ABSTRACT
Background/Aims Giant cell arteritis (GCA) is the most common vasculitis in adults aged over 50 years old with the highest incidence among persons aged 70- 79. It is more commonly seen in female patients. Most cases have been reported in whites of Northern European descent. A broad range of symptoms can be reported including headache, jaw or tongue claudication, visual disturbances, PMR and other systemic features including weight loss, fever and sweats. In recent years new evidence has emerged regarding the investigation and treatment of GCA. This audit is to review the demographics, symptoms and investigations of patients who presented to the Rheumatology Department in SEHSCT with features concerning for possible GCA. Methods Retrospective collection of data from January 2020 to July 2021 using the regional Electronic Care Record NI with reference to presentations, investigation results, clinic records and follow-up letters. Results 70 patients were included (24 males and 46 females). Mean age was 72 years old. Table 1 shows the percentages of clinical symptoms reported. All patients investigated had an ESR (mean 57.8) and CRP (mean 54.1) checked. 43 patients had ANCA checked with 3 positive results. 40 patients underwent CT brain with 2 abnormalities reported unrelated to GCA. TA ultrasound was performed on one occasion with a positive result demonstrating ''halo'' sign recorded. 6 patients underwent CTPET with 3 diagnoses of LVV and 1 of PMR. 70 TAB performed with 12 positive results and 4 'suggestive' of GCA. Conclusion Our cohort of patients demonstrated demographics similar to the current global geographic trends in GCA. There are a broad range of clinical symptoms that can present in GCA, none of which are entirely specific or pathognomonic. Clinical diagnosis is based on clinical symptoms, signs and laboratory tests, each of which are imperfect markers for GCA. Our audit demonstrated that the use of additional confirmatory diagnostic tests including temporal artery ultrasound and CTPET was being under-utilized in the SEHSCT. Use of these tests may improve the diagnostic yield in this challenging condition. As a result of this audit, a quality improvement project to provide a rapid access GCA pathway is being designed. (Table Presented).
ABSTRACT
Institutes of higher learning (IHL's) face unprecedented, restricted movement challenges during the COVID-19 pandemic. This paper describes how the School of Electrical and Electronic Engineering of Singapore Polytechnic undertook the re-design of teaching and learning practices and remote e-proctoring of assessments, in such an environment. The pandemic accelerated the switch to blended flipped learning, with all face-to-face lectures, replaced with asynchronous e-learning contents. A structured school-wide approach for teaching and learning to help both staff and students to adapt to the new learning environment was implemented. For Academic Year 2020/21, the School mounted large-scale e-proctored remote online assessments, with carefully considered measures to preserve academic integrity and rigour, to satisfy various stakeholders' needs. Semester 1 saw more than 100 staff, 2400 full-time and part-time students, and over 100 modules involved. In Semester 2, more than 400 full-time students and 31 modules were involved. Communication and training of the staff were carried out to prepare for the new way of assessment, and also to guide them to help their students for this. The use of a student response system (SRS) for diagnosing student learning of the asynchronous learning contents in-class was introduced. Survey findings show positive results generally, and these included real-time performance data analysis and immediate feedback, checking understanding, and appropriate learning interventions. Similarly, survey findings on the online assessments to engage students in their learning and progress are also shared. A comparison of the overall academic performance of students, pre-pandemic, against those conducted under the remote e-proctored conditions in the changed learning environment, suggests minimal impact. This paper concludes that SEEE's school-wide strategy supports the learning engagement of the students in the new teaching and learning practices, with the total switch to flipped learning for the diploma engineering courses it offers. © CDIO 2022.All rights reserved.
ABSTRACT
Purpose: To identify factors associated with an increased or decreased risk of SUDEP. Method: The EpiNet study group is undertaking a prospective case-control study, aiming to recruit 200 participants from approximately 40 international centres over four years. Patients with epilepsy from a pre-defined cohort who die of definite or probable SUDEP will be included. Cases must be alive when the cohort is defined. For each case, three true controls and one proxy control will be recruited from the same cohort. A structured telephone interview with the next-of-kin of SUDEP cases will be conducted. Controls will be asked about their epilepsy and lifestyle. Proxy controls will be asked about the control patient they know. Information regarding seizure type and medication, sleeping arrangements, nocturnal supervision, use of seizure-detection devices, socio-economic factors and other health issues will be entered into the EpiNet database. Pathologists' and coroners' data regarding circumstances and cause of death will also be recorded if available. The data will be analysed to identify risk factors for SUDEP. Odds ratios will be calculated using the Mantel-Haenszel method and logistic regression to control for covariates. 200 cases and 800 controls will detect an odds ratio of 1.7 over a control exposure range of 22-65%, with 80% power and 95% confidence level (2-sided). Result: The study is now underway in 8 countries through Asia-Oceania, Europe and North America. COVID-19 has adversely affected case enrolment, and new centres are being sought. Conclusions: SUDEP is second only to stroke as the leading neurological cause of years of potential life lost. The causes remain uncertain. A large prospective case-control study is the best way to determine the extent of the association between specific variables and SUDEP, in particular, those that could be modified to prevent this tragedy. Anyone interested in participating is welcome to contact: epinetadmin@adhb.govt.nz.
ABSTRACT
Introduction: Acute disseminated encephalomyelitis (ADEM) is a rare autoimmune disease involving inflammation of the brain and spinal cord, usually triggered by a preceding illness or vaccination. We describe a case triggered by SARSCoV-2. Case: A previously healthy 1 year old girl presented with reduced GCS, decorticate posturing, seizures and a 3-day history of fever. She required intubation, was started on intravenous antibiotics, Aciclovir and Levetiracetam and was transferred to PICU. PCR nasal swabs revealed the child was SARSCoV-2 and Adenovirus positive. CSF investigations were normal, including a negative SARSCoV-2 RNA. MRI brain showed bilateral widespread T2 and FLAIR signal changes of subcortical white matter and the splenium. Diffusion restriction with T2/FLAIR signal change was noted in the thalami and pons. This was initially felt to be in keeping with Covid-19 encephalopathy, especially given the presence of the splenial lesion. A spinal MR was normal. She made good progress with steroid therapy and at discharge, was able walk a few steps, recognise voices, clap at nursery rhymes, eat and drink normally, but had cortical visual impairment, which is improving. Her anti-MOG antibodies were later found to be positive, which explains the symmetrical scan changes and brainstem involvement. Discussion: In literature, there is a paucity of information regarding COVID-19 related encephalopathy. Lesions in the splenium of the corpus callosum appear to be a relatively consistent finding in children with PIMS-TS. Our child did not have any feature to suggest PIMS-TS. It is likely that SARSCoV-2 triggered off an inflammatory process in this child mediated by MOG antibodies. Conclusion: In the advent of the COVID-19 pandemic, it is important not to attribute clinical findings to SARSCov-2 without excluding other disorders. MOG antibody associated demyelination may mimic the findings described in COVID-19 encephalopathy.