bluuebunny/crossref_metadata_2025_split huggingface dataset:
E008 Review of rheumatology care for women of childbearing age
Authors: Mohareb Marwa , Ahmed Sumaya , Bharadwaj Anurag , Nandagudi Anupama 
Published: April 2024

Abstract

Background/Aims
Autoimmune rheumatic diseases are frequently diagnosed in women of childbearing age. Managing these conditions during pregnancy is complex because commonly used disease-modifying antirheumatic drugs (DMARDs) can pose risks. Specialized care for this patient group is crucial, necessitating adherence to established rheumatology practice standards and British Society for Rheumatology (BSR) guidelines. Our main objective is to review management of childbearing age females with rheumatic diseases attending Basildon hospital as per BSR guidelines.

Methods
The data for this retrospective study was collected from the electronic records of female patients attending the rheumatology outpatient clinic at Basildon Hospital between September and December 2022. We reviewed age, the specific rheumatological diagnosis, disease duration, disease activity, current medications, and whether general advice or pregnancy-specific advice was provided.

Results
Out of the initial cohort of 63 female patients, 48 (76%) aged between 18-55 years were selected as women of childbearing age, The median age was 46 years, with 65% in the age groups of 31-50 years, 25% in group 51-55 years and 10% 18-30 years age group. 58% of patients had inflammatory arthritis, 18.7% had connective tissue disease, 18.7% had other conditions such as hypermobility, osteoarthritis, and regional pain syndrome, 2.3% were diagnosed with vasculitis and 2.3% with polymyalgia rheumatica. Breakdown of inflammatory arthritis patients revealed rheumatoid arthritis in 64%, psoriatic arthritis 15% and ankylosing spondylitis 12%. Axial spondyloarthropathy, palindromic rheumatism, and juvenile idiopathic arthritis, each accounted for 3%. Regarding prescribed medications, 66% of the individuals were on conventional DMARDs, biologics 24%, corticosteroids 6% and 4% were on other treatments. The DMARDs prescribed were methotrexate 27%, hydroxychloroquine 19%, sulfasalazine 13%, mycophenolate 3% and leflunomide 1%. The majority of patients had disease activity in remission or mild, each accounting for 23%. Moderate and severe disease activity were reported in 21% each of the audited sample. Patients received advice specifically related to pregnancy 29%, while 71% did not have documented pregnancy-related guidance. 70% of females of reproductive age received general advice.

Conclusion
The study highlights a gap in pregnancy-related advice among the childbearing age patients as only 29% received guidance on pregnancy. This underpins the need for proactive counselling and education for female patients in routine practice, work in partnership with obstetric teams, and primary care to reduce potential pregnancy related complications and improve outcomes.

Disclosure
M. Mohareb: None. S. Ahmed: None. A. Bharadwaj: None. A. Nandagudi: None.
E026 Severe odynophagia due to cricoarytenoid arthritis in a patient with rheumatoid arthritis and systemic lupus erythematosus
Authors: Berry Joe S , Robinson John , Ng Wan-Fai 
Published: April 2024

Abstract

Background/Aims
A 65-year-old man with a 20-year history of rheumatoid arthritis (RA) presented with dysphagia, odynophagia, polyarthralgia and significant weight loss.

Methods
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Results
In addition to raised markers of inflammation, he was anti-nuclear antibody, anti-dsDNA antibody, anti-chromatin antibody and rheumatoid factor positive. He was initiated on 20mg once daily prednisolone but reported continued dysphagia and odynophagia. Computerised tomography (CT) of the neck revealed sclerosis at both cricoarytenoid joints with positron emission tomography (PET-CT) imaging identifying focal FDG uptake in the right hemiglottis projected over the posterior right true cord. Direct visualisation showed reduced mobility of the arytenoids with incomplete glottic closure in the absence of other abnormalities. He was diagnosed with cricoarytenoid (CA) joint arthritis on a background of RA and systemic lupus erythematosus overlap, with the resolution of his symptoms following intravenous methylprednisolone.

Conclusion
CA arthritis is an increasingly rare manifestation of autoimmune disease, and severe ongoing odynophagia an atypical presentation. This case highlights the need for continued awareness of laryngeal manifestations of autoimmune disease and demonstrates the benefit of PET-CT in cases where the diagnosis is uncertain or delayed.

Disclosure
J.S. Berry: None. J. Robinson: None. W. Ng: Consultancies; Expert advice in the area of Sjogren’s syndrome to GlaxoSmithKline, MedImmune, UCB, Abbvie, Roche, Eli Lilly, Takeda, Resolves Therapeutics, Sanofi, Novartis and BMS.
E044 The role of patient education in a joint injection clinic. The most ‘cost effective’ approach for the management of your arthritis
Authors: Maunick Sheevam , Mullet Carl Manuel , Mccoll Tracy , Reed Michael , Gupta Monica , Hafeez Maira , Bawa Sandeep 
Published: April 2024

Abstract

Background/Aims
GGH operates a self-referral joint injection clinic where patients suffering from an acute arthritis flare, can call and book an appointment for review and possible joint injection. The self referral service applies to all the patients attending the GGH rheumatology service and are under the care of a rheumatologist. A screening questionnaire was originally designed to triage those requesting appointments last year. We have amplified this work further this year by raising awareness and educating patients about their rheumatological condition and specifically about steroid intra-articular joint injections. Their benefits, risks and their indications. Aims-1. Providing education and awareness of joint injections in the community aiding patients to participate in their joint care. 2. Help patient understand the indications, side effects and risks involved with repeated injection . 3. To know the difference between osteoarthritis and inflammatory arthritis.

Methods
Retrospective study of patients who self-referred for joint injection between 07/07/2022 and 22/05/2023. Total of 138 self referred via phone calls, emails or letters. All the self referral data was compiled, assessed by screening questions and reviewed. An education and awareness campaign was made possible through an improved waiting room, educational pamphlets, leaflets and 1:1 consultations.

Results
Two pools of patients who received joint injections were analysed. Group A (07/07/2022 - 08/12/2022) where 102 patients self-referred and 43 received a joint injection. Group B (04/01/2023 - 22/05/2023) 36 self-referred and 15 received injection. The table below shows the different demographics of the two groups.

Conclusion
Patient Education remains one of the most important cornerstones in management of arthritis patients. After an ongoing campaign of education/awareness, self referrals were reduced by 66 %.This audit demonstrates that patient education about joint injections allows for more effective management, allowing better informed shared care. It also reduces the waiting times for patients to be seen in the injection clinic - from 3 months to 2 weeks. A cost effective approach in service improvement. Population who still availed joined injection in the re- audit were more elderly, obese, female, and had more metabolic diseases however the self referral to injection ratio is almost the same both groups.

Disclosure
S. Maunick: None. C. Mullet: None. T. Mccoll: None. M. Reed: None. M. Gupta: None. M. Hafeez: None. S. Bawa: None.
E050 Angiotensin converting enzyme for the diagnosis of childhood sarcoidosis
Authors: Mackay Madeleine C , Deepak Samundeeswari , Warrier Kishore , Rangaraj Satyapal 
Published: April 2024

Abstract

Background/Aims
Childhood sarcoidosis is a rare multisystem inflammatory granulomatous disease. The prevalence of sarcoidosis in children is unknown due to its rarity. A review of sarcoidosis in Denmark found an incidence in children &lt; 15 years of 0.22-0.27 per 100 000/year. Diagnosis can be challenging given the varied presentations due to multisystem involvement. There is no one laboratory test that is diagnostic for sarcoidosis. Angiotensin converting enzyme (ACE) has been shown to be elevated in 50% of late-onset childhood sarcoidosis. Reference levels are laboratory and age dependent, and healthy children can have levels that are 40-50% higher than in adults. Our aim was to gain a better understanding of the use of ACE in clinical practice and to review its role in diagnosis and management of sarcoidosis.

Methods
We collated the list of all patients under 18 years who had ACE levels done at our hospital between 1/12/2021 and 30/11/2022 via clinical pathology. Electronic patient records were reviewed for all patients to gather information on demographics, and clinical symptoms.

Results
We had a total of 98 ACE blood tests done for 58 patients. Clinical notes and results were available for 34 of these patients with a total of 48 ACE results. Age range of patients was 3-17 years with a mean age of 12 years. 19 (56%) patients were female, 15 (44%) were male. 50% were of white ethnicity, 12% of black ethnicity, 3% Indian ethnicity, 3% Pakistani ethnicity, 3% Chinese ethnicity and 29% ethnicity not recorded. 45 were requested by in hospital specialties, 2 from other hospitals and 1 from a GP. Of those requested in hospital 73% had been requested by ophthalmology, rheumatology or dermatology, with the remainder requested by a range of other paediatric specialties. Results ranged from 11-195 U/L, with a median of 76 U/L. Hospital reference range is 13-64 U/L and 18 patients had results &gt;64 U/L. Reference ranges for paediatric patients in literature is 29-112 U/L. 6 patients had a result&gt;112U/L. One patient had a diagnosis of sarcoidosis. Following the initial results a further 4 years of results were analysed from 02/01/2018-30/11/2022. 10 further patients had ACE results &gt;112U/L. Of these, none had sarcoidosis.

Conclusion
These results support that the diagnosis of sarcoidosis is rare. ACE results need to be interpreted being mindful that normal childhood ACE levels may be higher than the reference ranges given by hospitals, which may be based on adult ranges. There is need for more research in this area to ascertain diagnostic ACE levels and role of ACE in disease monitoring. I plan to lead a trainee multicentre retrospective project looking at the diagnosis of paediatric sarcoidosis, and within this review the role of ACE levels.

Disclosure
M.C. Mackay: None. S. Deepak: None. K. Warrier: None. S. Rangaraj: None.
E054 Rituximab dose minimisation in rheumatoid arthritis, a retrospective outcome analysis
Authors: Butler Stephanie , Smith Helen 
Published: April 2024

Abstract

Background/Aims
Rituximab was originally developed as a non-Hodgkin lymphoma treatment and rheumatology adopted the same dosing for rheumatoid arthritis(RA); two 1000mg doses two weeks apart for each maintenance cycle. UHSussex utilises self-referral for maintenance rituximab dosing once disease control lessens. Evidence demonstrates patients treated with lower dose rituximab still enjoy good disease control with less immunosuppression, reduced hospital attendance and reduction in drug expenditure. Following one two-dose cycle, stable RA patients were prescribed a single 1000mg dose from 2020 onwards. A retrospective outcome analysis was completed in August 2022; however, results were highly impacted by Covid-19 and a repeat analysis was required. Aim: to assess impact of a single 1000mg dose rituximab regime on patient sustained outcomes, dose intervals, Disease Activity Scores (DAS) and drug expenditure.

Methods
The pharmacy database was used to identify RA patients receiving rituximab from March 2020 to August 2023. Patients received at least one standard two-dose cycle before switching to a single infusion. Patients were excluded if lost to follow up (under care of rheumatology for less than a year following dose switching) or considered clinically unstable. Patient letters and departmental records were accessed for disease scores and treatment intervals.

Results
Table1: Results from the two analysis periods

From the original cohort (31/59)53% remained on single dosing. Switch back tended to occur within 18 months of switching. DAS scores were not collected reliably and were omitted.

Conclusion
Covid-19 impacted services and attitudes during the initial study period. Many patients stopped treatment, particularly rituximab, due to the prolonged duration of effect, excluding them from analysis. The dose-interval increase during the first analysis was considered a result of the pandemic. Patients and clinicians delayed infusions; minimising immunosuppression due to perceived increased risk of Covid-19. The continued interval increase in the second analysis may identify a patient cohort in deep remission eligible for therapy review. The study highlights poor practice in collecting and recording DAS scores and appropriate patient-clinician interaction opportunities. 53% of patients remained on single infusions in August 2023 resulting in resource savings, reduced hospital attendance, immunosuppression and significant cost savings demonstrating the rationale for this option.

Disclosure
S. Butler: Honoraria; Abbvie, Janssen. H. Smith: Honoraria; Novartis, Abbvie.
E063 Discussion of contraception and family planning in the lupus clinic
Authors: Mashida Knievel , Benson Rosalind , Redfern Angela , Burton Christine , Mclaren Zoe 
Published: April 2024

Abstract

Background/Aims
Females with a diagnosis of systemic lupus erythematosus (SLE) have a higher risk of adverse pregnancy outcomes. Many medications used to treat SLE are teratogenic. Contraception counselling and discussion around family planning are essential to reduce pregnancy risks.
This service evaluation aimed to evaluate the appropriateness of contraceptive advice given to females of childbearing age with SLE in accordance with international guidelines and assess patient adherence to recommendations provided.

Methods
A retrospective evaluation of electronic medical records was undertaken. All females with a diagnosis of SLE seen in the preceding 12 months were identified. Any who were menopausal or trying to conceive were excluded. Based on BSR and EULAR guidance, five standards relating to contraceptive advice were assessed, primarily focusing on frequency of contraceptive discussions and the level of adherence to recommendations provided. For analysis of the established parameters, patients were stratified into different clinic groups; tertiary lupus clinic, vs. general clinic and whether the consultation was clinician or nurse led.

Results
42 females aged 16-55 were identified. 39/42 (93%) of patients had discussions regarding contraception and conception. 39/39 (100%) of females were recommended appropriate contraception methods. Only 3/42 (7.1%) received written information on family planning. Adherence to contraceptive advice was low. Only 10/39 (25.6%) of patients recommended non-barrier contraception were complying with advice. 29/42 (69%) patients were on teratogenic medication. 8/29 (27.6) were using long acting reversible contraceptives (LARC). Of those who were not, 2/29 (6.8%) were not sexually active, 1/29 (3.4%) relied on their partner’s vasectomy, 3/29 (10.3%) had alternative contraception preference and in 15/29 (51.7%) the reasons were unclear. Conception and family planning advice was given in all clinics, however those attending the tertiary lupus clinic were significantly more likely to receive follow up advice on contraception and conception advice compared to those attending general clinics (U = 44, P &lt; 0.001). There was no difference between the frequency of nurse or clinician led advice.

Conclusion
Contraceptive advice in line with current guidelines is being delivered routinely in lupus clinics. There appears to be barriers to the uptake of LARC. To better understand this, exploration of patient experiences of contraception and conception discussions is underway.

Disclosure
K. Mashida: None. R. Benson: None. A. Redfern: None. C. Burton: None. Z. Mclaren: None.
Karyopherin α2 is a maternal effect gene required for early embryonic development and female fertility in mice
Authors: Rother Franziska , Depping Reinhard , Popova Elena , Huegel Stefanie , Heiler Ariane , Hartmann Enno , Bader Michael 
Published: April 2024

AbstractThe nuclear transport of proteins plays an important role in mediating the transition from egg to embryo and distinct karyopherins have been implicated in this process. Here, we studied the impact of KPNA2 deficiency on preimplantation embryo development in mice. Loss of KPNA2 results in complete arrest at the 2cell stage and embryos exhibit the inability to activate their embryonic genome as well as a severely disturbed nuclear translocation of Nucleoplasmin 2. Our findings define KPNA2 as a new maternal effect gene.
The Effect of SGLT2 Inhibitor Therapy on Endothelial Progenitor Cell Function in Patients With Heart Failure
Authors: Kakzanov Yana , Sevilya Ziv , Goldman Alexander , Cipok Michal , Hershkovitz Vera , Bryk Gabriel , Lev Eli I. 
Published: April 2024

Abstract:
Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have been shown to reduce the risk of cardiovascular mortality and hospitalizations in patients with heart failure (HF) with preserved or reduced ejection fraction (HFpEF or HFrEF). The mechanism for this benefit is not clear. Endothelial progenitor cells (EPCs) are bone marrow–derived cells able to differentiate into functional endothelial cells and participate in endothelial repair. The aim of this study was to evaluate the effect of SGLT-2 inhibitors on the level and function of EPCs in patients with HF. We enrolled 20 patients with symptomatic HF, 12 with HFrEF and 8 with HFpEF (aged 73.3 ± 10.2 years, 95% men). Blood samples were drawn at 2 time points: baseline and ≥3 months after initiation of SGLT-2 inhibitor therapy. Circulating EPC levels were evaluated by expression of vascular endothelial growth factor receptor-2 (VEGFR-2), CD34, and CD133 by flow cytometry. EPC colony forming units (CFUs) were quantified after 7 days in culture. The proportion of cells that coexpressed VEGFR-2 and CD34 or VEGFR-2 and CD133 was higher following 3 months of SGLT-2 inhibitors [0.26% (interquartile range, IQR 0.10–0.33) versus 0.55% (IQR 0.28–0.91), P = 0.002; 0.12% (IQR 0.07–0.15) versus 0.24% (IQR 0.15–0.39), P = 0.001, respectively]. EPC CFUs were also increased following SGLT-2 inhibitor treatment [23 (IQR 3.7–37.8) versus 79.4 (IQR 25.1–110.25) colonies/106 cells, P = 0.0039]. In patients with symptomatic HF, both HFpEF and HFrEF, treatment with SGLT-2 inhibitors is associated with an increase in the level and function of circulating EPCs. This augmentation in EPCs may be a contributing mechanism to the clinical benefit of SGLT-2 inhibitors in patients with HF.
Ethical considerations for nurse practitioners conducting research in populations with opioid use disorder
Authors: St Marie Barbara J. , Bernhofer Esther I. 
Published: April 2024

ABSTRACT
People with opioid use disorder (OUD) are a vulnerable population who face unique risks of harm when participating in research. Despite a long-standing dialogue, written research codes of ethics, and institutional review board oversight for the conduct of ethical research in vulnerable populations, protections for study populations with OUD is rarely mentioned. Nurse practitioners who conduct research using participants with OUD, especially when recruiting their own patients (i.e., dual role), must be aware of the unique ethical considerations necessary to protect their patients and participants from increased risks. This article explores vulnerabilities and influences that can affect participant recruitment and consent, imbalances in the distribution of risk and benefits to participants participating in research, and the concerns of coercions, undue influence, and unjustifiable pressure contributing to vulnerabilities. Strategies to reduce the risks of influences that are of concern in the vulnerable population of research participants with opioid disorder are suggested. The goal of this article was to raise awareness of the unique potential risks of harm when using people with OUD as research participants and to explore strategies to minimize potential risks of various levels of influence in this vulnerable population.
Current progress in international pediatric emergency medicine
Authors: Gutiérrez Camilo E. , Lim Rodrick , Chu Simon 
Published: April 2024

Purpose of review
Over the past four decades, pediatric emergency Medicine (PEM) has witnessed significant global development, with a notable increase in training programs and official recognition by regulatory bodies. However, disparities persist in the recognition of PEM as an independent subspecialty, availability of training programs on a global scale, academic recognition, and the ability to provide high-quality care to children worldwide. There is paucity of published literature regarding development of PEM globally. This review explores the current trends and challenges in international pediatric emergency medicine.

Recent findings
Current trends in international pediatric emergency medicine encompass the provision of training in pediatric-focused emergency and acute care, increased propagation of evidence-based guidelines specific to the care of children, the growth of collaborative research networks and interest groups within national and international societies. Simultaneously, the field continues to face challenges such as the lack of recognition, inequities in access, and a lack of dissemination of global PEM initiatives.

Summary
While recent advancements have significantly enhanced the state of international pediatric emergency medicine, including pediatric specific research networks and training programs, barriers still hinder its overall quality. Many of these obstacles are not unique to pediatric emergency medicine but are directly affected by financial disparities and lack of governmental and public recognition of the essential role of pediatric emergency care.
Methods for Global Health Collaboration on Cardiovascular Disease: Vihiga 1
Authors: Shishani Kawkab , Kaduka Lydia , Olale Joanna , Mbuka Schiller , Mutai Joseph , Muniu Erastus , Ochieng Rodgers , Sivarajan Froelicher Erika 
Published: April 2024

Background
Partnership building and understanding of context that addresses global health concerns is essential in global health research. However, limited knowledge is available on the practical experiences of building such relationships.

Objectives
The aim of this study was to provide a detailed description of the processes involved in establishing international collaboration, gain community involvement and cooperation with gatekeepers, and study populations of rural village areas in Western Kenya.

Results
Because of the limited information available in the published literature about the extremely important practical considerations, our experiences on the logistical aspects of planning and implementing global health research projects are presented.

Conclusion
Understanding the local collaborators and their communities and allocating adequate resources in time and money during the planning phase is paramount in ensuring the successful completion of global health research studies.