Prioritisation of colonoscopy services in colorectal cancer screening programmes to minimise impact of COVID-19 pandemic on predicted cancer burden: A comparative modelling study

Objectives Colorectal cancer (CRC) screening with a faecal immunochemical test (FIT) has been disrupted in many countries during the COVID-19 pandemic. Performing catch-up of missed screens while maintaining regular screening services requires additional colonoscopy capacity that may not be available. This study aimed to compare strategies that clear the screening backlog using limited colonoscopy resources. Methods A range of strategies were simulated using four country-specific CRC natural-history models: Adenoma and Serrated pathway to Colorectal CAncer (ASCCA) and MIcrosimulation SCreening ANalysis for CRC (MISCAN-Colon) (both in the Netherlands), Policy1-Bowel (Australia) and OncoSim (Canada). Strategies assumed a 3-month screening disruption with varying recovery period lengths (6, 12, and 24 months) and varying FIT thresholds for diagnostic colonoscopy. Increasing the FIT threshold reduces the number of referrals to diagnostic colonoscopy. Outcomes for each strategy were colonoscopy demand and excess CRC-related deaths due to the disruption. Results Performing catch-up using the regular FIT threshold in 6, 12 and 24 months could prevent most excess CRC-related deaths, but required 50%, 25% and 12.5% additional colonoscopy demand, respectively. Without exceeding usual colonoscopy demand, up to 60% of excess CRC-related deaths can be prevented by increasing the FIT threshold for 12 or 24 months. Large increases in FIT threshold could lead to additional deaths rather than preventing them. Conclusions Clearing the screening backlog in 24 months could avert most excess CRC-related deaths due to a 3-month disruption but would require a small increase in colonoscopy demand. Increasing the FIT threshold slightly over 24 months could ease the pressure on colonoscopy resources.

Cost effectiveness of screening for intracranial aneurysms among patients with bicuspid aortic valve: a Markov modelling study

ObjectiveBicuspid aortic valve (BAV) is common and 7.7%–9.8% of patients with BAV have intracranial aneuryms (IAs) which might lead to a devastating subarachnoid haemorrhage (SAH). We aimed to evaluate different screening and follow-up strategies using magnetic resonance angiography for IAs among patients with BAV.MethodsA decision-analytic model was built to evaluate the costs and effectiveness of different management strategies from the Chinese healthcare payer’s perspective. The evaluated strategies included natural history without screening for possible IAs, regular screening and no follow-up for detected IAs, and regular screening with regular follow-up (Screen strategy/Follow-up strategy). Base case calculation, as well as probabilistic, one-way, and two-way sensitivity analyses, were performed.ResultsAccording to the base case calculation, natural history had the least cost and effectiveness while Every 5 years (y)/Annual gained the highest cost and effectiveness. Every 10y/Biennial was cost effective when compared with Every 10y/Every 5y under the willingness-to-pay threshold of ¥211 743 (US$30 162). Probabilistic sensitivity analysis showed that Every 10y/Biennial was superior in 88.3% of the cases when compared with Every 10y/Every 5y. One-way and two-way sensitivity analyses proved that Every 10y/Biennial was the dominant strategy under most circumstances.ConclusionsScreening for possible IAs among patients with BAV and follow-up for detected IAs would increase the effectiveness. Every 10y/Biennial was the optimal strategy from the Chinese healthcare payer’s perspective.

Psychological Distress, Burden of Care, and the Role of Coping Strategies Among Childminders in Residential Children’s Homes

This study aimed to identify the prevalence of psychological distress and its association with sociodemographic characteristics, burden of care, and the coping strategies used by childminders in residential homes. A total of 151 childminders (median age = 39; 64.7% female) participated in the study. The prevalence of psychological distress was 59.4%, and 74.0% recorded mild to moderate burden. Multivariate analyses showed that caregiver burden (adjusted beta = 0.464, P = .01), lesser application of problem-focused coping (adjusted beta = −0.292, P = .012), lower salary (adjusted beta = −0.196, P = .040), and lower educational qualification (adjusted beta = −0.212, P = .038) predicted higher psychological distress. Regular screening of psychological distress and burden of care is recommended among this population.

One-Year Course of Olanzapine-Induced Diabetic Ketoacidosis: A Case Report

Second-generation antipsychotics, despite being highly effective, are among the drugs known to cause insulin resistance and metabolic syndrome, eventually leading to diabetes mellitus and less commonly diabetic ketoacidosis (DKA). Here, we present the case of a 21-year-old male, who was not previously known to have any comorbid factors but presented with DKA 1 year and 9 months after beginning treatment with olanzapine for an unspecified psychotic disorder requiring hospital admission and the resolution of the same following discontinuation of the drug. Our case report emphasizes the need for regular screening of patients requiring diabetogenic drugs, so that early identification of possible side effects can be noted and averted.

Serological and Molecular Screening of Camels for Brucellosis in Bikaner, Rajasthan, India

Brucellosis is an important zoonotic disease affecting domestic animals and humans worldwide. The present study was undertaken on camels in and around Bikaner city of Rajasthan state of India to assess the extent of prevalence of Brucellosis in camels in this region. Since Rose Bengal Plate test (RBPT) is a serological screening method for diagnosis of Brucellosis approved by the Office International des Epizooties (OIE), RBPT was employed for detecting antibodies against Brucella organisms in camels. Polymerase Chain Reaction is widely followed for molecular diagnosis of several infectious diseases. DNA from whole blood of camels was analyzed by PCR for detection of Brucella organisms in the blood of camels. Blood samples from 177 camels (108 males and 69 females) from Bikaner and nearby villages were analyzed for Brucellosis by RBPT. Fifteen camels [7 (46.66%) males and 8 (53.33%) females] were found positive. However, none of the DNA samples from whole blood (RBPT positive or negative) from 25 camels tested was Brucella positive by PCR. The serological results indicate that Brucellosis is prevalent in camels and is of public health significance in Bikaner and nearby villages in Rajasthan state of India. However, detection of DNA of Brucella organisms in blood by PCR may not be advised for regular screening for Brucellosis since there is intermittent bacteremia in Brucellosis and Brucella DNA may not be detectable in blood continuously throughout the course of the disease. This reminds us that the OIE has approved RBPT, but not PCR for screening of Brucellosis.

A Novel Retinal Vascular Feature and Machine Learning-based Brain White Matter Lesion Prediction Model

White matter lesion (WML) is one of the common cerebral abnormalities, it indicates changes in the white matter of human brain and have shown significant association with stroke, dementia and deaths. Magnetic resonance imaging (MRI) of the brain is frequently used to diagnose white matter lesion (WML) volume. Regular screening can detect WML in early stage and save from severe consequences. Current option of MRI based diagnosis is impractical for regular screening because of its high expense and unavailability. Thus, earlier screening and prediction of the WML volume/load specially in the rural and remote areas becomes extremely difficult. Research has shown that changes in the retinal micro vascular system reflect changes in the cerebral micro vascular system. Using this information, we have proposed a retinal image based WML volume and severity prediction model which is very convenient and easy to operate. Our proposed model can help the physicians to detect the patients who need immediate and further MRI based detail diagnosis of WML. Our model uses quantified measurement of retinal micro-vascular signs (such as arteriovenular nicking (AVN), Opacity (OP) and focal arteriolar narrowing (FAN)) as input and estimate the WML volume/load and classify its severity. We evaluate our proposed model on a dataset of 111 patients taken from the ENVISion study which have retinal and MRI images for each patient. Our model shows high accuracy in estimating the WML volume, mean square error (MSE) between our predicted WML load and manually annotated WML load is 0.15. The proposed model achieves an F1 score of 0.92 in classifying the patients having mild and severe WML load. The preliminary results of our study indicate that quantified measurement of retinal micro-vascular features (AVN, OP and FAN) can more accurately identify the patients who have high risk of cardio-vascular diseases and dementia.

Screening Practices among First Degree Relatives of Breast Cancer Patients in Nepal: A Cross-sectional Study

Objective: Family history is a significant risk factor for development of breast cancer, particularly for women of first-degree relatives. For women at high risk for breast cancer, regular screening is the mainstay of risk management. This study aims to find out the breast cancer screening practices among first degree relatives of breast cancer patient. Methods: A cross-sectional study was carried out among 150 purposively selected first-degree female relatives of breast cancer patients undergoing treatment at B.P Koirala Memorial Cancer Hospital, aged between 20 and 60 years. A semi-structured questionnaire was used to collect data by face to face interview, which included socio-demographic characteristics, personal history, awareness on breast cancer and screening practices. Results: The mean age of the participants was 37.6 years (SD 10.9). A total of 116 (77.3%) women had ever practiced breast self-examination (regular=34.7%; irregular= 42.7%) and 42 (28.0%) had ever practiced clinical breast examination (regular=14.7%; irregular=13.3%). Only 10 percent of the women had performed mammogram regularly. Only two-fifth of them had a high level of awareness on risk factors and warning signs of breast cancer. Conclusions: This study showed a low rate of regular screening practices among the first degree relatives of breast cancer patients. There is a need to provide comprehensive, and inclusive information and support and interventions aimed at increasing awareness of the importance of healthy behaviors in cancer prevention among these high-risk groups.

Self-testing and vaccination against COVID-19 to minimize school closure

Schools were largely closed in 2020-2021 to counter COVID-19 spread, impacting students' education and well-being. With highly contagious variants expanding in Europe while vaccine hesitancy persists, safe options to maintain schools open are urgently needed. We developed an agent-based model of SARS-CoV-2 transmission in school. We used empirical contact data measured in a primary and a secondary school in France, and field estimates for adherence to screening from 683 schools during the spring 2021 wave. Examining different screening protocols, we performed a cost-benefit analysis for varying epidemic conditions and vaccination scenarios. In a partially immunized school population, weekly screening would reduce the number of cases on average by 24% in the primary and 53% in the secondary school compared to symptom-based testing alone, if R=1.3 and 50% adhered to screening. This adherence was met in primary schools (53% (95% confidence interval 21-85%)), but insufficient participation was recorded in secondary schools (10% (1-38%) in middle schools, 6% (2-12%) in high schools). Regular screening would also reduce by 90% the number of student-days lost compared to reactive class closure. No difference was predicted when fully vaccinating teachers, due to their limited number and mixing. Partially vaccinating adolescents would still require regular screening for additional control (20% case reduction with 50% vaccinated students). In the upcoming fall, COVID-19 epidemic will likely continue to pose a risk to the safe opening of schools. Increasing vaccination coverage in adolescents and implementing regular testing while largely incentivizing adherence are essential steps to keep schools open.

Evaluation of the frequency and patterns of thyroid dysfunction in patients with metabolic syndrome

Background Metabolic syndrome (MetS) and thyroid dysfunction have a degree of close association, and each of them affects the other. Due to the associated cardiovascular events, MetS has increased morbidity and mortality. The study tried to detect the frequency of thyroid function in patients with MetS. This is a case control study that recruited 100 patients with MetS and 100 healthy control subjects. Results Patients with MetS had significantly higher body mass index and waist circumference. Also, frequency of thyroid dysfunction was significantly higher in MetS group (32% vs. 9%; P<0.001). The most frequent form of thyroid dysfunction was subclinical hypothyroidism: 21% of the MetS group and 6% of the control group. Out of the studied patients with MetS, 13 (13%) patients had three criteria, 55 (55%) patients had four criteria, and 32 (32%) patients had five criteria for MetS. Conclusion Patients with MetS are vulnerable to develop thyroid dysfunction mainly subclinical hypothyroidism. So, it is recommended to perform regular screening for those patients as regard thyroid dysfunction.