COVID-19 in the Intravitreal Injection (IVI) Procedure at a Spanish Urban Tertiary Hospital

Purpose: To describe the rate of COVID-19 in intravitreal injection (IVI) procedure at the onset of the pandemic.Methods: This transversal, observational and retrospective study included patients treated with IVI, in 3 groups. A: from February 20 to March 15, 2020, a period prior to lockdown and the first preventive measures against viral transmission. B: from March 16 to May 3, after the start of both, and C: from May 4 to June 19, after lockdown. Age, sex, diagnosis, drug, IVI laterality, visual acuity, percentage of single eyes, date of COVID-19 diagnosis, incidence among the Hospital attended population and number of COVID-19 patients admitted daily, were collected.Results: 1049 patients were treated, 564 (53.7%) on two or more occasions. COVID-19 rate was 1.51% (8/529) in group A, 0.21% (1/469) in B and 0% in C (0/926) (p=0.0001). The highest incidence peak x105 inhabitants and the mean daily admission rate, for the periods corresponding to the three groups, were 93.70/7.70 (SD 7.32), 418.72/27.83 (SD 24.68) and 24.58/2.28 (SD 1.97), respectively.Conclusion: The favourable trend in the COVID-19 rate among our patients, after implementing preventive measures against viral transmission, may assist in adequately planning IVI procedure in the future.

Management of incontinence-associated dermatitis with topical antibiotics and antifungal medication

Objective: The primary goals of managing incontinence-associated dermatitis (IAD) are to control the incontinence and to stop the progress of dermatitis. This study evaluated the effectiveness of using a combination of topical antibiotic and topical antifungal medication to manage IAD. Method: Patients with grade 2 IAD treated with a combination of topical antibiotic Biomycin (CBC Biotechnological and Pharmaceutical, Taiwan) and antifungal clotrimazole (Sinphar Group, Taiwan) between January 2017 and January 2019 were included in this retrospective study. Data collected included patients' age, sex, diagnosis, body mass index, comorbidities and surface area involved. Patients were reviewed fortnightly until the wounds had healed, the patient was discharged or had died. Results: A total of 76 patients were included. There were 39 men and 37 women with a mean age of 74 years. In 58 (76%) patients, the surface area involved was >50cm2, in 13 (17%) patients the involved area was 20–50cm2 and in five (7%) patients the area involved was <20cm2. The mean number of days treated was 10.3 (range: 1–53). A total of 46 (61%) patients showed total healing of their IAD, 17 (22%) patients showed improvement of >50% of the involved area, seven (9%) patients showed improvement of 0–50%, five (7%) patients showed no improvement and one (1%) patient showed an increase in the area involved. Conclusion: This combination of treatment was effective in the management of IAD. It was cheap, easy to apply, easy to remove and easily accessible. It could be used efficiently by the hospital staff and the patient's family.

A22 PREVALENCE OF IRON DEFICIENCY AND SUPPLEMENTATION PRACTICES FOR PATIENTS ON HOME PARENTERAL NUTRITION

Background Iron deficiency (ID) is common in patients receiving parenteral nutrition (PN), likely due to a lack of iron in the PN formula. There is no clear consensus on how often serum iron should be tested or iron supplementation should be given, at which dose or route, in patients on long-term PN. Within the Hamilton Health Sciences (HHS) home PN (HPN) program, the prevalence of ID or iron deficiency anemia (IDA) is unknown. This knowledge will contribute to better iron prescribing practices with ultimate benefit on patient’s health. Aims To assess the prevalence of ID and IDA in patients enrolled in the HHS HPN Program. The secondary aim was to assess supplementation practices for patients enrolled in the HPN program according to gastrointestinal(GI) diagnosis and duration on PN. Methods We conducted a retrospective study including consecutive adult patients enrolled in the HHS-HPN program from January 2015 to November 2020. We collected data on demographics (age, sex, and GI diagnosis), iron supplementation (dose, duration, and route), and information related to iron-deficiency (hemoglobin, serum iron, ferritin, TIBC, and folate) at pre-set intervals (enrollment, 3, 6, 12, 18, 24, 30, 36, 48, 60 months) and last measured. ID was defined as ferritin ≤45μg/L or serum iron ≤9μmol/L. IDA was defined as hemoglobin &lt;130g/L in men or &lt;120g/L in women in the context of ID. Data were expressed as median (IQR) for continuous variables and n/N(%) for categorical variables. Chi2 was performed to assess differences between groups and logistic regression to assess predictors of ID and IDA. The analysis was conducted using SPSS software(v26). Results The analysis included 125 HPN patients (50 males, median age of 55 (40–65) years). Patients received PN for a median of 195 (83–521) days. The most common diagnoses were malignancy (36.8%) and inflammatory bowel disease (23.2%); the most common indications for HPN was short bowel (29.6%) and bowel obstruction (27.2%). Iron profiles were measured in 77% of patients. At enrollment, 42.2% of patients had ID and 38.9% had IDA. Only 13% of patients with ID and 22.8% with IDA had iron supplementation (Figure 1). A total of 38 patients received iron either oral or IV (oral=44.7% vs IV=55.3%; p=0.66). There was no correlation between low levels of serum iron or ferritin with iron supplementation (p=0.23, 0.45 respectively). Age, sex, diagnosis, or reason for PN did not correlate with ID or IDA at any time point. Conclusions Iron-deficiency and IDA are common in patients enrolled in the HHS HPN program independently of age, sex, diagnosis and reason for PN. Prospective studies are needed to implement the most effective way to ensure proper monitoring and treatment of iron deficiency in this population. Funding Agencies None

An exploration of mercaptopurine/methotrexate tolerance during maintenance therapy in children with acute lymphoblastic leukemia

Purpose Mercaptopurine (6MP) and methotrexate (MTX) cause myelosuppression and interruptions in therapy in children with lymphoblastic leukemia (ALL). Length of time off of therapy is related to poorer outcomes. To date the dose at which most children tolerate these agents without drops in blood counts has not been identified. This study attempts to determine the maximum tolerated dose of both 6MP/MTX. Methods A retrospective chart review of 77 ALL children, median age 4.5 years. Time to first interruption and dose, along with total number of interruptions were collected. Absolute neutrophil and platelet counts recorded at time of interruption. Subgroup analysis of age, sex, diagnosis and risk stratification were also completed. REB approval was gained. Results Of the 77 patients that were studied, 9 of them had no treatment interruptions. Descriptive statistics are reported using Strata software. The mean number of interruptions during maintenance was 3.2, the mean time to first interruption was 149.8 days. The mean dose percent of MTX and 6MP at first interruption was 94.4% and 106% respectively. Maintenance therapy was interrupted independent of age, sex, diagnosis or disease risk stratification. Conclusion Few patients complete maintenance therapy without interruptions at the current dose escalation schedules outlined by the Children’s Oncology Group protocols. The interruptions are due in part to intolerance of dose escalations of MTX and 6 MP above 100%. Future research should investigate doses of 6MP and MTX in maintenance therapy in relation to leukemia outcomes.

Teledermatology in paediatrics: Health-care impact on the early treatment of infantile haemangiomas

Introduction Teledermatology can solve diagnostic and therapeutic problems in paediatrics, for example in infantile haemangiomas (IHs) requiring early treatment with propranolol. This study aims to assess the impact of teledermatology following its implementation in a health area of Spain, specifically analysing its effectiveness in reducing the age of first propranolol treatment for IH. Methods This was a descriptive study of paediatric teledermatology from 2015 to 2018, studying age, sex, diagnosis, time and mode of resolution. All IHs referred via teledermatology were analysed, and age at propranolol initiation was compared to the period prior to implementation (2008–2014). We also analysed IHs according to referral pathways (teledermatology vs. conventional pathways). Results We included 432 consultations (47.7% boys). The main diagnoses were IH, erythematous-desquamative diseases and infections. Concordance in diagnosis between paediatricians and dermatologists was good, and 48.12% of cases consulted via teledermatology were resolved remotely. Response time was 2.81 days on average. Children younger than two months of age showed the highest proportion of in-person visits. In 2015–2018, children with IHs began treatment with propranolol at a mean age of 4.5 months (1.9 months in those referred via teledermatology vs. 5.6 months in those using conventional referral pathways). In 2008–2014, the mean age at referral was 7.1 months. These differences were significant. Discussion Teledermatology is a fast and effective tool to resolve paediatric cases, enabling a significant decrease in the age of treatment in infants with IH.

Cognitively normal women with Alzheimer’s disease proteinopathy show relative preservation of memory but not of hippocampal volume

Background We examined interactive effects of sex, diagnosis, and cerebrospinal fluid (CSF) amyloid beta/phosphorylated tau ratio (Aβ/P-tau) on verbal memory and hippocampal volumes. Methods We assessed 682 participants (350 women) from BioFINDER (250 cognitively normal [CN]; and 432 symptomatic: 186 subjective cognitive decline [SCD], 246 mild cognitive impairment [MCI]). General linear models evaluated effects of Alzheimer’s disease (AD) proteinopathy (CSF Aß/p-tau ratio), diagnosis, and sex on verbal memory (ADAS-cog 10-word recall), semantic fluency (animal naming fluency), visuospatial skills (cube copy), processing speed/attention functions (Symbol Digit Modalities Test and Trail Making Part A), and hippocampal volumes. Results Amyloid-positive (Aβ/P-tau+) CN women (women with preclinical AD) showed memory equivalent to amyloid-negative (Aβ/P-tau−) CN women. In contrast, Aβ/P-tau+ CN men (men with preclinical AD) showed poorer memory than Aβ/P-tau− CN men. Symptomatic groups showed no sex differences in effect of AD proteinopathy on memory. There was no interactive effect of sex, diagnosis, and Aβ/P-tau on other measures of cognition or on hippocampal volume. Conclusions CN women show relatively preserved verbal memory, but not general cognitive reserve or preserved hippocampal volume in the presence of Aβ/P-tau+. Results have implications for diagnosing AD in women, and for clinical trials.

Clinical outcomes of hepatocellular carcinoma variants compared to hepatocellular carcinoma.

435 Background: There is no consensus regarding treatment for HCC variants. Clinical outcomes of HCC variants differ from pure HCC. The aim of this study is to compare clinicopathological characteristics, treatment, and outcomes of HCC variants with pure HCC. Methods: Patients with HCC and variants with 8170/3-8175/3 and 8180/3 ICD-O-3 codes were identified from National Cancer Database between 2004 and 2013. Univariate and multivariate survival analyses were conducted to analyze the association between histology and overall survival (OS). Results: 80,280 patients were identified; pure HCC 78,461 (97.7%), fibrolamellar (FLHCC) 310 (0.4%), scirrhous 161 (0.2%), spindle cell 72 (0.1%), clear cell 487 (0.6%), pleomorphic 23 (0.0%), and combined HCC and cholangiocarcinoma (mixed HCC) 766 (1.0%). 76.7% were male and 72% Caucasian. The mean age was similar in all except FLHCC (37.9 vs. 60.9-64.1 years, p < 0.001). Liver transplant was performed in 10.1% of pure HCC, 14.5% of mixed HCC, 16.2% of scirrhous, 6.9% of spindle cell, 8.8% of clear cell, 8.7% of pleomorphic, and 3.2% of FLHCC (p < 0.001). Pure HCC (10.57%) underwent surgical resection less often than variants; FLHCC (54.8%), clear cell (34.5%), mixed HCC (29.8%), spindle cell (33.3%), pleomorphic (34.8%), and scirrhous (9.9%) (p < 0.001). Ablation was performed in 9.8% of pure HCC, and in up to 8.7% of HCC variants. More than a third of all patients received chemotherapy; pure HCC (42.3%), mixed HCC (38.5%), scirrhous (31.1%), spindle cell (36.1%), clear cell (35.5%), pleomorphic (34.8%), and FLHCC (41.3%). FLHCC had the best 5-year OS (38.7%), spindle cell and pleomorphic had the worst (9.6% and 13.0%). In univariate and multivariate analyses, fibrolamellar histology, female sex, diagnosis between 2009 and 2013, treatment at academic center, well/moderately differentiated histology, early stage, and chemotherapy was associated with better OS compared to pure HCC, male sex, diagnosis between 2004 and 2008, treatment at community cancer program, poorly differentiated, late stage, and no chemotherapy (p < 0.001). Conclusions: HCC variants underwent surgical resection more often than HCC. FLHCC had the best 5-year OS. Liver transplant is commonly performed in HCC variants.

Radiotherapy Cancer Registry (Hospital Based)

Background and context: The cancer registry is the information system designed to collect, manage and analyze the data on persons with malignancy (cancer). The objective of the cancer registry is collecting, classifying, evaluation of data and analysis. The purpose of the cancer registry is to identify the incidence, have cancer awareness program and cancer control activities. Aim: To analyze the demography of cancer patients seen at the Department of Radiation Oncology, Christian Medical College (CMC), Vellore, India during the period 2014-2016 and to categorize the data based on age, sex, type of cancer and geographical distribution. Strategy/Tactics: The Department of Radiation Oncology, CMC, Vellore, used to see 3500 to 5000 new patients annually with various malignancies. To develop a cancer registry, a detailed pro forma having three sections of information about the patient was developed. The first section includes patient identification information such as name, hospital ID, RT number, Hospital Based Cancer Registry (HBCR) number, date of registration, and geographic details of patients. The second section has the demographic details of the patient and the third section has the investigation details, the diagnosis and the treatment. Program/Policy process: In this study, we have collected data for the years 2014, 2015 and 2016 and compiled relating to demographic data such age, sex, diagnosis site, and geographic information. For the past three years period i.e., from 2015 to 2017, there were 3691, 4177 and 5036 new patients annually seen in our outpatient section respectively. From the three years data, distribution of patients with respect to age, sex, diagnosis, state and country were analyzed. Outcomes: The maximum numbers of patient seen were head and neck followed by CNS and gynecologic malignancies. The analysis showed the total number of patients seen was increasing every year. The study when compared with respect to sex distribution, the male patients were more than the female patients. There were patients from various states of India and few patients from abroad. The details of the age group, sex, cancer types and geographical distribution will be presented. What was learned: In conclusion, we used to see patients from different parts of India and abroad annually and the number of cancer cases seen are increasing annually. While analyzing the distribution on the types of cancer, head and neck cancer were the maximum followed by CNS, breast, and gynecologic malignancies. Early detection and diagnosis of cancers, for example, head and neck, cervix, and educating the patients on breast cancer by screening methods and on self-examination methods will help to control prevalence of cancer.