Screening Surveillance Research Articles

P0337 Incidentally Diagnosed Inflammatory Bowel Disease: Prevalence and Long-Term Outcomes

Abstract Background Incidentally diagnosed inflammatory bowel disease (IBD) can be found in asymptomatic individuals undergoing endoscopic examinations performed for various reasons such as colorectal cancer (CRC) screening. We aimed to characterize the prevalence of incidental IBD in individuals undergoing non-diagnostic colonoscopy and describe its clinical characteristics, disease course, and medium to long-term outcomes. Methods Retrospective cohort study including all asymptomatic adults who underwent colonoscopy for CRC screening or polyp surveillance between 2009 and 2023. Incidental IBD was considered any case with endoscopic and histologic findings suggestive of IBD. The endoscopic lesions considered were erythema, erosions, loss of vascular pattern, ulcerations, strictures, and pseudopolyps. On the other hand, the microscopic criteria were transmural inflammation, non-caseating granulomas, ulcers, crypt distortion and abscesses, cryptitis, Paneth cell metaplasia, and basal plasmacytosis. Clinical data and disease characteristics were collected. Tests for categorical variables were performed using the Fisher-Freeman-Halton Exact Test, while for quantitative variables the ANOVA and Kruskal-Wallis Test were utilized. Statistical analyses were conducted using R, with significance at p<0.05. Results Out of 40,573 colonoscopies, a total of 60 patients with incidental IBD were identified: 40 patients (67%) with Crohn’s disease (CD), 10 (18%) with ulcerative colitis (UC), and 10 (18%) with IBD-unclassified (IBD-U). Most CD patients presented with ileal (L1) involvement (98%) and inflammatory (B1) behavior (98%), while 60% of UC patients exhibited extensive (E3) disease. UC and IBD-U patients had lower hemoglobin values than those with CD (11.67 +/-1.97; 11,73 +/- 1.25; 13.74 +/- 1.93; respectively, p=0.019). Follow-up data was available from 27 patients (45%), after a mean follow-up of 27.9 +/- 34.7 months in CD patients, 20% (N=8) developed new-onset symptoms (diarrhea [n=3, 38%], abdominal pain [n=3, 37.5%], bloating [n=2, 25%], fatigue [n=1, 12.5%], weight loss [n=1, 13%]), while only one patient (10%) with UC reported symptoms (diarrhea and abdominal pain). A total of 5 patients (8%) initiated medical therapy, in most cases after symptom onset. Two patients (3%) with CD received oral corticosteroids, one (2%) with CD received sulfasalazine, and two patients (3%) with UC were started on oral mesalamine. No hospitalizations or surgeries were noted. Conclusion In our experience, the prevalence of incidental IBD was 0.2% with two-thirds receiving a diagnosis of ileal CD with inflammatory behavior. A low proportion of patients developed symptomatic disease (5% for CD and 2% for UC) after 2 years of follow-up and generally had milder disease course.

Lynch Syndrome: Similarities and Differences of Recommendations in Published Guidelines.

In this review, we aimed to compare the recommendations for Lynch syndrome (LS). We compared the LS's guidelines of different medical societies, including recommendations for cancer surveillance, aspirin treatment, and universal screening. Most guidelines for LS patients recommend intervals of 1-2 years for performing colonoscopy, though there is disagreement regarding the age to begin CRC screening (dependent on status as a MLH1/MSH2 or MSH6/PMS2 carrier). There are inconsistencies between LS guidelines for gastric cancer surveillance. Most guidelines do not recommend routine surveillance of the pancreas and small bowel. Most but not all of the guidelines support endometrial and ovarian surveillance with transvaginal ultrasound and endometrial biopsy. Only two societies recommend urological surveillance, while others recommend surveillance among high-risk carriers with family history only. There is significant disagreement between the guidelines about the recommendation for limited or extended bowel resection among patients with CRC. Aspirin use is recommended by most societies, though some with reservations, and most of them recommend universal screening. There are significant disparities and disagreements in the guidelines and recommendations for patients with LS, causing confusion and difficulties for clinicians. Harmonization and cooperation are needed between the societies creating LS guidelines.

Retinopathy of prematurity in Germany over 13 years: incidences, treatment preferences and effects of national guideline changes

ObjectiveRetinopathy of prematurity (ROP) is a leading yet avoidable cause of childhood blindness. Screening for ROP is highly effective in preventing blindness secondary to ROP. We provide epidemiological data on...

Age distribution of retinoblastoma tumours in familial disease.

40% of children with retinoblastoma have an RB1 gene mutation identified, known as heritable retinoblastoma. It is important to undertake active surveillance (screening) of relatives of those with identified RB1 gene mutations and ensure ongoing surveillance to monitor for new tumour formation or recurrences. Current guidance is to screen patients up to the age of 7 years old. With advancements in treatment methods and survival rates of retinoblastoma being 98%, it has become increasingly important to plan a surveillance programme that is both safe and cost effective. van Hoefen Wijsard et al. proposed that surveillance could be concluded at the age of 4 years. We conducted a retrospective analysis of all patients with familial retinoblastoma known to our service presenting from 1995 to 2020. 52 patients were eligible for analysis. 47 out of 50 had more than 4 years of follow up (median 129 months). In this cohort, the oldest age for new tumour occurrence was 47 months; if patients were screened from an appropriate age according to protocol, the latest age for new tumour occurrence was 28 months. Furthermore, the average age for tumour recurrence was 15 months; the oldest patient with an identified tumour recurrence was 56 months old. This supports the notion that it may be safe to reduce the length of surveillance for new tumours in familial retinoblastoma from 7 years of age.

Sustained applicability of SARS-CoV-2 variants identification by Sanger Sequencing Strategy on emerging various SARS-CoV-2 Omicron variants in Hiroshima, Japan

BackgroundThe evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) persists, giving rise to new variants characterized by mutations in the spike protein. However, public data regarding the virus's evolutionary trend is not widely available after the downgrade of coronavirus disease 2019(COVID-19). Therefore, this study aimed to investigate the applicability of an in-house Sanger-based method for identifying SARS-CoV-2 variants, particularly focusing on newly emerged Omicron variants, and updating the epidemiology of COVID-19 during the 8th wave in Hiroshima Prefecture.ResultsA total of 639 saliva samples of individuals who had tested positive for COVID-19, received from Hiroshima City Medical Association Clinical Laboratory Center between February 01, 2023, and March 12, 2024, were included in the study. SARS-CoV-2 variants were identified in 69.3% (443/639) with the mean viral titer 2 × 106 copies/mL, and high viral titer in Omicron variant XBC.1.6* (5 × 108 copies/mL) using RT-qPCR. By partial Spike gene-based sequencing using the Sanger Sequencing strategy, Omicron sub-lineages XXB.1, BA.5, and EG.1 were identified during different periods. A comprehensive phylogenetic analysis of 7383 SARS-CoV-2 strains retrieved from GISAID, collected in Hiroshima from the onset of the COVID-19 pandemic in early 2020 until July 2024, revealed the dynamic evolution of SARS-CoV-2 variants over time. The study found a similar pattern of variant distribution between the full genomes from GISAID, and the partial genomes obtained from our screening strategy during the same period.ConclusionsOur study revealed that all SARS-CoV-2 viruses circulated in Hiroshima were Omicron variants and their sub-lineages during the 8th wave outbreak in Hiroshima. Persistent molecular surveillance of SARS-CoV-2 is needed for the decision-making and strategic planning of the public promptly. Our study added evidence for the usefulness of SARS-CoV-2 spike gene partial sequencing-based SARS-CoV-2 variant identification strategy for mass screening and molecular surveillance even though the evolution of newly emerged various SARS-CoV-2 Omicron variants.

Serologic screening and molecular surveillance of Kaposi sarcoma herpesvirus (KSHV)/human herpesvirus-8 (HHV-8) infections for early recognition and effective treatment of KSHV-associated inflammatory cytokine syndrome (KICS) in solid organ transplant recipients

Kaposi sarcoma herpesvirus/human herpesvirus-8 (HHV-8) neoplastic and non-neoplastic disease in solid organ transplant (SOT) recipients can be life-threatening. We evaluated the seroprevalence of HHV-8 infection among donors (D) and recipients (R), the incidence of HHV-8 transmission/reactivation, and the clinical characteristics, management, and outcomes of HHV-8-related diseases, including Kaposi sarcoma herpesvirus-associated inflammatory cytokine syndrome (KICS), in consecutive SOT patients from 2011 to 2023. HHV-8 seroprevalence was 3.3% in 1349 donors and 8.4% in 1856 recipients screened (p<0.0001). Among the D+/R- group (n=49), 13 patients developed HHV-8-related diseases: 7 liver recipients had KICS, and 1 lung recipient had Kaposi sarcoma (KS) with subsequent KICS. Four KICS patients treated with rituximab survived, while the 3 patients not treated with rituximab died. Within the D-/R- group, out of 5 (0.3%) patients with non-donor-derived primary HHV-8 infection, 3 liver recipients developed KICS. In the R+ patients (n=155), 3 developed KS. In our cohort, 25/944 (2.6%) liver transplant recipients had a primary HHV-8 infection, and 10 of them (40%) developed KICS; 40% (4/10) of HHV-8 seropositive heart transplant recipients developed reactivation and 2 of them (50%) had fatal KS. Serologic screening and molecular surveillance of D+/R- patient groups facilitate early recognition and effective therapy of KICS.

"Chronic thromboembolic pulmonary hypertension is an uncommon complication of COVID-19: UK national surveillance and observational screening cohort studies." S.A. Reddy, J. Newman, O.C. Leavy, et al. Eur Respir J 2024; 64: 2301742.

"Chronic thromboembolic pulmonary hypertension is an uncommon complication of COVID-19: UK national surveillance and observational screening cohort studies." S.A. Reddy, J. Newman, O.C. Leavy, et al. Eur Respir J 2024; 64: 2301742.

Is limb asymmetry an intrinsic risk factor for time-loss groin injury in professional male soccer players?

To provide normative values for between-limb asymmetry of hip strength and range of motion (ROM) in professional male soccer players and evaluate the relationship between these asymmetries and groin injury. Secondary analysis of a prospective cohort study. A total of 438 professional male soccer players underwent musculoskeletal screening, injury and exposure surveillance over two consecutive seasons. Between-limb asymmetry for two hip strength (eccentric adduction and abduction) and six ROM measures were calculated, and normal asymmetry considered within 1 standard deviation (SD) of the mean. Cox proportional hazard regression analysis estimated the association between asymmetry and time-loss groin injury. Normal asymmetry ranged between 0.3% and 27.3% across strength and ROM variables. No association was found between groin injuries and asymmetry in eccentric hip adduction (HR=0.99, 95%CI=0.98-1.00; p=0.167) or abduction strength (HR=1.00, 95%CI=0.99-1.01; p=0.745). For five of the six ROM measures, no association with groin injuries were determined. A statistically significant, though likely clinically irrelevant, association was found between groin injury and dominant leg total hip rotation ROM (HR=1.03, 95% CI=1.00-1.05; p=0.040). Normal hip strength and ROM asymmetry ranged between -27 and +20%. No clinically relevant associations were found between asymmetry in hip strength or ROM and time-loss groin injuries.

Utility of Jaundice Surveillance and Bilirubin Screening in Identifying Neonates Who Qualify for Phototherapy ≤24 Hours after Birth

To assess the utility of jaundice surveillance and routine 24hour bilirubin screening in identifying neonates who qualify for phototherapy (PT) at≤24hours after birth. In this retrospective, single-center observational study, records of neonates ≥350/7weeks gestation born to O+, antibody negative mothers (n=6098) were screened to identify who received PT at≤24hours after birth. The hour specific TSB at which neonates qualified for PT, blood type, direct antiglobulin test (DAT), and whether treatment was triggered by jaundice detection at <24hours or the 24-hour bilirubin screen were determined. 59 neonates (1.0%) qualified for PT≤24hours after birth; 10 (17%) were identified by jaundice detection at<24hours, whereas 49 (83%) were identified on 24-hour bilirubin screening. Forty-eight of the 59 (81%) were ABO incompatible and DAT+; 11 were DAT negative, one of whom had glucose-6-phosphate dehydrogenase deficiency. Among the ≤24hour PT group, 17 had a PT qualifying TSB within 3mg/dL of exchange transfusion (ET); 14 of whom were only identified first on 24-hour bilirubin screening. Six exceeded ET thresholds, 4 of whom were identified on 24-hour bilirubin screening. Neonates who qualified for PT at ≤24hours were identified mostly by 24-hour bilirubin screening, a fraction of whom had a TSB that approached or exceeded ET thresholds. Our findings support routine birth hospitalization bilirubin screening and suggest screening no later than 24hours after birth may be beneficial.

Hepatitis B and C viral infections and correlates among pregnant women in Ilorin, Nigeria: a cross-sectional study

Background: Hepatitis B and C are significant viral infections in pregnancy with high risk of maternal and neonatal complications. This study was conducted to determine the prevalence of hepatitis B and C viral infections and correlates among pregnant women who attended antenatal care (ANC) unit of General and Civil Service Hospitals, Ilorin, Nigeria. Methodology: This was a descriptive cross-sectional study of 282 consented pregnant women randomly selected from the ANC units of two hospitals in Ilorin. Blood samples were collected from the pregnant women and tested for hepatitis B virus (HBV) surface antigen (HBsAg) and anti-hepatitis C virus (HCV) antibody using Enzyme Linked Immunosorbent Assay (ELISA) technique. Socio-demographic and obstetrics information of the pregnant women and potential risk factors for HBV and HCV infections were collected using a pretested structured questionnaire. Statistical analysis was done using SPSS version 22.0 Results: Majority of the women were married (78.4%), from monogamous families (57.8%), do not share sharp objects (65.6%), have not received blood transfusion (65.3%), have no history of organ transplantation (91.1%), and multigravida (61.4%,) in their first (36.9%), second (37.2%) and third (25.9%) trimesters of pregnancy. Overall, 22.3% and 1.4% tested positive for HBsAg and anti-HCV respectively. Family background of the study participants showed significant (p˂0.05) association with HBsAg positivity. None of the other analysed variables showed any significant association with both HBsAg and anti-HCV positivity. Conclusion: This result showed high prevalence of HBV but low prevalence of HCV infections among pregnant women in the study setting. Improved surveillance and routine screening for HBV and HCV for women attending ANC is recommended to reduce disease burden and help achieve WHO goal of eliminating viral hepatitis as a major public health threat by 2030.

Changing times: trends in risk classification, tumor upstaging, and positive surgical margins after radical prostatectomy - results from a contemporary National Cancer Database study

PurposeRecent advancements in screening, prostate MRI, robotic surgery, and active surveillance have influenced the profile of patients undergoing radical prostatectomy (RP). We sought to examine their impact on trends in clinicodemographic, risk classification, and adverse pathology in men undergoing surgery.MethodsWe queried the National Cancer Database for clinicodemographic, risk group, and pathology data in men undergoing upfront RP between 2006 and 2020. Patients were categorized by NCCN risk groups, and trends were assessed among 2006–2010, 2011–2015, and 2016–2020 periods. Endpoints included rates of pT3, positive surgical margins (PSM), pathologic upstaging, and Gleason grade group (GG) upgrading.Results610,762 patients were included. There were significant increases in African Americans (9.8–14.1%), comorbidities (2.1–5.2% with Charlson scores > 1), and robot-assisted RP (78–84%). Over the three time periods, high-risk cases increased from 15 to 20 to 27%, and intermediate-risk from 54 to 51 to 60%. Overall rates of pT3 rose from 20 to 38%, and PSM from 20 to 27% (p < 0.001). Pathologic upstaging increased in low (6–15%), intermediate (20–33%), and high-risk groups (42–58%) –p < 0.001. Gleason upgrading rose in low-risk (45–59%, p < 0.001), with slight reductions in the intermediate and high-risk groups.ConclusionsRecent trends in RP indicate a shift towards more advanced disease, evidenced by increasing rates of pT3, PSM, and pathologic upstaging across all NCCN risk groups. These findings emphasize the need for a careful balance in applying fascia and nerve-sparing techniques to avoid compromising oncological safety.

Trends in cancer and heart failure related mortality in adult US population: A CDC WONDER database analysis from 1999 to 2020

BackgroundWith the advent of novel chemotherapy, survival of patients with cancer has improved. However, people with cancer have an increased risk of heart failure (HF). Conversely, HF-related mortality may undermine survival among people with cancer. We aim to analyze the trends of mortality in people with HF and cancer in the adult US population. MethodsWe conducted an examination of death certificates sourced from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database, from the years 1999 to 2020. Mortality in adults with HF and cancer was assessed. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change were reported. ResultsBetween 1999 and 2020, 621,783 deaths occurred from HF in people with cancer. The AAMR declined from 16.4 in 1999 to 11.9 in 2017, after which an increase to 14.5 was observed in 2020. Men had consistently higher overall AAMR as compared to women (men = 18.1 vs women = 9.9). Similar AAMR was observed between non-Hispanic (NH) Blacks/African Americans (13.9) and NH Whites (13.3), with lower in American Indian/Alaska Native (9.6) and Hispanics (7.4). Asian/Pacific Islanders reported the lowest AAMR (5.7). The Midwestern region reported the highest AAMR (14.8). We observed the highest AAMR amongst the older population (61.4). ConclusionThe mortality rates of people with HF and cancer are increasing in the adult U.S. population. This underscores the need for increased screening, aggressive management, and subsequent surveillance of people at risk or with manifested HF in people with cancer.

Exploring Concurrent Approach for Respiratory Epidemiological Surveillance and Symptom Screening (CARES): a new strategy for preventing respiratory infection outbreaks in long-term care facilities.

The Concurrent Approach for Respiratory Epidemiological Surveillance and Symptom Screening (CARES) combines symptom screening to prevent external respiratory infections by managing staff and visitor health and surveillance to monitor the infection rates within the facility and take timely decisions on activity programs based on outbreak prevalence. This study examines the efficacy of the CARES strategy in preventing respiratory infection outbreaks in long-term care facilities. Prospective cohort study utilizing historical controls including an intervention and control group. This study was conducted in two long-term care facility wards (total: 110 beds) in Japan. We enrolled patients aged 1-72 years from the target ward with severe intellectual and physical disabilities from October 1, 2018, to March 31, 2019, and from October 1, 2017, to March 31, 2018, for the intervention (n = 104) and control (n = 98) groups, respectively. The study included all admitted patients and excluded those hospitalized or discharged during the study period. The total number of days that activity programs, new admissions, and visitations were cancelled in the two groups was compared before and after the introduction of CARES. CARES reduced the duration of new admission cancellations and visitation cancellations by 16 and 23 days, respectively (α = 0.1, P value < 0.001). Additionally, the maximum duration of activity program cancellations was reduced by 2 days. Furthermore, five cases of presenteeism were prevented. CARES improves patients' quality of life by continuation of activity programs, new patient admission, and ongoing visitations.

Providing Survivorship Care for a Young Adult With a History of Blood Cancer

Adolescents and young adults (AYAs) with a history of cancer are at an increased risk for late effects from their cancer treatment and have higher rates of long-term morbidity and mortality compared to their age-matched peers. As a result, this vulnerable population needs attentive follow-up care, end-organ surveillance, and secondary cancer screening; however, a history of cancer can often become buried on a problem list or not addressed at all. This case report illustrates an AYA survivor of classic Hodgkin lymphoma who relocates to a new city and establishes care with a new primary care provider (PCP). The PCP's awareness of a prior cancer diagnosis and the previous treatment regimen is a critical component in providing comprehensive care. In this case, the PCP's first step is to reach out and collaborate with oncology providers to gather an accurate treatment summary and then consult evidence-based guidelines to develop a plan of care. Based on the patient's previous treatment with chemotherapy adriamycin, bleomycin, vinblastine, and dacarbazine, the PCP orders recommended testing, reviews results, and provides subsequent counseling on health promotion and psychosocial wellness. This case illustrates strategies healthcare providers can use to provide coordinated, evidence-based care for AYA cancer survivors.

P043 PREACH IMPLEMENTATION PROJECT A SOCIO-ECOLOGICAL FRAMEWORK FOR HYPERTENSION IN PAKISTAN

Background: Worldwide hypertension prevalence is projected to reach 1.56 billion by 2025, affecting 29% of the global population according to the WHO1. It contributes to 7.5 million deaths, 3.7% of total disability-adjusted life years (DALYs) and is responsible for causing stroke in 54% of hypertensives2,3. Pakistan has a prevalence of 43% hypertension with merely 12.5% of controlled hypertensives4,5. There is a pressing need for a national level intervention through uniform clinical approaches for optimum hypertension prevention, treatment and control6, 7. Through PREACH project, we prioritize primary care physicians as first-line responders and are training them on standardized hypertension guidelines to alleviate the burden from tertiary care hospitals. To detect new onset hypertension the project also incorporates early surveillance and community level screenings. Objectives: • To build capacity of practitioners on standardized guidelines endorsed by health ministry, PCS (Pakistan Cardiac Society) &amp; PHL (Pakistan Hypertension League) • To raise community awareness, to screen and develop self-referral pathways to specialty care • To develop a robust national hypertension registry • To include hypertension in essential primary healthcare packages Methodology: Hypertension guidelines are developed. Accredited national certified workforce of more than 14,000 general practitioners (GPs) will be built through guidelines trainings via train the trainer model. Impact assessment studies will be done to assess training effectiveness and implementation at clinics. Community mobilization and awareness campaigns will be run to identify and direct self-referral pathway to an accredited GP. Development of national hypertension registry as a centralized system for data collection to report actual disease burden. Ministry of health will be advocated to prioritize hypertension management via multi-sectoral collaboration i.e. medical societies, academic, non-profit and private-sector for incorporations into annual development programs. Results \Conclusion: We aim to create an impact in the lives of 4.3 million beneficiaries (anti-hypertensive naïve hypertensive patients of Pakistan) by increasing self-referral of hypertensive cases to specialists through PREACH implementation project at all healthcare service delivery levels.

Poor adherence to proper Barrett’s esophagus screening and surveillance guidelines in patients with newly diagnosed esophageal adenocarcinoma

Background Screening for Barrett’s esophagus (BE) remains controversial, even for high-risk populations. Our study aimed to evaluate the proportion of patients diagnosed with esophageal adenocarcinoma (EAC) who were not screened for BE or did not receive recommended BE surveillance screening. We then evaluated the relationship between cancer staging and screening/surveillance opportunities. Methods This single-center retrospective study included 187 patients from January 2016 to January 2022 with newly diagnosed EAC. Data extracted from patient charts included BE risk factors, and BE, endoscopic, and histologic history. Results A total of 187 patients had a new diagnosis of EAC. Among this group, 44% had appropriate BE surveillance adherence, and 47% of patients met the criteria for BE screening but had not been screened prior to EAC diagnosis. Adherence to BE surveillance was associated with earlier stages of cancer on biopsy. No significant difference in cancer staging was found in those with missed BE screening opportunities. Discussion Patients with a diagnosis of BE who adhered to surveillance guidelines had earlier stage EAC at diagnosis, which emphasizes the importance of surveillance. Most of those with an initial diagnosis of EAC had not received any BE screening.

Establishment of ELISA method for canine adenovirus type 1.

Canine adenovirus (CAdV) had a high prevalence in fox populations and induced fox encephalitis. No ELISA kits specifically for CAdV-1 antigen had been commercialized for foxes in China. It is crucial to develop a rapid and accurate ELISA method for detecting of CAdV-1. The monoclonal antibodies (mAbs, IgG1A) and HRP-labeled polyclonal antibodies (pAbs) were used to establish the ELISA method in this experiment. The results showed that the optimal concentration and coating time for the mAbs (IgG1A) were 2.15 μg/mL and overnight at 4°C, respectively. The dilution ratio of the HRP-labeled pAbs was 1:2000. Five percent skimmed milk was selected as the blocking agent. The optimal incubation times for blocking, CAdV-1, and HRP-labeled pAbs were all 1 h. The cut-off value for negative rectal swab was determined to be 0.366 ± 0.032. The maximum dilution ratio was 100 TCID50/mL. The ELISA method was positive to CAdV-1, and that was negative to CAdV-2, Canine Parvovirus (CPV) and Canine Distempervirus (CDV). The ELISA method showed good repeatability, sensitivity, and specificity. Compared with RT-PCR, the sensitivity, specificity, and coincidence rates of the ELISA method were 93.75, 90.9, and 92.86%, respectively. These results indicate that the established ELISA method can be used for the large-scale screening and epidemiology surveillance of CAdV-1 in foxes.

Reproducibility of CT-based opportunistic vertebral volumetric bone mineral density measurements from an automated segmentation framework

BackgroundTo investigate the reproducibility of automated volumetric bone mineral density (vBMD) measurements from routine thoracoabdominal computed tomography (CT) assessed with segmentations by a convolutional neural network and automated correction of contrast phases, on diverse scanners, with scanner-specific asynchronous or scanner-agnostic calibrations.MethodsWe obtained 679 observations from 278 CT scans in 121 patients (77 males, 63.6%) studied from 04/2019 to 06/2020. Observations consisted of two vBMD measurements from Δdifferent reconstruction kernels (n = 169), Δcontrast phases (n = 133), scan Δsessions (n = 123), Δscanners (n = 63), or Δall of the aforementioned (n = 20), and observations lacking scanner-specific calibration (n = 171). Precision was assessed using root-mean-square error (RMSE) and root-mean-square coefficient of variation (RMSCV). Cross-measurement agreement was assessed using Bland-Altman plots; outliers within 95% confidence interval of the limits of agreement were reviewed.ResultsRepeated measurements from Δdifferent reconstruction kernels were highly precise (RMSE 3.0 mg/cm3; RMSCV 1.3%), even for consecutive scans with different Δcontrast phases (RMSCV 2.9%). Measurements from different Δscan sessions or Δscanners showed decreased precision (RMSCV 4.7% and 4.9%, respectively). Plot-review identified 12 outliers from different scan Δsessions, with signs of hydropic decompensation. Observations with Δall differences showed decreased precision compared to those lacking scanner-specific calibration (RMSCV 5.9 and 3.7, respectively).ConclusionAutomatic vBMD assessment from routine CT is precise across varying setups, when calibrated appropriately. Low precision was found in patients with signs of new or worsening hydropic decompensation, what should be considered an exclusion criterion for both opportunistic and dedicated quantitative CT.Relevance statementAutomated CT-based vBMD measurements are precise in various scenarios, including cross-session and cross-scanner settings, and may therefore facilitate opportunistic screening for osteoporosis and surveillance of BMD in patients undergoing routine clinical CT scans.Key PointsArtificial intelligence-based tools facilitate BMD measurements in routine clinical CT datasets.Automated BMD measurements are highly reproducible in various settings.Reliable, automated opportunistic osteoporosis diagnostics allow for large-scale application.Graphical

Prevalence, genetic characteristics and economic losses of Foot-and-Mouth Disease Virus (FMD) in global and Bangladesh context: A Review

Foot and Mouth disease virus (FMD) is a transboundary animal disease (TAD) affecting global cloven-hooved wild and domesticated animals. It is recognized as a significant economic infectious disease in the livestock business. Domesticated animals such as goats, sheep, cattle, pigs, and buffalo are vulnerable hosts for FMD. This RNA virus is classified as a member of the Aphthovirus genus in the Picornaviridae family. It encompasses around 60 subtypes and is divided into seven serotypes: C, O, A, SAT1, SAT2, SAT3, and Asia1. There is no cross-protection across different serotypes, and occasionally, the effectiveness of vaccination may be restricted, even when targeting the same serotype. Therefore, it is crucial to identify and classify the viruses currently in circulation, mainly when vaccination is employed for disease management. Hence, it is necessary to administer multivalent vaccines with genetically matching vaccines in circulation to ensure adequate protection through immunization. Bangladesh has a high cattle population, and FMD leads to significant economic losses for farmers. Serotypes A, O, and Asia 1 are circulating in Bangladesh. The most common serotype is O, although Bangladesh has reported multiple serotype infections. Strategic vaccination, immunity screening, and outbreak surveillance are being examined for FMD management in Bangladesh. This review analyses FMD epidemiology, genetics, diagnostics, economic impacts, and prevention-control efforts worldwide, emphasizing Bangladesh. Finally, the study recommends FMD management advice for endemic settings.

Chronic thromboembolic pulmonary hypertension is an uncommon complication of COVID-19: UK national surveillance and observational screening cohort studies.

Pulmonary embolism (PE) is a well-recognised complication of coronavirus disease 2019 (COVID-19) infection, and chronic thromboembolic pulmonary disease with and without pulmonary hypertension (CTEPD/CTEPH) are potential life-limiting consequences. At present the burden of CTEPD/CTEPH is unclear and optimal and cost-effective screening strategies yet to be established. We evaluated the CTEPD/CTEPH referral rate to the UK national multidisciplinary team (MDT) during the 2017-2022 period to establish the national incidence of CTEPD/CTEPH potentially attributable to COVID-19-associated PE with historical comparator years. All individual cases of suspected CTEPH were reviewed by the MDT for evidence of associated COVID-19. In a separate multicentre cohort, the risk of developing CTEPH following hospitalisation with COVID-19 was calculated using simple clinical parameters at a median of 5 months post-hospital discharge according to existing risk scores using symptoms, ECG and N-terminal pro-brain natriuretic peptide. By the second year of the pandemic, CTEPH diagnoses had returned to the pre-pandemic baseline (23.1 versus 27.8 cases per month; p=0.252). Of 334 confirmed CTEPD/CTEPH cases, four (1.2%) patients were identified to have CTEPH potentially associated with COVID-19 PE, and a further three (0.9%) CTEPD without PH. Of 1094 patients (mean age 58 years, 60.4% male) hospitalised with COVID-19 screened across the UK, 11 (1.0%) were at high risk of CTEPH at follow-up, none of whom had a diagnosis of CTEPH made at the national MDT. A priori risk of developing CTEPH following COVID-19-related hospitalisation is low. Simple risk scoring is a potentially effective way of screening patients for further investigation.