening, our results suggest that the effect size reported in prior trials underestimates that of currently recommended programs starting at age 50–55 yr. Patient summaryIn this study from the Göteborg-1 trial, we looked at the effect of prostate-specific antigen (PSA) screening in reducing men’s risk of dying from prostate cancer given the age at which they begin testing. Starting at a younger age reduced the risk of prostate cancer death by a greater amount. We recommend that PSA screening should start no later than at age 55 yr.

LBODP048 Barriers To Diabetic Retinopathy Screening In Hospitalized Patients With Diabetes

Abstract Diabetic retinopathy (DR) is a leading cause of preventable vision loss in the in the U. S., and DR screening is essential to prevent blindness. Yet minority populations have consistently lower DR screening rates than Non-Hispanic Whites and knowledge about barriers versus facilitators for completion of DR screening in these groups remains scant. Improvement in DR Screening rates in safety net populations has been observed after placing digital retinal cameras in primary care sites to capture images where patients get their basic health care. In this study, we therefore assessed DR screening in patients at time of hospitalization as a possible additional site to capture unscreened patients with diabetes. We identified patient with diabetes admitted for any reason to a safety net hospital to evaluate perceived barriers to DR screening. We performed an anonymous survey in English or Spanish in 156 hospitalized adult patients with diabetes during hospital stays between 10/2019-12/2021, using a convenience sample. Barriers specified in the survey were derived from the literature. The study population had a mean [+SD] age of 50+10.5 years, were predominantly male [72.4%], of low-income [83.7% &amp;lt;$25,000/year] and minority groups [Latinos 79.5% and African American [10.3%]. Diabetes duration was &amp;gt;5years in 63.6% of patients. Reported DR screening rate in the 12 months prior to admission was only 31.4%, despite 97% of patients confirming they were aware that diabetes causes impaired vision and blindness. The main perceived barriers to DR screening identified in the survey were financial [50%], transportation [22%] and depression [17%]. There were no significant differences in the number or nature of perceived barriers in those who reported DR screening vs. those who did not. Surprisingly, the pandemic appeared to have little impact on DR screening rates. Comparison of patients surveyed before (n=96; 10/2019-03/20) and after COVID lockdown (n=60; 08/2020-12/2021), did not show any significant differences in patient demographics, number or nature of perceived barriers, or DR screening rates (32% vs 30%). However, DR screening among patients without a Primary Care Provider (PCP) was considerably lower compared to patients with a PCP, 10% vs 49% (p&amp;lt;0. 001). In summary, this study reveals low prior outpatient DR screening rates in hospitalized patients with diabetes in low-income minorities in a safety-net hospital, and identifies potential remediable barriers associated with this. The results suggest that cost and transport barriers could be addressed by implementation of DR screening during hospitalization in safety net hospitals. These results also emphasize the significance of a having a PCP. We conclude that inpatient DR screening and facilitating PCP-patient connections might lead to improvement in DR screening rates and thus prevent blindness in this segment of the diabetes population. Presentation: No date and time listed

ODP039 Giant Cystic Pheochromocytoma and GIST in a Patient With NF-1

Abstract Introduction Neurofibromatosis-1 (NF-1) is a genetic condition known to be associated with pheochromocytoma. We report a case of giant cystic pheochromocytoma in a patient with NF-1 and hypertensionincidentally found to have gastrointestinal stromal tumor (GIST) at operation. Clinical case: A 60-years old woman presented with a 5-week history of left sided abdominal lump. Her history is significant for NF-1, flank surgery age 5 and hypertension managed by amlodipine. Examination revealed a large nontender left upper quadrant abdominal mass crossing the midline. Computed tomography showed a20. 0×13.1×21.1 cm septate cystic and/or necrotic lesion arising from the left retroperitoneum versus adrenal gland, displacing the kidney anteromedially. Plasma free metanephrine was 3.38 nM (0-0.49) normetanephrine 3.47 nM (0-0.89),urine metanephrine 2605 mcg/day (36-229), urine normetanephrine 1215 mcg/day (95-650). There were no prior images or screens for pheochromocytoma. After preoperative blockade with phenoxybenzamine, open left adrenalectomy was performed. Intraoperative blood pressure fluctuated significantly. Exophytic firm nodules were incidentally noted and removed from the jejunum. Pathology revealed a22.5×21. 0×11.9 cm pheochromocytoma weighing 3058.9 g and five 0.2-0.7 cm gastrointestinal stromal tumors, spindle type. One-month postoperative metanephrine was 0.16 with normetanephrine 0.53 nM. The blood pressure remained normal without antihypertensives. Discussion Giant cystic pheochromocytomas are rare and may be silent. In populations with NF-1 the prevalence of pheochromocytoma is 0.1-7.7% and GIST 1.2% 1–3 . Their co-existence is seen less frequently. Recommendations for pheochromocytoma screening in NF-1 vary, from only hypertensive or symptomatic patients to routinely every 3 years 2–5 . There is no screening test for GIST 1 . Our patient presented at age 60 with the rare combination of clinically giant unilateral cystic pheochromocytoma, with incidental GIST in the setting of NF-1 and hypertension . Conclusion Routine screening for pheochromocytoma in patients with NF-1, especially those with hypertension may lead to earlier diagnosis and treatment.

Complications of Frontal Sinusitis. Bibliographic Review

Introduction and objective: Frontal rhinosinusitis usually resolves with medical therapy. However, when the sinonasal infection persists, the anatomy of this region can lead to severe and life-threatening complications due to infection spreading beyond the sinus namely to the intracranial compartment. This review aims to highlight the more recent developments on the management of frontal rhinosinusitis and its complications, from a practical perspective that is essential to accurately diagnose these complications. Method: A review of the literature was performed by the authors. PubMed database was searched with relevant terms, which included the following: «frontal sinusitis complications», «pediatric frontal sinusitis» and «frontal sinusitis imaging». Relevant scientific treaties were also used as ancillary to this review. A comprehensive review of the English and Portuguese literature was carried out, including papers published between 2000 and 2021. Our inclusion criteria included clinical trials, expert opinion papers, literature reviews, systematic reviews and clinical guidelines. Duplicate articles, case reports or very small sample studies were excluded prior general screening. Results: Twenty-one studies met the inclusion criteria. Most of them concerned the adult population, with four papers directly addressing the pediatric population. Two clinical guidelines, one large retrospective cohort study and two systematic reviews were selected. Twelve clinical review articles and small retrospective studies were selected, comprising most of the papers addressed. Four clinical textbooks were also consulted for this review. Discussion: Morbidity and mortality from complicated sinusitis are mainly related to intracranial involvement. Although the mortality rate was higher before the era of antibiotic therapy, intracranial abscess still carries high mortality. Frontal sinusitis can be complicated by periorbital cellulitis, abscess formation, both periorbital and subperiosteal in the frontal bone anterior wall (Pott puffy tumor), and, rarely, cavernous sinus thrombosis. Intracranial complications include subdural and epidural empyema, meningitis, and intracerebral abscess. These complications will be reviewed in this paper. Conclusions: Complications of frontal sinusitis can be severe and life threatening, mainly due to the proximity of the frontal sinus with the intracranial compartment. Due to its high availability, CT frequently is the first imaging technique performed in the emergency setting. The excellent bone and high-spatial resolution make CT the preferred imaging examination in presurgical planning. However, contrast-enhanced MRI is far superior in soft-tissue evaluation and should be considered whenever an orbitary or intracranial complication is suspected. These complications are mostly treated with intravenous antibiotics and surgical drainage procedures. Early aggressive intervention has decreased morbidity and shortened hospital stay, although significant morbidity and mortality from complications can still occur.