Visceral Adiposity Associates With Malnutrition Risk Determined by Royal Free Hospital-Nutritional Prioritizing Tool in Cirrhosis

Mounting evidence has suggested the clinical significance of body composition abnormalities in the context of cirrhosis. Herein, we aimed to investigate the association between visceral adiposity and malnutrition risk in 176 hospitalized patients with cirrhosis. The adiposity parameters were obtained by computed tomography (CT) as follows: total adipose tissue index (TATI), visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), and visceral to subcutaneous adipose tissue area ratio (VSR). Malnutrition risk was screened using Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT). Visceral adiposity was determined given a higher VSR based on our previously established cutoffs. Multivariate analysis implicated that male gender (OR = 2.884, 95% CI: 1.360–6.115, p = 0.006), BMI (OR = 0.879, 95% CI: 0.812–0.951, P = 0.001), albumin (OR = 0.934, 95% CI: 0.882–0.989, P = 0.019), and visceral adiposity (OR = 3.413, 95% CI: 1.344–8.670, P = 0.010) were independent risk factors of malnutrition risk. No significant difference was observed regarding TATI, SATI, and VATI among patients with low or moderate and high risk of malnutrition. In contrast, the proportion of male patients embracing visceral adiposity was higher in high malnutrition risk group compared with that in low or moderate group (47.27 vs. 17.86%, p = 0.009). Moreover, this disparity was of borderline statistical significance in women (19.05 vs. 5.88%, p = 0.061). Assessing adipose tissue distribution might potentiate the estimation of malnutrition risk in cirrhotics. It is pivotal to recognize visceral adiposity and develop targeted therapeutic strategies.

P104 A review of patients referred to Rheumatology with haemophagocytic lymphohistiocytosis who were treated with anakinra successfully

Background/Aims Haemophagocytic lymphohistiocytos (HLH) is a potentially life-threatening condition characterised by over-activation of the innate immune system. It can be classified into primary HLH, often inherited, or secondary which is triggered by non-genetic causes, such as chronic immunosuppression, malignancy or infection.Primary HLH is more frequently observed in infants, however, secondary HLH is more commonly observed in adults. Diagnosis is often delayed, most likely due to the rarity of the condition and is usually prompted by serological abnormalities, including hyperferritinaemia, organ and bone marrow dysfunction.Treatment options are limited; however, the Royal Free Hospital has observed a number of secondary HLH cases who were successfully treated with steroids and anakinra. Methods A retrospective search of clinic letters and patient records was undertaken using electronic care records. We also searched through pharmacy records of patients treated with anakinra at the Royal Free Hospital. Patients with a documented diagnosis of HLH prior to March 2020 who had been referred to Rheumatology were included. We excluded patients after March 2020 due to patients with COVID-19 having similar overlap of symptoms and biomarkers as those with HLH. We identified key demographic details, laboratory, pathology investigations,the course of hospital admission, primary diagnosis and follow-up data. The diagnosis was confirmed withan H-score and bone marrow biopsy where possible. Results We identified nine adult cases with adocumented diagnosis of HLH whohad been admitted to the Royal Free Hospitaland referred to Rheumatology. They had allbeen subsequently followed up in outpatientclinic.Ages of patients ranged from 19 to 58 with a male to female ratio of 2:1. The predominant underlying pathology was adultonsetStill’s disease(78%), with the remaining cases being secondary to HIV (22%). Bone marrow aspirate was performed in all patients and 78% of patients aspirated had bone marrowappearances in keeping with HLH.Ferritin levels varied from 532 micrograms/Lto 93309 micrograms/L with a median ferritin of 5045.5 micrograms/L.H-Scores were variable witha median score of 171.5 (96-238).All patients received steroids as part of their treatment. Anakinra (interleukin-1 receptor antagonist) was delivered intravenously(6/9) or subcutaneously (3/9). Conclusion We present data from nine cases of HLH treated with anakinra who survived their admission and have been subsequently followed up in clinic. We found that the majority of these patients had an underlying diagnosis of adult onset Still’s disease. Anakinra was used successfully as part of their treatment both intravenously as well as subcutaneously. Further work is needed comparing patients with good and poor outcomes to establish identifiable prognostic markers as well as effective treatment strategies. Disclosure D. Kurzeja: None. J. Perera: None. K. Pillai: None. S. Amin: None. R. Stratton: None. A. Singh: None.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Organic Disease or Psychosomatic Illness? A Re-Examination of the Royal Free Epidemic of 1955

Background and Objectives: Controversy exists over whether myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is an organic disease or a psychosomatic illness. ME/CFS usually occurs as sporadic cases, but epidemics (outbreaks) have occurred worldwide. Myalgic encephalomyelitis was named to describe an outbreak affecting the lymphatic, muscular, and nervous systems that closed the Royal Free hospital for three months in 1955. Fifteen years later, two psychiatrists concluded that epidemic hysteria was the likely cause. ME/CFS research studies show multiple pathophysiological differences between patients and controls and a possible etiological role for infectious organisms, but the belief that ME/CFS is psychosomatic is widespread and has been specifically supported by the epidemic hysteria hypothesis for the Royal Free outbreak. Our objective was to obtain accounts from ex-Royal Free hospital staff who personally experienced the 1955 outbreak and evaluate evidence for it being an infectious illness versus epidemic hysteria. Materials and Methods: Statements in the newsletters of two organizations for staff who had worked at the Royal Free hospital invited anyone who had experienced the 1955 Royal Free outbreak to contact the authors. Accounts of the outbreak from telephone interviews and letters were evaluated against the “epidemic hysteria hypothesis” paper and original medical staff reports. Results: Twenty-seven ex-Royal Free hospital staff, including six who had developed ME, provided descriptions typical of an infectious illness affecting the lymphatic, muscular, and nervous systems, and were not consistent with epidemic hysteria. Conclusions: The 1955 Royal Free hospital epidemic of myalgic encephalomyelitis was an organic infectious disease, not psychogenic epidemic hysteria.

The skeletal effects of congenital syphilis: the case of Parrot’s bones

We provide a brief account of the life and work of Jules Parrot, a significant figure in French paediatrics, about whom almost nothing has been written. We focus on his work relating to congenital syphilis, specifically reporting on the examination of a collection of bones taken at autopsy from children with congenital syphilis. The collection of bones was brought to London in 1879 by Parrot to illustrate a talk that he gave before the Pathological Society of London. Subsequently, it travelled a circuitous route to the Royal Free Hospital pathology collection, where it remained until we (GC and TW) ‘discovered’ it. The bones represent the largest assemblage of material from cases of congenital syphilis in the UK and they are important as they clearly demonstrate the skeletal lesions associated with congenital syphilis and are now irreplaceable. The bones have been identified to anatomical element and have come from a minimum of eight children, both foetuses and neonates covering the period 30–50 weeks post-conception. Radiological and micro computerised tomography examinations were carried out and three-dimensional models printed at twice life size. The models are durable and can be handled with impunity by students and others wishing to familiarise themselves with the skeletal changes shown.

1920 Problems of marriage and sexual morality: the Lambeth Conference

This article by Dame Mary Scharlieb (1845–1930) addresses issues on marriage and sexuality raised at the 1920 Lambeth Conference of Anglican Bishops. It is likely that she had a strong influence on the Bishop of London on medical issues, and, through him, on the resolutions on marriage and sexuality at this Conference. Her article, published in Theology in November 1920, is clearly a piece of its time and reflects a fascinating mixture of pro-women and conservative ethical views, tempered by her understanding of medical science as it was then: for example, she and the bishops at the Conference strongly opposed the use of contraception even within marriage (ten years later the Lambeth Conference dropped this opposition). Mary Scharlieb was a pioneer female gynaecologist. Raised as an Evangelical, she became an Anglo-Catholic after her marriage to a British lawyer who was employed in Madras. Her medical training, prompted by the lack of medical help for Indian women, began at the Madras Christian College but was completed at Mrs Garrett Anderson’s London School of Medicine for Women, leading to her appointment at the Royal Free Hospital in 1902. Her husband stayed working in India until his death, while she worked as a gynaecologist in London. She was created a Dame two years before her death. Editor.