Regular Treatment Research Articles

O-218 Prospective validation of an artificial intelligence platform for automated follicle counting

Abstract Study question How often are fully automated follicle counts and measurements modified in expert review? Summary answer Automatic follicle annotations provided by an artificial intelligence platform in regular operation of a clinic were edited 3.27% of the time. What is known already Ovarian follicle counting is frequently performed, time-consuming, and subject to noticeable inter-observer variability; as such, it is well-suited to automatizing with artificial intelligence. FOLLISCAN (MIM Fertility) is a software platform that automatically annotates follicles on 2D or 3D ultrasound cine videos, with exact outlines and measurements, without any manual pre-processing. It has undergone several retrospective tests of its precision and recall in detecting ovarian follicles, accuracy of measurements, and time-savings compared to manual counting Study design, size, duration The platform was integrated with a clinic’s existing picture archiving and medical record systems. Ultrasound scans of ovaries were performed as part of regular infertility treatment in two IVF centers. Scans were made by 3 experts in a period from November to December 2023, automatically sent to the platform, analyzed, and then immediately visualized for review by the person performing the ultrasound, in place of manual annotation. Participants/materials, setting, methods The study included 294 cine videos from 147 examinations of 101 patients, with 4347 follicles in total (14.7 per ovary on average, from 2mm). The platform allows users to modify proposed measurements and introduce new follicle annotations. After confirming the review, results were automatically sent back to the clinic’s system to be used in medical decisions just as manual annotations would be. Main results and the role of chance Among all videos the average number of editions (follicle additions, modifications, or deletions) was 0.48 (CI: 0.37-0.61). In total, 142 follicles out of 4347 (3.27%, CI: 2.74-3.80) were edited: 66 follicles were added (1.52%, CI: 1.15-1.88), 26 were modified, (0.60%, CI: 0.37-0.83 ), and 50 were deleted (1.15%, CI: 0.83–1.47). Out of the 151 edited follicles, 13 (9.2%) had 2–5 mm, 29 (20.4%) had 5-10 mm, 51 (35.9%) had 10-15 mm, 42 (29.6%) had 15-20 mm, and 7 (4.9%) had 20 mm or more in diameter. Among follicles of 15 mm or more in size, 49 were edited. Out of 294 videos, 87 (29.6%, 95% Confidence Interval: 24.4-34.6) were edited in review in any way. Limitations, reasons for caution The study was limited in scope and did not track patients until success rates in IVF treatments could be observed. A multi-center randomized control trial could compare pregnancy rates for treatments performed with and without the platform. Wider implications of the findings An integrated platform allows for easy review, while significantly reducing the time spent on follicle counting in a real-world setting. Automated annotations result in consistent, reliable, and quick measurements, with the number of expert modifications smaller than the inter-observer reliability reported in previous studies. Trial registration number Project support was provided by the Polish National Center for Research and Development no. POIR.01.01.01-00-1634/20-00 and ERC Consolidator Grant TUgbOAT no. 772346. This study was conducted following the approval of the research protocol by the review board of the Regional Medical Chamber in Gdańsk (approval no. KB – 51/22).

Risk Factors and Prognosis of Perioperative Atrial Fibrillation in Elderly Patients Undergoing VATS Lung Surgery: A Retrospective Cohort Study.

Atrial fibrillation (AF) has become the most common postoperative arrhythmia of thoracic surgery. This study aimed to investigate the risk factors and complications of perioperative atrial fibrillation (PoAF) in elderly patients who underwent video-assisted thoracoscopic surgery (VATS). Data were collected from patients who underwent VATS between January 2013 and December 2022 at Peking Union Medical College Hospital (PUMCH). Univariable analyses and multivariable logistic regression analyses were used to determine the factors correlated with PoAF. Receiver operating characteristic (ROC) curve was used to evaluate the discrimination of the indicators to predict PoAF. The study enrolled 2920 patients, with a PoAF incidence of 5.2% (95% CI 4.4%-6.0%). In the logistic regression analyses, male sex (OR=1.496, 95% CI 1.056-2.129, P=0.024), left atrial anteroposterior dimension (LAD) ≥40 mm (OR=2.154, 95% CI 1.235-3.578, P=0.004), hypertension (HTN) without regular treatment (OR=2.044, 95% CI 0.961-3.921, P=0.044), a history of hyperthyroidism (OR=4.443, 95% CI 0.947-15.306, P=0.030), surgery of the left upper lobe (compared to other lung lobes) (OR=1.625, 95% CI 1.139-2.297, P=0.007), postoperative high blood glucose (BG) (OR=2.482, 95% CI 0.912-5.688, P=0.048), and the time of chest tube removal (per day postoperatively) (OR=1.116, 95% CI 1.038-1.195, P=0.002) were found to be significantly associated with PoAF. The area under the ROC curve was 0.707 (95% CI 0.519-0.799). 86.9% patients were successfully converted to sinus rhythm. Compared with the non-PoAF group, the PoAF group had significantly greater risks of prolonged air leakage, postoperative acute coronary syndrome, longer ICU stays, and longer hospital stays. Male sex, LAD≥40 mm, HTN without regular treatment, a history of hyperthyroidism, surgery of the left upper lobe, postoperative BG, and the time of chest tube removal were associated with PoAF. These findings may help clinicians identify high-risk patients and take preventive measures to minimize the incidence and adverse prognosis of PoAF.

Valproate-induced leucocytoclastic vasculitis: A rare case report

ABSTRACT Drug-induced vasculitis is essentially a small-vessel vasculitis. Histopathological changes in this condition are characterised by neutrophilic leucocytoclasia of the small vessels. To label it leucocytoclastic vasculitis, one must exclude other types of vasculitis where autoimmune workup comes into play. Antiepileptics, although rare, are also known to have such a presentation. We present a case of a 35-year-old male, a known case of hypertension and seizure disorder (on regular treatment), with a recent history of generalised tonic–clonic seizures, leading to a change in his antiepileptics. This was followed by extensive rash development, predominantly on his lower limbs, which was diagnosed as leucocytoclastic vasculitis, with sodium valproate (VPA) being the aetiology for the same. The offending drug was removed, and after treatment with steroids, the patient’s condition significantly improved.

From waste to soil: Can we create functioning manufactured soils by recycling rock processing waste?

AbstractRock mining industries do not only exploit and transform extensive areas of land, but also produce vast amounts of rock waste material that lacks an adequate utilization. Some of these rock wastes have the potential to provide nutrients to plants and can therefore have positive impacts on soil properties. Consequently, we tested their potential for valorization as components of manufactured soils for use in urban areas. We conducted a 10‐week incubation experiment of soil mesocosms with sunflowers (Helianthus annuus L.) to evaluate the performance of manufactured soils with respect to plant growth and soil properties. We used three common rock materials (augite‐porphyry, greywacke‐hornfels, basalt), ground to powder and mixed into natural soils of either clayey or sandy texture. In order to test the performance under challenging environmental conditions, we applied a drought treatment in addition to a regular watering treatment. All manufactured soils were able to maintain plant growth, although the yield of aboveground biomass was significantly lower compared to the original soils. However, the effects of the water regime and the original soils on the overall plant growth were stronger than the effect of the rock powders, indicating that the manufactured soils were not hampering plant development more than challenging environmental conditions. The preparation of the manufactured soils altered the grain size distribution of the originally sandy and clayey soils. Since the rock powders contributed mainly to the silt‐sized particles, their addition to soils may improve the physical properties of the soil, especially the plant's available water content. We used wet‐sieving to isolate aggregate size fractions and thus analyse the formation of soil aggregates. The manufactured soils had a higher mass contribution of microaggregate‐sized particles, although this was mostly attributed to the presence of silt‐sized rock powder particles instead of aggregate formation. The total organic carbon (OC) content of the original soils was diluted in the manufactured soils, as the rock powders did not contain OC. However, the manufactured soils may have the potential for future OC storage due to the abundance of OC‐free mineral surfaces, which can retain organic matter as well as capture CO2 through enhanced weathering of primary minerals. Based on this work, the tested rock materials have the potential to be utilized as components in manufactured soils in the urban context that provide soil‐like functions, particularly in terms of sustaining plant growth. For improved results, additional measures to initiate a rapid development of soil structure are highly recommended, for example, by adding an easily decomposable source of organic matter.

Rehabilitation needs of geriatric patients in subacute inpatient care after acute inpatient hospitalization-aneglected claim

Geriatric patients after hospitalization often utilize subacute inpatient care (SC); however, little is known about their care and further health status. To identify persons in SC with rehabilitation needs and improvement potential after hospitalization and to describe the care, relevant parameters of the health status as well as use of medical/nursing services in and after SC. After positive screening for previous hospitalization and need of rehabilitation with improvement potential in 13nursing homes, the length of stay, therapeutic treatments and physician contacts in SC as well as functional parameters, pain, quality of life and the utilization of services according to the Social Security Code V (SGBV) and SGBXI were assessed at baseline, at the end and 3months after SC. Atotal of 108 (44%) out of 243 screened persons with previous hospitalization had aneed of rehabilitation with improvement potential, of whom 57participated in the study. In SC (median = 26days) 35% received no therapeutic treatments and 28% had no physician contact. After SC 40% were transferred to rehabilitation. Participants with rehabilitation transition more frequently received therapeutic treatments in SC (p = 0.021) and were less frequently in long-term care 3months after SC (p = 0.015). This study suggests that ahigh proportion of persons in SC after hospitalization are in need of rehabilitation with improvement potential, which is not sufficiently treated. Regular therapeutic treatments in SC could improve the transition rate to rehabilitation and subsequent home environment.

Malassezia restricta as an unexpected cause of infectious osteomyelitis diagnosed by metagenomic sequencing: a case report and literature review

BackgroundMalassezia restricta, a lipophilic and lipodependent yeast belonging to the basidiomycetes group, is an opportunistic fungal pathogen associated with various skin diseases, including seborrheic dermatitis and dandruff. Typically, Malassezia infection in neonates manifests as fungemia or hematogenous dissemination to the bone or lungs. However, vertebral osteomyelitis caused by these fungi is rarely reported owing to non-specific clinical presentations and laboratory/imaging findings. The Pathogen Metagenomics Sequencing (PMseq) technique enables direct high-throughput sequencing of infected specimens, facilitating the rapid and accurate detection of all microorganisms in clinical samples through comprehensive reports.Case presentationA 52-year-old male was admitted to our hospital on July 20, 2022 with a 3-month history of ambulatory difficulties and localized low back pain. Magnetic Resonance Imaging (MRI) examination of the spinal column revealed irregular bone destruction affecting the L2, L3, and L5 vertebral bodies. Additionally, low T1 and high T2 intensity lesions were observed at the intervertebral discs between L3 and L5. The presumptive diagnosis of tuberculous spondylitis was made based on the imaging findings, despite negative results in all mycobacterium tests. However, the patient exhibited no improvement after receiving regular anti-tuberculosis treatment for 3 months. Subsequent MRI revealed an expansive abnormal signal within the vertebral body, leading to progressive bone destruction. The absence of spinal tuberculosis or other infective microorganisms was confirmed through culture from blood and pathological tissue from the L4 vertebral body. Subsequently, PMseq was performed on the specimens, revealing M. restricta as the predominant pathogen with the highest relative abundance value. The pathological examination revealed the presence of fungal mycelium in the L4 vertebral body, with positive findings on periodic Schiff-methenamine and periodic acid-Schiff staining. The anti-tuberculosis treatment was discontinued, and an antifungal combination of fluconazole and voriconazole was administered. All symptoms were resolved after 7 consecutive months of treatment, and the patient was able to ambulate autonomously. Vertebral lesions were reduced on MRI during the 13-month follow-up.ConclusionsM. restricta is not a commonly recognized pathogen associated with infectious vertebral osteomyelitis. However, PMseq can aid in diagnosis, timely treatment, and decision making for some non-specific infectious diseases.

LONG-TERM OUTCOMES OF PREVENTIVE MEASURES IN CHILDREN FOLLOWING RADICAL URANOSTAPHYLOPLASTY

The presence of congenital non-union of the palate in children does not allow to carry out hygienic measures to the full extent, therefore it requires carrying out planned remedial and medical and preventive measures at all stages of observation. The purpose of the work is to study the long-term outcomes of the effectiveness of treatment and preventive measures after the radical uranostaphyloplasty. Research methods. In order to objectively assess the dental situation in 17 patients, we assessed the hygiene indices of Green-Vermillion, Silness-Loe, РМА SBI, saliva secretion rate, oral fluid pH, optical density, viscosity, α-amylase activity, medium molecular weight content, the presence of sialic acids, and the content of total protein and oxyproline. Results and discussion. When examining children in 6 months after surgery, it was found out that during this period of time the Green-Vermillion, Silness-Loe and bleeding indexes worsened by 1,3; 1,2; 1,3 times, respectively, and the PMA index increased by 1,4 times. The picture of changes in the physicochemical and biochemical components of oral fluid and its qualitative properties looks different. We would like to remind you that after the completion of the first course of treatment and prevention measures, we failed to normalize the levels of some of them. Over a period of time of 6 months, there was a deepening of the negative trend and the rate of salivation was by 1,3 times lower, but the activity of α-amylase improved by 1,2 times compared to the previous period of examination. The indexes of average mass molecules, sialic acids, total protein and oxyproline increased again by 1.5; 1,4; 1,2; 1,3 times, respectively. The fact of the stability of indexes of hydrogen ion concentration, optical density and viscosity was encouraging, which indicated an improvement in the rheological properties of oral fluid. This situation prompts the need to develop new methodological approaches regarding long-term observation of children with congenital non-union of the palate and determining an algorithm for their medical support. Conclusion. Persistent deterioration in hygiene indexes, periodontal tissue condition, salivary gland secretory activity, and qualitative properties of oral fluid cannot be fully resolved even in the long term after surgical intervention. This necessitates regular treatment and preventive measures, along with continuous improvement of these strategies. Prospects for further research. Further research is planned.

QUALITATIVE STUDIES OF CREAM CHEESE MADE BY USING BIFIDOBACTERIUM BIFIDUM & LACTOBACILLUS ACIDOPHILUS

World is facing a lot of health problems especially in under developed countries of Asia. This crucial situation demands beneficial foods. This study was planned to produce quality Cream cheese. Probiotic Cream cheese had been promoted for health benefits by using Bifidobacterium bifidum & Lactobacillus acidophilus. Buffalo milk was used to produce Cream cheese. Five treatments were handled; T₀ was the regular treatment in which yoghurt culture was inoculated to make Cream cheese while a combination of yoghurt as well as Bifidobacterium bifidum & Lactobacillus acidophilus was inoculated in T1, T2 and T3. Besides T4 was produced by using only Bifidobacterium bifidum & Lactobacillus acidophilus. In the process milk was standardised up to 5% milk fat then it was pasteurized (63°C for 30 minutes). Cooled to 42°C and 2% starter culture was inoculated in that mixture. After incubation the pH reached up to 4.6. Salt (0.5-1%) was added and product packed into plastic cups and stored (4°C, 4 weeks). Qualitative study of the product showed that T4 treatment was better as compare to T₀, T1, T2 and T3. Conclusively, probiotic Cream cheese produced by using buffalo milk is beneficial for reducing health problems like gastric problems, colon cancer etc. This product can play a vital role in functional foods industry as well as cheese industry.

Evaluation of Mandibular Projection in Class II Division 2 Subjects Following Orthodontic Treatment Using Clear Aligners.

The purpose of this study was to evaluate the mandibular growth and/or projection following maxillary incisor proclination, overbite correction, and maxillary dentoalveolar expansion without the use of any class II mechanics, in growing class II division 2 patients treated with clear aligners. Before and after treatment cone-beam computed tomographic (CBCT) generated lateral and posteroanterior cephalograms of thirty-two patients with skeletal class II division 2, 16 in the treatment group and 16 in the untreated group, were reviewed to evaluate treatment-related changes. Upper incisors were proclined and protruded, as well as upper arch expansion and overbite correction were performed as part of their regular treatment. Cephalometric analysis was performed to evaluate skeletal and dental changes. Unpaired statistical t-tests were performed to determine if significant skeletal class II correction was achieved in the treatment group. In the treatment group, after treatment, the upper incisors became more proclined and protruded, and the inter-molar width increased while the overbite was reduced compared to the control group. An increase in skeletal mandibular growth and forward projection was also observed, thus contributing to an improvement of the sagittal skeletal relationship as evidenced by ANB and Wits values compared to the control group. A combination of upper incisor proclination, correction of deep overbite, and maxillary dentoalveolar expansion using clear aligners appears to contribute to an improvement of the skeletal class II relationship in growing patients with class II division 2. This study shows that unlocking the mandible by correcting a deep overbite, proclining upper incisors, and expanding the upper arch in growing class II division 2 patients can improve skeletal class II using clear aligners. How to cite this article: Mirzasoleiman P, El-Bialy T, Wiltshire WA, et al. Evaluation of Mandibular Projection in Class II Division 2 Subjects Following Orthodontic Treatment Using Clear Aligners. J Contemp Dent Pract 2024;25(4):295-302.

Rare micropupil secondary to congenital cataract surgery favoring the development of the affected eye: a case report

BackgroundCongenital microcoria has been extensively reported and usually leads to visual dysfunction or blindness. However, micropupil development secondary to cataract surgery has never been reported. Here, we describe a rare case of micropupil development in infancy that occurred secondary to combined cataract extraction and intraocular lens implantation for treatment of congenital cataract. When the patient reached adulthood, the affected eye not only gained good vision but also showed better ocular development and refractive status than the fellow eye.Case presentationA 17-year-old boy presented to our outpatient clinic with decreased vision in his left eye related to congenital cataract surgery at 6 months of age. The affected eye had exhibited a pinhole pupil since the third month postoperatively. The condition had been managed with observation and regular monocular occlusion treatment. Upon presentation to our clinic, the best-corrected visual acuity (BCVA) in his fellow eye was 0.0 logMAR(20/20) with a refraction of − 5.75 diopters cylinder/−2.25 diopters sphere, and the BCVA in his affected eye was 0.5 logMAR(20/40) with a refraction of 0.00 diopters. Ophthalmic examination of the affected eye revealed a pinhole pupil (approximately 0.5 mm) with high light reflex sensitivity but no response to pupil-dilating drugs. The patient underwent pupilloplasty of the affected eye under corneal surface anesthesia. Postoperative examination revealed better ocular development in the affected eye than in the fellow eye (axial length: 24.21 vs. 27.02 mm, respectively) as well as better refractive status in the affected eye (BCVA of 0.0 logMAR(20/20) with a refraction of − 2.23 diopters cylinder/−3.00 diopters sphere vs. 0logMAR(20/20) with a refraction of -5.75 diopters cylinder/-2.25 diopters sphere).ConclusionsWe have reported a rare case of micropupil development secondary to congenital cataract surgery, which is an uncommon complication, especially in children. However, unlike congenital microcoria, the secondary pinhole pupil may have reduced imaging haze and halos, possibly favoring the development of the affected eye. This case provides further insight into the treatment of congenital cataract.

The Effect of Sargassum fusiforme and Fucus vesiculosus on Continuous Glucose Levels in Overweight Patients with Type 2 Diabetes Mellitus: A Feasibility Randomized, Double-Blind, Placebo-Controlled Trial.

Brown seaweed is promising for the treatment of type 2 diabetes mellitus (T2DM). Its bioactive constituents can positively affect plasma glucose homeostasis in healthy humans. We investigated the effect of the brown seaweeds Sargassum (S.) fusiforme and Fucus (F.) vesiculosus in their natural form on glucose regulation in patients with T2DM. We conducted a randomized, double-blind, placebo-controlled pilot trial. Thirty-six participants with T2DM received, on a daily basis, either 5 g of dried S. fusiforme, 5 g of dried F. vesiculosus, or 0.5 g of dried Porphyra (control) for 5 weeks, alongside regular treatment. The primary outcome was the between-group difference in the change in weekly average blood glucose levels (continuous glucose monitoring). The secondary outcomes were the changes in anthropometrics, plasma lipid levels, and dietary intake. The data were analyzed using a linear mixed-effects model. The change in weekly average glucose levels was 8.2 ± 2.1 to 9.0 ± 0.7 mmol/L (p = 0.2) in the S. fusiforme group (n = 12) and 10.1 ± 3.3 to 9.2 ± 0.7 mmol/L (p = 0.9) in the F. vesiculosus group (n = 10). The between-group difference was non-significant. Similarly, no between-group differences were observed for the changes in the secondary outcomes. A daily intake of 5 g of fresh, dried S. fusiforme or F. vesiculosus alongside regular treatment had no differential effect on weekly average blood glucose levels in T2DM.

Relapse during and after regular single-dose rituximab treatment in adult patients with steroid-dependent nephrotic syndrome.

Rituximab is widely used in patients with steroid-dependent nephrotic syndrome. However, information on the effect of long-term rituximab treatment is limited. This study examined the efficacy of rituximab during and after treatment in adult patients with steroid-dependent nephrotic syndrome. This retrospective cohort study included 30 patients with steroid-dependent nephrotic syndrome. Patients received regular single-dose rituximab (500mg) intravenously every 6months. Discontinuation of rituximab was considered after four to six doses if there was no recurrence of nephrotic syndrome. Glucocorticoid discontinuation with remission, first relapse after rituximab initiation, and relapse after regular rituximab treatment discontinuation were evaluated. The median age was 38 (range 18-67) years. Of 30 patients, 13 and 17 were men and women, respectively. Prior to rituximab treatment, the median number of nephrotic syndrome relapses in the patients was 5 (range 2- > 20). The 1year discontinuation rate of glucocorticoids with remission was 83%. All patients discontinued glucocorticoid treatment at least once until 3years and 7months. The 1 and 2year relapse rates after initiation of rituximab treatment were 0% and 3%, respectively. 25 patients discontinued regular rituximab treatment after a median number of six (4-12) doses. Six patients relapsed after discontinuing rituximab, and the 1 and 2year relapse rates after the last regular rituximab treatment were 9% and 25%, respectively. All patients with steroid-dependent nephrotic syndrome who received rituximab could discontinue glucocorticoid treatment with remission, and three-fourths of the patients remained in remission for > 2years after discontinuing rituximab treatment.

Role of projective psychological tests in patients with Prader-Willi syndrome.

The purpose of this study was to evaluate the usefulness and relevance of projective techniques such as house-tree-person (HTP) and family in individuals with Prader-Willi syndrome (PWS), who have a limited ability to identify and verbalize emotions and express them often using behaviors. We included individuals with genetic confirmation of PWS immersed in a regular transdisciplinary treatment in an institution dedicated to rare diseases. All individuals were evaluated using the HTP and family projective techniques. These instruments are commonly administered to the general population and, in this case, to people with mild to moderate intellectual disabilities, including difficulties in their communication abilities. A total of 25 individuals with PWS between 10 and 41 years old (15 men and 10 women) were included. We identified the presence of graphic indicators corresponding to the behavioral phenotype of individuals with PWS, such as anxiety, stubbornness, emotional lability, difficulty in achieving adequate externalization and identification of emotions, impulsivity, aggressive traits, poor social skills, need for support and interaction, low self-concept, and compulsive behaviors. In the present study, we demonstrated the usefulness of graphic techniques to elucidate aspects of behavior, emotions, and thoughts that individuals with PWS cannot formulate due to expression and communication difficulties.

Prognostic Significance of Progression of Disease within 24 Months in Mantle Cell Lymphoma

To investigate the effect of progression of disease within 24 months (POD24) on overall survival (OS) in patients with mantle cell lymphoma (MCL), and compare the clinical characteristics between POD24 and non-POD24 patients. A retrospective analysis was performed on 50 MCL patients with treatment indications and regular treatment who were admitted to the Affiliated Hospital of Xuzhou Medical University from January 2010 to August 2020. According to the occurrence of POD24, the patients were grouped for prognostic evaluation and clinical characteristics comparison. Univariate Cox regression analysis showed that POD24, PLT, albumin, MIPI score, ECOG PS score, LDH were the factors influencing OS in newly diagnosed MCL patients (all P < 0.05). The results of multivariate Cox regression analysis showed that POD24［HR=16.797(95%CI : 3.671-76.861),P < 0.001］, albumin<40 g/L［HR=3.238(95%CI :1.095-9.572),P =0.034］ and ECOG PS score≥2［HR=4.005(95%CI :1.033-15.521),P =0.045］ were independent risk factors influencing OS in MCL patients. The incidence of PLT<100×109/L (33.3% vs 5.9%, P =0.033) and ECOG PS score ≥2 (45.5% vs 5.9%, P =0.040) were significantly higher in POD24 patients than those in non-POD24 patients. POD24 is an independent poor prognostic factor affecting the OS of MCL patients, and the patients with PLT<100×109/L and ECOG PS score≥2 at diagnosis have a higher probability of POD24.

Therapeutic Role of Nusinersen on Respiratory Progression in Pediatric Patients With Spinal Muscular Atrophy Type 2 and Nonambulant Type 3.

Nusinersen has shown significant functional motor benefit in the milder types of spinal muscular atrophy (SMA). Less is known on the respiratory outcomes in patients with nusinersen-treated SMA. The aim of this study was to describe changes in respiratory function in pediatric patients with SMA type 2 and 3 on regular treatment with nusinersen within the iSMAc international cohort and to compare their trajectory with the natural history (NH) data published by the consortium in 2020. This is a 5-year retrospective observational study of pediatric SMA type 2 and nonambulant type 3 (age ≤18 years) treated with nusinersen. The primary objective was to compare the slopes of decline in forced vital capacity % predicted (FVC% pred.), FVC, and age when FVC dropped below 60% between the treated patients and a control group from the natural history cohort. Data on peak cough flow and the use of noninvasive ventilation (NIV) and cough assist were collected. Data were available for 69 treated patients, 53 were SMA type 2 and 16 type 3. The mean (SD) age at first injection was 8.5 (3.2) and 9.7 (3.7) years, respectively. The median (interquartile range) treatment duration was 1 (0.7; 1.9) and 1.2 (0.9; 1.9) years, respectively. At the time of the first nusinersen injection, 24 of 52 (46%) patients with SMA type 2 and 2 of 16 (13%) patients with SMA type 3 were on NIV. Forty-three of 53 (81%) and 4 of 16 (25%) patients used cough device. FVC% pred. in treated patients with SMA type 2 declined annually by 2.3% vs 3.9% in NH (p = 0.08) and in treated patients with type 3 by 2.6% vs 3.4% NH (p = 0.59). Patients treated reached FVC <60% later than untreated (12.1 vs 10 years, p = 0.05). A higher percentage of treated vs untreated patients maintained FVC% pred. equal/above their baseline after 12 (65% vs 36%) and 24 (50% vs 24%) months, respectively. NIV use among treated did not significantly change throughout 1-year follow-up. This study included the largest real-world cohort of pediatric patients with milder SMA types. The results suggest a positive role of nusinersen in delaying the respiratory decline in patients treated longer than 1 year when compared with natural history. Larger cohorts and longer observation are planned. This study provided Class III evidence that nusinersen slows progression for patients with SMA types 2 and 3 compared with a natural history cohort.

Correlation between imatinib trough concentration and efficacy in patients with advanced GIST with different genotypes.

e23515 Background: Imatinib (IM) has significantly enhanced the prognosis of patients (pts) with advanced gastrointestinal stromal tumors (GISTs). The clinical outcomes may correlate with IM exposure. However, the efficacy threshold, particularly based on different primary KIT mutant, remains undefined. This study aimed to establish the efficacy threshold of IM plasma trough concentration (Cmin) at steady-state in Chinese pts with advanced GIST, additionally to define subgroup thresholds based on various primary KIT mutations. Methods: This was a single-center, prospective, observational cohort study. Pts with histologically confirmed recurrent/metastatic GIST who received regular IM treatment and had undergone at least two measurements of steady-state IM Cmin were enrolled from Jul 2017 to Jun 2022. Clinical outcomes including objective response rate (ORR), survival, and IM Cmin were assessed. Results: A total of 168 pts with a median age of 52y were enrolled. The primary lesion locations comprised stomach, small intestine, rectum and others. Metastatic lesions were found in the liver, peritoneum, both liver and peritoneum and others. Median sum of longest diameter of target lesions was 10.7cm. Of 168 pts, 117 (69.6%) harbored KIT 11, 27 (16.1%) harbored KIT 9, 5 (3.0%) harbored PDGFRA, and 9 (5.4%) were KIT/PDGFRA wild type. During IM response period, 104 pts combined with surgical treatment (surgery or interventional therapy). After a median follow-up duration was 50.6m (range, 16.3–189.8), 72 pts had disease progression and 20 died. Estimated median progression-free survival (mPFS) for all patients was 79.4m (95%CI 55.7–103.1). The median overall survival was not reached. A Cmin threshold of ≥738ng/ml defined by log-rank test was associated with longer PFS for the whole population (P = 0.002) irrespective of other clinical characteristics. Pts with an IM Cmin below 738ng/ml exhibited a shorter mPFS (25.3m, 95%CI 41.9–97.1) compared to those surpassing this threshold (96.7m, 95%CI 65.8–127.6). The ORR for the whole population was 73.0% (CR 2.2%, PR 70.8%), with no significant difference observed between pts with IM Cmin below and above 738ng/ml. For pts with KIT 11 and KIT 9 mutations, the efficacy thresholds for IM Cmin were ≥680ng/ml and ≥1877ng/ml, respectively. Multivariate Cox regression analysis revealed that IM Cmin ≥738ng/ml, primary gastric origin, liver-only metastasis, sum of target lesions diameter ≤5cm, KIT 11 mutation, and combined with surgical treatment were favorable prognostic factors. Conclusions: IM exposure significantly correlates with clinical benefits in advanced GISTs, with an IM Cmin above 738ng/ml associated with a longer PFS in Chinese population. Considering different primary KIT mutant, a threshold of 680 ng/ml could be considered for efficacy in KIT 11 mutations, while a higher Cmin of 1877 ng/ml was necessary for KIT 9 mutation.

Evaluation of groundwater quality in communities near Sokoban Wood Village

Groundwater is vital for drinking, agriculture, and domestic use in Sokoban Wood Village, Ghana, but concerns exist about its quality. This study assessed the suitability of 20 groundwater samples for domestic purposes. The study was carried out in 2023. We collected samples from boreholes and hand-dug wells using standard methods, analyzing them for various physicochemical parameters (pH, electrical conductivity, turbidity, nitrates, fluorides, and heavy metals). The microbiological analysis assessed fecal coliforms and E. Coli to identify microbial contamination. Established methodologies were used to evaluate potential health risks (carcinogenic and non-carcinogenic) associated with heavy metals. The Water Quality Index (WQI), Hazard Potential Index (HPI), and Heavy Metal Evaluation Index (HEI) provided a comprehensive water quality evaluation. The results revealed that the water fell below the recommended WHO pH range for drinking water. While most other parameters and heavy metals fell within WHO guidelines, 25 % of the samples contained fecal coliforms and E. Coli, indicating ongoing microbial contamination. The overall cancer risk was low for all age groups. Although some parameters met WHO standards, the WQI classified 20 % of the samples as not of good quality. Despite this, the HPI and HEI (−4.62 and 0.001) suggested generally good water quality based on heavy metal content. In conclusion, despite some positive indicators, acidic water and microbial contamination raise concerns. Regular monitoring and potential treatment measures are crucial to ensure safe drinking water for the Sokoban Wood Village community.

Effect of central dialysis fluid delivery system using high flux dialyzer versus regular water treatment stations on endotoxemia and inflammatory markers among prevalent patients on regular hemodialysis

Effect of central dialysis fluid delivery system using high flux dialyzer versus regular water treatment stations on endotoxemia and inflammatory markers among prevalent patients on regular hemodialysis

The Relationship of The Medication Adherence Model to The Quality of Life of Communities Pulmonary Tuberculosis Suffering in The Working Area of The Muliorejo Health Center, Sunggal District, Deli Serdang 2023

Tuberculosis sufferers experience changes in their physical, psychological health and social life which can have an impact on the quality of life of pulmonary tuberculosis sufferers. Curing pulmonary tuberculosis requires regular treatment for up to 6 months. The purpose of this research is to identify the relationship between the Medication Adherence Model and the Quality of Life of People Suffering from Pulmonary Tuberculosis at the Muliorejo Community Health Center, Sunggal District, Deli Serdang Regency. This research method uses descriptive collaborative with a cross sectional approach. Sampling was taken by accidental sampling with a sample size of 60 respondents. Medication adherence was obtained using the MMAS-8 questionnaire and quality of life using the WHO Qol-BREF questionnaire. The statistical analysis used is the Chi-Square test. Of the 60 respondents, 25 respondents were found in the low medication adherence category, namely 25 people (41.7%) had a poor quality of life, 20 people (33.3%) had a moderate quality of life and none had a moderate quality of life. good, out of a total of 30 respondents in the high medication adherence category, 35 people (58.3%) had a quality of life in the moderate category, 20 people (33.3%) experienced a quality of life in the good category and no one experienced a poor quality of life. Based on the results of the Chi-Square Test, it was found that the pvalue (0.000) was smaller than the significant value (0.05) so that Ha was accepted, which means there is a relationship between adherence to taking medication and the quality of life of Tuberculosis patients in the Muliorejo Community Health Center working area. There is a relationship between adherence to taking medication and quality of life in tuberculosis patients in the Muliorejo Community Health Center working area. Consume nutritious food · Let sunlight enter the room · Use a mask · Limit contact at the start of treatment · Wash your hands frequently.

#2701 Prevalence of chronic kidney disease associated pruritus among hemodialysis patients in Switzerland

Abstract Background and Aims Chronic Kidney Disease Associated Pruritus (CKD-aP) is a frequent symptom in patients with end-stage renal disease. The reported prevalence differs between countries and is estimated between 20-40%; data on the prevalence of CKD-aP in Switzerland are lacking. This ongoing study aims to determine the prevalence and severity of CKD-aP among patients on hemodialysis in the French-speaking part of Switzerland and to investigate its association with demographic and clinical factors. Method Patients aged ≥18 years, on hemodialysis for ≥6 months, and free of cognitive impairment were recruited. Clinical, laboratory and dialysis prescription characteristics were collected by an independent research nurse, who also performed CKD-aP assessment using the Visual Analog Scale (VAS, numeric score 0-10) and the Verbal Rating Scale (VRS, 0 = no itch - 4 = extremely severe itch). Multiple linear regression analysis was carried-out to investigate associations of CKD-aP with demographic and clinical factors. Results Preliminary data from 401 participants (mean age 69.4 years, SD 13.6; 65% men) showed a CKD-aP prevalence of 24%. Most participants with CKD-aP (69%) reported generalized itching and 35% waking-up at night because of the itching. Mean VAS in participants with CKD-aP was 4.78 (SD 2.02) during the last 24 hours and 6.65 (SD 2.2) for the worst intensity itching during the last 24 hours. According to the VRS, most participants with CKD-aP suffered from moderate (60%) to severe itching (23%), and 72% experienced at least one severe to extremely severe episode of itching during the last 24 hours. Conclusion Despite high dialysis standards and easy access to medications, CKD-aP affected around 24% of patients on hemodialysis in the French-speaking part of Switzerland, and its intensity was moderate to severe. Results may help to increase clinicians’ awareness of CKD-aP, improve its regular screening, severity reporting and treatment.