VCAM-1 Is Upregulated in Uranium Miners Compared to Other Miners

The United States has a rich history of mining including uranium (U)-mining, coal mining, and other metal mining. Cardiovascular diseases (CVD) are largely understudied in miners and recent literature suggests that when compared to non-U miners, U-miners are more likely to report CVD. However, the molecular basis for this phenomenon is currently unknown. In this pilot study, a New Mexico (NM)-based occupational cohort of current and former miners (n = 44) were recruited via a mobile screening clinic for miners. Serum- and endothelial-based endpoints were used to assess circulating inflammatory potential relevant to CVD. Non-U miners reported significantly fewer pack years of smoking than U-miners. Circulating biomarkers of interest revealed that U-miners had significantly greater serum amyloid A (SAA), soluble intercellular adhesion molecule 1 (ICAM-1, ng/mL), soluble vascular cell adhesion molecule 1 (VCAM-1, ng/mL), and VCAM-1 mRNA expression, as determined by the serum cumulative inflammatory potential (SCIP) assay, an endothelial-based assay. Even after adjusting for various covariates, including age, multivariable analysis determined that U-miners had significantly upregulated VCAM-1 mRNA. In conclusion, VCAM-1 may be an important biomarker and possible contributor of CVD in U-miners. Further research to explore this mechanism may be warranted.

NCOG-37. THE UTILITY OF NEUROPSYCHOLOGICAL SCREENING IN MULTIDISCIPLINARY CLINICS FOR PEDIATRIC NEURO-ONCOLOGY POPULATIONS

BACKGROUND The purpose of this project was to examine the utility of neuropsychological screening in multidisciplinary clinics for pediatric neuro-oncology populations and determine whether a brief evaluation can adequately screen children for cognitive dysfunction or psychiatric comorbidities. METHODS Children underwent neuropsychological screening as part of their multidisciplinary clinic visit. This screening evaluation consisted of clinical interview, neuropsychological testing, and the completion of emotional/behavioral checklists. Our neuropsychological test battery included the Kaufman Brief Intelligence Test-Second Edition (KBIT-2) and the NIH Toolbox Fluid Cognition Composite (consisting of 6 subtests). RESULTS Over a six-month period 40 children and adolescents with CNS tumors and/or NF1 were seen in our neuropsychology screening clinic. Females made up 37.5% of the sample. The average age was 11.1 years (range=5-25 years). The average time to complete neuropsychological testing was 56.8 minutes. On average, children in this sample met criteria for 1.8 neuropsychological diagnoses with an average of 1.2 new diagnoses that had not been given prior to their neuropsychological screening. The most common new diagnoses were major or mild neurocognitive disorder (mild=27.5%, major=20%), anxiety (27.5%), ADHD (15%), mood disorder (12.5%), and intellectual disability (10%). On average, these children performed lower than expectation on neurocognitive tests, including intellectual functioning (KBIT-2 Verbal IQ=93.1; KBIT-2 Nonverbal IQ=88.7; KBIT-2 Total IQ=90.1), attention (NIH Flanker T-Score=44.1), working memory (NIH Working Memory T-Score=42.9), processing speed (NIH Processing Speed T-Score=39.9), cognitive flexibility (NIH Card Sort T-Score=43.4), memory (NIH Picture Memory T-Score=44.5), and fluid cognition (NIH Fluid Cognition Composite T-Score=38.7). Behavioral health recommendations were needed for 72.5% of this sample. Educational recommendations were needed for 62.5%. CONCLUSIONS Brief neuropsychological screening completed as part of multidisciplinary clinics for pediatric neuro-oncology patients was efficient and useful in identifying neuropsychological diagnoses in children.

Evaluation of an oncology diagnostic and screening clinic at a large safety net hospital.

94 Background: Increasingly, dedicated clinics have been established to expedite patients with suspicion of malignancy into cancer care. The Lyndon B. Johnson General Hospital (LBJGH) is part of the Harris County Hospital District (HCHD), serving the third largest county in the United States. A 2012 study at our institution found long mean ambulatory wait times for the diagnosis of breast, colon, and lung cancers (77.1 days, 65.4 days, and 70.8 days, respectively). The LBJGH Oncology Diagnostic and Screening clinic (DSC) was subsequently established to reduce ambulatory diagnostic times, decrease frequency of admissions, and improve patient outcomes. Our present study sought to establish the effectiveness of the DSC in bringing patients into care. Methods: The charts of 100 new patients seen in the DSC between August 2018 and November 2020 were reviewed. Demographic data, insurance status, date of referral to the DSC, date of first DSC visit, date biopsy or outside pathology ordered, date biopsy performed or outside pathology obtained, total number of visits to the DSC, and total time from initial DSC visit to initial oncology clinic visit were collected, as well as cancer stage upon arrival to the oncology clinic. The project was approved by the MD Anderson Quality Improvement Assessment Board and the Harris Health Quality Improvement Committee. Results: 57% of patients seen in the DSC were referred by the emergency department, and 23% by a PCP. The median time from referral to initial visit in the DSC was 19 days. 26% of patients had a known cancer diagnosis at the time of referral. The median time from biopsy ordered to performed was 39 days, and the median time from pathology requested to obtained was 23 days. The median total number of visits per patient to the DSC was 2. 48% of patients seen in the DSC were ultimately diagnosed with cancer, 29% had a benign condition, and 23% were lost to follow up. Of those patients with confirmed malignancy, 46% of patients had stage IV disease at their first oncology clinic visit. The average time from initial DSC visit to initial visit at the oncology clinic was 53 days. Conclusions: Establishment of an oncology DSC has improved the ambulatory wait time for entry into oncologic care from an average of approximately 70 days to an average of 53 days. However, almost half of patients referred from the DSC had stage IV disease at their initial oncology visit, indicating an urgent need to further expedite entry of these patients into oncologic care. Avenues for future quality improvement efforts include an expedited process to obtain outside pathology results, implementation of an “e-consult” option for PCPs to avoid unnecessary referrals, and a close analysis of insurance and financial barriers to entry into care. Reference: Mougalian SS, Wang J, Zarzour M et al. Feasibility and savings of a suspicion of cancer clinic at a large county hospital. JCO 2012; 30 (34 supplement): 104.

Effective response to a regional outbreak of COVID-19 – Experience of a tertiary emergency center

Objective: This study evaluates the usefulness, safety, and outcomes of operating a pretriage screening clinic and an expanded preemptive quarantine area in the ED during a regional COVID-19 outbreak. Methods: A descriptive cross-sectional, retrospective study conducted in a single institution. General patient demographic data, initial vital sign, symptoms, and patient outcome was collected from January to March of 2020. Data were compared according to the implementation of a new protocol involving pretriage screening and risk stratification. Outcome was also analyzed according to quarantine areas, including conventional, negative pressured, cohort, or preemptive quarantine area. Results: The pretriage clinic lowered the volume of low severity patients entering emergency department. Preemptive and cohort quarantine area provided more care to febrile patients compared to conventional quarantine area with longer length of hospital stay and lower mortality. After implementing the new protocol, emergency department in the study hospital was not closed again. Conclusions: In a regional outbreak of an epidemic, pretriage clinic safely screened infectious patients from entering ED. Expanded preemptive quarantine area increased surge capacity on quarantine area. An infectious disease protocol implementing two treatment area may contribute to preserve and maintain ED function.

Awareness and knowledge about glaucoma among patients visiting the screening clinic in Jeddah Eye Hospital, Saudi Arabia

AIM: To explore levels and determinants of awareness and knowledge about glaucoma among patients. METHODS: This was a cross-sectional study that included adult patients from October to the end of December 2018. A semi-structured questionnaire was designed by the researchers to measure the levels of awareness and knowledge about 18 basic information about glaucoma. The sheet was divided into 4 domains: types of glaucoma, risk factors, clinical features, and management. A knowledge score (KS, range=0-18) was calculated, with higher scores indicating higher levels. RESULTS: A total of 383 patients responded to the questionnaire, 61.9% males, mean±SD age was 38.5±12.94 years old, and 61.6% had a university degree or higher. Of them, 6.3% and 23.2% reported personal and family history of glaucoma, respectively. The most frequently reported source of information about glaucoma was another person with glaucoma (28.2%), followed by physicians (24.8%) and TV (19.6%). Knowledge by item ranged from 3.1% to 82.5% correctness rate, while KS showed mean=5.91 and median=5; and reliability testing of the knowledge scale showed Cronbach’s alpha=0.782. Higher KS were found among respondents with higher educational level (P=0.036), diabetes history (P=0.025), and personal (P<0.001) and family (P<0.001) history of glaucoma. CONCLUSION: This study reveals low awareness and knowledge levels about glaucoma among the attendees of a local eye care hospital, where several misconceptions about disease risk factors, clinical features, and management are identified.

Clinical Characteristics of the First 100 Patients of COVID-19 in Tobruk, Libya: A Brief Report from Low-Resource Settings

ABSTRACT Objective: This study aims to report the clinical features of a cohort of patients with suspected COVID-19 from Tobruk, Libya and reflect upon the diagnosis challenge in low-resource settings. Methods: A descriptive report of the first 100 patients with suspected COVID-19 who have visited the SARS-Cov-2 (Severe Acute Respiratory Syndrome-related Coronavirus-2) (COVID-19) screening clinic at the National Centre for Disease Control (NCDC) in Tobruk, Libya. Results: The most common presenting symptoms were fever (90%), cough (89%), dyspnoea (85%), sore throat (79%), fatigue (78%), headache (64%), loss of smell (52%), loss of taste (53%), loss of appetite (43), nausea and vomiting (26%), diarrhoea (22%), and rhinorrhea (16%). 51% of the patients had lymphocytopenia while 13% had thrombocytopenia. Bilateral infiltrates was the most common radiologic finding on chest X-ray (76%), and COVID-19 IgM and /or IgG antibodies were detected in 80% of the patients, while only 37% of the patients were tested positive by the RT-PCR. Conclusions: The disease continued its spread across the region. Fever, cough and dyspnoea were the main symptoms. 21% of the patients did not have any CXR abnormalities. Initial negative results for either antibody testing or RT-PCR-testing for COVID-19 do not rule out the infection.