Assessing the Benefits of a One-Stop Medical and Financial Support Program: From the Standpoint of Patients of Eduardo L. Joson Memorial Hospital in the Philippines

This study described the benefits of the Malasakit Center based on the perspectives and experiences of patients of Eduardo L. Joson Memorial Hospital. It employed mixed research methods and interviews as the primary data collection tool. The study was conducted in March 2020 with thirty patients and patient's relatives receiving services of the hospital. Most of the respondents are male and within the age bracket of 30 to 39 years old. All the participants reflected a positive response to Malasakit Center, as it lessened the burden of producing documentary evidences to avail of the services. A procedure observed prior to implementing the Malasakit program. This study also focuses on how the Center made the service more accessible. To further maximize its benefits, information dissemination needs to be widened and its location in the province and in the Philippines should be advertised for increase patronage. Posting of the requirements for availment of Malasakit Center services is likewise essential and may considerably increase the number of applicants for the services of the Center.

Multi-Institutional Validation of a Mammography-Based Breast Cancer Risk Model

PURPOSE Accurate risk assessment is essential for the success of population screening programs in breast cancer. Models with high sensitivity and specificity would enable programs to target more elaborate screening efforts to high-risk populations, while minimizing overtreatment for the rest. Artificial intelligence (AI)-based risk models have demonstrated a significant advance over risk models used today in clinical practice. However, the responsible deployment of novel AI requires careful validation across diverse populations. To this end, we validate our AI-based model, Mirai, across globally diverse screening populations. METHODS We collected screening mammograms and pathology-confirmed breast cancer outcomes from Massachusetts General Hospital, USA; Novant, USA; Emory, USA; Maccabi-Assuta, Israel; Karolinska, Sweden; Chang Gung Memorial Hospital, Taiwan; and Barretos, Brazil. We evaluated Uno's concordance-index for Mirai in predicting risk of breast cancer at one to five years from the mammogram. RESULTS A total of 128,793 mammograms from 62,185 patients were collected across the seven sites, of which 3,815 were followed by a cancer diagnosis within 5 years. Mirai obtained concordance indices of 0.75 (95% CI, 0.72 to 0.78), 0.75 (95% CI, 0.70 to 0.80), 0.77 (95% CI, 0.75 to 0.79), 0.77 (95% CI, 0.73 to 0.81), 0.81 (95% CI, 0.79 to 0.82), 0.79 (95% CI, 0.76 to 0.83), and 0.84 (95% CI, 0.81 to 0.88) at Massachusetts General Hospital, Novant, Emory, Maccabi-Assuta, Karolinska, Chang Gung Memorial Hospital, and Barretos, respectively. CONCLUSION Mirai, a mammography-based risk model, maintained its accuracy across globally diverse test sets from seven hospitals across five countries. This is the broadest validation to date of an AI-based breast cancer model and suggests that the technology can offer broad and equitable improvements in care.

Sickle Cell Disease (SCD) As a Risk for COVI19 Compared to Those without SCD Among Patients Admitted in a Large Urban Center, As Estimated By PCR Sars-v-2 Positive Vs Negative Testing

A diagnosis of SCD is considered to be at risk for COVD19. To further define the association between SCD and infection with COVID-19, we estimated risk, by comparing presence or absence of COVID19 infections in individuals with and without SCD admitted concurrently to a large urban health care facility (Grady Memorial Hospital, Atlanta, GA; 960 beds, 5th largest public hospital in the US). Primary outcome was a positive or negative COVID-19 diagnosis as defined bySARS-CoV-2 PCR testing. A patient was considered to be COVID-19 positive if tested positive withSARS-CoV-2 PCR for the first time, anytime during the study period, irrespective of number of tests. A patient was considered to be COVID-19 negative if patient had no positive tests during the study period, and had one or moreSARS-CoV-2 PCR negative tests. For COVID19 positive patients, the admission of theSARS-CoV-2 PCR positive test was included in the analysis. For COVID19 negative patients, the first admission with aSARS-CoV-2 PCR negative test was considered for analysis. For this interim analysis, SCD was defined by ICD10 and registry data. Clinical diagnosis such as obesity and respiratory failure were defined by ICD10 coding. Data was obtained from quarterly centralized Epic EMR data extractions. Analysis of outcome of COVID19 positive vs negatives was stratified in four separate analysis: all admissions, ICU admissions, those with respiratory failure and those who died. Multivariate dichotomous logistic regression analyses modeled binary outcome effect of SCD, adjusted for age (<40 vs. > 40 years), sex at birth (females vs. males) and obesity (SAS version 9.4 was used for statistical analyses and overall significance level was set at 0.05). To ensure population homogeneity analysis was conducted on patient ages 20 to 60 years that were Black/African American and admitted from the Emergency Department for a short stay and/or the medicine service (variable interactions at a p<0.01). The study was approved by the institutional review board and by the hospital research oversight committee. Overall, between 3/23/2020 and 6/30/2020, 23697 patients were admitted once or more to Grady Memorial Hospital with one or more PCR sars-cov-2 test, of these 405 were patients with SCD (1.7%). Of the total, 2566 patients (10.8%) tested positive for COVID-19, and 48 patients with SCD (11.8%) were positive. Of 7041 (29.7%) were part of the study population, 332 (4.7%) where patients with SCD (hemoglobin [hb] SS/Sbeta0 =252, hbSC n=55, hbS beta thalassemia+ or hbS beta thalassemia undetermined n=21). Among patients without SCD, 36.3% were female, (n=2557) and among patients with SCD, 53.6% (n=178). The mean age of patients without SCD was: 51.1 years (standard deviation [std]) +/- 19.5 years), and for those with SCD: 35.0 years (std +/- 12.0 years). Results of univariate and multivariate analysis are presented in the table. In conclusion, in a Black/African American patients admitted from the Emergency Room for observation and/or the internal medicine service, when adjusted for age, gender and obesity, with SCD are at a significant increased risk for admissions with COVID-19 infection in general as well as ICU admission or admission with respiratory failures. Further studies can help articulate the risk associated with SCD as well as its potential interaction with other factors, with attention to confounders. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

592 ATR-mediated CD47 and PD-L1 upregulation restricts radiotherapy-induced immune priming and abscopal responses in colorectal cancer

BackgroundBackground: Radiotherapy of colorectal cancer (CRC) can prime adaptive immunity against tumor-associated antigen (TAA)-expressing CRC cells systemically; however, incidences of abscopal tumor remission are extremely rare. We sought to unravel the post-irradiation immune escape mechanisms in CRC.MethodsMethodsFlow cytometry, gene knockdown, RNA and T cell receptor sequencing, and multiple murine syngeneic CRC models were used to interrogate mechanisms of CRC immune evasion following radiotherapy. Comparison of immunohistochemistry staining between pretreatment biopsy and post-irradiation surgical specimens was performed in rectal patients who underwent neoadjuvant radiotherapy with 5 Gy for 5 fractions.ResultsResultsWe find that CRC cells utilize a common DNA repair signaling pathway — ATR/Chk1/STAT3 — to upregulate both CD47 and PD-L1 in response to radiotherapy, which through engagement of SIRPα and PD-1 suppresses the capacity of antigen-presenting cells (APCs) to phagocytose them thereby preventing TAA cross-presentation. This post-irradiation CD47 and PD-L1 upregulation can be observed in CRC cells treated with either photon or proton radiotherapy and across a wide variety of human solid tumor cells. Concordantly, rectal cancer patients who responded poorly (tumor regression grade 4–5, n = 10) to neoadjuvant radiotherapy exhibited significantly elevated post-irradiation CD47 levels (P = 0.005). In murine CRC models, the combination of radiotherapy, αSIRPα, and αPD-1 (RSP) profoundly enhances TAA uptake, activation of innate immune sensors, and TAA cross-priming across various antigen-presenting myeloid populations in the irradiated tumor microenvironment and facilitates TAA-presenting APC migration to secondary lymphoid organs. Furthermore, we observed robust production of TAA-specific CD8 T cells, functional activation of effector T cells, and increased tumor-infiltrating T cell clonality and clonal diversity in mice treated with RSP. Importantly, radiotherapy coupled with phagocytosis checkpoint blockade significantly improves complete response rates in both irradiated and abscopal tumors and prolongs survival in three distinct murine CRC models, including a cecal orthotopic model. In addition, αSIRPα exerts superior tumoricidal efficacy than αCD47 in combination with RT and αPD-1. We find RSP efficacy to be STING dependent as knockout animals lose most benefit of phagocytosis checkpoint blockade.ConclusionATR-mediated CD47 and PD-L1 upregulation restrains radiation-induced immune priming in CRC. Blockade of the phagocytosis checkpoints SIRPα and PD-1 during radiotherapy promotes vigorous anti-CRC immune priming leading to systemic tumor regression.AcknowledgementsThis study is supported in part by NIH grant P30 CA16672, the MD Anderson Andrew Sabin Family Fellowship, and Chang Gung Memorial Hospital grant CMRPG3K1751. RCH was supported by the CPRIT Research Training Grant (RP170067) and Ralph B. Arlinghaus Ph.D. Scholarship. The authors are grateful to the members of the Advanced Cytometry & Sorting Facility at South Campus, Tissue Bank of Chang Gung Memorial Hospital at Linkou, and MHC Tetramer Core Facility at Baylor College of Medicine for their invaluable help.Ethics ApprovalThis study was approved by the Institutional Review Board of Chang Gung Memorial Hospital, Taiwan; approval number: 202001191B0C601.

USE OF PRELACTEAL FEEDS- STUDY IN TRADITION

Objective: To find the types and frequency of prelacteal use, factors influencing their use and its impact on breastfeeding. Study Design: Cross-sectional study. Place and Duration of Study: Fatima Memorial Hospital, Lahore, Pakistan from Jul to Dec 2019. Methodology: In the study, mothers and female attendants of newborn babies were interviewed following a specific questionnaire. The given answers were recorded and captured data about socio-demographics, knowledge, attitude and actual practices of mothers and families related to use of prelacteals. The results were analysed using SPSS 22. Results: We interviewed 1601 mothers and female attendants of neonates. The mean age was 32.3 ± 8.2 years. Most of the females were married (1211, 75.6%) and resided in Lahore (1281, 80%). About one third, 581 (36.3%) were either illiterate or had inadequate schooling. Two-thirds (1000, 62.5%) of women wanted to give some prelacteal feed soon after birth. Honey was the most the commonest choice (in 722, 45.1%), seconded by ghutti (107, 6.7%). Most females (1467, 91.6%) wanted to give colostrum, and 1552 (96.9%) would breastfeed the baby. 1221 (75.2%) wanted to start mother-feed immediately or within 2 hours of birth. Conclusion: The use of prelacteal is common in Pakistan culture. A consistent effort is needed to counter the unsafe prelacteal use.

Measurements of Dimensions of Nasopalatine Canal Using Cone Beam Computed Tomography in Patients Reporting to A Local Tertiary Care Dental Hospital in Lahore

Objective: To measure the mean length and width of NPC in patients reporting to Fatima Memorial hospital Lahore, for implant surgery. Methods: This crossectional study was conducted at Department of Periodontology, Fatima Memorial Hospital, Lahore. Fatima Memorial Hospital is a tertiary care dental hospital affiliated with University of Health Sciences. After taking informed written consent history was taken, clinical examination was done and CBCT from SIRONA CBCT machine will be taken to assess the outcome i.e the mean length and width of NPC. Result: Total of 72 patients requiring CBCT for dental procedures were included. 38 patients were males (52.8%) & 34 patients were females (47.2%) with the mean age of 40.944+7.507 years. The mean length and width of Nasopalatine canal (NPC) was 8.787+1.534 mm and 3.919+0.738 mm respectively. Conclusion: Significant differences in nasopalatine canal length and width were observed among the patients and CBCT was useful in determining nasopalatine canal length and width before implant placement Key words: Cone-Beam Computed Tomography; nasopalatine canal, length, width

Comparison of Supraclavicular Artery Flap and Skin Graft in Management of Neck Contractures

Background: Burn cases are highly prevalent in developing countries like Pakistan. If not managed timely they can result in lifetime complications as well as morbidity. Aim: To compare the supraclavicular artery flap method with skin graft. Place and duration of study: Department of Plastic Surgery, Allama Iqbal Memorial Hospital, Sialkot from 1st September 2015 to 31st August 2019. Methodology: In this comparative study forty four patients were enrolled and half were operated by supraclavicular artery flap method and other half by skin graft procedure. The patients were followed for their skin contour, colour matching and neck extension improvement and recurrent neck contracture after a year. Results: Mean age of the patients was 29.5 years with 75% as females. Only one patient had recurrent neck contracture from supraclavicular artery flap group while 81.8% of skin graft showed recurrent neck contracture Conclusion: Supraclavicular artery flap is a better management approach in post neck contracture burn patients. Key words: Supravlaciular artery flap, Skin graft, Neck contractures