bluuebunny/crossref_metadata_2025_split huggingface dataset:
A253 PRIMARY PROPHYLAXIS FOR SPONTANEOUS BACTERIAL PERITONITIS IN HOSPITALIZED CIRRHOTIC PATIENTS WITH LOW PROTEIN ASCITES AND RENAL DYSFUNCTION OR LIVER FAILURE: A RETROSPECTIVE REVIEW FROM A TERTIARY CENTRE IN BRITISH COLUMBIA
Authors: Fetz A , Li L , Lee C , Leung L 
Published: March 2023

Abstract

Background
Spontaneous bacterial peritonitis (SBP) is a severe and often fatal infection that can occur in patients with cirrhosis and ascites. The benefits of primary prophylaxis with antibiotics for SBP have been demonstrated in patients with cirrhosis presenting with gastrointestinal (GI) bleeding; patients hospitalized for other reasons with an ascitic protein less than 10 g/L; and patients with ascitic protein less than 15 g/L with either impaired renal function (serum creatinine greater than 106 µmol/L, BUN greater than 8.9 mmol/L, or serum sodium less than or equal to 130 mEq/L) or liver failure (Child-Pugh score greater than or equal to 9 or bilirubin greater than 50 umol/L).

Purpose
To evaluate the rate of primary prophylaxis in patients discharged from a tertiary care hospital with low protein ascites and impaired renal function or liver failure, and subsequent episodes of SBP, hospitalizations, or deaths.

Method
A retrospective chart review at St. Paul’s Hospital in Vancouver, British Columbia, from November 2019 to August 2021 was conducted. Hospitalized patients with cirrhosis who had an ascitic protein less than 15 g/L and met criteria for either renal dysfunction or liver failure were included in the study. The rate of primary prophylaxis prescribed in eligible patients as well as the subsequent incidence of SBP, hospitalizations, or all-cause mortality were evaluated. Patients were followed up to 12 months after the index paracentesis.

Result(s)
A total of 279 patients with cirrhosis were hospitalized during the study period. 69 patients underwent a diagnostic paracentesis and 41 patients met the inclusion criteria for primary SBP prophylaxis. 28 patients were excluded with most common reasons being ascitic protein above 15 g/L (n=12), no documented ascitic protein concentration (n=9), or index paracentesis met the criteria for the diagnosis of SBP (n=5). Of the patients included, 37 (90.2%) did not receive primary prophylaxis. 8 of these patients (21.6%) developed subsequent SBP. 30 patients (81.1%) were hospitalized at least once in the following 12 months. 18 (48.6%) died during the follow-up period with 1 death attributed to SBP. 4 patients (9.76%) received primary prophylaxis and were prescribed either ciprofloxacin or trimethoprim/sulfamethoxazole. None of these patients developed SBP, however, 3 (75%) were hospitalized and died from other causes.

Conclusion(s)
The rate of primary prophylaxis for SBP in hospitalized patients with low protein ascites and impaired renal function or liver failure at our institution is low. The guarded prognosis in this subset of patients is also demonstrated. Further studies are needed to assess the root causes for the lack of primary prophylaxis given.

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None

Disclosure of Interest
None Declared
A260 PYOGENIC LIVER ABSCESS FORMATION SIX MONTHS AFTER PERFORATED APPENDICITIS IN AN OTHERWISE HEALTHY CHILD
Authors: Sutton H , Carman N 
Published: March 2023

Abstract

Background
Pyogenic liver abscesses (PLA) in children are uncommon in the developed world. When they are diagnosed, it is often in patients with hepatobiliary cancers, biliary diseases and liver transplants. PLA post perforated appendicitis has been reported as an aetiology in non-immunocompromised children. Reported cases of PLA’s developing as a late complication of perforated appendicitis are rare. The longest time from appendicitis to PLA diagnosis previously reported was four months.

Purpose
To report a rare case of liver abscess formation, post ruptured appendicitis, in a previously healthy and review the recent literature relevant to this topic.

Method
Retrospective chart review through electronic patient records was conducted for our reported case. Literature review of the relevant medical literature was performed.

Result(s)
Patient is an 11-year-old female with no significant past medical history apart from a perforated appendix requiring laparotomy for washout and 10 days of antibiotics, 6 months prior to presentation. The patient presented to her local emergency room with 6-week history of right flank pain and 10 days of fever. Abdominal ultrasound (US) identified a 3cm x 3cm x 3cm mass in the right lobe of the liver consistent with an abscess which was confirmed with magnetic resonance imaging (MRI). She was transferred to Toronto Hospital for Sick Children for management and investigation. At the Hospital for Sick Children she was started on Intravenous (IV) cefotaxime and metronidazole. After a repeat US on transfer it was determined the liver abscess was not amenable to drainage. Echinococcosis and Entamoeba serology were negative and neutrophil oxidative burst test (NOBT) test was within normal limits. Liver enzymes never exceeded 2x the upper limit of normal and synthetic function remained intact. After 7 days of IV antibiotics the patient’s inflammatory markers had improved and she had remained afebrile, but repeat US and MRI showed little to no change in abscess size. The decision was made for a prolonged course of IV antibiotics. After another two weeks of IV antibiotics her repeat US showed reduction in abscess size by roughly one third, and she was switched to oral antibiotics, after a total of 28 days, for a further four weeks with ongoing improvement.

Conclusion(s)
A review of the literature identified one nationwide population-based analysis in the United States reporting 4075 cases of PLAs, as well as three single centre reviews, from Iran, Tailand and the United Kingdom, reporting 18, 15 and 38 cases of liver abscesses, respectively. Common underlying aetiologies included primary immunodeficiency’s, liver transplantation, hepatobiliary cancers and non-PLA intra-abdominal infections. Managements included IV antibiotics plus/minus drainage when amenable. No cases of liver failure or death were reported.

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None

Disclosure of Interest
None Declared
A280 DOES THE PLACEMENT OF A MANOMETRY PROBE WITH ENDOSCOPY AND CONSCIOUS SEDATION EFFECT MEASUREMENTS ON ENSUING HIGH RESOLUTION MANOMETRY? A RETROSPECTIVE COHORT STUDY IN PATIENTS POST-PERORAL ENDOSCOPIC MYOTOMY
Authors: Sandhu N K , Bechara R , Rodrigues D M 
Published: March 2023

Abstract

Background
High resolution manometry (HRM) is the gold standard for diagnosis of esophageal motility disorders. This is traditionally conducted without sedation, using intranasal intubation with a manometry probe. Inserting the HRM probe immediately after endoscopic examination allows for endoscopic visualization and sedation for probe placement. This method is used commonly used for our patients who are post-peroral endoscopic myotomy (POEM). However, it is unclear whether short acting sedative drugs administered during endoscopy can affect contractility measurements during HRM.

Purpose
The purpose of this study was to determine if conscious sedation with short-acting anaesthetic agents (Midazolam and Fentanyl) influenced HRM readings in patients undergoing evaluation post-perioral endoscopic myotomy (POEM).

Method
We conducted a retrospective cohort study, comparing patients post-POEM who had endoscopy under conscious sedation with placement of the manometry probe versus those without preceeding endoscopy/sedation. Post-POEM patients who had undergone HRM over a 3-year period (2019-2022) were identified from motility lab records. Electronic charts were reviewed for data abstraction, and HRM parameters (resting lower esophageal pressure and integrated relaxation pressure) were determined for both groups and compared using t-tests, and error listed as standard error of the mean.

Result(s)
From 2019-2022, 15 patients underwent manometry using a non-endoscopic approach with no sedation and 25 underwent manometry following endoscopy with conscious sedation and placement of the probe during the procedure. In the latter group, HRM occurred within 2 hours of probe placement. The mean doses of fentanyl and midazolam were 115mcg (+/-29.7) and 3.3mg (+/-1.3) respectively. The mean end-expiratory lower esophageal sphincter pressure was 9.8 mmHg (+/- 2.9) in the non-endoscopic group and 26.24mmHg (+/- 5) in the endoscopy group (p &lt;0.02). The median integrated relaxation pressure was 11.2 mmHg (+/-1.2) in the non-endoscopic group and 14.52mmHg (+/- 0.9) in those in the endoscopy group (p &lt;0.04).

Conclusion(s)
In conclusion, this small, retrospective cohort study shows that manometry probe placement after endoscopy with conscious sedation may affect esophgeal HRM measurement parameters in the post-POEM patient population. Physicians should consider delaying HRM measurements for &gt;4 hours to maximize clearance of the sedative medications.

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None

Disclosure of Interest
None Declared
A282 RISK FACTORS ASSOCIATED WITH UNSUCCESSFUL HIGH-RESOLUTION MANOMETRY: FAILURE IS COMMON BUT WHAT CAN WE CHANGE
Authors: Patel V , Rodrigues D 
Published: March 2023

Abstract

Background
High-resolution manometry (HRM) is a diagnostic tool used to evaluate esophageal motor function and diagnose motility disorders. A standardized protocol is used to make an accurate diagnosis based on the Chicago Classification. Some existing literature suggests that incomplete or imperfect manometry tests are common, however; there remains a paucity of data to evaluate risk factors for failure to help clinicians determine when a study may be difficult to perform.

Purpose
Our goal was to quantify how often failed tests occurred and determine specific factors that may be associated with failed HRM.

Method
We retrospectively evaluated records for HRM tests performed over 1 year at our academic centre. Based on clinical experience, we identified several factors that may be associated with the success of HRM testing including the following: indications and symptoms leading to testing, patient’s age and biological sex, previous esophageal manometry history, previous esophageal/gastric surgery, previous septal repair/deviated septum, history of significant nausea/vomiting, history of anxiety/depression, history of irritable bowel syndrome, and medication use (opioids, proton pump inhibitors, calcium channel blockers, nitrates). We then compared patients with successful HRM vs. unsuccessful HRM with regard to our pre-specified risk factors.

Result(s)
29 HRM tests were unsuccessful from a total of 152 that were performed (19% failure rate). Reasons for failure included the inability to pass the probe through LES (55%) and the inability to tolerate the manometry probe for a minimum of 10 saline swallows (45%). After separating the failed cases from successful tests, both groups had a similar distribution of age and sex. Specific symptoms and indications did not have a significant association with unsuccessful tests. A previous history of failed manometry was associated with unsuccessful HRM (OR: 15, 95% CI 1.88 to 183.8, p=0.0156). Conversely, PPI usage was associated with fewer failed HRM tests (OR: 0.37, 95% CI 0.16 to 0.90, p=0.0343). Other medical history or medication use was not found to be associated with testing failure in our study.

Conclusion(s)
HRM is useful for diagnosing esophageal motility disorders, but incomplete tests are common. Although this study did not identify any factors in a patient’s medical history that could be used to predict failure in patients who have never had testing, further investigations may identify if PPI therapy can make HRM testing more tolerable. Additionally, the association between previous failed HRM and repeat failures suggests that endoscopic probe placement techniques should be considered instead of retrying conventional probe placement.

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None

Disclosure of Interest
None Declared
A283 ROLE OF IMMUNOGLOBULIN E IN ABDOMINAL PAIN DUE TO INTERACTIONS BETWEEN DIET AND STRESS IN A MODEL OF IBS
Authors: Lopez Lopez C , Jaramillo Polanco J , Tsang Q K , Lomax A E , Vanner S J , Reed D E 
Published: March 2023

Abstract

Background
Food and stress are common triggers of symptoms in IBS patients. We previously showed in a murine model of IBS that exposure to a food antigen during a period of psychological stress leads to visceral hypersensitivity in both the ileum and colon upon re-exposure to the food antigen. This was inhibited by blocking mast cells and histamine receptors, suggesting that mast cell activation is involved in this increased pain signaling. However, it is unknown if immunoglobulin E (IgE) is involved in the activation of mast cells leading to visceral hypersensitivity.

Purpose
Determine the role of IgE in the increased pain signaling in ileum and colon of mice re-exposed to ovalbumin after an initial exposure to ovalbumin during chronic stress.

Method
Balb/c mice underwent water avoidance stress (WAS) for 10 days and were exposed to ovalbumin (OVA) from days 2-10. Five weeks later, mice were re-exposed to ovalbumin for two weeks (WAS/OVA+OVA mice). Mice were injected with anti-mouse IgE or isotype control antibody (1 mg/kg, i.p.) just prior and during ovalbumin re-exposure. Ex-vivo extracellular afferent recordings from nerves innervating the ileum were obtained to assess changes in mechanosensitivity. Ileum and colonic supernatants were also collected. Dorsal root ganglion neurons (DRG) from control mice (n = 12) were incubated with ileal and colonic supernatants. The excitability of these neurons was assessed by measuring the rheobase (minimum current required to evoke an action potential; lower rheobase=increased excitability) using perforated patch clamp. Data were analyzed by unpaired t-test or two-way ANOVA with Sidak’s post hoc test.

Result(s)
WAS/OVA+OVA mice treated with anti-IgE antibody had decreased mechanosensitivity of ileal nerves following lumen distention compared to WAS/OVA+OVA mice treated with isotype control antibody (7.7 ± 0.65 vs 12.9 ± 1.04 Hz, p = 0.034, n = 9 and 8 mice, respectively). Ileal supernatants from anti-IgE treated WAS/OVA+OVA mice evoked lower excitability (higher rheobase) in DRG neurons than neurons incubated with supernatants from isotype control treated WAS/OVA+OVA mice (rheobase: 89.2 ± 4.7 vs 71.9 ± 5.1 pA, p= 0.018). Colonic supernatants showed similar effects of the anti-IgE treatment (rheobase: 95.5 ± 4.4 vs 76.7 ± 5.4 pA, p = 0.01).

Conclusion(s)
IgE is involved in the increased pain signaling observed in both ileum and colon induced by antigen re-exposure following an initial stress-food antigen interaction. This suggests that IgE-mediated mast cell activation in response to food antigens may be a mechanism of meal-induced pain in IBS patients.

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Other

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Department of Medicine, Translational Medicine Grant, Queen's University

Disclosure of Interest
None Declared
A286 THE ROLE OF A GUT HORMONE VERSUS NUCLEAR FACTOR-KAPPA B IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE
Authors: Abdel-Samiee M , Abdelsameea E , Badran A 
Published: March 2023

Abstract
NOT PUBLISHED AT AUTHOR’S REQUEST

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None

Disclosure of Interest
None Declared
Identifying the latent space geometry of network models through analysis of curvature
Authors: Lubold Shane , Chandrasekhar Arun G , McCormick Tyler H 
Published: March 2023

Abstract
A common approach to modelling networks assigns each node to a position on a low-dimensional manifold where distance is inversely proportional to connection likelihood. More positive manifold curvature encourages more and tighter communities; negative curvature induces repulsion. We consistently estimate manifold type, dimension, and curvature from simply connected, complete Riemannian manifolds of constant curvature. We represent the graph as a noisy distance matrix based on the ties between cliques, then develop hypothesis tests to determine whether the observed distances could plausibly be embedded isometrically in each of the candidate geometries. We apply our approach to datasets from economics and neuroscience.
Airway emergency after dental extraction
Authors: Cheng Dong Tony , Young Thomas , Kim Paul Mercedes , Nikolarakos Dimitrios 
Published: March 2023

AbstractLife-threatening airway emergencies and uncontrolled haemorrhage following dental extractions is rarely encountered. Inappropriate handling of dental luxators may lead to unexpected traumatic events resulting from penetrating or blunt trauma to the surrounding soft tissues and vascular damage. Bleeding during or after surgery usually resolves spontaneously or with local haemostatic interventions. Pseudoaneurysms are rare occurrences secondary to blunt or penetrating trauma usually produced by arterial injury leading to extravasation of blood. The rapidly enlarging haematoma with risk of spontaneous pseudoaneurysm rupture is an airway and surgical emergency necessitating urgent intervention. The following case highlights the importance of appreciating the potential complications associated with extractions in the maxilla, significant anatomical relationships and recognizing the clinical signs of a threatened airway.
Caecal perforation from CT colonography: an unexpected complication
Authors: Pather Vijay , Rodrigues Justin , Sefa Tasmea , MacDermid Ewan 
Published: March 2023

AbstractComputer tomography colonography (CTC) is an increasingly utilized diagnostic modality in Australia. CTC aims to image the entire colon, and is often used in higher risk patient populations. Colonic perforation following CTC is a rare complication, with only 0.008% of patients undergoing CTC requiring surgical intervention. Most published cases of perforation following CTC are due to identifiable causes, often involving the left colon or rectum. We present a rare case of caecal perforation following CTC, requiring right hemicolectomy. This report highlights the need for high suspicion for CTC complications, despite their rarity, and the utility of diagnostic laparoscopy for diagnosis in atypical presentations.
A case of accidental ingestion of a hooked denture without symptoms for 6 years
Authors: Ishikawa Shinji , Fukuma Daiki , Taki Katsunobu , Ishiko Takatoshi 
Published: March 2023

AbstractSix years prior, the patient accidentally swallowed a denture during a meal and immediately visited a nearby doctor. However, because spontaneous excretion was expected, regular imaging testing was used to monitor it. After 4 years, although the denture was still in the small bowel, as there were no symptoms, the regular follow-up was terminated. Because the patient’s anxiety increased, he visited our hospital 2 years later. Surgery was performed, as it was determined that there was no possibility of spontaneous excretion. The denture was palpated in the jejunum. The small intestine was incised, and the denture was removed. As far as we know, there are no guidelines prescribing a clear follow-up period for accidental denture ingestion. In addition, there are no guidelines specifying surgical indications in asymptomatic cases. Nonetheless, there have been reports of gastrointestinal perforations with dentures, and we consider that earlier preventive surgical intervention is better.
Sexual function and quality of life in women with idiopathic premature ovarian insufficiency
Authors: Gosset Anna , Claeys Jeanne Marie , Huyghe Eric , Tremollieres Florence 
Published: March 2023

Abstract

Background
Premature ovarian insufficiency (POI) is a disruptive diagnosis for women, with major consequences on fertility but also on quality of life and sexual functioning.

Aim
The aim of this study was to evaluate the impact of vaginal symptoms from the genitourinary syndrome of menopause on the quality of life and sexual functioning of women with POI.

Methods
This cross-sectional observational study involved 88 women who were investigated in a specialized setting at the University Hospital of Toulouse (France) between 2014 and 2019. All women completed the Day-to-Day Impact of Vaginal Aging (DIVA) questionnaire on well-being and quality of life and the Female Sexual Function Index (FSFI) on sexual functioning. Analysis of total scores and subdomains of the questionnaire was performed and compared according to use of hormone replacement therapy or local low-dose estrogen treatment, age at POI, and use of antidepressant therapy or current psychological support.

Outcomes
Outcomes included the DIVA questionnaire and the FSFI.

Results
Among the 88 women who fulfilled the inclusion criteria, 66 (75%) answered the questionnaires. Mean ± SD age at POI diagnosis was 32.6 ± 6.9 years and mean age at questionnaire time was 41.6 ± 6.9 years. The highest mean scores on the DIVA questionnaire were found in the self-perception and body image domain (2.05 ± 1.36), followed by the sexual functioning domain (1.52 ± 1.28). The mean FSFI score was 23.08 (95% CI, 21.43-24.73), with 32 women (78% of sexually active women) having a score &lt;26.55, which defines sexual dysfunction. There was no difference in the FSFI score and for all DIVA domains whether or not women were taking hormone replacement therapy or local hormone therapy.

Clinical Implications
This should encourage practitioners to systematically discuss the impact of POI on sexuality and vulvovaginal symptoms to provide women with specific care and advice to improve their quality of life.

Strengths and Limitations
This is the first French study that aimed to assess the impact of the genitourinary syndrome of menopause on the quality of life and sexual well-being in women with POI by using standardized validated questionnaires with a very good participation rate (75%). The sample size was limited, and we could not eliminate selection bias due to university hospital recruitment.

Conclusion
POI can have a negative impact on sexual quality of life, which raises the needs for specific advice and care.