Ve Patients Research Articles

A STUDY OF COMPARISON OF PURE TISSUE REPAIR (DESERDA) AND PROSTHETIC REPAIR (LICHTENSTEIN) METHODS FOR INGUINAL HERNIA REPAIR-A COMPARATIVE STUDY

INTRODUCTION: An ideal hernia repair should be tension free, tissue based, with no potential damage to vital structures, no long term pain or complications and no recurrence. Although Lichtenstein's prosthetic repair is simple and safe, but it is also correlated with risk of infections, recurrence, chronic pain, testicular atrophy and infertility, foreign body sensations and chronic groin sepsis. Desarda hernia repair does not require mesh and provide more physiological support. It is simple, easy to learn. AIMS AND OBJECTIVES: a) To compare the operative time, postoperative stay and time required to return normal activity between two groups. b) To compare early complication rate and late complication rate between two groups. MATERIALAND METHODS: This observational study was conducted among patients admitted with the diagnosis of primary inguinal hernia in SMIMER, Surat. The patients were randomly allocated to either Lichtenstein or Desarda method of hernia repair. Operating time, post operative stay and duration of return to normal activity were recorded. Early complications were noted and the patients were followed up to 12 months for late complications (chronic pain, foreign body sensation, and recurrence). RESULTS: The mean operative time and postoperative stay did not show signicant differ for both groups. Patients operated by Desarda technique returned to normal activity signicantly early by 12.2 ± 2.54 days as compared to patients operated by Lichtenstein techniques (14.0 ± 2.76 days, p = 0.01). Most common early complication in both groups was pain (D group; 40.0%, Lgroup: 45.2%) followed by wound infection (D group; 8.0%, Lgroup: 6.5%) and seroma (D group; 0.0%, Lgroup: 3.2%). Occurrence of chronic pain was more in Lgroup (58.1%) as compared to D group (16.0%, p=0.001). None of the patients from D group had foreign body sensation. Foreign body sensation was observed only in ve patients of Lgroup (16.1%). Recurrence rate during one year in Lgroup (6.5%) was higher than D group (4.0%). CONCLUSION: Early return to work was potential benet of Desarda repair. Early complications were similar in both procedures. Desarda repair has lower incidence of chronic pain and foreign body sensation. However, there is no signicant difference for chronic pain in Desarda group when compared in same patients operated bilaterally with different technique. This study was conducted with small sample size with short follow up. Therefore, result of late complication in the present study may insufcient to conclude the probability of occurrence as longer follow up and larger sample size is required.

Airway Bacteria Quantification Using Polymerase Chain Reaction Combined with Neutrophil and Eosinophil Counts Identifies Distinct COPD Endotypes.

Background: Chronic obstructive pulmonary disease (COPD) inflammatory endotypes are associated with different airway microbiomes. We used quantitative polymerase chain reaction (qPCR) analysis of sputum samples to establish the bacterial load upper limit in healthy controls; these values determined the bacterial colonisation prevalence in a longitudinal COPD cohort. Bacteriology combined with sputum inflammatory cells counts were used to investigate COPD endotypes. Methods: Sixty COPD patients and 15 healthy non-smoking controls were recruited. Sputum was analysed by qPCR (for Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae and Psuedomonas aeruginosa) and sputum differential cell counts at baseline and 6 months. Results: At baseline and 6 months, 23.1% and 25.6% of COPD patients were colonised with H. influenzae, while colonisation with other bacterial species was less common, e.g., S. pneumoniae—1.9% and 5.1%, respectively. H. influenzae + ve patients had higher neutrophil counts at baseline (90.1% vs. 67.3%, p < 0.01), with similar results at 6 months. COPD patients with sputum eosinophil counts ≥3% at ≥1 visit rarely showed bacterial colonisation. Conclusions: The prevalence of H. influenzae colonisation was approximately 25%, with low colonisation for other bacterial species. H. influenzae colonisation was associated with sputum neutrophilia, while eosinophilic inflammation and H. influenzae colonisation rarely coexisted.

Frequency of ALK gene rearrangement and its association with survival rate among Upper Egypt Non-Small cell lung cancer patients

Background: Anaplastic Lymphoma Kinase(ALK)gene rearrangement shows ethnic variations worldwide. There isn’t a population-based study measuring its prevalence among the Egyptian population till now. Aim: To measure ALK gene rearrangement prevalence correlated with survival rates among a sample of Upper Egypt Non-Small Cell Lung Cancer (NSCLC) patients. Patients and Methods: The study included twenty-six NSCLC patients. 21 of them were males and the rest were females, the enrolled patients had a median age of 60 years. 8 presented with pleural effusion, while 4 showed brain metastases, and 10 had liver metastases. Most of the cases were given a diagnosis with adenocarcinoma, squamous cell carcinoma (14, 6 cases, respectively), and the rest were given a diagnosis with undifferentiated carcinoma. Fluorescence Insitu Hybridization (FISH) technique was used for detection of rearranged ALK gene from FFEP Tissue Sections. Vysis ALK Break Apart FISH Probe Kit was used, it’s composed of two probes green-labeled one to bind to the 5′ end of the ALK gene, and another orange labeled one to bind to the 3′ end. Tumor cells with 15 % or more separate green 5′ and red 3′ signals or isolated red 3′ signals were considered positive for the rearranged ALK gene, while cells with yellowish signals (representing overlapped signals between green and red probes) were considered negative for ALK gene rearrangement. A fluorescence microscope supplied with a Leica CCD camera was used to detect clinicopathological characteristics of rearranged ALK gene, image processing was done using an imaging system and software. Results: Patients were followed up for 63 months, 15 of them were positive for the rearranged ALK gene. All patients were treated with chemotherapy and they had different objective response rates (ORR), ALK+ve cohort 73.3% (PR:3, SD:8), ALK–ve cohort 100% (PR:6, SD:5). The overall survival rate (OSR) was 51,6%, and two- year progression-free survival rate (PFSR) was 68,8%. Univariate analysis was done between ALK+ve / ALK–ve for different risk groups (age, gender, histological subtype, the site of metastasis, and grade). Patients with adenocarcinoma showed better OSR than those with squamous cell carcinoma, PConclusions: Patients with ALK gene rearrangement are resistant to chemotherapy, so they should be directed for individualized treatment, the prevalence of ALK+ve patients could be more than expected among the Egyptian population. further confirmation is required through multiple center population-based studies. Policymakers are invited for validating central laboratory, they are also recommended to enhance accessibility for diagnostic facilities and services, and adopting inhibitors of tyrosine kinase (TKI) as a new effective treatment strategy for NSCLC cases.

CLINICOEPIDEMIOLOGICAL STUDY OF CHILDHOOD PSORIASIS PATIENTS AND ITS ASSOCIATION WITH HLA-CW6 IN A TERTIARY CARE CENTRE OF EASTERN INDIA

BACKGROUND- Psoriasis is chronic common papulosquamous disorder. Its aetiology included various environmental and genetic factors. In genetics, HLA-Cw6 is most commonly associated with psoriasis. Childhood psoriasis is also common in worldwide population. However, very few studies done on epidemiological data and HLA-Cw6 analysis in childhood psoriasis patients. AIMS AND OBJECTIVE- Clinicoepidemiological study of childhood psoriasis patients and its association with HLA-Cw6 in a tertiary care centre of Eastern India MATERIALAND METHOD- We conducted a cross-sectional study in a tertiary care centre and recruited 20 patients of psoriasis with age group below 18 years after taking proper consent. Clinical history and blood was taken from them and HLA-Cw6 analysis was done by PCR method. Data compilation was done by Microsoft excel using SPSS software. RESULTS- A total of the 20 childhood psoriasis patients, 9 were males and 11 were females. Generalized plaque type psoriasis (N=19) is commonest followed by guttate psoriasis (N=1). None of the patients had arthalgia. Family history was present in only 3 patients. Higher numbers of childhood psoriasis patients (N=14) were positive for HLA-Cw6. Also Higher numbers of females (N=10) were positive for HLA-Cw6. ve patients had nail changes. CONCLUSION- We found HLA-Cw6 is strongly associated with childhood psoriasis and also HLA-Cw6 frequency is higher in female than male childhood psoriasis patients.

Safety and efficacy of the BNT162b mRNA COVID-19 vaccine in patients with chronic lymphocytic leukemia.

Patients with chronic lymphocytic leukemia (CLL) have a suboptimal humoral response to vaccination. Recently, BNT162b2, an mRNA COVID-19 vaccine with a high efficacy of 95% in immunocompetent individuals, was introduced. We investigated the safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine in patients with CLL from nine medical centers in Israel, Overall 400 patients were included, of whom 373 were found to be eligible for the analysis of antibody response. The vaccine appeared to be safe and only grade 1-2 adverse events were seen in 50% of the patients. Following the second dose, an antibody response was detected in 43% of the cohort. Among these CLL patients, 61% of the treatment-naïve patients responded to the vaccine, while responses developed in only 18% of those with ongoing disease, 37% of those previously treated with a BTK inhibitor and 5% of those recently given an anti-CD20 antibody. Among patients treated with BCL2 as monotherapy or in combination with anti-CD20, 62% and 14%, respectively, developed an immune response. There was a high concordance between neutralizing antibodies and positive serological response to spike protein. Based on our findings we developed a simple seven-factor score including timing of any treatment with anti-CD20, age, treatment status, and IgG, IgA, IgM and hemoglobin levels. The sum of all the above parameters can serve as a possible estimate to predict whether a given CLL patient will develop sufficient antibodies. In conclusion, the BNT162b2 mRNA COVID-19 vaccine was found to be safe in patients with CLL, but its efficacy is limited, particularly in treated patients.

The treatment effi cacy of disturbed swallowing function in patients with ischemic stroke and neurogenic dysphagia

The aim. To evaluate the effi cacy of swallowing recovery of patients with ischemic stroke carried out with the use of training rehabilitation method using special nutrient mixtures as part of combination therapy. Material and methods. The study included 65 patients (35 men and 30 women, aged 45 to 80 years) with dysphagia in the acute period of ischemic stroke. Thirty patients (control group) were treated with special binding compounds as part of a combination therapy. Thirty fi ve patients (comparison group) did not use the mixture. The dynamics of the recovery function of swallowing using the Penetration–Aspiration Scale (PAS) and the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), as well as the transition from tube to independent feeding were studied. Results. The training method of rehabilitation using special nutritional mixtures is eff ective assessed with PAS and FEDSS in patients with ischemic stroke and neurogenic dysphagia (p &lt; 0.05). The most pronounced eff ect was achieved in the group of patients with pseudobulbar syndrome. In patients with bulbar syndrome no statistically signifi cant diff erences were observed in the dynamic assessment of the severity of dysphagia on the PAS and FEDSS scales. The application of the training method leads to a signifi cantly better transition from tube to independent feeding. Conclusion. The training method of rehabilitation using special nutritional mixtures is eff ective in patients with ischemic stroke and neurogenic dysphagia and leads to a signifi cantly better transition from tube to independent feeding.

EVALUATION OF POSTOPERATIVE SHOULDER TIP PAIN IN LOW PRESSURE VERSUS STANDARD PRESSURE PNEUMOPERITONEUM DURING LAPAROSCOPIC CHOLECYSTECTOMY

Introduction:- Insufation of carbon dioxide during laparoscopic cholecystectomy carries on to postoperative shoulder tip pain. The beginning of shoulder pain is commonly presumed to be due to overstretching of the diaphragmatic muscle bres due to high carbon dioxide pressure. Methods: - Patients came and admitted to the surgery department for elective cholecystectomy were enrolled in the study. The patients were randomly divided in two groups (group A and group B). In group A - low-pressure pneumoperitoneum (8 mm Hg) and in group B- standard pressure pneumoperitoneum (14 mm Hg) was created during laparoscopic cholecystectomy. Postoperative shoulder tip pain was evaluated at 4 hours and 24 hours after the operation. Results:- Fourteen patients or 28 % of patients in group B complained of postoperative shoulder tip pain as collated to only ve patients (10%) in group A. The mean intensity of postoperative shoulder tip pain assessed by the visual analogue scoring scale at 4 hours and 24 hours was less in group A as collated to group B. However, statistical signicance was seen only at four hours. Analgesic requirements and the mean length of postoperative stay in the hospital were minor in group-A as collated to group B. Conclusion: - Low-pressure laparoscopic cholecystectomy signicantly reduces the frequency and intensity of postoperative shoulder tip pain. Low-pressure laparoscopic cholecystectomy decreases the demand for postoperative analgesics, decreases postoperative hospital stay, and improves the quality of life in the initial stage of postoperative rehabilitation.

The impact of the nucleotide-binding oligomerization domain 1 (NOD 1) gene polymorphism on Helicobacter Pylori induced chronic gastritis in hepatic patients.

Background: Chronic infection with Helicobacter pylori (H.pylori ) causes atrophic and even gastric metaplastic changes, and it has a well-known link to peptic ulceration. Nucleotide-binding oligomerization domain-containing protein 1 (NOD1) is a protein receptor that is presented by the NOD1 gene. It distinguishes H.pylori bacterial molecules and enhances an immune response Objectives: to describe the relation between the NOD1 gene (rs2075820) polymorphism and H.pylori infection in hepatic and non hepatic patients with chronic gastritis, study its impact on the degree of chronic gastritis in H.pylori positive individuals, and to examine the effect of H. pylori on clinical, endoscopic and histopathological findings and child paugh scoring in hepatic patients. Methodology: Gastric tissue samples were taken from selected 200 patients with chronic gastritis, either hepatic or non hepatic. Rapid urease test and pathological findings classified them into H.pylori infected and non infected patients. Genotyping of NOD 1 was studied using polymerase chain reaction /restriction fragment length polymorphism (PCR–RFLP) method. Results: A significant higher frequency of AA genotype, and the A allele of NOD1 gene in H.pylori +ve patients, either hepatic; (58%)-(73%) or non hepatic;(62%)-(78%) as compared to H.pylori –ve patients,(P &lt;0.001). A highly significant relation between NOD1 genotypes and endoscopic findings, where most of H.pylori infected patients with AA genotype had more peptic ulcer, antral erosion, gastric prolapse, esophageal varices and esophageal hiatus hernia compared to patients with GA and GG genotypes, (P&lt;0.001). No significant impact of H.pylori on signs of liver affection and child paugh scoring in hepatic patients. Conclusions: In NOD1 gene polymorphism, AA genotype and A allele have significantly implicated in H.pylori infection susceptibility and progression. While GG genotype and G allele have a protective effect against H.pylori infection.

Isolated Myeloperoxidase Immunohistochemical Expression in Bone Marrow Biopsy Depicts Clinical Outcomes in Adults with Typical B-Acute Lymphoblastic Leukemia.

Introduction:Recently, isolated myeloperoxidase expression (isoMPO) has been documented in B-acute lymphoblastic leukemia (B-ALL) and several contradictory studies addressed its clinical significance in pediatric patients. Aim:In this study, isoMPO was evaluated in bone marrow biopsies (BMB) from adults with B-ALL using immunohistochemistry (IHC) in relation to a number of risk-stratification factors and patients’ outcomes. Methods:Sixty B-ALL adult patients were selected upon electronic database search. Demographic, clinical, laboratory, therapy and survival data were reviewed and tabulated. Flowcytometry (FCM), histopathology and IHC available material were reviewed to confirm the diagnostic criteria according to our standard laboratory protocols. IHC was performed on BMB using antiMPO. Cases were divided into MPO+ve and MPO-ve based on a 3% blast cell staining threshold. Results:Using IHC, 26.7% of B-ALLs were MPO+ve, in most of which ≥10% of blasts were stained. Among standard risk-stratification factors, isoMPO was associated with a mean WBC count above 30x109/L. MPO+ patients achieved therapeutic complete remission at lower rates and were more prone to progressive/refractory disease and relapse. There was a concordant expression of MPO in FCM and IHC. All of the aforementioned parameters reached the level of significance when compared to the MOP-ve group. Kaplan-Meier curves revealed a significantly lower survival probability for the MPO+ group than the MOP-ve one (p= 0.0066; Log-rank test) and also when separating MPO+ and -ve patients by gender (p= 0.0033; Log-rank test). Conclusion:isoMPO occur in a considerable percentage of B-ALL in adults contributing to misdiagnosis. It depicts poor outcomes and might be introduced as a B-ALL risk-stratification factor.

Oxidative, Inflammatory, Angiogenic Markers and Vitamin D Status in Pre- and Postmenopausal Breast Cancer Egyptian Patients

We aimed to investigate the oxidative, inflammatory, angiogenic biomarkers and vitamin D status in serum of Egyptian patients with cancer breast. Seventy patients with known cancer breast (non-metastatic and metastatic) were evaluated and compared to and healthy women. We observed significant decreases in serum malondialdehyde, nitric oxide, total antioxidant capacity (TAC) and uric acid in patients with non-metastatic and metastatic cancer. Subjects with metastatic cancer exhibited significantly lower nitric oxide and TAC compared with non- metastatic cancer. Meanwhile, significant increases in serum VEGF, HGF, and MMP-9 occurred in both pre- and post-menopausal patients with either non-metastatic or metastatic cancer with significantly higher values in metastatic disease. Significant increase in serum TNF-α was observed with significantly higher values in metastatic disease. Serum 25 hydroxy vitamin D (VITD) decreased in both types of cancer with significantly lower values in pre-menopausal compared to post-menopausal patients. Pre-menopausal subjects showed significantly lower serum VITD level compared to their post-menopaual counterparts, but there were no differences between those who were –ve for PR receptor and +ve patients. These results suggest that vascular and inflammatory markers VEGF, HGF, MMP-9 and TNF-α increased in serum in advanced stages of breast cancer and could monitor disease progression and/or severity.

Flow Cytometric Minimal Residual Disease As Risk Stratification Tool in Younger Adults with NPM1 Wild Type Standard Risk Acute Myeloid Leukemia

Response to induction therapy is a powerful prognostic indicator in acute myeloid leukemia (AML). Measurable/minimal residual disease (MRD) assays are being increasingly incorporated into response assessment; however, their value as a surrogate for long-term outcome remains unclear because of assay limitations and the effect of post remission therapies. This is particularly the case for the molecularly heterogeneous NPM1 wild type standard risk patients for whom treatment decisions, including predicting the benefit of allogeneic stem cell transplantation (SCT), are particularly challenging. We investigated the effect on outcome of MRD status compared to other response criteria after each cycle of induction for NPM1 wild type (wt) standard risk patients and other risk groups in a cohort of younger AML patients.Patients and MethodsAs part of the UK NCRI AML17 trial (ISRCTN55675535) for patients with AML or high risk MDS up to the age of 60, prospective flow cytometric MRD (MFC-MRD) monitoring was performed after each course of induction. Any level of MRD detected was considered MRD+ (sensitivity thresholds: ~0.02% by tracking diagnostic leukemic aberrant phenotypes/LAIP, ~0.05-0.1% by “different-from normal” blast LAIP). Clinicians were not informed of MFC-MRD results. Following cycle 1 of induction with daunorubicin/ara-C based therapy, patients were allocated a risk group by a validated score (comprising cytogenetics, WBC, age, secondary disease, blast response to cycle 1 and mutation status). Standard risk patients including ITD wt/ NPM1 wt received a second daunorubicin/ara-C induction with some proceeding to SCT after 1 or 2 consolidation cycles (high dose ara-C).Results2450 non APML patients, median age 51, randomised 4/09 to 12/14, contributed data. For the total cohort, 5 year overall survival (OS) excluding early deaths was 52% for those achieving CR/CRi vs 31% for those not in CR (p<.001).Post cycle 1 (C1) responses were categorised as resistant disease (RD), partial remission (PR) and CR/CRi by clinicians, with CR/CRi subdivided by MFC-MRD assay into MRD+ and MRD-. RD vs PR vs MRD+ vs MRD- frequencies were 15% vs 14% vs 40% vs 31% for all patients with response data (n=1443), 5% vs 7% vs 45% vs 43% for good / standard risk (n=785), 10% vs 8% vs 47% vs 35% NPM1 wt standard risk (n=320).Post C1 response was prognostic for survival: OS for RD vs PR vs MRD+ vs MRD- were 25% vs 36% vs 43% vs 63% all patients; 33% vs 49% vs 51% vs 70% good/standard risk and 28% vs 38% vs 47% vs 59% NPM1 wt standard risk. (p<.0001 throughout). For NPM1 wt standard risk as well as good/standard risk patients adjusted analyses confirmed significant OS differences between C1 RD vs PR or MRD+ but not PR vs MRD+. Results were similar when censored at SCT.Post C1 best response was CRi for 39/446 MRD- vs 49/575 MRD+ overall (11/111 vs 8/149 for NPM1 wt standard risk). C1 CRi was associated with reduced OS overall (39% vs 53% CR, p=.002) and in MRD+ (19% vs 45% CR, p=.001) but not for MRD- patients. OS for NPM1 wt standard risk MRD+ was 25% CRi vs 43% CR (p=0.4). No significant difference was detected for 5 year cumulative incidence of relapse (CIR).The effect on outcomes of MRD status post cycle 2 (C2) for the 806 patients in CR/CRi with MFC-MRD data appeared greater (relapse HR 1.88(1.50- 2.36), p<0.001; OS HR 1.77(1.41-2.22) p<0.001)than C1 (relapse HR 1.70(1.40- 2.06), p<0.001; OS HR 1.50(1.23-1.84) p<0.001). MRD+ levels of ≥0.1% predicted highest CIR in NPM1 wt standard risk patients at C1 (CIR 71%) and C2 (CIR 89%) but any MRD+ at C2 reduced OS (32% vs 63% MRD-, p=0.003) and OS censored at any SCT (35% vs 88%). The effect of CR vs CRi was smaller post C2 although outcomes were still worst in CRi/MRD+ve patients.Of 204 NPM1 wt standard risk patients with C2 MRD data 83 had an allograft (44 in CR1: 29 MRD-, 15 MRD+). In Mantel-Byar analyses, although numbers were small, there was a suggestion that transplant could be considered in MRD +ve (HR 0.72 (0.31-1.69)) but not MRD -ve patients (HR 1.68 (0.75-3.85); p-value for interaction p=0.16).ConclusionMRD status by MFC refines response criteria at induction time-points to differentiate NPM1 wild type standard risk patients with poor outcome and helps define a group of patients who may benefit from SCT in CR1. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Longitudinal Detection of DNMT3AR882H Transcripts in Patients with Acute Myeloid Leukemia

Introduction The DNMT3A gene is recurrently mutated in normal karyotype acute myeloid leukemia (NK-AML) and the most common alteration (65% of cases) is located at residue R882 of methyltransferase domain. DNMT3A mutations often occur in association with other mutations such as FLT3 and NPM1 and while it is now generally accepted that AML patients with NPM1 or FLT3 -ITD mutations have favourable and poor outcome respectively, the impact of DNMT3A mutations on survival remains controversial. Recent studies reported that DNMT3A -mutated cells are detectable in patients with AML in long-lasting complete remission, questioning whether quantification of DNMT3A levels could be used to minimal residual disease (MRD). To address this issue, we carried out sequential monitoring studies of DNMT3AR882H levels in AML patients and compared our results with those obtained with multiparametric flow-cytometry (MPFC) and NPM1 molecular status and expression levels.Methods The mutational analysis of DNMT3AR882, NPM1 and FLT3 (ITD/TKD) was assessed at diagnosis in 556 patients with de novo AML (median age: 49 years, range 16-89 years) enrolled in clinical trials conducted by the Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA) during the period 2012-2015. DNMT3AR882H molecular status was also studied in 100 patients with chronic myeloid leukemia (CML) and in 56 elderly healthy individuals. The expression levels of DNMT3AR882H and NPM1 Type_A mutation (NPM1mutA) were longitudinally analysed by qRT-PCR in 21 AML patients. For patients achieving complete morphologic remission (CR), DNMT3AR882Hlevels were compared with those of NPM1mutA and with MRD assessed by multiparametric flow cytometry (MPFC). W e then compared the levels of DNMT3AR882H and of MPFC-MRD in follow-up BM-samples from AML patients in CR , classified as MRDneg or MRDpos, according to threshold established based on previous work from our group (Buccisano et. al. Blood 2010). Finally, we evaluated the kinetics of DNMT3AR882H, NPM1mutA and FLT3 -ITD in 9 FLT3 -ITD+ve patients, using a FLT3 -ITD patient-specific qRT-PCR, and in 6 FLT3 -wt patients.Results Expression levels of DNMT3AR882H was also studied in sorted cell subpopulations from AML and CML patients and in healthy individuals. Distinct from NPM1mutA, DNMT3AR882H expression levels did not correlate with leukemic blast proportion assessed by MPFC (Figure 1) and decreased in AML samples only after induction treatment (Figure 2), while it was constantly detectable during remission and at relapse (Figure 3). Within FLT3 -ITD+ve AML, the kinetics of DNMT3AR882H paralleled that of NPM1mutA in 3 of 9 patients only. DNMT3AR882H expression levels were constant, independent from NPM1mutA in all 6 FLT3 -wt patients. Figure 4 shows 4 exemplary cases, with stable DNMT3AR882H levels during disease course in three of them. In CML patients, the DNMT3AR882H transcript was found only during follow-up in 4/100 patients, while it was undetectable at the time of CML diagnosis. DNMT3AR882H transcript levels were constantly low in all available CML samples. As previously reported, clonal hematopoiesis of indetermined potential (CHIP) was identified in 3/56 elderly healthy individuals. Similarly low expression levels of DNMT3AR882H were detected in blast and T-lymphocyte samples obtained from AML cases at CR and relapse phases, in CML patients and healthy individuals (Figure 5 and 6). There were no differences in DNMT3AR882H expression between MRDpos and MRDneg follow-up samples. DNMT3AR882H transcripts levels in MRDpos follow-up samples were significantly lower than those of samples harvested at diagnosis (Figure 6). These data show that DNMT3AR882H mutations probably arise in very early hematopoietic precursors in the context of CHIP. Interestingly, as reported in figure 6, DNMT3AR882H expression levels were similar in samples from CML patients, healthy individuals and AML follow-up samples.Conclusions In summary, the results of our study indicate that DNMT3AR882H quantification is unreliable as a tool for AML monitoring. In fact, together with its detection in CML and healthy subjects, the presence of DNMT3AR882H at constant levels detected in AML during active disease or CR clearly point to a lack of specificity of this abnormality for the leukemic AML blast population. [Display omitted] DisclosuresCicconi:TEVA: Speakers Bureau. Lo Coco:Lundbeck: Honoraria, Speakers Bureau; Novartis: Honoraria, Speakers Bureau; TEVA: Honoraria, Speakers Bureau.

PLATELET RICH PLASMA IN DELAYED UNION FRACTURE OF LONG BONE (A PROSPECTIVE STUDY OF 25 CASES)

Background: Functional outcome of inltration of autologus platelet rich plasma (PRP) in delayed union of long bones. Prospective clinical study with 6 months of follow-up. Clinically proven Designe: Methods: 25 patients of delayed union were included in this study according to inclusion and exclusion criteria after getting written and informed consent, treated by autologous PRP inltration thrice 1 weeks apart, evaluation done clinically as well as radiologically. Out of twenty ve patients, union was achieved in 21 patients (84%) at Results: the end of six months, 4 cases progressed to non-union.The mean time between PRP injection &amp; Union was 12.2 weeks. Final assessment was done according to RUS score at 6 months of follow-up Most of the patients 72% (18 patients) were in Excellent category, 12% (3 patients) were in Fair category and 16% (4 patient) was in poor category. Conclusion: Autologus Platelet rich plasma inltration locally is effective method in the treatment of delayed union of long bone fractures.

RESULTS OF TFN AND SHORT PFNA-II IN UNSTABLE TROCHANTERIC FRACTURES: A RETROSPECTIVE COMPARATIVE STUDY

Background: Advancements in modern medicine have given people the opportunity to live longer. The resultant increase in the elderly population has led to a higher incidence of peri-trochanteric fractures of the femur. The preferred implant for the comminuted unstable variety has been intramedullary nails with one or two head/neck compression screws, which are known to have high rate of complications like screw cut-out, back out, Z-effect, varus collapse and rotational instability, especially in the osteoporotic patients leading to the development of helical blade systems. Here we have compared the results of trochanteric xation nail (TFN) and short proximal femoral nail antirotation (PFNA)-II. Methods: It was a retrospective, comparative study in seventy-ve patients with comminuted unstable trochanteric fractures (AO classication31A2) treated using TFN in 34 and short PFNA-II in 41 patients with a minimum follow up period of six months. Results: Most of the data were comparable between the two groups except: signicantly higher operation time and implant-related complications in the TFN group. No signicant differences in the functional outcome between the two groups were noted as indicated by Harris Hip Score at six months. Conclusion: Short PFNA-II should be used in preference to TFN for comminuted unstable trochanteric fractures with no sub-trochanteric extension in the elderly osteoporotic patients in view of the shorter operative time, easier insertion and lower complications rate.

757-P: Cardiometabolic Disease Risk Assessment of HIV Medication Regimens

Objective: To determine the effect of non-nucleoside reverse transcriptase inhibitor (NNRTI) or integrase strand transfer inhibitor (IIh) based regimens on cardiovascular and metabolic disease risk in HIV +ve patients without diabetes, with normal CD4:CD8 count. Our goal was to use hematopoietic progenitor cells (CD34+ve) as the biomarker while examining the traditional serum markers. Methods: 21 male subjects ages 32-66 years with BMI 21.0- 36.0, were enrolled. This was a single time point analysis study. Subjects were stratified into 2 groups (IIh with 11 and NNRTI with 10 subjects) who were taking stable doses of HAART. The medication regimens were a combination of two NRTI (typically tenofovir-emtricitabine) plus one IIh or NNRTI. We used CD34+ve cells, arterial stiffness measures and serum for the analysis. Results: The IIh group had a higher average CD34+ve cell count 0.93% vs. 0.75% in NNRTI group. However, colony forming units (CFU) were lower in IIh group, 7.54 vs. 20.62. LDL levels were similar at 103.9 ±40.3 (IIh) vs. 107.8 ±37.5 (NNRTI). Average HDL were also similar. Inflammatory markers such as hs-CRP were lower in IIh at 1.726±1.45 vs. 1.832±1.50 in NNRTI group. Vitals such as average systolic BP in the IIh arm was 126.18±13.53 vs. 141.2±30.0 in NNRTI group. The diastolic BP averages were similar. The average augmentation index-75 (a measure of arterial stiffness) was avg.12.8 in IIh vs. 16.7 in NNRTI group. The average augmentation index (AI) were 15.2 in IIh vs. 20.2 in NNRTI group, with higher values indicating increased arterial stiffness. Average urinary albumin: creatinine ratio was 15.53 in IIh group vs. 76.72 in NNRTI group. No differences were noted in HbA1C, Leptin and adiponectin however average fasting insulin was 11.24 (IIh) vs. 22.96 (NNRTI). No significant differences were noted in CD34+ve cell gene expression assays. Conclusion: Considering all parameters we conclude that Integrase Inhibitor based regimens may have a better cardiometabolic disease risk profile compared to NNRTI based regimens. Disclosure A. Elzarki: None. S. Nandula: None. H. Awal: None. S. Sen: None. Funding District of Columbia Center for AIDS Research (to S.S.)

MO252PLA2R -VE MEMBRANOUS GLOMERULONEPHRITIS PATIENTS SHOWS MORE EFFECTIVE RESPONSE THAN PLA2R +VE ON TACROLIMUS PLUS LOW DOSE PREDNISOLONE THERAPY*

Abstract Background and Aims PLA2R is an autoantigen present in glomerular podocytes of Membranous Nephropathy (MN) patients. Several drugs have been tried which included nonspecific anti-proteinuric agents; corticosteroids, alone or with alkylating agents; cyclosporine; intravenous Ig; mycophenolate mofetil; and rituximab. There is no standard therapy for patients with frequent relapsing or steroid-dependent MN. We propose the efficacy of low dose Tacrolimus (TAC) plus prednisolone and associated changes in anti-PLA2R in adult IMN. Method Total 101 membranous nephropathy patients were treated with combination of prednisolone 1mg/kg alt-day) and Tac 0.1mg/kg/day (trough 6-10 ng/ml first 6M and 4-6 ng/ml for next 3M) then both taper by 1/3 every month up to 12M. Out of 101 patients; 15 diabetic; 7 lupus; 1HBV and 1 ankylosing spondylitis patients were excluded. Finally; 77 Patients were followed and evaluated for the anti-PLA2R level at baseline; 3M; 6M; 12M and end of follow-up (17-61 ; median 38 months). CR; PR; relapse; and side-effects were recorded.Of the 77 patients; at 3M 60(77.92%; CR-37; PR-23); at 6M 61(79.22%; CR-53; PR-8); at 12M 53(68.86%; CR-47; PR-6) achieved remission. Eight (10.38%) relapsed and 16(20.77%) showed no response at 12M. At end of follow-up; out of 54 responsive patients 37(68.51%; CR-36; PR-1) remained in remission and 17(31.48%) patients relapsed. Results Out of 77 patients; 51 (66.3%) were anti-PLA2R positive. Remission rate was significantly low in PLA2R+ve than PLA2R-ve (36/51 vs 24/26; p=0.03) at 3M; (36/51 vs 25/26; p=0.009) at 6M and (31/51 vs 22/26; p=0.03) at 12M. PLA2R level was decreased by 60.38% and 77.56% at 3M and 6M respectively (1A &amp; 1B). There were significant correlations between PLA2R level and 24h proteinuria at baseline; 3M and at 6M (1C). During therapy 4 patients develop cutaneous tenia; 1 osteonecrosis of the femur head; 1 corpus tunnel syndrome; 4 onset diabetes; 3 tremor; and 14 patients experienced GI symptoms. The eGFR was decreased significantly (p=0.003) by 26.5% at the end of therapy and was normalized after stopping Tac; and 5 non-responsive patients had doubling of serum creatinine and progressively deteriorated eGFR. To note; 4 females had pregnancy and successful delivery in our cohort of patients. Conclusion PLA2R+ve patients showed poor response compare to PLA2R-ve patients. Remission with Tacrolimus and prednisolone therapy is comparable to historical Ponticelli (Pred plus CYP) regimen. Successful pregnency was ovserved on Tac based regimen.

P055. The effects of the COVID-19 pandemic on breast cancer services at a Tertiary University Hospital

Introduction: The COVID-19 pandemic significantly impacted the treatment of breast cancer. Management deviated from standard practice. The Association of Breast Surgery (ABS) advised - aim for day case surgery with priority given to: estrogen receptor (ER)-ve, HER2+ve, and pre-menopausal ER+ve patients. Neoadjuvant chemotherapy was advised for inoperable disease only. Oncoplastic procedures and breast reconstruction was not advised. ER+ves were to be considered for bridging endocrine treatment. We audited this change in practice.

The impact of overactive bladder on health related quality of life.

Objective: To determine the impact of overactive bladder on health related quality of life (HRQOL). Study Design: Cross Sectional study. Setting: Department of Obstetrics and Gynaecology, Gambat Institute of Medical Sciences Gambat, Khairpur Sindh. Period: 1st November 2018 to 30th June 2019. Material &amp; Methods: One Hundred forty nine women included who fulfilled inclusion criteria after taking inform consent. The questionnaire consisting of domain of general health perception, urinary incontinence, role limitation on physical, social &amp; personal relationship, emotion with score was analyzed. Each question was carry 1 point as score .Score was analyzed further on percentage basis. Those who gain &gt;33% were be labeled as impact of overactive bladder –ve patients. Finally data was analyzed on SPSS version 21. Results: The present study consisted of 145 subjects presented to the Department of Psychiatry, Services Hospital Lahore (both in and Out-patients). Over reactive bladder were matched on age, sex and socio-economic status &amp; educational status. The age range of the total sample was 23-60 years. Mean age was 42.53 + 11.69. The duration of symptoms range of the total sample was 09-20 years. Mean duration was 16.7 + 5.6. The prevalence of over reactive bladder (OAB) syndrome were found 21%, respectively. The age were divided in to four classification age groups 17(11.7%) under the age of &lt;30years, 31(21.4%) under the age of 31-40 years, 85(58.6%) found under the age of (58.6%) &amp; 41-50 Years of age 85(58.6%) Women constitute the largest age groups. Out of 145 Women 68(46.9%) were Illiterate, 48(33.1%) were literate up to intermediate, 29(20%), took graduation education. The distribution of income classes of women 61(42.06%) belong to low class, 65(44.84%) belong to middle class and only 19(13.10%) belong to upper class. The parity distributions were revealed that most of the 78(53.7%) women had multiparty. Stratification of confounding variable for effect modifier Age &amp; parity were found to be significantly associated with over reactive bladder syndrome. Again Stratification of confounding variable for effect modifier socio economic status &amp; education status are not found significantly associated with over reactive bladder syndrome &amp; P –Value were not found significantly associated with OAB P&gt;0.05. Conclusion: We concluded incidence of overactive bladder in the female is almost similar and associated with increasing your age. Patients of OAB are under-diagnosed and under-treated. This patient can benefit from standard tests.

The Role of Internet of Things to Control the Outbreak of COVID-19 Pandemic.

Currently, COVID-19 pandemic is the major cause of disease burden globally. So, there is a need for an urgent solution to fight against this pandemic. Internet of Things (IoT) has the ability of data transmission without human interaction. This technology enables devices to connect in the hospitals and other planned locations to combat this situation. This article provides a road map by highlighting the IoT applications that can help to control it. This study also proposes a real-time identification and monitoring of COVID-19 patients. The proposed framework consists of four components using the cloud architecture: 1) data collection of disease symptoms (using IoT-based devices); 2) health center or quarantine center (data collected using IoT devices); 3) data warehouse (analysis using machine learning models); and 4) health professionals (provide treatment). To predict the severity level of COVID-19 patients on the basis of IoT-based real-time data, we experimented with five machine learning models. The results reveal that random forest outperformed among all other models. IoT applications will help management, health professionals, and patients to investigate the symptoms of contagious disease and manage COVID-19 +ve patients worldwide.

ROLE OF PLATELET PARAMETERS IN DENGUE FEVER IN CHILDREN

Aim: To evaluate the role of platelet parameters in dengue fever and also to determine relationship of platelet parameters with platelet count and the severity of the disease. The platelet para Materials and methods: meters [platelet count, plateletcrit, mean platelet volume (MPV), platelet distribution width (PDW)] of 50 dengue infected children were calculated using BC 3000 plus Mindray Automated Hematology Analyzer. Normal range of MPV is 7.5-11.5 . Plateletcrit cut off value in thrombocytopenia is 0.2-0.36%. The PDW reported varies with reference intervals ranging from 8.3 to 56.6%. Subjects were divided into four groups according to their platelet count on day 3 of illness (&lt;20,000 cells/cumm, 20,000 to 50,000 cells/cumm, 50,000 to 100,000 cells/cumm and &gt;100,000 cells/cumm). Platelet indices were studied among these groups and also the indices were evaluated with respect to the severity of disease as group A (dengue without warning signs), group B (dengue with warning signs and group C (severe dengue). Results: Male: female ratio was 28:22. Mean age of presentation was 7.8 + 2.2 years. Thirty-ve patients belonged to Group A, 26 to group B and 2 belonged to group C. PLT (cells/cumm) on Day 3 and Day 7 was 91,828 ±33,532 vs 195,371 + 70,586 in Group A patients (p&lt;0.0001), 69,076 ±45,904 vs 163,230 + 85,053 in Group B patients (p=0.0018) 38,500 + 38,890 vs 86,000 + 28,284 in Group C patients (p=0.29). PCT (%) on Day 3 and Day 7 was 0.09 + 0.04 vs 0.18 + 0.06 in Group A patients (p&lt;0.0001), 0.07 + 0.04 vs 0.15 + 0.07 in Group B patients (p=0.0009) and 0.04 + 0.04 vs 0.08 + 0.28 in Group C patients (p=0.84). MPV () on Day 3 and Day 7 was 10.73 + 1.07 vs 11.34 + 1.09 in Group A patients (p=0.0212), 10.41 + 1.39 vs 10.87 + 0.99 in Group B patients (p=0.3389), 9.35 + 1.62 vs 10.3±1.41 in Group C patients (p=0.59). PDW () on Day 3 and Day 7 was 14.46 ± 1.35 vs 13.22 + 1.10 in Group A patients (p=0.0001), 14.61 + 1.36 vs 13.0 + 0.76 in Group B patients (p=0.0011) and 14.5 + 1.84 vs 13.5 + 0.71 in Group C (p=0.54). Though MPV was lower in patients with platelet count &lt;20,000 cells/cumm (8.57 + 0.5 ) as compared to other groups, it was not statistically signicant (p=0.325). PCT increases with increase in platelet count on Day 3 and Day 7 (p=0.000). Though PDW was lower on Day 3 in patients with platelet count &lt;20,000 cells/cumm as compared to the other 3 groups, it was not statistically signicant (p=0.0740). Conclusion: Lower platelet count and low PCT are seen with severe dengue, increasing platelet count and PCT suggest recovery phase of dengue. MPV had no correlation with severity of dengue or level of thrombocytopenia suggestive that there is no role to predict severity of dengue. PDW does not uctuate with severity of dengue or level of thrombocytopenia