WHO Criteria Research Articles

Prevalence of Oral Diseases and the Influence of the Presence of Overweight/Obesity in Schoolchildren Population in Mallorca.

Background: The pediatric population is one of the social groups most affected by oral pathology, and overweight and/or obesity is increasingly frequently observed. This work presents a study of the prevalence of oral disease in the school population in Mallorca and its relationship with overweight/obesity. Methods: A cross-sectional study was carried out with a sample of 718 students aged 5-6 (n = 255), 12 (n = 230) and 15 years (n = 233). The WHO criteria for diagnosing and coding examined teeth and overweight/obesity prevalence values. To explore the differences in data, the mean was analyzed using the Student's t-test or a one-way analysis of variance followed by the Bonferroni post hoc analysis. Results: Results found that students aged 15 years have a caries prevalence rate of 45.49%, higher than those aged 12 (27.39%). The presence of dental calculus in 15-year-old students is 52.8%, even higher than in 12-year-olds (30%). Students aged 6 and 12 with lower weight percentiles have fewer healthy teeth than those with higher percentiles. Conclusions: The schoolchildren have experienced a decrease in caries and an increase in periodontitis, with weight percentile potentially influencing the number of healthy teeth.

Prognostic role of extent of resection and adjuvant radiotherapy in de novo anaplastic meningiomas.

Grade 3 meningiomas, although rare, are associated with high morbidity and mortality. The respective impacts of extent of surgical resection and adjuvant radiotherapy are still debated. Moreover, anaplastic meningiomas are studied in heterogenous cohort of de novo and progressive anaplastic tumors. We conducted a retrospective multicentric study on patients operated from a de novo anaplastic meningioma between 1999 and 2021. A centralized pathological review using 2016 WHO criteria was performed for all cases. Patients with history of radiotherapy or NF2-related Schwannomatosis were excluded. Sixty-five patients were included in the study. Median progression free survival was 23months and median overall survival was 2years. Neither quality of resection nor adjuvant radiotherapy alone were predictive of better overall survival. Progression free survival were impacted by combination of gross-total resection and adjuvant radiotherapy (HR = 0.47 CI95% = [0.24-0.92], p = 0.027) and age at diagnosis (HR = 2.92 CI95% = [1.38-6.21], p = 0.005) in univariate analyses. Within anaplastic tumors, those graded on mitosis number had a poorer prognosis than those graded on overt anaplasia. Among anaplastic tumors with high mitotic score (> 20/10HPF), progression free survival were impacted by postoperative radiotherapy (HR = 0.44 CI95% = [0.22-0.88], p = 0.020) and gross total resection and adjuvant radiotherapy association (HR = 0.44 CI95% = [0.21-0.90], p = 0.024) in univariate analyses. Simpson grade didn't show any impact on overall survival. Gross total resection + adjuvant radiotherapy favorably impacted progression free survival in our cohort of de novo anaplastic meningiomas.

Association of overweight and obesity with gestational diabetes mellitus among pregnant women attending antenatal care clinics in Addis Ababa, Ethiopia: a case-control study

ObjectiveMaternal obesity and gestational diabetes mellitus (GDM) are becoming major public health concerns in developing countries. Understanding their relationship can help in developing contextually appropriate and targeted prevention strategies and...

Evaluation of Early Childhood Caries and Its Association with Risk Factors among School Children: A Cross-sectional Study.

The study aimed to assess early childhood caries and its correlation with risk variables among school children. 242 children under the age of 5 years were clinically assessed and to ascertain early childhood caries, a validated structured questionnaire was utilized. Demographic data (four questions) and oral health-related activities questions (two questions) were included. To verify visible signs of caries on the occlusal, buccal, and lingual surfaces, the community periodontal index (CPI) probe was used. Caries was diagnosed using the WHO criteria for carious lesions Children's saliva samples (3 mL) were taken, and a digital portable pH meter was used to determine the pH level. All data were gathered and statistically analyzed. The mean age with early childhood caries (ECC) was 4.6 ± 0.4 and 3.8 ± 0.8 without ECC. In both the groups, the highest education of mothers was secondary and less [104 (59%) and 37 (56%), respectively]. In both with and without ECC, the maximum number of mothers Working was 111 (63%) and 41 (62%), respectively. The maximum number of children brushing their teeth once a day in both the groups were139 (79%) and 35 (53%), respectively, and 148 (84%) were using dentifrices to brush their teeth in the ECC group and 37 (56%) were using dentifrices to brush their teeth in without ECC group. The salivary pH is slightly less in with ECC (7.22 ± 0.34) group compared to without ECC group (7.48 ± 0.46). And there was a statistically significant difference found between the groups. The current study demonstrated a significant association between the risk factors under investigation and early childhood caries among school children considered in the present study. Identifying children who are at risk might be aided by early screening for caries development. Both developed and developing nations continue to face a major public health issue with ECC. Despite the extensive knowledge that dental health professionals possess about the variables that lead to the development of ECC, it continues to be the most common and neglected oral healthcare requirement in children. How to cite this article: Chavan S, Chetani H, Yumnam G, et al. Evaluation of Early Childhood Caries and Its Association with Risk Factors among School Children: A Cross-sectional Study. J Contemp Dent Pract 2024;25(8):758-761.

Physical Activity Level and Dietary Intake Associated with Fat-Free Muscle Mass Changes During Intentional Weight Loss in Overweight and Obese Subjects.

The prevalence of obesity and related complications is increasing relentlessly worldwide. The effect of intentional weight loss strategies for obese individuals on fat-free muscle mass (FFMM) and metabolic and general health is not well known. The aim of this research is to measure the effects of dietary intake and physical activity level on FFMM change during intentional weight loss in obese subjects. Nine hundred and sixty-five overweight and obese community free-living subjects had the effects of physical activity level and dietary intake on FFMM change during intentional weight loss assessed in a prospective longitudinal study. Anthropometric, physical activity, dietary intake, inflammatory markers, and oxidative damage were assessed at baseline and follow-up. Validated questionnaires were used to measure dietary intake and physical activity. We compared FFMM loss or gain between subjects stratified by calorie, protein, and fruit and vegetable intake and physical activity levels. The Cox proportional hazards analysis was used to determine the independent effects of dietary intake and physical activity on FFMM changes. A total of 965 subjects [(mean (SD) age 39 ± 12 years, 801 (83%)] females] were assessed at baseline with follow-up for a period of 427 ± 223 days. Using the WHO criteria for body mass index (BMI), 284 (30%) subjects were found to be overweight and 584 (62%) were obese. We found significant correlations between fat-muscle mass ratio (FMR) and inflammatory and oxidative damage markers. After adjusting for important prognostic indicators, age, gender, occupation, physical activity, and fruit and vegetable consumption were found to be significantly associated with FFMM at baseline (p < 0.05). We found no statistically significant difference in dietary protein or amino acids intake in subjects who gained FFMM compared to those who lost FFMM both at baseline and follow-up. By contrast, high consumption of fruits and vegetable and increased calorie intake were associated with increased odds of FFMM gain (p < 0.05). Increased physical activity was independently associated with significant FFMM gain after adjusting for other important indicators ([hazard ratio (95% CI): 0.49 (0.25, 0.97); p = 0.039]. Increased physical activity and high calorie, fruit and vegetable intake are associated with FFMM preservation or gains during intentional weight loss in obese subjects.

Prognostic Value of Baseline Serum Pro-Inflammatory Cytokines in Severe Multisystem Inflammatory Syndrome in Children.

Background: Severe clinical manifestations of multisystem inflammatory syndrome in children (MIS-C) are associated with the dysregulation of immune response following SARS-CoV-2 infection. Therefore, we analyzed the levels of 10 selected cytokines at admission to estimate disease severity and to predict the length of hospitalization. In remission samples, these mediators were followed after intravenous immunoglobulin (IVIG) treatment before discharge. Methods: Thirty-five MIS-C patients at the age of 8.4 ± 4.1 years and 11 clinical controls were included. Acute MIS-C patients were divided into two severity subgroups based on their clinical score determined by the WHO criteria. Serum concentrations of IFN-γ, IL-1α, IL-1RA, IL-8, IL-10, IL-17A, IL-18, IP-10, MCP-1, and TNF-α were measured by MILLIPLEX® Human Cytokine/Chemokine panel, while ACE2 activity was determined by a fluorescent kinetic assay. These results were correlated with routinely determined laboratory parameters and clinical characteristics. Results: MIS-C patients demonstrated significantly elevated baseline levels of most of these cytokines compared to controls. Even higher concentrations of IL-18, TNF-α and ferritin with reduced lymphocyte count were found in severe subjects with elevated clinical scores of 4-5 compared to moderate cases with a clinical score of 1-3. Furthermore, the development of cardiovascular dysfunction and prolonged hospitalization (≥8 days) were related to augmented ACE2 and IL-6 levels. IL-18, IL-1RA, IL-10 and TNF-α were diminished in response to IVIG treatment in remission samples. Finally, pre-treatment IL-18 (≥516.8 pg/mL) and TNF-α (≥74.2 pg/mL) effectively differentiated disease severity in MIS-C with AUC values of 0.770 and 0.750, respectively. Conclusions: IL-18 and TNF-α have a prognostic value in disease severity at admission and are capable of monitoring the efficacy of IVIG treatment in MIS-C.

Caries Level in 3-Year-Olds in Germany: National Caries Trends and Gaps in Primary Dental Care.

Nationally representative long-term data on caries in the primary dentition are rare but essential for determining the need for prevention and treatment. This research assessed the prevalence and trends of dental caries in 3-year-old children across Germany, with national data analyzed and compared with the corresponding data for 6-7-year-olds. Data were extracted from the most recent German National Oral Health Survey in 2016. Children aged 3 years were examined by calibrated dentists in 10 German regions using the WHO criteria for d3-4mft, including assessment of initial carious lesions d1-2mft. In addition, the Significant Caries Index (SiC), the Care Index (CI) and the Specific Affected Caries Index (SaC) were considered to identify provision of care and risk groups. In a total of 95,127 3-year-old preschool children, caries prevalence was 13.7% with a mean d3-4mft of 0.48. Including initial carious lesions, prevalence increased to 18.7% (mean 0.67 d1-4mft). Dependent on the German region, d3-4mft values varied noticeably from 0.38 (Schleswig-Holstein) to 0.58 (Saxony-Anhalt and Berlin). Comparing data from 3-year-olds to 6-7-year-olds, the d3-4mft value for 6-7-year-olds (1.73) was more than three times higher than that for 3-year-olds (0.48). The SiC value was 1.47 for 3-year-olds and 4.88 for 6-7-year-olds, while the SaC values were 3.57 and 3.97, respectively. The Care Index was low for both groups (26.1% and 57.5%, respectively). Germany exhibited a high level of dental caries in the primary dentition for 3 (13.7%) to 6-7-year-olds (44%) children. This large cross-sectional study revealed considerable room for improvement in the early caries prevention and treatment within the well-equipped German dental health infrastructure.

Body mass index and fat influences the role of Bifidobacterium genus in lupus patients concerning fibrinogen levels.

Metabolic disorders and autoimmune diseases elicit distinct yet interconnected manifestations of inflammation, which may be boosted by an excess of body adiposity. The purpose of this investigation was to analyze anthropometric, biochemical, and inflammatory/coagulation variables concerning patients diagnosed with systemic lupus erythematosus (SLE) exploiting low-grade metabolic inflammation (MI), as reference. A population stratification by body mass index (BMI), allowed to assess the impact of adiposity on the putative role of gut microbiota composition on coagulation markers. A total of 127 participants with MI and SLE were categorized into two main groups based on their BMI, following WHO criteria: a low BMI group (<30 kg/m2) and a high BMI group (≥30 kg/m2). Each group included recorded data on demographics, comorbidities, and key clinical markers. Anthropometric and body composition variables, clinical features, and inflammatory/coagulation markers were measured while fecal 16S rRNA sequencing was examined at the genus Bifidobacterium. Regression models were fitted to evaluate the relationship between gut microbiota, inflammatory/coagulation markers, and body weight in these types of diseases. The study revealed worse clinical outcomes in anthropometric, body composition, and clinical markers in low-grade MI conditions as compared to SLE. However, inflammatory and coagulation markers such as C-reactive protein (CRP) and fibrinogen were significantly more elevated in patients with SLE, which was exacerbated by high BMI/ body fat as compared to the other screened groups. An interaction analysis revealed that fibrinogen levels showed different trends when Bifidobacterium was increased depending on BMI/adiposity, which evidenced an effect modification by this microorganism in patients with SLE. These findings underline that gut microbiota composition, particularly the presence of Bifidobacterium, may play a crucial role in modulating inflammation and coagulation processes in patients with SLE and high fat. These insights highlight the potential of targeting gut microbiota as a therapeutic strategy to mitigate inflammation and improve clinical outcomes in SLE patients.

P001 Sleep disturbance in patients with long-term neurological sequelae of COVID-19

Abstract Introduction Post COVID-19 neurological sequelae (popularly termed “Long COVID”), which include chronic sleep disruption and “brain fog” are widespread; however, studies have not yet comprehensively evaluated the concurrent effects of these disruptions of neurocognitive function and their relationship to sleep disturbance. Methods Participants aged between 40-65, with no more than 2 cardiovascular risk factors were stratified into three groups of ten: Group 1 (pre-pandemic datasets), Group 2 (individuals recovered from COVID-19), and Group 3 (individuals diagnosed with Long COVID under the WHO criteria). Polysomnography (PSG), Multiple Sleep Latency Test (MSLT), participant surveys and neurocognitive testing, among other data, were collected. Results Control group 1 included more participants (70%) with obstructive sleep apnoea (OSA) compared to the Long COVID group, resulting in a markedly greater arousal index (ANOVA p=0.03), but no significant differences in percentage of Slow Wave Sleep (SWS) and Rapid Eye Movement (REM) sleep were observed between all three groups (ANOVA p=0.29). The Long COVID group displayed heightened daytime sleepiness, based on MSLT, Epworth Sleepiness Scores, and fatigue severity scores (Group 2: 28±10 vs Group 3:44±11, unpaired t-test p=0.01). Discussion Initial observations suggest sleep architecture (proportion of SWS and REM sleep) in Long COVID does not differ from controls, however the reduced sleep latency and elevated subjective fatigue suggest dysfunction of sleep in Long COVID which needs to be further explored.

Avapritinib (Ayvakyt)

Canada’s Drug Agency (CDA-AMC) recommends that Ayvakyt be reimbursed by public drug plans for the treatment of adult patients with advanced systemic mastocytosis (AdvSM), including patients with aggressive systemic mastocytosis (ASM), systemic mastocytosis with an associated hematological neoplasm (SM-AHN), and mast cell leukemia (MCL), only if certain conditions are met. Ayvakyt should only be covered to treat adult patients with AdvSM who have a diagnosis of ASM, SM-AHN, or MCL based on WHO criteria and have an Eastern Cooperative Oncology Group (ECOG) performance status score (which estimates patients’ ability to perform activities of daily living) of 0 (no symptoms, fully active) to 3 (symptomatic, confined to bed or chair 50% or more of waking hours). Patients with AdvSM who have low platelet counts are not eligible for Ayvakyt. Ayvakyt should only be reimbursed if prescribed by medical teams with access to expertise in the diagnosis, treatment, and response evaluation of patients with AdvSM. It should only be reimbursed if the cost of Ayvakyt is reduced and the economic feasibility of Ayvakyt is addressed.

TIME INTERVALS AT DIFFERENT STAGES OF MEDICAL CARE IN ACUTE CORONARY SYNDROME WITH ST SEGMENT ELEVATION ON THE ECG

Objective: to analyze the time intervals of medical care for patients with acute coronary syndrome with STsegment elevation on an electrocardiogram at different stages of care.Materials and methods. The study included 189 patients of both genders hospitalized with a diagnosis of acute coronary syndrome with ST-segment elevation, 3 age groups were formed, according to WHO criteria: 1 group (up to 59 years old) – 72 patients, 2 group (60–75 years old) – 69 patients and 3 group (over 76 years old) – 48 patients. The analysis of the time intervals of care at different stages was carried out, the intervals were compared in the group of men and women, as well as in different age groups.Results. The time interval from PMC to hospitalization in cPCI was 33 minutes, the interval from PMC to the start of PCI was 90 minutes, which corresponds to the standards of care. The median time to seek care from the onset of symptoms in our study was 191,65 ± 142,49 min. No gender differences were identified in seeking care. Younger patients (group under 60 years) sought care reliably earlier from the onset of symptoms than older patients, which is probably due to a more erased clinical picture in older patients.Conclusion. The main delay occurs at the symptom-PMC stage, which is the main problem. This indicator depends on the awareness of the population about the symptoms and danger of ACS. To improve this indicator, it is necessary to carry out educational work. The result of this activity should be an earlier recognition of ACS symptoms by patients and a reduction in the time from the onset of symptoms to the call of the NSR.

Ameliorative impacts of carvacrol on DNA integrity, oxidative stress, and sperm quality in asthenozoospermic infertile individuals during cryopreservation.

Nowadays, the cryopreservation process can produce reactive oxygen species (ROS), which cause damage to the motility, cell membrane, and DNA integrity of sperm. This study is aimed at evaluating the impact of carvacrol, as a powerful antioxidant, on sperm features and improving oxidative stress throughout the cryopreservation procedure. In this prospective study, semen samples from 25 patients with asthenozoospermia were separated into three groups: fresh, freezing, and freezing + carvacrol (a dose of 100µM). The subsequent parameters were evaluated using standard methods in all three groups: sperm motility according to WHO criteria, sperm morphology using Papanicolaou staining, sperm viability with eosin-nigrosin staining, DNA integrity with acridine orange staining, levels of antioxidant enzymes (catalase, glutathione, and superoxide dismutase), total antioxidant capacity (TAC), and malondialdehyde (MDA) using ELISA. Also, DNA fragmentation was analyzed by the SDFA kit, and mitochondrial membrane potential (MMP) was assessed by rhodamine staining. Average sperm viability, motility, mitochondrial membrane potentiality, integrity of sperm membrane, and antioxidant enzyme levels are meaningfully reduced in the freezing group in contrast to the control group. The freezing group showed a meaningful rise in the mean MDA levels and DNA fragmentation compared to the control group. In the freezing group supplemented with carvacrol, a meaningful rise could be visible in mean percentages of viability, motility, and antioxidant enzyme levels, whereas mean levels of MDA and DNA fragmentation meaningfully declined in contrast to the freezing group. The results demonstrate that carvacrol, a potent antioxidant, offers significant protection against the loss generated by the freeze-thaw procedure, thereby improving sperm quality.

Postpartum dysglycaemia after early gestational diabetes: Follow-up of women in the TOBOGM randomised controlled trial

AimTo evaluate the incidence and predictors of postpartum dysglycaemia among high-risk women who develop early gestational diabetes (eGDM) prior to 20 weeks’ gestation. MethodsThis is a sub-study of the Treatment of Booking Gestational Diabetes (TOBOGM) Study, a randomised controlled trial of early or deferred treatment for women with risk factors for gestational diabetes diagnosed with eGDM, using current WHO criteria. Overt diabetes in pregnancy was excluded. A repeat oral glucose tolerance test (oGTT) was recommended at 6–12 weeks postpartum. ResultsOf 793 participants, 352 (44.4%) underwent a postpartum oGTT. Baseline characteristics of participants with and without an oGTT were similar. Ninety-two (26.1%) had postpartum dysglycaemia: 11 (3.1%) diabetes, 31 (8.8%) impaired fasting glucose (IFG), 39 (11.1%) impaired glucose tolerance (IGT), and 11 (3.1%) combined IFG/IGT. Participants with postpartum dysglycaemia were more likely to have had past GDM, lower body mass index, more gestational weight gain, and higher 1 and 2-hour glucose concentrations on the early pregnancy oGTT. On logistic regression, higher 1 and 2-hour glucose concentration, previous GDM and greater gestational weight gain were independently associated with postpartum dysglycaemia. ConclusionThere is a high incidence of postpartum dysglycaemia among high-risk women with eGDM.

Changes in weight distribution and trends in obesity among children and adolescents in East Asia: Insights from NCD-RisC data.

Pediatric obesity is a serious global health challenge. In East Asia, rapid socioeconomic changes have increased obesity rates. This study examines weight distribution and obesity trends in East Asian children using WHO criteria. Data from the Non-Communicable Disease Risk Factor Collaboration was used to analyze weight categories (thinness, normal weight, overweight, and obesity) among children aged 5 to 19 in China, Japan, South Korea, and Taiwan. Data were collected through probabilistic sampling and national surveys and classified using WHO BMI standards. Age standardized prevalence rate enabled cross-country comparisons for boys and girls from 2010 to 2022. Statistical methods included arithmetic statistics, linear regression, and time series analysis using the ARIMA model, with SAS 9.4 and SPSS for analysis. Significant trends were found (p for trend < 0.05). Taiwan and South Korea showed increased thinness, while China and Japan showed decreases. Normal weight prevalence declined, notably among South Korean boys. Overweight and obesity rates rose, especially among South Korean boys and Chinese girls. Japan's rates remained stable, while Taiwan showed minor fluctuations. Boys had higher overweight and obesity rates than girls in all countries. The highest rates were among children aged 10 to 11 years. East Asia, particularly South Korea and China, has seen rising obesity rates. Increasing thinness in South Korea and Taiwan also requires attention. The decline in healthy-weight children is concerning. Interventions should target children before ages 10 to 11. Urgent, tailored public health interventions are needed.

QLTI-06. NEXT GENERATION SEQUENCING SIGNIFICANTLY IMPROVES THE DIAGNOSTIC ACCURACY IN GLIOBLASTOMAS

Abstract The 2021 WHO Classification of CNS Tumours recognizes the presence of TERT promoter (pTERT) mutations, combined +7/-10 chromosome copy-number alterations, or EGFR amplification as a defining molecular feature(s) of glioblastoma, independent of histology. We evaluated these biomarkers in a cohort of Indian patients using a single-run next-generation sequencing (NGS) platform at a relatively low depth of 100. Seventy-four adult diffuse gliomas were selected from the Exsegen Genomics Research Pvt Ltd Biobank established during the trial CTRI/2021/09/036861 after reviewing their clinical and pathological data. Paired surgical tissue and blood samples underwent whole-exome sequencing on an Illumina NovaSeq-6000 (Illumina, San Diego, USA). Single-nucleotide variations (SNVs) were processed using the DRAGEN pipeline to generate Mutation Annotation Format (MAF) files. Copy number variations (CNVs) analysis was performed using GATK and GISTIC2.0. Thirty-nine glioma samples with IDH1R132H mutations were excluded. A total of 32/35 (91.4%) IDH-wildtype tumours met the 2021 WHO criteria for glioblastoma, IDH-wildtype and were included. Twenty-four glioblastomas also underwent whole-transcriptome analysis. Microvascular proliferation (n=24, 75%) and necrosis (n=30, 93.9%) were present in the majority. pTERT mutations were identified in 23 (71.9%) samples, with C228T mutations (n=15/23, 65.2%) being more common than C250T mutations (n=8/23, 34.8%). EGFR amplification, defined as ≥5 copies by NGS CNV, was seen in 15 (46.9%) samples, with a strong correlation between EGFR CNV and logEGFR expression (r=0.79; p=0.017). Whole-arm +7/-10 genotype was evident in 17 (53.1%) tumours, and another 5 (15.6%) showed partial copy-number alterations. Notably, two gliomas without necrosis and proliferation initially diagnosed as oligodendrogliomas due to misinterpretation of the IDH immunostain, were reclassified as glioblastoma, IDH-wildtype. The data was validated using Sanger Sequencing and targeted panel sequencing to a depth of 500. Even low depth NGS sequencing, that is cost effective and time efficient offers significant improvements in diagnostic molecular neuropathology.

BIOM-01. CDKN2A HOMOZYGOUS DELETION HAS STRONGER PROGNOSTIC POWER THANIDH MUTATION IN CNS WHO GRADE 4 GLIOMAS

Abstract We conducted retrospective analysis of glioma cohorts in our institute. Medical records were reviewed for 142 glioblastoma patients for 15 years, and pathological slides were examined again for the updated diagnosis according to 2021 WHO classification of CNS tumors. The IDH mutation and CDKN2A deletion were examined by NGS analysis using ONCOaccuPanel®. Traditional prognostic factors were also examined. Mean follow-up duration was 27.5 months (ranged from 4.1 to 43.5 months) and mean overall survival (OS) was 19.4 months (95% CI 16.3 – 20.9 months). After the exclusion of 4 patients with poor status of pathologic samples, total 109 glioblastoma which were diagnosed by previous WHO criteria were changed into 26 (23.9%) astrocytoma, IDH-mutant, CNS WHO grade 4 and 83 (76.1%) glioblastoma, IDH-wildtype, CNS WHO grade 4. Among them, 61 patients (56.0%) had CDKN2A deletion. Group A was classified for 59 patients with IDH-wildtype and present CDKN2A deletion, group B was classified for 16 patients with IDH-mutant and present CDKN2A deletion, group C was classified for 48 patients with IDH-wildtype and absent CDKN2A deletion, and group D was classified for 13 patients with IDH-mutant and absent CDKN2A deletion. Group A had a mean OS of 15.70 months (95% CI 13.86 – 17.54 months), group B had a mean OS of 19.37 months (95% CI 13.43 – 25.30 months), group C had a mean OS of 22.63 months (95% CI 20.10 – 25.17 months), and group D had a mean OS of 33.38 months (95% CI 29.35 – 37.40 months). Multivariate analysis showed IDH mutation (mutant vs. wildtype; HR 6.358), and CDKN2A deletion (absence vs. presence; HR 13.452). The presenting study suggest that CDKN2A deletion should play a powerful prognostic role in CNS WHO grade 4 gliomas as well as low grade glioma. Even if CNS WHO grade 4 gliomas had mutant IDH, they can have poor clinical outcome due to CDKN2A deletion.

PATH-20. CLINICAL FINDINGS AND PROGNOSIS OF ADULT GLIOBLASTOMA HARBORING ABRAF V600E MUTATION

Abstract BACKGROUND AND AIM Although the BRAF V600E mutation is commonly associated with pediatric low-grade gliomas, glioblastomas (GB) with this mutation (BRAF-GB) have also been reported. The recent emergence of RAF and MEK inhibitors for BRAF V600E-positive tumors highlights the potential for targeted therapy in a subset of GB patients. This study aimed to characterize the clinical features and prognosis of BRAF-mutant glioblastomas. MATERIALS AND METHODS A retrospective analysis was conducted on a cohort of patients diagnosed with GB (confirmed by 2021 WHO criteria) above 16 years of age. Targeted genetic analysis for mutations in BRAF V600E, TERT promoter, and CDKN2A/B was performed on the GB samples. Clinical features of BRAF-GB were analyzed, and patients were further categorized into three groups: BRAF-GB, typical GB, and molecular GB. Subsequent analysis compared the prognosis among these groups. RESULTS Our study identified 11 cases (5.1%) harboring the BRAF V600E mutation among 215 adult GB patients. Patients with BRAF-GB exhibited a significantly younger median age of onset (38-year-old) compared to the typical GB (N = 167, 64-year-old) and molecular GB (N = 37, 61-year-old) groups. Further analysis of the BRAF-GB cohort (n=11) revealed a high prevalence (82%) of homozygous CDKN2A/B deletions, and only one case (9%) harbored a TERT promoter mutation. Interestingly, three BRAF-GB patients presented with hemorrhagic onset. Four cases showed evidence of prior lesions, with one case diagnosed histologically as a low-grade glioma 14 years earlier. The BRAF-GB group exhibited significantly longer median progression-free survival (32.8 months) and overall survival (84.2 months) compared to both the typical GB group (9.6 months and 18.9 months, respectively) and the molecular GB group (14.1 months and 32.1 months, respectively). CONCLUSIONS Early-age onset, with hemorrhagic onset or presence of prior lesions are factors that could lead to recommendation of BRAF analysis for adult GB patients.

SURG-56. TRANSCRIPTION FACTOR CELL LINEAGE DETERMINES AGGRESSIVE BEHAVIOR AMONG NONFUNCTIONAL PITUITARY ADENOMAS

Abstract INTRODUCTION Pituitary neuroendocrine tumors (PitNETs) are the second most common intracranial neoplasm. Silent or non-functional PitNETs represent a common neuro-oncological challenge due to their size and unpredictable invasion of parasellar structures. This makes their complete surgical resection difficult and puts patients at higher risk for recurrence. OBJECTIVE To characterize differences in tumor volume, cavernous sinus invasion, and recurrence in nonfunctional PitNETs. METHODS Out of 615 transsphenoidal surgeries from 2012 to 2024, there were 309 overall PitNETs and 181 nonfunctional PitNETs. Based on new WHO criteria for transcription factor profiling (PIT-1, TPIT, and SF-1), there were 98 silent gonadotroph adenomas (SGA), 31 silent corticotroph adenomas (SCA), 10 silent pleurihormonal tumors (PHT), and 2 null cell adenomas. Tumor volume was calculated using (AxBxC/2). Knosp grade was calculated. Cavernous sinus invasion was defined as Knosp ≥ 3. Residual disease at 3 months postoperative was recorded and surgical intervention for growing residual disease was captured. RESULTS Average tumor volume of PHT (18.08 cm3) was significantly higher than SGA (8.44 cm3, p=0.007) and similar to SCA (10.33 cm3, p=0.11). Percentage of cavernous sinus invasion was significantly different between SCA (31.82%) and SGA (10.20%, p=0.003), but not PHT (33.33%; p&amp;gt;0.05). There was a significantly higher residual rate in SCA compared to SGA (31.71% vs. 11.22%, p=0.006). There were significantly more reoperations in the SCA group compared to SGA and PHT. CONCLUSIONS Despite similar tumor volume between SCA and SGA, there was a significantly higher rate of cavernous sinus invasion and residual disease among SCA. This has important neuro-oncological implications regarding surgical technique, postoperative surveillance, and need for adjuvant therapy to mitigate aggressive recurrent disease.

Prevalence and factors associated with cerebral malaria among children aged 6 to 59 months with severe malaria in Western Uganda: a hospital-based cross-sectional study

IntroductionCerebral malaria, caused by Plasmodium falciparum, represents the most severe neurologic complication of malaria. Its association with high morbidity and mortality rates, especially among young children, underscores its clinical significance. In sub-Saharan Africa, including Uganda, cerebral malaria remains a major health challenge, contributing significantly to the high child mortality rate. Despite advances in malaria control, the burden of cerebral malaria among children under five is substantial, reflecting the need for targeted interventions and improved management strategies. This study aimed to determine the prevalence of cerebral malaria and identify associated factors among children admitted with severe malaria at a tertiary hospital in western Uganda.MethodsThis was a cross-sectional, descriptive, and analytical study involving children aged 6 to 59 months admitted with severe malaria. The study was conducted from January to March 2023 at Fort Portal Regional Referral Hospital. Severe and cerebral malaria were defined as per the WHO criteria. Sociodemographic, clinical, and laboratory data were collected and analyzed using IBM SPSS version 27. Logistic regression analysis was used to evaluate the factors associated with cerebral malaria. A p-value < 0.05 indicated statistical significance.ResultsA total of 250 children were recruited (mean age 33.1 ± 17.3 months). The prevalence of cerebral malaria was 12.8% (95% CI: 8.9–17.6). Cerebral malaria was independently associated with male sex (aOR: 3.05, 95% CI: 1.20–7.77, p = 0.02), abnormal bleeding (aOR: 13.22, 95% CI: 11.54–15.16, p = 0.001), history of convulsions (aOR 12.20, 95% CI: 10.7–21.69, p = 0.010), acute kidney injury (aOR: 4.50, 95% CI: 1.30–15.53, p = 0.02), and hyponatremia (aOR: 3.47, 95% CI: 1.34–8.96, p = 0.010).Conclusions and recommendationsThe prevalence of cerebral malaria was high among children with severe malaria. Factors associated with cerebral malaria included male gender, history of convulsions, abnormal bleeding, acute kidney injury, and hyponatremia. Targeted interventions and early management are essential to improve clinical outcomes.

TP53 Mutation Status in Myelodysplastic Neoplasm and Acute Myeloid Leukemia: Impact of Reclassification Based on the 5th WHO and International Consensus Classification Criteria: A Korean Multicenter Study.

TP53 mutations are associated with poor prognosis in myelodysplastic neoplasm (MDS) and AML. The updated 5th WHO classification and International Consensus Classification (ICC) categorize TP53-mutated MDS and AML as unique entities. We conducted a multicenter study in Korea to investigate the characteristics of TP53-mutated MDS and AML, focusing on diagnostic aspects based on updated classifications. This study included patients aged ≥ 18 yrs who were diagnosed as having MDS (N=1,244) or AML (N=2,115) at six institutions. The results of bone marrow examination, cytogenetic studies, and targeted next-generation sequencing, including TP53, were collected and analyzed. TP53 mutations were detected in 9.3% and 9.2% of patients with MDS and AML, respectively. Missense mutation was the most common, with hotspot codons R248/R273/G245/Y220/R175/C238 accounting for 25.4% of TP53 mutations. Ten percent of patients had multiple TP53 mutations, and 78.4% had a complex karyotype. The median variant allele frequency (VAF) of TP53 mutations was 41.5%, with a notable difference according to the presence of a complex karyotype. According to the 5th WHO classification and ICC, the multi-hit TP53 mutation criteria were met in 58.6% and 75% of MDS patients, respectively, and the primary determinants were a TP53 VAF >50% for the 5th WHO classification and the presence of a complex karyotype for the ICC. Collectively, we elucidated the molecular genetic characteristics of patients with TP53-mutated MDS and AML, highlighting key factors in applying TP53 mutation-related criteria in updated classifications, which will aid in establishing diagnostic strategies.