Association between exposure to radioactive iodine after the Chernobyl accident and thyroid volume in Belarus 10-15 years later

Background While there is a robust literature on environmental exposure to iodine-131 (131I) in childhood and adolescence and the risk of thyroid cancer and benign nodules, little is known about its effects on thyroid volume. Methods To assess the effect of 131I dose to the thyroid on the volume of the thyroid gland, we examined the data from the baseline screening of the Belarusian-American Cohort Study of residents of Belarus who were exposed to the Chernobyl fallout at ages ≤18 years. Thyroid dose estimates were based on individual thyroid activity measurements made shortly after the accident and dosimetric data from questionnaires obtained 10-15 years later at baseline screening. During baseline screening, thyroid gland volume was assessed from thyroid ultrasound measurements. The association between radiation dose and thyroid volume was modeled using linear regression where radiation dose was expressed with power terms to address non-linearity. The model was adjusted for attained age, sex, and place of residence, and their modifying effects were examined. Results The analysis was based on 10,703 subjects. We found a statistically significant positive association between radiation dose and thyroid volume (P < 0.001). Heterogeneity of association was observed by attained age (P < 0.001) with statistically significant association remaining only in the subgroup of ≥18 years at screening (P < 0.001). For this group, increase in dose from 0.0005 to 0.15 Gy was associated with a 1.27 ml (95% CI: 0.46, 2.07) increase in thyroid volume. The estimated effect did not change with increasing doses above 0.15 Gy. Conclusions This is the first study to examine the association between 131I dose to the thyroid gland and thyroid volume in a population of individuals exposed during childhood and systematically screened 10-15 years later. It provides evidence for a moderate statistically significant increase in thyroid volume among those who were ≥ 18 years at screening. Given that this effect was observed at very low doses and was restricted to a narrow dose range, further studies are necessary to better understand the effect.

Mission-Based Filters in the Electronic Residency Application Service: Saving Time and Promoting Diversity

ABSTRACT Background Holistic review promotes diversity, but widespread implementation remains limited. Objective We aimed to develop a practical approach to incorporate holistic review principles in screening applicants in the Electronic Residency Application Service (ERAS) and to assess the impact on diversity. Methods Three residency programs (internal medicine [IM], pediatrics, and surgery) at McGovern Medical School developed filters to identify applicants with experiences/attributes aligned with the institutional mission. These filters were retroactively applied to each program's 2019–2020 applicant pool using built-in ERAS capabilities to group applicants by user-defined features. We compared the demographics of applicants reviewed during the cycle with those identified retrospectively through experiences/attributes filters. Results The IM, pediatrics, and surgery programs received 3527, 1341, and 1313 applications, respectively, in 2019–2020. Retrospective use of experiences/attributes filters, without scores, narrowed the IM applicant pool for review to 1301 compared to 1323 applicants reviewed during actual recruitment, while the pediatrics filters identified 514 applicants compared to 384 at baseline. The surgery filters resulted in 582 applicants, but data were missing for baseline comparison. Compared to the baseline screening approach utilizing scores, mission-based filters increased the proportions of underrepresented in medicine applicants selected for review in IM (54.8% [95% CI 52.1–57.5] vs 22.7% [20.4–24.9], P &lt; .0001) and pediatrics (63.2% [95% CI 59.1–67.4] vs 25.3% [20.9–29.6], P &lt; .0001). Conclusions Program directors can leverage existing ERAS features to conduct application screening in alignment with holistic review principles. Widespread implementation could have important repercussions for enhancing physician workforce diversity.

Effect of a synthetic feline facial pheromone product on stress during transport in domestic cats: a randomised controlled pilot study

Objectives Transport can be a stressful experience for domestic cats. The objective of this study was to evaluate the effect of a new synthetic feline facial pheromone product on relieving stress in domestic cats during short-distance transport. Methods A randomised, blinded, placebo-controlled pilot study was conducted. Prior to baseline screening, cat owners were trained via online meetings in the assessment of stress-related behaviours and overall stress visual analogue scoring. All assessments were completed 30 mins after the start of transport. A total of 150 domestic cats exhibiting stress-related behaviours during baseline screening were recruited and randomly assigned to either the treatment group (n = 75) or the placebo group (n = 75). For the placebo-controlled intervention, the product and placebo, which were identical in appearance, were provided to the treatment and placebo groups, respectively. Fifteen minutes after spraying the carriers with the product or placebo, cat owners were required to take their cat out and complete the same assessments (baseline screening). Results After the intervention, the performance of the stress-related behaviours curling, lack of motion and meowing during transport outside the home was significantly reduced in the treatment group compared with the placebo group ( P <0.05). When the baseline stress visual analogue scale (VAS) score was >2.94 cm, cats in the treatment group had significantly lower post-intervention stress VAS scores compared with those in the placebo group ( P <0.05). Conclusions and relevance A synthetic feline facial pheromone product can alleviate short-distance transport-related stress in domestic cats with higher stress scores. This finding will benefit domestic cats during transport outside of the home.

Rama Co-RADS: Categorical Assessment Scheme of Chest Radiographic Findings for Diagnosing Pneumonia in Patients With Confirmed COVID-19

Due to the rapid spread of COVID-19 during the third wave of infection in Thailand, the number of confirmed COVID-19 cases has increased exponentially since April 2021. As a result, the country’s healthcare facilities and personnel are overwhelmed. Hence, many new intervention strategies have been designed and implemented. In such a resource-constrained condition, multiple alternate care sites, such as converted hotels (the so-called hospitels) and mobile field medical units, have been established for quarantine and taking care of confirmed COVID-19 cases having no or mild symptoms. In this context, it is essential to have clinical and chest radiographic assessment as a baseline screening for an accurate and rapid triage of patients and early detection of COVID-19 pneumonia, which significantly impacts patient outcomes. Therefore, a clear, concise and standardized chest radiographic report is mandatory. To facilitate this process, the authors have introduced Rama Co-RADS for the categorical assessment scheme of pulmonary involvement in COVID-19. After the pilot implementation of Rama Co-RADS in the routine radiology workflow for chest radiography screening in patients with confirmed COVID-19 at the Ramathibodi Hospitels, there is a 24% reduction in the median turnaround radiology reporting time. It also enhances the radiologist’s performance in establishing the diagnosis of COVID-19 pneumonia (especially in the early phase). Furthermore, the categorical assessment scheme in Rama Co-RADS facilitates communication among healthcare personnel, guiding effective management, triage, consultation and treatment of patients with confirmed COVID-19.

Anti-VEGF-resistant subretinal fluid is associated with better vision and reduced risk of macular atrophy

Background/aimTo evaluate relationships between subretinal fluid (SRF), macular atrophy (MA) and visual outcomes in ranibizumab-treated neovascular age-related macular degeneration (nAMD).MethodsThis post hoc HARBOR trial (NCT00891735) analysis included ranibizumab-treated (0.5 or 2.0 mg, monthly or as-needed, all treatment arms pooled) eyes with nAMD and baseline (screening, baseline and week 1) SRF. SRF presence, SRF thickness (0, >0–50, >50–100 and >100 µm) and subretinal fluid volume (SRFV) were determined by spectral domain optical coherence tomography (SD-OCT). Best-corrected visual acuity (BCVA) was assessed. MA was identified using fluorescein angiograms and colour fundus photographs, as well as SD-OCT.ResultsSeven hundred eighty-five of 1097 eyes met analysis criteria. In eyes without baseline MA, residual versus no SRF at month (M) 3 was associated with lower MA rates at M12 (5.1% vs 22.1%) and M24 (13.3% vs 31.2%) (both p<0.0001); MA percentages at M12/M24 were similar among patients with residual SRF at M6. Higher baseline SRFV was associated with a lower MA rate. Greater mean BCVA was observed with residual SRF of any thickness (>0–50 µm, 71.2 letters; >50–100 µm, 71.3 letters; >100 µm, 69.2 letters) versus no SRF (63.6 letters), but the change in BCVA from baseline to M12 or M24 was the same for eyes with or without treatment-resistant subretinal fluid (TR-SRF) at M3 or M6.ConclusionTR-SRF was not detrimental to vision outcomes over 2 years, regardless of thickness. MA rates were significantly higher without TR-SRF.

POS1153 EFFECTIVENESS OF SCREENING IN PATIENTS WITH RHEUMATIC DISEASE ON BIOLOGICAL THERAPY AND RISK OF ACTIVE TUBERCULOSIS

Background:Treatment with biologic therapy has been associated with a high risk of reactivation of latent tuberculosis (TB). Preventive strategies for tuberculosis remain a crucial step before initiating biologics in rheumatic disease.Treatment with biological therapy has been associated with high risk of reactivation of latent tuberculosis (TB). Prevention strategies remain a crucial step before initiating biologics.Objectives:We aimed to assess the effectiveness of TB screening before the initiation of biologics and the risk of occurrence of active TB among patients with rheumatic diseases on biologic therapies.The study aimed to access the effectiveness of TB screening recommendations before the initiation of biological therapy and identify the incidence of active TB among these patients.Methods:We performed a hospital-based retrospective cohort study among rheumatic disease patients on biological therapy in two centers in Jeddah between January 2005 to December 2019. Medical files were retrospectively reviewed for demographics data, baseline screening for TB, use of prophylaxis, information on DMARDs and biological therapies, and outcomes results were collected.Results:A total of 365 patients were included over a period of 14 years. Two hundred ninety-two (80%) had Rheumatoid arthritis (RA),13% psoriatic arthritis (PSA), 9% spondyloarthritis (SPA), 2% SLE, and 4% others. The mean age was 47.54 (±14.2), 311 (85%) were females with a mean duration of disease 8.45 years (± 6.58). Hundred forty-nine (42.3%) were on steroids. Anti TNFs were prescribed in 213 (58.4%) patients, Non Anti-TNFs 124 (36.6%) patients, and Jak inhibitors 18 (5%) patients.TB screening was done to all patients except 3 patients (data missing) before commencing biologics. Forty-four (12.1%) patients had latent TB at baseline and all received chemoprophylaxis with isoniazid before starting biologics. Four patients with active TB were identified (one with Behcet’s disease and three with RA). One patient had a reactivation of latent TB and 3 patients developed de novo TB. Three out of four had an infection in the first 6 months of treatment (one on infliximab and two on rituximab) and one case after 1 year of stopping adalimumab. Two cases had pulmonary TB and two others with extrapulmonary TB (pericarditis and brain abscess each). All four patients with active TB were treated with standard anti TB medications. Three had complete resolution of their TB and one died.Conclusion:Baseline screening has been effectively carried out in our cohort as per recommendations. Physician should be vigilant not only for reactivation of latent TB but occurrence of de novo TB in patients on biological therapy.References:[1]Gardam, M. A. et al. Anti-tumour necrosis factor agents and tuberculosis risk: mechanisms of action and clinical management. Lancet. Infect. Dis.3, 148-155, doi:10.1016/s1473-3099(03)00545-0 (2003).[2]Winthrop, K. L., Yamashita, S., Beekmann, S. E. & Polgreen, P. M. Mycobacterial and other serious infections in patients receiving anti-tumor necrosis factor and other newly approved biologic therapies: case finding through the Emerging Infections Network. Clin. Infect. Dis.46, 1738-1740, doi:10.1086/587989 (2008).[3]Cantini, F., Niccoli, L. & Goletti, D. Tuberculosis risk in patients treated with non-anti-tumor necrosis factor-α (TNF-α) targeted biologics and recently licensed TNF-α inhibitors: data from clinical trials and national registries. J. Rheumatol. Suppl.91, 56-64, doi:10.3899/jrheum.140103 (2014).Acknowledgements:We would acknowledge Dr. Noran Alhashmi, Dr. Roaa Jodah, and Dr. Lamis Ramadan for their assistance in data collection.Disclosure of Interests:None declared.

Cardiometabolic risk factors in obese individuals and the risk of incident diabetes mellitus in 12-year prospective study

Aim of the study was to investigate the risk of developing type 2 diabetes mellitus (T2DM) in individuals with metabolically healthy and unhealthy obesity phenotypes (MHO and MUO) and evaluate the contribution of metabolic syndrome (MS) components to the 12-year risk of developing T2DM according to a prospective study.Material and methods. The study included 1958 people with a BMI ≥30 kg/m² and no T2DM, from among those examined at the baseline screening in 2003– 2005 of the HAPPIE project. New cases of T2DM were diagnosed between 2003 and 2018 according to the register of diabetes mellitus and repeated screenings. The median follow-up period was 12.1 years. Were used to define MHO: criteria of the NCEPATP III, 2001 and IDF, 2005.Results. The incidence of T2DM in the MHO group according to all studied criteria is on 1,5 times lower than in persons with MUO, p<0,001. According to the results of Cox regression multivariate analysis, the risk of developing T2DM in individuals with MHO is 2.3 times lower according to the IDF criteria, 2005 and 2,2 times lower according to the NCEP ATP III, 2001 criteria, compared with persons with MUO. The risk of developing T2DM increases in direct proportion to the number of MS components: 3 components—OR = 3,1 (95% CI: 1.0; 9.9), p = 0.048, 4 components—OR = 4.4 (95% CI: 1.4; 14.0), p = 0.011. However, the presence of obesity in a person with one risk factor does not lead to the development of T2DM within 12 years, p>0.05. When analyzing obese individuals who had abdominal obesity (AO), the risk of developing T2DM is 2 times higher compared to individuals with normal waist circumference (WC), and people without AO demonstrate no risk of developing T2DM, with an increase in the number of MS components, p> 0.05.Conclusions. The incidence of first-­onset T2DM during 12 years in the MHO group by any used criteria is on 1.5 times lower than in the MUO group. In individuals with obesity, regardless of its phenotype, the most significant independent predictors of the risk of incident T2DM are AO and fasting hyperglycaemia. In individuals without AO, the risk of developing T2DM does not increase, even with an increase in the number of MS components. In the presence of AO, the risk of developing T2DM increases 2 times already with the appearance of any other component.

Fluorescein diacetate and rapid molecular testing for the early identification of rifampicin resistance in Mali

BACKGROUND: Non-conversion on auramine smear microscopy indicates a lack of treatment response, possibly associated with initial rifampicin-resistant tuberculosis (RR-TB). However, dead bacteria still stain positive and may be detected. Fluorescein diacetate smear microscopy (FDA) shows live mycobacteria only. Therefore, we studied the potential of 2-month (2M) FDA for the identification of initial RR-TB.METHODS: Between 2015 and 2018, we enrolled new smear-positive pulmonary TB patients from five local centres in Bamako, Mali. After baseline screening, sputum samples were collected at 1M, 2M, 5M and 18M. We used rpoB sequencing to identify initial RR-TB.RESULTS: Of 1359 patients enrolled, 1019 (75%) had rpoB sequencing results. Twenty-six (2.6%, 95%CI: 1.7–3.7) had mutations conferring rifampicin resistance. Most frequent rpoB mutations were located at the codons Asp435Val (42.4%) and Ser450Leu (34.7%). Among patients with initial RR-TB, 72.2% were FDA-negative at 2M (P = 0.2). The positive and negative predictive value of 5M FDA for culture-based failure was respectively 20.0% and 94.7%.CONCLUSION: FDA did not identify the majority of patients with initial RR-TB or culture-based failure. As the full spectrum of mutations identified on sequencing was identified using Xpert, our data support its rapid universal implementation in Mali.