bluuebunny/crossref_metadata_2025 huggingface dataset:
Sequencing for COVID-19 in the Pandemic Era: What Does it Mean?
Authors: Petersen J M , Jhala D
Published: October 2021

Introduction/Objective

SARS-CoV-2 has been developing mutations over the course of the pandemic, leading to the rise of variants. The sequencing of these variants, however, has an unclear role for the medical center providing patient treatment.

Methods/Case Report

Patient specimens that were positive for the presence of SARS-CoV-2 with a cycle threshold <30 by reverse transcriptase polymerase chain reaction (RT-PCR) were sent for sequencing at the Veterans Health Administration Public Health Reference Laboratory (PHRL). Testing for SARS-CoV-2 was by RT-PCR was initially done by either the Abbott Alinity m SARS-CoV-2 assay (Chicago IL) or the Cepheid Xpert Xpress SARS-CoV- 2/Flu/RSV assay (Sunnyvale CA). All sent patient specimens had been selected by the clinical team for concern of the presence of a SARS-CoV-2 variant.

Results (if a Case Study enter NA)

There were a total of 8 patients (4 males and 4 females) that were sent for sequencing. The patient ages ranged from 38 to 80 years (average 58.8). The racial proportion of the 8 patients was 2 African Americans, 2 Caucasian Americans, and 4 unanswered. All were positive for SARS-CoV-2 by RT-PCR (4 Abbott assay and 4 Cepheid assay). Six of the sequenced samples showed the NextClade 20I/501Y.V1, Pango Lineage B.1.1.7, a variant first identified in the United Kingdom; four of these six patients had documentation of vaccination prior to the infection. One sequence was a NextClade 20C Pango Lineage B.1.526.1, a variant first identified in New York. The last sequence identified was a NextClade 20G, Pango Lineage B.1, a variant predominantly seen in the United States.

Conclusion

At the present time, sequencing of SARS-CoV-2 does not have a clear clinical role. However, from a public health and epidemiological point of view, sequencing has a role in SARS-CoV-2 variant tracing and detection. Vaccine protection against variant SARS-CoV-2 may not be complete as some infected patients had been vaccinated.
Using Deep Learning for Whole Slide Image Prostate Cancer Diagnosis and Grading in South Florida Veteran Population
Authors: Jayaratne N , Sasikumar A , Subasinghe S , Borkowski A , Mastorides S , Thomas L , Mastorides E , DeLand L
Published: October 2021

Introduction/Objective

Prostate cancer is the most common non-cutaneous malignancy in veterans, with approximately 11,000 new prostate cancer cases diagnosed in the Veteran’s Affairs system each year. Prostate cancer diagnosis and grading can be challenging even for experienced pathologists. Although large VA medical centers have pathologists that specialize in urologic pathology, the vast majority have not. We hypothesized that the AI-augmented diagnosis and grading may provide the solution for such situations.

Methods/Case Report

Dataset consisted of 10,000 prostate biopsy whole slide images (WSI) from the Kaggle PANDA challenge, and 6,000 WSI from the James A. Haley Veterans’ Hospital. Two Classification models were trained on the combined Kaggle and VA datasets using whole slide labels, and not annotated slides that resemble semi-supervised training.

Two-Class Classification to predict Benign: ISUP [0] / Cancerous: ISUP [1,2,3,4,5] Three-Class Classification to predict Benign: ISUP [0] / Low-grade: ISUP [1,2] / High-grade: ISUP [3,4,5] WSI split into “tiles” were used for training the models to reduce whitespace around samples, manage large images, and normalize dimensions/orientations.

Results (if a Case Study enter NA)

Models trained purely as binary and 3-class classifiers performed very well. Two-Class Model:

Accuracy = 0.937

Precision = 0.965

F1 = 0.94

AUC = 0.979

Three-Class Model:

Accuracy 0.89

o Benign:

Precision=0.897

f1=0.928

o Low-grade:

Precision=0.866

f1=0.841

o High-grade:

Precision=0.91

f1=0.878

We plan to develop multi-stage prediction models using these 2-Class and 3-Class classifiers as the first stage and a cancer grade predictor in the second stage.

Conclusion

We successfully showed that AI can augment pathologist’s diagnosis and grading of prostate cancer.
Applying Best Practice to Converting Blood Collection Tube Suppliers: Overcoming Laboratory Supply Shortages
Authors: Tsang P C , Absar S F , Gingrich D
Published: October 2021

Introduction/Objective

Changing blood tube suppliers is a complex process that requires systematic validation. It can serve to expand a laboratory’s options during a supply shortage, and can lead to cost savings. Just prior to the pandemic, our laboratory underwent a large-scale conversion of blood tube suppliers after successful validation of serum, plasma, and whole blood tubes for blood bank, chemistry, immunology, hematology, coagulation, molecular diagnostics, and flow cytometry.

Methods/Case Report

First, we designed a patient consent form for collecting extra blood samples. Per CLSI standards, validation of blood tubes is needed for each testing methodology but not for each analyte. Hence, we selected high-impact assays to represent each testing methodology used by our instrument platforms. We designed comparison studies to test the new blood tubes for result accuracy, precision and specimen stability that covered an assay’s reportable range. Allowable error limits were set based on Westgard and CAP guidelines. Spiked specimens were used when positive patient samples were not feasible. We also took the opportunity to optimize the blood tube sizes, e.g., converting the lavender-top tubes from 2 ml (vendor A) to 3 ml (vendor B). We then confirmed with our reference labs the acceptability of the new vendor’s products, and administered an electronic survey to solicit staff feedback. Finally, we coordinated supply chain, formulary changes and test catalog updates.

Results (if a Case Study enter NA)

Data analyses showed 100% acceptable performance of the new supplier’s blood tubes. The survey showed that our phlebotomists supported the new products, citing their ease of use and good vacuum. Our hematology technologists provided favorable feedback on the larger lavender-top tubes that reduced the number of insufficient samples. On the economic front, this supplier conversion has yielded a 26% cost savings.

Conclusion

To our knowledge, our study is the most comprehensive of all blood collection device comparison analyses published. Our validation strategies that were designed to comply with best practice standards have led to our confidence in the interchangeability of the new and old blood tube products. This initiative serves to elucidate a protocol to add vendor options that can be replicated by other laboratories to mitigate blood tube supply shortages and backorders. It has helped us control supply costs without compromising quality.
The first case of BRG (SMARCA4)/INI Deficient Tracheal Carcinoma: A Case Report and Review of the Literature
Authors: Omo-Ogboi A C , Wang W , Zhao B
Published: October 2021

Introduction/Objective

Primary tumors of the trachea are rare, they account for less than 0.1% of tumors in humans. In adults, 90% of primary tracheal tumors are malignant, with squamous cell carcinoma and adenoid cystic carcinoma accounting for two-thirds, with other forms occurring less frequently. The BRG (SMARCA4)/INI deficient tumor is a relatively new defined entity which is recently introduced in the WHO Classification of Tumors, 5th edition, 2021. The gene SMARCA4 is located at 19p13. Loss of SMARCA4 has been reported in several aggressive tumors with high- grade undifferentiated rhabdoid morphology but has not been reported in the trachea. Hence, we report the first case of BRG (SMARCA4)/ INI deficient tracheal carcinoma.

Methods/Case Report

We present a 60-year-old male with a history of tobacco abuse, shortness of breath, and a tracheal mass on chest imaging. Bronchoscopy was performed and showed a fleshy friable lesion at the anterior trachea with evidence of blood dripping into the distal airways.

Results (if a Case Study enter NA)

Microscopic examination showed a high grade, poorly differentiated carcinoma with tumor necrosis, high mitotic counts, and marked nuclear pleomorphism. Immunohistochemical stains were performed. The tumor cells were strongly and diffusely positive for CK-7 and weakly positive for synaptophysin, negative for pan-cytokeratin, TTF-1, CK-20, p40, CK5/6, and chromogranin. Then BRG (SMARCA4) and INI 1 (BAR47) were performed and showed negative staining on BRG expression, while INI 1 is intact (nuclear expression). These features are consistent with BRG (SMARCA4)/ INI deficient carcinoma.

Conclusion

BRG (SMARCA4)/ INI deficient carcinoma is a new entity in the trachea, which is very aggressive with a poor prognosis. Targeted therapy or clinical trials may be available as additional cases are diagnosed in the future.
Rare presentation of kappa light chain proximal tubulopathy with fibrillar aggregates
Authors: Alkashash A M , Phillips C L
Published: October 2021

Introduction/Objective

Patients with dysproteinemias may show a spectrum of renal alterations due to organized deposits of excess immunoglobulins, including primary amyloidosis, myeloma cast nephropathy, monoclonal immunoglobulin deposition disease, and light chain proximal tubulopathy (LCPT). Among the least common is LCPT, which shows ultrastructural cytoplasmic light chain inclusions with crystalline morphology or rarely fibrillar aggregates. We present the case of a patient with LCPT with fibrillar aggregates that is the only such case registered in our large academic surgical pathology electronic database. Our aim is to increase understanding and recognition of this rare variant.

Methods/Case Report

A 73-year-old man presented with 540 mg/day proteinuria, serum creatinine 5.73 mg/dL, platelets 178,000/cc, and 20% plasma cells in his bone marrow biopsy specimen. Kidney needle biopsy cores examined by light, fluorescent and transmission electron microscopy (EM) showed kappa light chain cast nephropathy and kappa LCPT with fibrillary aggregates, the latter requiring unmasking of kappa epitopes using pronase-treated paraffin sections. Congo red stain was negative. By EM, proximal tubules contained intracellular bundles of tightly aggregated fibrils with mean fibril diameter of 7.7 +/- 1.6 nm. Individual bundles were variably shaped as round, oval, spicular or irregular blobs. Fibrils were not seen in glomeruli.

Results (if a Case Study enter NA)

NA

Conclusion

This rare presentation of LCPT with fibrillar aggregates reinforces the utility of renal biopsy diagnosis that includes careful ultrastructural examination of renal tubules. In the absence of EM, the unique fibrillar organization of these cytoplasmic light chain aggregates would otherwise go unrecognized.
Relapse of Myelodysplastic Syndrome after Allogeneic Hematopoietic Stem Cell Transplantation as Blood Bank Sees It: a Case Report
Authors: Kanakis C E , Gvozdjan K
Published: October 2021

Introduction/Objective

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative treatment option for patients with myelodysplastic syndrome (MDS). Nonetheless, a large proportion of patients with MDS experience disease relapse. Declining donor chimerism and detection of recurrent gene mutations have been used as indicators of graft failure and recurrent disease. Blood Bank serologic findings have rarely been described as first indicators of disease relapse in this setting and could potentialy add to engraftment and relapse surveillance testing.

Methods/Case Report

A 72-year-old, ABO group O, RhD positive male with history of anti-Fyb alloimmunization underwent allo-HSCT from an ABO group B, RhD negative, Fyb positive donor as part of the treatment for MDS. Successful engraftment was achieved, and the patient’s red blood cell phenotype transitioned to ABO group B, RhD negative, Fyb positive. Two years following allo-HSCT, the patient received chemotherapy for recurrent cholangiocarcinoma. Supportive blood component transfusions were provided, all of which typed as RhD negative. However, new antibody with anti-D specificity was detected in serum while the patient still typed as ABO group B, RhD negative, preceding anti-D and later recurrent anti-Fyb detection in eluate, and prompting further chimerism testing. Declining donor chimerism was noted (72% donor, compared to >98% donor on prior chimerism testing). Chemotherapy and donor-lymphocyte infusion were initiated.

Results (if a Case Study enter NA)

NA

Conclusion

The early detection of de novowlvw anti-D was most consistent with resurgence of patient’s erythroids within the bone marrow in the presence of donor’s immune system. This was followed by sufficient peripheralization of patient’s red blood cells and detection of anti-D in the eluate. Lastly, the switch to recipient’s immune system is evidenced by recurrent detection of anti-Fyb in the eluate. This case, therefore, emphasizes the utility of Blood Bank serology in raising suspicion for disease relapse and guiding further allo-HSCT patient management. More systematic use of Blood Bank serology may serve as a time- and cost-effective adjunct to the current strategies employed for detection of disease recurrence in allo-HSCT recipients.
Renal allograft rejection with thrombotic microangiopathy associated with a Kidd blood group system alloantibody
Authors: Lee E S , McHenry A , Siddon A , Tormey C
Published: October 2021

Introduction/Objective

The Kidd blood group antigens are urea transporters found on the surface of red blood cells, renal tubular epithelial cells, and endothelial cells in the renal medulla and vasa recta. While controversial, some reports have described an association between Kidd antigen donor/recipient mismatches and kidney transplant rejection when recipients possess or form anti-Kidd alloantibodies. To date, none of these reports have described development of a thrombotic microangiopathy (TMA) in the renal graft associated with these antibodies. We describe a case of fulminant renal transplant rejection associated with TMA in a patient with anti-Jk(a) alloantibodies who received a deceased-donor kidney transplant (DDKT).

Methods/Case Report

A 64-year-old woman with end-stage renal disease secondary to AL amyloidosis caused by plasma cell neoplasm received a DDKT associated with delayed graft function. No pre- or post-transplant donor specific antibodies (DSA) were detected, the flow crossmatch testing was negative, and a pre-operative type and screen identified anti-Jk(a) alloantibodies. On post-transplant day 5, her creatinine remained elevated at 6 mg/dL (ref range: 0.4–1.3 mg/dL) with an acute drop in platelets and undetectable haptoglobin. Allograft biopsy showed a combination of TMA with some additional evidence of acute cellular rejection. Tacrolimus was stopped to rule out drug-induced TMA, and the workup showed negative Shiga toxin, normal ADAMTS13 activity, negative atypical HUS genetic testing, and negative antiphospholipid syndrome testing. Genotyping of the donor kidney was positive for the Jk(a) antigen. Eculizumab, IVIG, and a trial of 8 sessions of therapeutic plasma exchange (TPE) were administered. Her creatinine improved (1.93–2.05 mg/dL), indicating a significant antibody-mediated etiology to her delayed graft function. About one month later, her creatinine worsened, and she received another trial of TPE with IVIG and eculizumab. Despite a mild decrease in her creatinine, repeat biopsies showed acute cellular rejection, persistent TMA, and chronic allograft injury. No DSAs were ever detected. Her creatinine never recovered, and she is now dialysis-dependent.

Results (if a Case Study enter NA)

NA

Conclusion

We speculate that anti-Jk(a) antibodies interacting with a Jk(a)-positive donor kidney account for graft TMA. This case underscores the potential importance of matching Kidd antigens in kidney transplantation.
Associations of Stay-at-Home Order Enforcement With COVID-19 Population Outcomes: An Interstate Statistical Analysis
Authors: Huntley Kyle S , Wahood Waseem , Mintz Joel , Raine Samuel , Hardigan Patrick , Haffizulla Farzanna
Published: October 2021

In the United States, state governors initially enacted coronavirus diseases 2019 (COVID-19)-mitigation policies with limited epidemiologic data. One prevailing legislative approach, from March to May 2020, was the implementation of “stay-at-home” (SAH) executive orders. Although social distancing was encouraged, SAH orders varied between states, and the associations between potential legal prosecution and COVID-19 outcomes are currently unknown. Here, we provide empirical evidence on how executive enforcement of movement restrictions may influence population health during an infectious disease outbreak. A generalized linear model with negative binomial regression family compared COVID-19 outcomes in states with law-enforceable stay-at-home (eSAH) orders versus those with unenforceable or no SAH orders (uSAH), controlling for demographic factors, socioeconomic influences, health comorbidities, and social distancing. COVID-19 incidence was less by 1.22 cases per day per capita in eSAH states compared with uSAH states (coefficient = −1.22, 95% confidence interval (CI): −1.83, −0.61; P < 0.001), and each subsequent day without an eSAH order was associated with a 0.03 incidence increase (coefficient = 0.03, 95% CI: 0.03, 0.04; P < 0.001). Daily mortality was 1.96 less for eSAH states per capita (coefficient = −1.96, 95% CI: −3.25, −0.68; P = 0.004). Our findings suggest allowing the enforcement of public health violations, compared with community education alone, is predictive of improved COVID-19 outcomes.
The Influence of Sagittal Head Tilt on Periorbital Appearance: Implications for Clinical Photography and the Evaluation of Postoperative Results
Authors: Vaca Elbert E , Bricker Jonathan T , Mioton Lauren M , Fagien Steven , Alghoul Mohammed S
Published: October 2021

Background

Consistency in standardized periorbital photography—specifically, controlling for sagittal head tilt—is challenging yet critical for accurate assessment of preoperative and postoperative images.

Objectives

To systematically assess differences in topographic measurements and perceived periorbital attractiveness at varying degrees of sagittal head tilt.

Methods

Standardized frontal photographs were obtained from 12 female volunteers (mean age 27.5 years) with the Frankfort plane between −15° and +15°. Unilateral periorbital areas were cropped, and topographic measurements were obtained. The images of each individual eye, at varying head tilt, were ranked in order of attractiveness by 11 blinded evaluators.

Results

Inter-rater and intra-rater reliability was excellent (intraclass correlation > 0.9). Downward sagittal head tilt was linearly associated with an improved aesthetic rating (Spearman’s correlation; ρ = 0.901, P < 0.001). However, on subgroup analysis, eyes with lower lid bags received the highest aesthetic score at neutral head tilt. Pretarsal show and upper lid fold heights progressively decreased (P < 0.001), positive intercanthal tilt became more pronounced (P < 0.001), and the apex of the brow (P < 0.001) and lid crease (P = 0.036) arcs lateralized with downward sagittal head tilt, contributing to a more angular appearance of the eye. Marginal reflex distance (MRD) 1 was maintained, while MRD2 progressively increased (P < 0.001) with downward head tilt.

Conclusions

Negative sagittal head tilt significantly improves periorbital aesthetics; however, in the presence of lower eyelid bags, this also increases demarcation of the eyelid cheek junction which may be aesthetically detrimental. Controlling for sagittal head tilt is critical to reliably compare preoperative and postoperative clinical photographs.
Neither glutamate nor alanine but arginine sensitizes BY-2 cells to arsenate
Authors: Nahar Nur-E-Nazmun , Prodhan Md Yeasin , Mimata Yoshiharu , Yonezawa Anna , Nakamura Toshiyuki , Nakamura Yoshimasa , Munemasa Shintaro , Murata Yoshiyuki
Published: October 2021

Arsenic is toxic for plants. Our previous results showed that the application of proline enhanced the sensitivity of tobacco BY-2 cells to arsenate. In order to clarify the enhancement mechanism, we investigated the effects of other amino acids on the arsenate-stressed BY-2 cells. Glutamate at up to 10 m m did not affect the cell growth in the absence or presence of arsenate. Arginine at up to 10 m m did not affect the growth in the absence of arsenate but arginine at 10 m m enhanced the inhibition of the cell growth by arsenate. Alanine at up to 10 m m did not affect the cell growth under nonstressed condition but alanine at 10 m m significantly improved the cell growth under arsenate stress. These results suggest that alanine mitigates arsenate stress in BY-2 cells and that arginine like proline enhances the sensitivity of BY-2 cells to arsenate.
EP.WE.67Management of Acute Appendicitis during the Early phase of the COVID-19 Pandemic: a Single NHS Centre Study
Authors: Buksh Md Mahfooz , Kerans George , Al Samaraee Ahmad
Published: October 2021

Aims

During the early phase of the COVID-19 pandemic, general surgeons were advised to apply conservative management/open surgery for appendicitis. This single NHS centre study has explored the resulted management differences.

Methods

Retrospective study covering prepandemic data over (March-May, 2019) & early pandemic data over (March-May, 2020).

Results

Prepandemic data (43 patients): The mean age was 38.3 years. The mean length of stay was 1.7 days. Preoperative imaging was used in 32(74.4%) patients; this was diagnostic in 28(87.5%). Non-surgical management was used in 4(9.3%) patients; one needed surgery eventually. Surgical approaches in 40 patients were (laparoscopic: 38(95%), open: 2(5%)). Neither significant morbidity nor mortality was reported.

Early pandemic data (35 patients): The mean age was 31.2 years. The mean length of stay was 2.2 days. Preoperative imaging was used in 30(85.7%) patients; this was diagnostic in 26(86.6%). Non-surgical management was used in 8(22.9%) patients; one needed surgery eventually. Surgical approaches in 28 patients were (laparoscopic: 10(35.7%), open: 18(64.3%)). Neither significant morbidity nor mortality was reported, apart from one patient with COVID-19 postoperative infection.

Conclusions

There was a tendency towards applying a conservative approach/open surgery during the early days of the pandemic. Though this was statistically significant (p<0.05), the total number of patients was small to achieve statistically stronger conclusions. Laparoscopy was selectively used during the early days of the pandemic where the benefit outweighed the risks.
EP.WE.83Surgeon’s Acute Stress Disorder During Covid-19: A Case Study with E-Mail Therapy
Authors: El Boghdady Michael , Ewalds-Kvist Béatrice Marianne
Published: October 2021

Aims

A higher surgical trainee combatted patients’ deaths and disasters from COVID-19. The trainee treated daily COVID-19-positive patients. In May 2020, he recognized symptoms of COVID-19. Throat swab test confirmed the suspicion of contagion. We aimed to study the acute stress disorder (ASD) during the COVID-19 pandemic in the surgical trainee.

Methods

The case self-isolated for 2 weeks with an intensifying fear of health deterioration. The case’s isolation and feelings of being in poor health, opened for an e-mail therapy. Sixty open-ended questions were answered in Socratic-maieutic style. The finding of severe (ASD) was validated and confirmed by use of the National Stressful Events Survey Acute Stress Disorder Short Scale. The mail therapy continued until the case felt that the crisis had faded. After 10 weeks a follow up was completed A, B and C times for 7 issues: death anxiety, worries about family after own death, chest pressure, other physical symptoms, stress, depression, other psychological symptoms

Results

Our hypothesis was termed “acute stress reactions”. Our case’s ASD was categorized as “severe”. Friedman test was applied for the related groups A, B and C, indicating an overall symptom improvement (p < .001) which by Page’s L trend test disclosed a significant trend in symptom cutback from A to C (p < .001).

Conclusion

The surgeons’ awareness is required that in some cases, the psychological symptoms escalate during isolation and quarantine periods and may even override the physical awkwardness, urging us to address both types of discomfort simultaneously and intensely.
EP.WE.162Correct consenting for Vascular Patient
Authors: Khalaf Hasan , Behbahani A. , Walsh Aideen
Published: October 2021

Introduction

Surgeons must establish and maintain effective relationships with patients and, where appropriate, with their supporters. Before surgery, surgeons should strive to have an honest and sensitive discussion with patients about their options for treatment that leads to informed and deliberate consent. The aim of this study is to compare our consent practice in the vascular department in Royal Stoke Teaching Hospital against consent guideline in the Best surgical practice and to if we are meeting patient satisfaction.

Method

A prospective study of 30 patients from 21/09/2020 to 21/10/2020. Questionnaire form was designed based on the best surgical practice guideline and was given to the patient to fill. We include patients admitted for elective vascular procedures, wide range ages. The questionnaire

Results

Most of the of the patient (90%) were consented by the professionals who provide the treatment. 63% of the patients asked for further information in the form pf leaflets or websites. 70% of them request to know the recent guidelines of their procedures. Only 13% of them had a copy of the consent prior to surgery.

Recommendations

We must provide the patients with further information, Recent guidelines, and a copy of the consent to take home prior to surgery day. This can be achieved by consenting them before the operation day.
EP.WE.190Post-operative Hypocalcaemia: Analysis of factors influencing and predicting hypocalcaemia post total thyroidectomy
Authors: Ash Javier , Lucas Tylan , Kirmani Naveed
Published: October 2021

Aims

Hypocalcaemia is a severe complication post total thyroidectomy leading to increased morbidity, length of inpatient stay and associated costs. The leading cause is damage or de-vascularisation of the parathyroid glands intra-operatively however this is not always easy to identify and is usually inadvertently performed. Prompt identification of patients likely to become severely hypocalcaemia is difficult for clinicians but is of interest as timely management of hypocalcaemia in these patients is crucial to reduce length of stay and worsening/development of symptoms.

Methods

A retrospective audit of 42 patients who were admitted for a total thyroidectomy at a district general hospital was performed. Data was collected on demographics, indication, post-operative diagnosis and pre- and post- electrolyte levels and calcium supplementation.

Results

Eight patients were identified with severe hypocalcaemia post operatively. Age, indication, post-operative diagnosis or pre-operative electrolyte levels were not statistical significant predictors of post-operative hypocalcaemia. Percentage difference between pre and immediate post-operative calcium levels was a significant predictor of subsequent severe hypocalcaemia and increased length of inpatient stay (p < 0.05).

Conclusions

Reducing patient morbidity and length of stay is of crucial importance to clinicians and patients alike. Commonly post-operative calcium levels are interpreted independently to determine need of supplementation. However, using pre-operative calcium levels in conjunction with the immediate post-operative levels has lead to a better prediction of patients likely to suffer from this complication. We theorise that prospectively identifying these patients and starting treatment early as appropriate will lead to improved patient outcomes.
EP.WE.279Impact of COVID-19 on West of Scotland Colorectal Cancer Services
Authors: Welsh Silje , Al-Ani Ahmed
Published: October 2021

Aim

The coronavirus disease-19 (COVID-19) pandemic has driven unprecedented restriction of the National Health Service to accommodate additional pressures. Our aim was to analyse the impact of COVID-19 on the largest colorectal cancer (CRC) services in NHS Greater Glasgow & Clyde.

Method

Audit data collected from multidisciplinary team meetings for South Glasgow CRC service were accessed. We compared April-June 2020 (‘Lockdown group’) to corresponding months in 2019 (‘Control group’). Statistical analysis by unpaired T-test, Pearson’s χ2 test with post hoc analysis using adjusted Z scores and Bonferroni correction.

Results

There was a 39.5% reduction in CRC diagnoses during lockdown (n = 49) compared to control (n = 81). There was a 34.1% reduction in CRC operations during lockdown (n = 27) compared to control (n = 52). The proportion of patients managed operatively did not differ between groups (p = 0.140). There was no difference in the number of days from diagnosis to first treatment between Lockdown and Control groups (Mean(SD): 40.1±35.3 and 43.2±42.9, p = 0.257). Primary care physicians were the main referral source for both lockdown (52%) and control groups (46%). The cessation of bowel screening programme saw no referrals in lockdown whereas it accounted for 21% of referrals in control group, p < 0.001).

Conclusions

We experienced dramatic reductions in CRC diagnoses during lockdown that was not only accounted for by the cessation of bowel screening. The diagnostic delay in the 39.5% ‘missed’ CRC patients may result in patient morbidity; a severe repercussion of COVID-19. The resurgence of COVID-19 cases poses a real threat to cancer services.
EP.WE.330The role of computerized tomography scan in 2 week wait colorectal pathway during COVID-19 pandemic
Authors: Ali Muhammad , Castelhano Rute , Theofilis Aris , Wass Emily , Alexander Roderick , Owais Anwar
Published: October 2021

Aims

The standard way to investigate patients referred on the two week wait colorectal cancer (2WW) pathway is to do a colonoscopy when patients are deemed fit. Due to limited endoscopy services during the COVID-19 lockdown period, we performed computerized tomography scan of thorax, abdomen and pelvis (CT TAP) for all fast-track colorectal referrals in addition to colonoscopy when service restarted. The aim of this study is to assess the benefit of CT scan in this group of patients.

Methods

All 2WW patients referred to our district general hospital from April 1, 2020 to July 31, 2020 were included in the study. The data were collected retrospectively from GP referral forms and the electronic patient records. Patient demographics, presenting complaints, investigations, diagnosis and treatment were recorded.

Results

A total of 658 patients were included in the study. The commonest presenting complaint was change in bowel habit (62.5%). A total of 414 colonoscopies, 347 CT TAP, 89 flexible sigmoidoscopies and 37 CT colonography were performed. 194 patients had both CT TAP and colonoscopy and another 32 patients had both CT TAP and flexible sigmoidoscopy showing that 34% of patients had both CT TAP and endoscopy. 41 patients were diagnosed with colorectal malignancy (6.2%) and 120 had polyps (18%). CT TAP missed 3 colorectal cancers but picked up 28 patients (4.3%) diagnosed with extra-colonic tumours.

Conclusions

Colonoscopy remains the gold standard for investigating colorectal cancer. However, CT scan have their value in diagnosing extra-colonic tumours in this specific group of patients.
EP.WE.433Assessment of the temporary Surgical ED Study and Audit
Authors: Abdelkarim Mostafa , Nawaz Syed , Venkatesan Gowtham , Murali Sreedut , Asqalan Ahmed , Morgan Richard
Published: October 2021

Aims

To ascertain the effectiveness of the newly formed surgical ED during Covid-19 outbreak in terms of:

Methods/Study design

Retrospective cohort of 992 patients were identified and included from the period of the 5th April to 5th May 2020

Inclusion criteria: All patients attended and triaged in the new surgical emergency department.

Exclusion criteria: Patients who were not triaged.

Results

The temporary surgical emergency department was successful in accommodating all surgical patients categorized 2, 3 and 4 with category 4 being the highest number at 45%.

Hospital services were successfully accessed in 771(77.72%) during patients stay in ED including Bloods and imaging with X-ray as the most service used at 42.33%.

221(22.27%) patients didn’t require any investigations and were discharged after review by the surgical doctor within the 4-hour window.

Conclusion

Presence of a dedicated surgical emergency during the covid period was essential to separate medical patients from non-medical patients.

Having a decision maker on the front line right after triage has reduced the overall number of admissions, number of emergency breeches and unnecessary investigations.

Having a dedicated space with dedicated team could make a huge impact on the service in terms of time, effort and money spent.
EP.WE.561The impact of COVID-19 on infra-inguinal revascularisation in patients with symptomatic peripheral occlusive arterial disease
Authors: Tait Sophie , McGillivray Kay , McKenna Roisin , Hussey Keith
Published: October 2021

Introduction

Standard Operating Procedures were revised in response to the Covid-19 pandemic. There are descriptions from across Europe of increased rates of major extremity amputation. We have explored practice in a regional vascular unit serving two Health Boards in Scotland with specific reference to infra-inguinal revascularisation for patients with symptomatic peripheral occlusive arterial disease.

Methods

A retrospective review of the administrative theatre database was performed. Pre-Covid (1st April–July 31st 2019) and peri-Covid (1st April-31st July 2020) periods were examined and index cases identified. Practice and outcomes were examined.

Results

There was a 50% reduction in scheduled theatre sessions during the peri-Covid period. There were 100 procedures performed pre-Covid and 71 procedures performed during the peri-Covid period. The patient demographics were comparable – mean age 68-years with a male to female ratio of 1.6:1. Intervention for chronic limb threatening ischaemia was much more common in the peri-Covid period than in the pre-Covid period (94% versus 64% respectively). There was a clear change in anaesthetic practice with regional anaesthesia more commonly performed in the peri-Covid period (49% versus 12% respectively). There was no difference in the types of revascularisation performed. The 30-day mortality in the peri-Covid period was less than in the pre-Covid period (3% vs 1.4%).

Conclusion

The Covid-19 pandemic created imperatives that necessitated re-structure of service. Despite a reduction in theatre access we have managed to maintain a limb salvage service for patients with chronic limb threatening ischaemia.
EP.WE.593Cardiovascular risk modification in patients admitted for vascular surgical intervention
Authors: Al-Obaidly Deemah , Khan Mujahid , Aji Aida , Hussey Keith
Published: October 2021

Introduction

Management of cardiovascular risk is fundamental for patients with symptomatic atherosclerosis to reduce both medium and long-term cardiovascular morbidity and mortality. All patients admitted for operative vascular intervention with atherosclerotic arterial disease should be prescribed appropriate secondary prevention.

Methods

This was a single-cycle retrospective audit in a patient population undergoing operative intervention for symptomatic atherosclerotic arterial disease in a single regional vascular unit in June 2020. Episodes of care were examined for the prescription of an antiplatelet agent and statin.

Results

There were 81 procedures identified. The majority of patients were male and the mean age was 63-years. A diagnosis of diabetes was common. Antiplatelet agents were only prescribed to 48 (59%) and statins to 61 (75%). There was no clear pattern that could be defined between elective and emergency admissions [antiplatelet prescription 24 (71%) and 23 (49%); statin prescription 27 (79%) and 34 (72%)], or arterial reconstruction and major limb amputation [antiplatelet prescription 28 (76%) and 19 (45%); statin prescription 31 (84%) and 28 (67%)].

Conclusion

It is a concern that a significant proportion of patients did not have antiplatelet and/or statin therapy prescribed. This implies failure of both primary and secondary care. In secondary care the medicines reconciliation process should be augmented with regular review of the prescription.
EP.WE.620The utility of Computerized Axial Tomography (CT) investigation in two week waits colorectal referral pathway: should it be done more often during the pandemic?
Authors: Bavikatte A , Olugbemi M , Athisayaraj T Winston
Published: October 2021

Aim

Colorectal two week wait pathway investigations have been majorly affected due to Covid 19 especially with regards to endoscopy as well as virtual colonoscopy procedures in comparison to CT scan. We aimed to analyze the CT scan findings of colorectal rapid access patients.

Method

A total of 1900 patients was referred via the straight to test pathway in the year 2020.A retrospective analysis of CT scan investigation performed in these patients was analyzed.

Results

A total of 90 (4.74%) patients had a CT Scan as part of the work.20 patients (22%) of the CT scan revealed malignancy. 10 patients (50%) had metastatic disease on the scan. Among them, 6 (60%) were due to colorectal primary and another 2 (20%) was due to thoracic cancers. The remaining were diagnosed with widespread metastatic disease of unknown origin. Among the remaining 10 patients, Curative surgery was offered to 5 patients with colorectal primary and one patient with hepatocellular carcinoma. The remaining patients were diagnosed with High grade B cell lymphoma, Neuroendocrine tumor, pancreatic mass and primary renal cell carcinoma. One patient had high grade small bowel obstruction due to a band adhesion resulting in emergency surgery and 5% of the patient needed a vascular referral for Abdominal aneurysm.

Conclusion

CT scan in two week colorectal referral patients play a significant role in diagnosis of advanced disease. The ease of the procedure makes it more attractive during the pandemic in contrast to endoscopy and virtual-colonoscopy which has been significantly impacted by COVID 19.
EP.WE.635The Pied-Piper, How Gastroenteritis Led Us Astray. Fibromuscular Dysplasia: A Surgical Perspective of a Rare Vascular Disorder
Authors: Mishra Shashwat , Davis Heather , Adams Lawrence , Culmer Cicely , Shrestha Ashish
Published: October 2021

Case

A 73-year-old female was admitted for abdominal pain after eating an out-of-date pie. She was treated for gastroenteritis for 48 hours, after which she became unexpectedly haemodynamically unstable. Computerised Tomography (CT) suggested mesocolic arterial bleed with a large mesenteric haematoma. CT angiography confirmed false aneurysms of the middle colic artery and multiple beading of coeliac branches, small mesenteric vessels and the inferior mesenteric artery. Opinion was sought from multiple specialties, pseudoaneurysm embolisation was undertaken and steroids commenced for presumed vasculitis. Vasculitis screen was negative, and PET CT scan showed no metabolically active vasculitis. It was felt a diagnosis of fibromuscular dysplasia (FMD) was likely. Steroids were weaned and the patient is under active observation.

Background

FMD is a rare idiopathic condition of abnormal cellular growth in medium/large arterial vessel walls. It has a frequency of approximately 0.02%, predominantly affecting middle-aged Caucasian women. It manifests mostly in renal and cerebrovascular arteries and can present as hypertension or stroke. Complications include aneurysms, stenosis and dissections. Characteristic angiographical finding is a “beads on a string” appearance. There is no current cure, but surgical or interventional involvement by angioplasty and stenting may play a role treatment.

Discussion And Conclusion

This case elegantly highlights the ambiguity in diagnosis of abdominal pain in a general surgical setting; with a wide variety of differentials spanning multiple specialties, it emphasises the importance to consider rare presentations of equally rare pathologies. It is a celebration of the merits of a multi-disciplinary approach to solve complex clinical questions.
EP.WE.690PPI Prescribing in Vascular Discharges
Authors: Hooper Amy , Cheung Fang Yi , Murray Anna
Published: October 2021

Aims

Aspirin and clopidogrel are ubiquitously seen in prescriptions of most attendees to hospitals, especially those being admitted to a vascular unit. Most, if not all, are on at least one anti-platelet agent, and some are on dual antiplatelets (DAPA) or an anticoagulant. These increase the risk for upper gastrointestinal (UGI) bleeds, which lead to significant morbidity and mortality. In order to prevent this, proton pump inhibitors (PPIs) are recommended to be prescribed for patients with increased risk of UGI bleeds.

Our aim for this audit was to evaluate the prescription of PPIs in vascular patients discharged from a major vascular hub.

Methods

Data was collected from a prospectively maintained database of consecutive primary vascular discharges between 01/09/2020 and 31/09/2020.

Results

87 patients discharged in this period (71% Male, Median age 72 (22-92) yrs). 26% of admissions accounted for Diabetic foot infection management, 25% for Critical Limb Ischaemia management and 20% for Thoracic or Aortic Aneurysm management.

70% of patients were discharged with either a single or DAPA.

94% of patients met the NICE guideline for requirement for a PPI. 49% of those patients were not discharged with a PPI.

Of the patients who should have been prescribed a PPI on discharge, 5% suffered UGI bleeds in the follow up period (2/42).

Conclusions

PPIs are often not prescribed when discharging vascular patients, most of whom are high risk for having UGI bleeds. We will re-audit this after education and protocols have been implemented.
EP.WE.712Predictors of remission for type 2 diabetes mellitus after bariatric surgery: a systematic review and meta-analysis
Authors: Kumar Gautam , Narayanasamy Sangara N , Ramesh Vibha , Aspari Ajay , Gumber Ashutosh O
Published: October 2021

Aims

Bariatric surgery has been implicated as a practical therapeutic approach to cure Type 2 Diabetes Mellitus. Hence, the present study aims to analyse the factors that can predict type2 diabetes remission after bariatric surgery and the recent literature to update information by systematic review.

Methods

Search strategy followed PICOS framework and PRISMA standards. PubMed, EMBASE, Cochrane Library, MEDLINE, and CINAHL databases were searched. SPSS version 19 and RevMan 5.0 software were utilised for statistical analysis.

Result

Five articles were eligible for inclusion from 2010 to November 2019. The mean age of the population in the remission group was younger (40.24 years) than the non-remission groups (p < 0.02). Statistically, a significant difference (p < 0.08) was also found with mean HbA1c in the remission group (7.78%) than the non-remission group (8.96%). Mean BMI and duration of DM were different in two groups, but statistical significance was not observed.

Conclusion

ABCD (Age, BMI, C-peptide and duration of type 2 DM) score has been widely used over the years for defining remission in type 2 DM following bariatric surgery. The current analysis statistically identified advanced age and HbA1c levels as an influential factor for non-remission. Though the difference in BMI and duration of DM noticed in two groups, it was not statistically significant. Our analysis is in agreement and the continuation of the review by Wang et al. (2015). He concluded that younger age group, shorter duration of type 2 DM and adequate glycemic control were responsible for remission after bariatric surgery.
EP.WE.721The effects of COVID-19 on emergency theatre utilisation
Authors: Rizkalla Nagy , Cubas Vanessa , Digne-Malcolm Holly , Sallam Ali , Fishwick Anna , Khaira Harmeet
Published: October 2021

Aims

The ongoing COVID-19 pandemic and subsequent lockdown have adversely affected elective care services within the NHS. Emergency Services are also affected to varying extents nationally. Due to deferred elective services our hospital was able to implement two emergency theatres running in parallel as an attempt to minimise these effects.

We aimed to assess the change in delivery of essential and emergency surgeries due to the pandemic in a local district general hospital.

Methods

Retrospective study of emergency theatre cases performed during the month of November 2019 and November 2020. Parameters of theatre efficiency included: sending times, anaesthetic times, operating times and length of recovery, with specific attention to recovery in theatre time

Results

The time taken to send for patients from the wards increased by 24% (n = 124 vs 49) during the pandemic compared with before. Anaesthetic time also increased by 15% (p = 0.0072, n = 124 vs 49). Recovery time required in theatre increased by 150% (p = 0.0321, n = 124 vs 49). Total recovery time however reduced by 9%.

Conclusion

Our audit quantifies the effects of COVID 19 pandemic on surgical care delivery and documents delays at nearly all stages of the patient journey through emergency theatres.

Alternating procedures in a second emergency theatre has mitigated the delay of theatre-based recovery.
EP.WE.741Management of a giant extraocular sebaceous carcinoma during the COVID-19 Pandemic: a case report
Authors: Mantelakis Angelos , Nicholas Rebecca , Geh Jenny
Published: October 2021

Introduction

Sebaceous carcinoma is a rare malignant skin tumour of the sebaceous glands which is most frequently located in the ocular region (75% of cases). Prompt recognition and treatment is vital, as it bears a high mortality rate ranging from 9 – 50%. We present a rare case of a giant sebaceous carcinoma of the upper back, managed as a day-surgery case because of resource and safety restrictions due to the COVID-19 pandemic.

Case report

We present a case of a 58-year-old male patient with a giant lesion on his upper back measuring 13 x 13cm in size. Due to the COVID-19 pandemic, this was resected under local anaesthetic. The histology and immunohistochemistry confirmed the diagnosis of a giant sebaceous carcinoma. Resection margins were clear and subsequent investigations confirmed there were no metastases. The defect was reconstructed with Matriderm © and a split-thickness skin graft, achieving a satisfactory cosmetic outcome at 3 months follow-up.

Conclusion

This is the first report which demonstrates the wide local excision under local anaesthetic for a rare presentation of a giant sebaceous carcinoma. This approach may be more widely utilised in the extraocular manifestation of this tumour, reducing the morbidity and length of hospital stay for such patients.