Pregnancy Outcomes of Non-Visualization of The Foetal Gallbladder From A Chinese Tertiary Single Centre And Literature Review

Objection To explore the clinical features and prognosis of non-visualization of fetal gallbladder (NVFGB). Methods 65 cases diagnosed of NVFGB in the Peking University First Hospital was collected retrospectively from January, 2019 to December, 2020. Results 49 cases were successfully followed up. Among them, the gallbladder of 21 fetuses (42.9%) was visible later, either in the later pregnancy or after birth. In the rest 28 cases (57.1%), the gallbladders were not seen during the whole pregnancy. 11 of 28 fetuses (39.3%) with NVFGB were complicated with other structure anomaly. In the remaining 17 cases of isolated NVFGB (60.7%), one case was diagnosed of congenital biliary atresia, 3 cases of small gallbladder, 1 case of gallstone and one case of irregular size of gallbladder. There are 9 cases who underwent prenatal diagnosis, with 4 cases of abnormal result. Conclusion Prenatal ultrasound plays a role in the early recognize of abnormal gallbladder, which will improve the postnatal prognosis.

126 BRUE and evaluation of higher-risk infants with overnight oximetry

Primary Subject area Hospital Paediatrics Background BRUE (Brief resolved unexplained event) is a worrisome event for parents. Investigation guidelines for infants 2 months and older have been published, but an evaluation framework for higher-risk infants is still evolving. Objectives The goal of this study is to determine if an overnight oximetry for patients presenting with BRUE under the age of the 2 months would help to target patients at higher risk of recurrent BRUE. The secondary goals are to evaluate the characteristics of those infants, the rate of recurrence of BRUE and to evaluate the effectiveness of other investigations. Design/Methods This was an observational retrospective study of infants presenting with BRUE between the age of 7 days and 60 days between January 1 2010 and October 1 of 2018. Patients were selected if they matched the definition of BRUE defined by the American Academy of Pediatrics in 2016. Patient demographics and antecedents, characteristics of the events, investigations results, recurrence of BRUE, and hospitalizations until the age of 1 year were recorded. Results 103 patients presented with BRUE under the age of 2 months. Of those, 63 (61.2%) were boys. Only four (3.9%) had a recurrence of BRUE. The mean corrected age at the presentation was 20.7 days. Thirty-three (32%) infants had an overnight oximetry; of those 19 (18.4%) had an abnormal result. An abnormal overnight oximetry result was associated with a lower risk of recurrent BRUE (0%) compared to infants without an oximetry (4.3%) or with a negative result (7.1%) (p=0.6195). 68.4% of patients with an abnormal overnight oximetry had received medical treatment (caffeine, oxygen or anti-acid), which was significantly higher than those with normal overnight oximetry (14.3%) or no oximetry (9.4%) (p < 0.0001). There was an association between male sex and abnormal overnight oximetry (p=0.0137). No other investigation was able to predict a higher risk of recurrent BRUE among those evaluated. Conclusion In our cohort, boys were more frequently affected and had a higher rate of abnormal overnight oximetry. One hypothesis is that BRUE under 2 months of age might be a presentation mode for immature respiratory control and boys might be at higher risk for such events. Even though an abnormal result was present in 18.4% of the overnight oximetry, this investigation was not able to identify infants at higher risk of recurrent BRUE. This could be partly explained by the fact that a recurrent BRUE is a rare event and that a majority of patients with abnormal overnight oximetry were treated medically, which might have prevented recurrence.

Spirometry parameters used to define small airways obstruction in population-based studies: systematic review protocol

IntroductionIn recent years, there has been increasing interest in the use of spirometry for the assessment of small airways obstruction (SAO) driven by the idea that these changes occur prior to development of established obstructive lung disease. Maximal mid-expiratory and distal flow rates have been widely used despite a lack of agreement regarding parameter selection or definition of an abnormal result. We aim to provide evidence from population-based studies, describing the different parameters, definitions of normal range and the resulting impact on prevalence estimates for SAO. Summarising this evidence is important to inform development of future studies in this area.Methods and analysisA systematic review of population-based studies will be conducted. MEDLINE, Web of Science and Google Scholar will be searched from database inception to May 2021. Primary outcomes will include the spirometry parameter used to define SAO, and the definition of an abnormal result. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be followed for study selection. Study methods will be assessed using the Newcastle-Ottawa scale and the Grading of Recommendations Assessment, Development and Evaluation working group methodology. Narrative synthesis will be conducted for all included studies. Meta-analysis will also be conducted for prevalence estimates and associated risk factors where data quality and availability allow. Random effects models will be used to conduct the meta-analysis and I2 statistics will be used to assess heterogeneity across studies. Where appropriate subgroup analysis will be conducted to explore heterogeneity.Ethics and disseminationThere is no requirement for ethical approval for this project. Findings will be disseminated via peer-reviewed publications and other formats, for example, conferences, congresses or symposia.PROSPERO registration numberCRD42021250206.

Interference by piperacillin/tazobactam in the measurement of creatinine with the Jaffe method and of total protein with the biuret method

Serum creatinine and total protein are routinely measured biochemical parameters used in clinical medicine. An abnormal result caused by interference with the assay does not accurately reflect a patient’s clinical state and therefore risks misleading clinicians. We report the case of a patient who had unexplainable high creatinine and total protein results. The blood collection was contaminated with intravenous fluid and the patient was receiving piperacillin/tazobactam. Additional laboratory studies demonstrated piperacillin/tazobactam was the cause of the false positive results and the elevation in both serum creatinine and protein level was dependent on the concentration of antibiotic present.

Physical health examination in outpatients with schizophrenia: the cost effectiveness of laboratory screening tests

Background Guidelines on laboratory screening in schizophrenia recommend annual monitoring of fasting lipids and glucose. The utility and the cost effectiveness of more extensive laboratory screening have not been studied. Methods The Living Conditions and the Physical Health of Outpatients with Schizophrenia Study provided a comprehensive health examination, including a laboratory test panel for 275 participants. We calculated the prevalence of the results outside the reference range for each laboratory test, and estimated the cost effectiveness to find an aberrant test result using the number needed to screen to find one abnormal result (NNSAR) and the direct cost spent to find one abnormal result (DCSAR, NNSAR x direct cost per test) formulas. In addition, we studied whether patients who were obese or used clozapine had more often abnormal results. Results A half of the sample had 25-hydroxyvitamin D below, and almost one-fourth cholesterol, triglycerides or glucose above the reference range. One-fifth had sodium below and gamma glutamyltransferase above the reference range. NNSAR was highest for potassium (137) and lowest for 25-hydroxyvitamin D (2). DCSAR was below 5€ for glucose, all lipids and sodium, and below 10€ for creatinine and gamma glutamyltransferase. Potassium (130€), pH-adjusted ionized calcium (33 €) and thyroid stimulating hormone (33€) had highest DCSARs. Several abnormal results were more common in obese and clozapine using patients. Conclusions An annual laboratory screening panel for an outpatient with schizophrenia should include fasting glucose, lipids, sodium, creatinine, a liver function test and complete blood count, and preferably 25-hydroxyvitamin D.

The Discovery of Vibrio harveyi on Litopenaeus vannamei Infected White Feces Disease in Situbondo, East Java

This research was conducted to discover Vibrio harveyi infected vannamei shrimp with White Feces Disease (WFD) in Situbondo, East Java Province. This research was conducted in November 2017 until September 2018. All Vibrio isolates from shrimp infected WFD were identified with biochemical tests, Analytical Profile Index/ API 20NE (BioMeriuex), and PCR with specific primers for V. harveyi. Additional parameters were the water quality, plankton brackishwater pond abundance, and antibiotic resistance test. Result showed that from 17 bacterial isolates identified, 10 isolates were V. harveyi (58.82%), three isolates were V. alginolyticus (17.65%), one V. fluvialis isolate (5.88%), one V. parahaemolyticus isolate (5.88%), and two non Vibrio isolates which were identified as Shewanella putrefaciens (11.76%). All isolates of V. harveyi also showed resistance activity on more than one antibiotic. Poor water quality had been identified as abnormal result of pH, alkalinity, salinity, ammonia levels and total organic matter level. Plankton abundance observation showed that Chloropyceae, Diatom, and Dinoflagellata dominated all sampled brackishwater ponds. This research concluded that V. harveyi were discovered on vannamei shrimp with poor water quality and plankton abundance in the pond samples.

LO26: The mean abnormal response rates of laboratory tests ordered in the emergency department: shooting percentage insights from a multicentre study

Introduction: There is ongoing concern about the burden placed on healthcare systems by lab tests. Although these concerns are widespread, it is difficult to quantify the extent of the problem. One approach involves use of a metric known as the Mean Abnormal Response Rate (MARR), which is the proportion of tests ordered that return an abnormal result; a higher MARR value indicates higher yield. The primary objective of this study was to calculate MARRs for tests ordered between April 2014 and March 2019 at the four adult emergency departments (EDs) covering a metropolitan population of 1.3 million. Secondary objectives included identifying tests with highest and lowest MARRs; comparison of MARRs for nurse- and physician-initiated orders; correlation of the number of tests per order requisition to MARR; and correlation of physician experience to MARR. Methods: In total, 40 laboratory tests met inclusion criteria for this study. Administrative data on these tests as ordered at the four EDs were obtained and analyzed. Multi-component test results, such as from CBC, were consolidated such that an abnormal result for any component was coded as an abnormal result for the entire test. Repeat tests ordered within a single patient visit were excluded. Physician experience was quantified for 209 ED physicians as number of years since licensure. Analyses were descriptive where appropriate for whole-population data. Risk of bias was attenuated by the focus on administrative data. Results: The population dataset comprised 33,757,004 test results on 415,665 unique patients. Of these results, 30.3% were the outcomes of nurse-initiated orders. The 5-year MARRs for the four hospitals were 38.3%, 40.0%, 40.7% and 40.9%. The highest per-test MARRs were for BNP (80.5%) and CBC (62.6%), while the lowest were for glucose (7.9%) and sodium (11.6%). MARRs were higher for nurse-initiated orders than for physician-initiated orders (44.7% vs. 38.1%), likely due to the greater order frequency of high-yield CBC in nurse-initiated orders (38.6% vs. 18.1%). The number of tests per order requisition was inversely associated with MARR (r = -0.90, p < 0.001). Finally, the number of years since licensure was modestly but significantly associated with MARR (r = 0.28, p < 0.001). Conclusion: This is the first and largest study to apply the MARR in an ED setting. As a metric, MARR effectively identifies differences in test ordering practices on per-test and per-hospital bases, which could be useful for data-informed practice optimization.