Tool For Monitoring Patients Research Articles

Transcranial Ultrasound Guided Assessment of Brain Midline Shift in Neuro Intensive Care Unit

Background: Neuro Intensive Care Unit (Neuro-ICU) handles neurological emergencies that involve intracranial (IC) hemorrhages. It can be challenging to manage elevated intracranial pressure (ICP) and midline shift (MLS), as they requires constant monitoring and frequent imaging. Trans-cranial Color Coded Sonography (TCCS), a bedside monitoring tool, may be helpful in monitoring MLS under such conditions. Objectives: To correlate MLS of the third ventricle in the brain measured by TCCS with CT midline shift. Method: A prospective observational study was conducted on patients with IC bleed who were mechanically ventilated and had a head CT done to rule out MLS. Within an hour of doing a CT brain, TCCS-MLS was identified. Data was collected and analyzed. Results: A total of fifty patients studied, the MLS (mean ±SD) was 5.3mm ± 3.1 mm using TCCS and 6.7±4.4 mm using CT brain. The calculated midline shift between TCCS and CT brain demonstrated a Pearson's correlation of 0.78 (P<0.001). With TCCS, the area under the ROC curve to identify a significant MLS was 0.91 (95%CI=0.8-1). TCCS-MLS of 3.9mm as a cut-off, predicted the occurrence of >5mm MLS on CT scan with a sensitivity of 95% and specificity of 90%. Conclusions: This study suggests that TCCS could serve as an alternative bedside monitoring tool in patients whose transportation is risky, in predicting the transcranial MLS >5mm with reasonable accuracy.

Remote Patient Monitoring Using Mobile Health Technology in Cancer Care and Research: Patients' Views and Preferences

PURPOSE There is an increasing interest in studying the potential of mobile health (mHealth) technologies, such as smartphone apps and wearables, as monitoring tools for patients with cancer during or after their treatment. However, little research is dedicated to exploring the opinions and concerns of patients regarding the adoption of these technologies. This study aimed to gain insight into patients' perspectives and preferences for participating in mHealth-based monitoring in cancer care. METHODS A qualitative study comprising semistructured interviews was conducted in the Netherlands between April and June 2023. Participants were eligible if they were 18 years or older with a current or past diagnosis of cancer. The interview guide was developed on the basis of the technology acceptance model, with main themes being use, communication, trust, privacy, and expectations. RESULTS Thirteen participants with urologic primary cancer were interviewed. Most patients had already some familiarity with the use of digital monitoring devices or wearables. Main barriers included persistent reminders of the illness, receiving notifications deemed unnecessary or unwanted, and the acknowledgment that mHealth technology does not serve as a substitute for human doctors. Conversely, patients recognized the potential for time-savings through the utilization of mHealth, viewed active monitoring as nonburdensome, considered mHealth a tool for reducing the communication threshold with their doctor, and expressed willingness to adopt such a platform if they perceived personal or societal relevance. CONCLUSION This study has elucidated which factors are important for successful development of mHealth for patients with cancer. While both barriers and facilitators play a role, patients' attitudes were positive toward the implementation of remote digital monitoring, showing promising prospects for future research of mHealth in oncology.

Circulating tumor DNA status and dynamics predict recurrence in patients with resected extrahepatic cholangiocarcinoma

Background & AimsSurgery is the only curative therapeutic option for resectable extrahepatic cholangiocarcinoma (eCCA), but recurrence is common, and prognosis is poor. There is an unmet clinical need for improved decision-making regarding adjuvant chemotherapy (ACT). Here we evaluated the usefulness of monitoring longitudinal circulating tumor DNA (ctDNA) for minimal residual disease (MRD) in patients of the STAMP trial, which compares the efficacy of adjuvant capecitabine (CAP) versus gemcitabine plus cisplatin (GemCis). MethodsBetween July 2017 and November 2020, 101 patients were randomized 1:1 to receive GemCis (n=50) or CAP (n=51). Efficacy outcomes were analyzed with an extended follow-up of 19 months from the previous report. From a biomarker cohort of 89 patients, longitudinal plasma samples (n=254) were prospectively collected post-surgery before adjuvant chemotherapy (ACT), and on-ACT at 12 and 24 weeks from cycle 1 day 1 (C1D1). ctDNA was evaluated using a personalized, tumor-informed, 16-plex PCR-NGS assay and was correlated with clinical outcomes. ResultsIn the extended follow-up analysis, median disease-free survival (DFS) and overall survival (OS) did not significantly differ between the CAP and GemCis groups. Significantly inferior DFS was associated with ctDNA-positivity before ACT (HR, 1.8; p=0.029), on-ACT at 12 weeks from C1D1 (HR, 7.72; p<0.001), on-ACT at 24 weeks from C1D1 (HR, 5.24; p<0.001), and anytime post-surgery (HR, 3.81; p<0.001). Analysis of pre-treatment to on-treatment ctDNA dynamics revealed that serially ctDNA-negative patients exhibited a significantly longer DFS compared to those with sustained ctDNA-positivity (HR, 6.7; p<0.001) or who turned ctDNA-positive (HR, 5.8; p<0.001). ConclusionIn patients with resected eCCA, ctDNA status and dynamics predicted recurrence during adjuvant therapy, and may help optimize clinical decision-making. Impact and implicationsThe findings from this study highlight the critical role of ctDNA as a prognostic biomarker and monitoring tool for patients with resected extrahepatic cholangiocarcinoma (eCCA). By demonstrating the superiority of ctDNA to predict disease recurrence compared to conventional biomarkers such as CA 19-9 and CEA, this study underscores its potential in guiding decision-making during adjuvant chemotherapy. These results may be crucial to refine post-surgical treatment strategies and improve patient outcomes. The practical application of ctDNA monitoring could lead to more personalized treatment approaches, enabling timely interventions based on minimal residual disease (MRD) status. Clinical Trial Registration numberNCT03079427

Criterion validity of a single-item measure of fear avoidance behavior following mild traumatic brain injury

Maladaptive coping such as fear avoidance behavior can prolong recovery from mild traumatic brain injury (mTBI). Routine assessment of fear avoidance may improve management of mTBI. This study aimed to validate a single-item measure of fear avoidance to make its assessment more pragmatic. The present study is a secondary analysis of a clinical trial that involved adults with persistent post-concussion symptoms (N = 90, 63% female). Participants completed the single-item fear avoidance rating, a validated legacy measure of fear avoidance (Fear Avoidance Behavior after Traumatic Brain Injury; FAB-TBI), and measures of anxiety (General Anxiety Disorder-7), depression (Patient Health Questionnaire-9), post-concussion symptoms (Rivermead Postconcussion Symptoms Questionnaire), and disability (World Health Organization Disability Assessment Schedule 12.0). Questionnaires were completed twice, at baseline (mean 18.1 weeks post injury) and again 12–16 weeks later following study-delivered rehabilitation in addition to usual care. We analyzed the associations (Spearman’s correlations) and agreement (weighted Kappa) between the single-item and FAB-TBI at baseline, posttreatment, individual FAB-TBI item scores, and the change in scores between baseline and posttreatment. In addition, we examined correlations between the single-item fear avoidance measure and related constructs, including anxiety, depression, post-concussion symptoms, and disability. The single-item fear avoidance measure correlated strongly with the FAB-TBI both at baseline and following treatment (ρ = 0.63 − 0.67, p < .001), and moderately with FAB-TBI item scores (ρ = 0.4 − 0.6). The correlation between the change in these scores from baseline to posttreatment was moderate (ρ = 0.45, p < .001). Agreement between the single-item fear avoidance measure and discretized FAB-TBI scores was moderate (κ = 0.45 − 0.51). Before and after treatment, the single-item fear avoidance measure correlated moderately with anxiety (ρ = 0.34), depression (ρ = 0.43), post-concussion symptoms (ρ = 0.50), and disability (ρ = 0.43). The FAB-TBI was more strongly correlated with these measures (ρ = 0.53 − 0.73). In summary, the present study supports the criterion validity of the single-item fear avoidance measure. This measure may be a useful screening and monitoring tool for patients with mTBI but is not a substitute for the FAB-TBI questionnaire.

LUNA EMG as a Marker of Adherence to Prehabilitation Programs and Its Effect on Postoperative Outcomes among Patients Undergoing Cytoreductive Surgery for Ovarian Cancer and Suspected Ovarian Tumors.

Prehabilitation is a novel strategy in preoperative management. The aim of this study was to investigate the effect of prehabilitation programs on peri- and postoperative outcomes and to verify if LUNA EMG has the capacity to monitor compliance with prehabilitation programs. A total of seventy patients with suspected ovarian cancer were recruited between April 2021 and September 2022 and were divided into a prehabilitation group (36 patients) or a control group (34 patients). A LUNA EMG device was utilized to monitor muscle strength and tension. Within the prehabilitation group, we observed a significant increase in the 6-Minute Walk Test distance by 17 m (median, IQR: 0-42.5, p < 0.001) and a significant increase in muscle strength measured with LUNA EMG. In comparison to the control group, the prehabilitation group showed fewer complications according to the Clavien-Dindo classification (47.2% vs. 20.6%, p = 0.02) and shorter postoperative hospital stays (median 5.0 days [IQR: 4.0-6.2] vs. 7.0 days [IQR: 6.0-10.0], p < 0.001). Prehabilitation has a positive effect on physical capacity and muscle strength and is associated with a reduction in the number of complications after surgery. LUNA EMG can be a useful tool for monitoring patients' adherence to prehabilitation programs.

Evaluation of the clinical use of MGMT methylation in extracellular vesicle-based liquid biopsy as a tool for glioblastoma patient management

Glioblastoma (GB) is a devastating tumor of the central nervous system characterized by a poor prognosis. One of the best-established predictive biomarker in IDH-wildtype GB is O6-methylguanine-DNA methyltransferase (MGMT) methylation (mMGMT), which is associated with improved treatment response and survival. However, current efforts to monitor GB patients through mMGMT detection have proven unsuccessful. Small extracellular vesicles (sEVs) hold potential as a key element that could revolutionize clinical practice by offering new possibilities for liquid biopsy. This study aimed to determine the utility of sEV-based liquid biopsy as a predictive biomarker and disease monitoring tool in patients with IDH-wildtype GB. Our findings show consistent results with tissue-based analysis, achieving a remarkable sensitivity of 85.7% for detecting mMGMT in liquid biopsy, the highest reported to date. Moreover, we suggested that liquid biopsy assessment of sEV-DNA could be a powerful tool for monitoring disease progression in IDH-wildtype GB patients. This study highlights the critical significance of overcoming molecular underdetection, which can lead to missed treatment opportunities and misdiagnoses, possibly resulting in ineffective therapies. The outcomes of our research significantly contribute to the field of sEV-DNA-based liquid biopsy, providing valuable insights into tumor tissue heterogeneity and establishing it as a promising tool for detecting GB biomarkers. These results have substantial implications for advancing predictive and therapeutic approaches in the context of GB and warrant further exploration and validation in clinical settings.

Abstract PO1-06-06: Underestimation of metastatic spread in patients with lobular breast cancer: results from the post-mortem tissue donation program UPTIDER

Abstract Background: Invasive lobular carcinoma (ILC) accounts for 15% of all invasive breast cancers (BC) and has a peculiar metastatic spread in comparison to BC of no-special type. Since ILC is less likely to disrupt normal tissue architecture and is usually non-mass forming, imaging of ILC lesions entails many challenges. Insights into pathologic versus radiological metastatic invasion can lead to better diagnostic and monitoring tools for patients with ILC. Here, we compare microscopical findings during autopsy with clinical findings prior to death in patients with metastatic ILC included in our post-mortem tissue donation program UPTIDER (NCT04531696). Methods: UPTIDER was started in November 2020 in University Hospitals Leuven/KU Leuven with inclusion of patients with stage IV BC who were willing to participate. One of the predefined subgroups consisted of patients with primary pure (i.e. not mixed) ILC. Samples were taken from different macroscopically invaded and non-invaded sites. Clinical data on disease progression, imaging, biochemistry and treatment regimens were extracted from patient files. The number of samples that were preregistered as pathological served as a surrogate for lesions that were seen on imaging performed during the treatment of the patient. These samples are compared to microscopical findings of the autopsy. Results: Since the start of UPTIDER, an autopsy has been performed on 6 patients with pure ILC (26.1% of all autopsies). Median age at initial diagnosis was 52 years (range: 37 – 80 years). Three patients (50.0%) had stage IV disease at diagnosis, the others relapsed on average 162.7 months (range: 55 – 358 months) after initial diagnosis. The average time between clinical occurrence of metastases and death was 44.8 months (range: 15 – 83 months). Median number of treatment lines for stage IV disease was 5 (median endocrine lines 2; median chemotherapy regimens 3.5). To follow disease evolution, computed tomography of thorax and abdomen was used for 4 (66.7%) patients and whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) for the remaining 2 (33.3%). Median time between last premortem imaging and death was 5.9 weeks (range: 1.6 – 16.6 weeks). At autopsy, a median of 26 unique metastases (range: 12-36) were sampled per patient. Table 1 gives an overview on the unique microscopically invaded metastases that were sampled per patient. Only 47.3% of the sampled unique metastases was preregistered. Of all unique metastases, 26.7% appeared macroscopically normal during autopsy. Tissues that appeared normal but turned out to be microscopically infiltrated included liver, stomach, adrenal glands, heart, pericardium, visceral and subcutaneous fat tissue. There were 2 patients with normal appearing, microscopically infiltrated livers. In these patients, elevation of γGT and transanimases was seen in the months prior to death. Conclusions: The disease burden of metastatic ILC reported on premortem imaging does not reflect the microscopical findings at autopsy. One of the priorities of metastatic ILC research should be the development of diagnostic tools to better estimate the extent of the disease. Future analyses of the performed postmortem MRIs in our study can aid in improving the interpretation of WB-DWI/MRI for patients with ILC. For now, clinicians should consider that unexplained clinical and/or biochemical findings might indicate progression of ILC. Table 1: patient overview on performed imaging and unique metastases sampled during autopsy CT = computed tomography; ER = estrogen receptor; HER2 = human epidermal growth factor receptor 2; pt = patient; WB-DWI MRI = whole-body diffusion-weighted magnetic resonance imaging *exclusion of samples of patient 2012 since no preregistration was performed for this patient due to unexpected death Citation Format: Karen Van Baelen, Gitte Zels, Maxim De Schepper, Marion Maetens, Josephine Van Cauwenberge, Tatjana Geukens, Kristien Borremans, François Richard, Amena Mahdami, Ha-Linh Nguyen, Sophia Leduc, Anirudh Pabba, Ann Smeets, Ines Nevelsteen, Patrick Neven, Hans Wildiers, Vincent Vandecaveye, Wouter Van Den Bogaert, Giuseppe Floris, Christine Desmedt. Underestimation of metastatic spread in patients with lobular breast cancer: results from the post-mortem tissue donation program UPTIDER [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-06-06.

Head-to-toe bedside ultrasound for adult patients on extracorporeal membrane oxygenation.

Bedside ultrasound represents a well-suited diagnostic and monitoring tool for patients on extracorporeal membrane oxygenation (ECMO) who may be too unstable for transport to other hospital areas for diagnostic tests. The role of ultrasound, however, starts even before ECMO initiation. Every patient considered for ECMO should have a thorough ultrasonographic assessment of cardiac and valvular function, as well as vascular anatomy without delaying ECMO cannulation. The role of pre-ECMO ultrasound is to confirm the indication for ECMO, identify clinical situations for which ECMO is not indicated, rule out contraindications, and inform the choice of ECMO configuration. During ECMO cannulation, the use of vascular and cardiac ultrasound reduces the risk of complications and ensures adequate cannula positioning. Ultrasound remains key for monitoring during ECMO support and troubleshooting ECMO complications. For instance, ultrasound is helpful in the assessment of drainage insufficiency, hemodynamic instability, biventricular function, persistent hypoxemia, and recirculation on venovenous (VV) ECMO. Lung ultrasound can be used to monitor signs of recovery on VV ECMO. Brain ultrasound provides valuable diagnostic and prognostic information on ECMO. Echocardiography is essential in the assessment of readiness for liberation from venoarterial (VA) ECMO. Lastly, post decannulation ultrasound mainly aims at identifying post decannulation thrombosis and vascular complications. This review will cover the role of head-to-toe ultrasound for the management of adult ECMO patients from decision to initiate ECMO to the post decannulation phase.

The perfusion index as a noninvasive method for monitoring revascularized and replanted digits.

Monitoring replanted digits remains a challenging task in microsurgical units. Previous studies have indicated the perfusion index (PI), a parameter directly proportional to the blood flow, might be a useful tool. The PI is evaluated as a monitoring tool in patients with replanted digits. This prospective, non-interventional study includes 31 patients with revascularized or replanted digits. After successful revascularization or replantation, the PI and peripheral oxygen saturation of the affected finger and its contralateral equivalent were measured simultaneously. The values were detected by the device Radical-97® Pulse CO-Oximeter® (Masimo Corporation, 52 Discovery, Irvine, CA 92618, USA). The median PI of affected fingers was 3.5±0.56 for revascularized and 2.2±0.8 for replanted fingers. The difference between the PI values of replanted digits and the healthy contralateral side was highly significant (p < 0.0001). The area under the curve in the receiver operating characteristics was 0.92 for a PI difference > 80.49% and predicted a loss of replant with a specificity of 100% and a sensitivity of 75%. The assessment of the PI in patients with reperfusion of a vascular compromised digit is a useful tool to continuously monitor peripheral perfusion. The dynamic behavior of the PI is essential to detect perfusion disturbance.

P601 Intestinal ultrasound correlates with clinical, biochemical, endoscopic and histologic biomarkers in patients with Ulcerative Colitis: a cross-sectional study

Abstract Background Intestinal ultrasound (IUS) is emerging as a non-invasive monitoring tool in patients with ulcerative colitis (UC). Our goal was to correlate IUS with clinical, biochemical, endoscopic and histological activity. Methods Cross-sectional multicentric study of patients with left (E2) or extensive (E3) UC. Consecutive patients were included and clinical (Patient-Reported Outcome (PRO2) and Simple Clinical Colitis Activity Index (SCCAI)), biochemical (fecal calprotectin (FCal) and C-reactive protein (CRP)), endoscopic (Mayo endoscopic sub-score (sMayo)) and histological (Nancy score) activity were evaluated. IUS activity was characterized by Milan Ultrasound Criteria (MUC). Clinical, biochemical, ultrasonographic, endoscopic and histologic remission were defined as SCCAI≤2, FCal&amp;lt;250 ug/g, MUC&amp;lt;6.2, sMayo=0 and Nancy=0, respectively. All evaluations were performed within 1 month. Pathologist was blinded to endoscopic and IUS results. In patients in IUS remission, the sigmoid colon was considered for analysis. Results 58 patients with UC were included (55% men, with a mean-age of 38 (+/-17) years, 65% with E2 UC). Clinical, biochemical, ultrasonographic, endoscopic and histologic remission occurred in 53%, 53%, 53%, 31% and 12% of the patients, respectively. The most affected segment by both IUS and endoscopy was the sigmoid colon (34.5% and 41.4%, respectively). In our cohort, IUS activity had a strong correlation with PRO2 (r=0.778, p&amp;lt;0.001), SCCAI (r=0.810, p&amp;lt;0.001) and endoscopic activity (r=0.758, p&amp;lt;0.001), and a moderate correlation with FCal (r=0.517, p&amp;lt;0.001), CRP (r=0.402, p&amp;lt;0.001) and histological activity (r=0.475, p&amp;lt;0.001). We observed a consistent increase in the bowel wall thickness (BWT) and MUC score as the sMayo raised. Accordingly, patients with endoscopic activity presented higher BWT and MUC score, when compared to patients in endoscopic remission (Table 1). On the other hand, patients in IUS remission showed higher rates of clinical (90% vs 10%, p&amp;lt;0.001) biochemical (74% vs 26%, p&amp;lt;0.001) and endoscopic remission (94% vs 6%, p&amp;lt;0.001), with a trend towards higher rates of histologic remission (86% vs 14%, p=0.054). Conclusion In our cohort, IUS activity had a moderate to strong correlation with clinical, biochemical, endoscopic and even histologic activity. Additionally, patients with endoscopic activity presented worse IUS activity, suggesting this method as a reliable non-invasive monitoring tool in UC patients.

Longitudinal Monitoring of Circulating Tumor DNA to Assess the Efficacy of Immune Checkpoint Inhibitors in Patients With Advanced Genitourinary Malignancies.

Circulating tumor DNA (ctDNA) detection in blood has emerged as a prognostic and predictive biomarker demonstrating improved assessment of treatment response in patients receiving immune checkpoint inhibitors (ICIs). Here, we performed a pilot study to support the role of ctDNA for longitudinal treatment response monitoring in patients with advanced genitourinary (GU) malignancies receiving ICIs. Patients with histologically confirmed advanced GU malignancies were prospectively enrolled. All eligible patients received ICI treatment for at least 12 weeks, followed by serial collection of blood samples every 6-8 weeks and conventional scans approximately every 12 weeks until disease progression. ctDNA analysis was performed using Signatera, a tumor-informed multiplex-polymerase chain reaction next-generation sequencing assay. Overall, the objective response rate (ORR) was reported and its association with ctDNA status was evaluated. Concordance rate between ctDNA dynamics and conventional imaging was also assessed. ctDNA analysis was performed on 98 banked plasma samples from 20 patients (15 renal, four urothelial, and one prostate). The median follow-up from the time of initiation of ICI to progressive disease (PD) or data cutoff was 67.7 weeks (range, 19.6-169.6). The ORR was 70% (14/20). Eight patients ultimately developed PD. The overall concordance between ctDNA dynamics and radiographic response was observed in 83% (15/18) of patients. Among the three patients with discordant results, two developed CNS metastases and one progressed with extracranial systemic disease while ctDNA remained undetectable. In this pilot study, longitudinal ctDNA analysis for monitoring response to ICI in patients with advanced GU tumors was feasible. Larger prospective studies are warranted to validate the utility of ctDNA as an ICI response monitoring tool in patients with advanced GU malignancies.

Analysis of C-reactive Protein Level as a Monitoring Tool in Patients with Odontogenic Space Infection: A Prospective Clinical Study

Analysis of C-reactive Protein Level as a Monitoring Tool in Patients with Odontogenic Space Infection: A Prospective Clinical Study

Role of EEG as a monitoring tool in patients with glucose transporter type I deficiency syndrome (GLUT1-DS) on ketogenic diet.

Glucose transporter type I deficiency syndrome (GLUT1-DS) is the fourth most frequent single-gene epilepsy refractory to standard antiepileptic drugs. Multiple seizure types and variable electrographic findings are reported. Ketogenic diet is expected to result in the complete resolution of the epileptiform activity. A retrospective chart review of patients with GLUT1-DS on ketogenic diet between December 2012 and February 2022 was done. Analysis of the EEGs prior to and during the ketogenic diet was done. 34 patients on ketogenic diet were reviewed. Ten had clinical diagnosis of GLUT1-DS, and seven of them had genetic confirmation. 71% were female. The average age at seizure onset was 13.85 m.o. (range: 3-60, SD ±20.52), at diagnosis was 44.57 m.o (range: 19-79), and at the onset of ketogenic diet was 46.43 m.o. (range: 20-83). 29 months (range: 13-38) delay between symptoms onset until diagnosis was noticed. At the diagnosis 100% reported seizures: 71% myoclonic, 57% generalized motor, 57% absence, 28% atonic, and 14% focal motor. Also, 71% abnormal eye movements, 57% ataxia, and 28% intolerance to fasting. 86% had normal brain MRI. 71% had abnormal EEG. All were on ketogenic diet, and four on classical (1.75:1-2.25:1 ratio). Six were clinically seizure-free after the ketogenic diet. EEG features included notch delta, focal spike and wave, and generalized spike/polyspike and wave. One patient had bilateral independent centrotemporal spikes. Spikes showed high and very high amplitude in all of them (>200 μV). The variation of the spike index decreased in three patients but increased in two. Ketogenic diet is the choice treatment for patients with GLUT1-DS. Electrographic features could show worsening after initiation of the ketogenic diet even with seizure control. EEG did not prove to be a reliable tool for adjusting KD in our cohort. Centrotemporal spikes have not been reported in patients with GLUT-1 DS.

Retromode Imaging in Age-Related Macular Degeneration.

Background and Objectives: Retromode is a relatively new retinal-imaging technique that is based on the transillumination principle and is obtained with a scanning laser ophthalmoscope that uses light in the infrared spectrum. The laser light penetrates into the deep retinal layers and the choroid. Retromode images are captured with a laterally displaced aperture, and the detector captures only the scattered light. The result is a high-contrast pseudo-three-dimensional image. Age-related macular degeneration (AMD) is a disabling retinal disease. AMD is characterized in its early stage by small and intermediate drusen formation, while the signs of intermediate AMD are large drusen and/or pigmentary abnormalities. Late AMD has two forms, geographic atrophy, which is the advanced form of dry AMD, and wet AMD. Most of the lesions of AMD are located in the outer layers of the retina. This new imaging method can provide a glimpse of the deep retinal layers' topographic changes in a non-invasive, fast, and effective way that can match the other imaging tools available. Materials and Methods: The literature review was performed by searching the PubMed database using the following combination of keywords: retromode imaging and age-related macular degeneration. Relevant images similar to the ones in the literature were identified and used as models. Results: The purpose of this article is to highlight the utility of incorporating retromode imaging into the multimodal evaluation of the retina in patients with AMD and to gather and integrate these findings into a brief but comprehensive paper. Conclusions: Retromode imaging is a good screening, diagnosis, and monitoring tool for patients with AMD.

P357 Intestinal ultrasound as a promising non-invasive monitoring tool in patients with Ulcerative Colitis

Abstract Background Intestinal ultrasound (IUS) is an established non-invasive tool for monitoring disease activity in Crohn’s disease, however its value in ulcerative colitis (UC) is still less clear. Our goal was to correlate IUS features with well-established disease targets in UC. Methods Prospective study including patients with left-sided (E2) or extensive (E3) UC. Simple Clinical Colitis Activity Index (SCCAI), patient reported outcomes (PRO-2), C-reactive protein (CRP), fecal calprotectin (FCal) and endoscopic activity (Mayo endoscopic subscore - sMayo) were evaluated. IUS features included bowel wall thickness (BWT) and color Doppler flow (CDF), assessed by modified Limberg score. The most affected segment was selected for analysis. Clinical remission was defined by SCAAI ≤ 2, endoscopic remission by sMayo of 0 and IUS remission by BWT ≤ 3 mm and CDF=0. Results 17 UC patients (59% males, median age 44 (20-68) years, 53% E3) were included and evaluated in 46 different time-points, with concomitant endoscopic assessment in 31 cases. Overall, 55% were in clinical remission, 30% in endoscopic remission and 22% in IUS remission. The sigmoid colon was the most affect segment by IUS (46%) and endoscopy (39%). Median BWT in the most affected segment was 4.28 (3.08-6.25) mm and 83% had a Limberg score ≥ 1. Median CRP was 0.41 (0.06-18.55) mg/dL and FCal 80 (3-8000) ug/g. There was a moderate agreement between IUS and endoscopy regarding the most affected segment (k=0.43, p&amp;lt;0.001). BWT showed a strong correlation with sMayo and CRP and a moderate correlation with FCal, SCCAI and PRO-2. CDF showed no significant correlations with clinical, biochemical and endoscopic features (Table 1). Patients with IUS remission presented higher rates of endoscopic remission (78% vs 10%, p&amp;lt;0.001) and lower sMayo scores (0 vs 2, p&amp;lt;0.001), together with lower FCal (21 vs 133 ug/g, p=0.01) and CRP levels (0.08 vs 0.54, p&amp;lt;0.01). Conclusion IUS features showed a significant correlation with endoscopic activity, clinical activity and biomarkers. IUS remission was associated with endoscopic remission and lower biomarker activity, suggesting that IUS is an accurate method to evaluate UC patients both with active disease and in remission.

Implementation of IMU sensor for Fall Detection in Dementia Syndrome Patients with Location Notification System

Monitoring tool for patients at risk of dementia has been made using an IMU sensor with Location Notification System. The aim of this research is to design and manufacture a tool using the IMU sensor to identify and determine the characteristics of a person’s condition in falling for patients at risk of dementia. The research method starts from making prototypes, and measuring system performance. The results of the measurement of system performance are shown by the IMU sensor readings with an average x angle value of 175.74, angular velocity x, and angular acceleration x an average of 175.70 and 0.052 for forward fall activities. For activities falling backwards the average x angle value is 27.97, the angular velocity x, and the angular acceleration x averages 28.12 and -0.25. For activities falling to the right the average x angle value is 85.07, the angular velocity x, and the angular acceleration x averages 37.31 and 79.59. As for the activity falling to the left, the average x angle value is 32.91, the angular velocity x, and the angular acceleration x averages 32.54 and 0.62. Overall the tool can function well. Suggestions for further research, methods can be added to predict the position of the nearest hospital and police station based on the Internet of Things.

Pharmaceutical care for patients with G6PD deficiency

Historically, G6PD deficiency was reported for the first time in individuals who received doses of primaquine, the primary drug to be addressed in the study, to treat malaria, and triggered a symptomatic response with jaundice and a hematological field of erythroenzymopathies. In this sense, through an integrative review, the present research aimed to discuss the importance of pharmaceutical care and its relationship with the treatment of patients with G6DP enzyme deficiency. Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common enzyme deficiency prevalent in many malaria-endemic countries. In this sense, patients with G6PD deficiency are susceptible to hemolysis during oxidative stress, which can occur from exposure to certain drugs, including 8-aminoquinolines used to treat Plasmodium vivax malaria. In this way, pharmaceutical care would become a tool for monitoring patients and managing problems that may occur during pharmacotherapy. Guiding, educating and implementing quantitative mechanisms for diagnosing and providing adequate radical cure in heterozygous women, who remain at risk of hemolysis.

Un percorso di integrazione tra strutture ospedaliere e servizi territoriali

The forty years of work in the Ser.D. have taught us to grasp changes, often beyond laws and resources, proposing the correct organizational evolutions. The evolution of consumption and states of dependence, the new consumption of young people, the challenges to the limit of risks, the addictive behaviors such as chemic sex recall the need for new reading paradigms, a new clinic and new operational tools. A collaboration between the SMEL Clinical Chemical Analysis and Microbiology Laboratory of the Lodi Hospital and the Ser.D. has begun a few months ago, aimed at introducing a new protocol for the research of substances of abuse on the keratin matrix in drug addiction monitoring. Furthermore, with this type of analysis, the laboratory can provide its Ser.D. with a more effective analysis tool in monitoring patients. The high specificity of the test is able to determine greater diagnostic reliability with a consequent improvement in the specificity of treatment.

Retinal pigment epithelium melanin imaging using polarization-sensitive optical coherence tomography for patients with retinitis pigmentosa

This study aimed to evaluate the distribution of retinal pigment epithelium (RPE) melanin in patients with retinitis pigmentosa (RP) using entropy measurements by custom-made polarization-sensitive optical coherence tomography (PS-OCT) images, and compare entropy with the intensity of short-wavelength (SW) and near-infrared (NIR) autofluorescence (AF). We retrospectively reviewed the retinal images, including PS-OCT, SW-AF, and NIR-AF of patients with RP who had a hyperautofluorescent ring on AF. A total of 12 eyes of 12 patients (8 women and 4 men; mean age: 37.9 years) were included. There was a strong positive correlation between entropy value and NIR-AF intensity (r = 0.626, p < 0.001), and there was a very weak negative correlation between entropy value and SW-AF (r = − 0.197, p = 0.001). The mean values of the entropy in the foveal, temporal (2 mm from the fovea), and nasal (2 mm from the fovea) sections were 0.41 (± 0.09), 0.29 (± 0.08), and 0.26 (± 0.08), respectively. The entropy was significantly higher in the foveal section than in the temporal and nasal sections (p = 0.002 and p = 0.003, respectively). There was no significant difference between the entropies values for the temporal and nasal sections (p = 0.157). Age, logMAR best-corrected visual acuity, ellipsoid zone width, and central retinal thickness were not correlated with foveal entropy. We presented RPE melanin imaging in patients with RP using PS-OCT for the first time. PS-OCT can be a useful tool for monitoring patients with RP.

Telemedicine in the monitoring of patients with dementia: a Brazilians caregivers's perspective.

The SARS-CoV-2 (COVID-19) pandemic warranted expanded care via telemedicine across a breath of medical specialties. The aim of the study is to analyze the preferences of caregivers of patients with dementia on the use of telemedicine in monitoring these patients. Caregivers and family members responsible for patients with dementia completed an online self-applicable questionnaire, which was distributed in Facebook and WhatsApp groups between April and October 2020. 130 responses were obtained; most caregivers were women (83.8%), of whom 60% were daughters of patients. Most patients were also women (75.3%). Alzheimer's disease caused dementia in 73% of cases. The Internet was accessible to 98% of respondents, yet less than half (33.8%) had used telemedicine at least once. Although 66.9% of caregivers would be willing to use telemedicine if the doctor offered it, 63% believed that the cost of video consultations should be lower than those face-to-face. During the COVID-19 pandemic, 85.3% of caregivers needed to contact the physician: just over half of these consultations were face-to-face (52.2%), but telemedicine was preferred (62.3%) if possible. Caregivers accepted and were interested in telemedicine as a tool for monitoring patients with dementia, especially those with walking difficulties.