SIGNIFICANT REDUCTION IN THE DIAGNOSIS OF BARRETT'S ESOPHAGUS (BE) AND RELATED DYSPLASIA DURING THE COVID-19 PANDEMIC: AN ANALYSIS OF THE GIQUIC NATIONAL BENCHMARKING REGISTRY

DDW 2022 Author Disclosures: Sachin Wani: NO financial relationship with a commercial interest ;Jeffrey Williams: NO financial relationship with a commercial interest ;Jennifer Holub: NO financial relationship with a commercial interest ;Audrey Calderwood: YES financial relationship with a commercial interest;Dark Canyon Laboratoties:Advisory Committees or Review Panels ;Jason Dominitz: NO financial relationship with a commercial interest ;Prasad Iyer: YES financial relationship with a commercial interest;Exact Sciences:Consulting;Exact Sciences:Grant/Research Support;Pentax:Grant/Research Support;Pentax:Consulting;Ambu:Consulting;Symple Surgical:Consulting;Medtronic:Consulting ;Nicholas Shaheen: YES financial relationship with a commercial interest;Lucid:Grant/Research Support;Medtronic:Grant/Research Support;Steris:Grant/Research Support;Pentax:Grant/Research Support;CDx Medical:Consulting;Cernostics:Consulting;Interpace Diagnostics:Grant/Research Support;Phathom Pharmaceuticals:Consulting;Exact Sciences:Consulting;Aqua Medical:Consulting;Cook Medical:Consulting Background: The COVID-19 pandemic has disrupted endoscopy practices with significant reductions in procedural capacity creating unprecedented decreases in cancer screening and surveillance services. Using a national registry with matched endoscopy and pathology data, we aimed to assess the impact of the pandemic on the proportion of patients diagnosed with BE and BE-related dysplasia and adherence to established quality indicators in BE. Methods: We analyzed data from the GI Quality Improvement Consortium (GIQuIC) Registry, a national repository of endoscopy data. Procedure data from all EGDs in the registry during the study period, including procedure indication, demographics, endoscopy findings, pathology results and recommendations were assessed from 1/2018 – 5/2021. Three cohorts based on date of EGD performance were created: Pre-pandemic (1/2018-2/2020), Early Pandemic (3/2020-7/2020) and Late-pandemic (8/2020-5/2021). Observed and expected number of BE and dysplasia cases/month were calculated. Adherence to Seattle protocol was assessed by dividing the BE length by number of pathology jars submitted;a ratio of ≤2.0 with rounding down was considered adherent. Adherence to recommended surveillance for non-dysplastic BE (NDBE) was calculated by assessing the proportion recommended to undergo an EGD between 3-5 years. Results: Among 1,619,684 EGDs assessed, 94,081 (5.8%) met inclusion criteria (Table 1). These cases were largely performed by GIs and represented 394 practices and 2666 endoscopists nationwide with geographic distribution within the U.S. as follows: West 24%, Midwest 13%, South 40%, and Northeast 23%. Fewer endoscopies were performed by non-GIs during the early (1.5%) and late pandemic (1.5%) compared to pre-pandemic period (9.3%, p<0.001). The mean BE length was 2.3 (2.5) cm and distribution based on histology was NDBE 87.5%, low-grade dysplasia (LGD) 2.2%, indefinite for dysplasia (IND) 2.9%, high-grade dysplasia (HGD) 1.5%, and unknown 5.8%. Table and Figure highlight the significant reduction in the number of patients diagnosed with BE (47.9% and 24.1%) and BE-related dysplasia (HGD: 38.5% and 25.3%;LGD: 45% and 34%, any dysplasia: 43.9% and 31.3%) per month during the early and late pandemic periods. Over the pandemic, there was no decline in adherence rates to quality indicators in BE with an overall adherence rate to the Seattle protocol and appropriate recommended surveillance interval in NDBE of 83% and 68.4%, respectively. Conclusions: Results of this study demonstrate a significant decline in EGD volume with an associated reduction in the number of patients diagnosed with BE and related dysplasia during the COVID-19 pandemic. The absence of a compensatory increase in diagnoses in the late pandemic period is concerning with likely long-term deleterious downstream effects on esophageal adenocarcinoma morbidity and mortality. [Formula presented] [Formula presented]

The Effect of Microphone Frequency Response on Spectral and Cepstral Measures of Voice: An Examination of Low-Cost Electret Headset Microphones.

PURPOSE: The purpose of this study was to establish the frequency response of a selection of low-cost headset microphones that could be given to subjects for remote voice recordings and to examine the effect of microphone type and frequency response on key acoustic measures related to voice quality obtained from speech and vowel samples. METHOD: The frequency responses of three low-cost headset microphones were evaluated using pink noise generated via a head-and-torso model. Each of the headset microphones was then used to record a series of speech and vowel samples prerecorded from 24 speakers who represented a diversity of sex, age, fundamental frequency (F o), and voice quality types. Recordings were later analyzed for the following measures: smoothed cepstral peak prominence (CPP; dB), low versus high spectral ratio (L/H ratio; dB), CPP F o (Hz), and cepstral spectral index of dysphonia (CSID). RESULTS: The frequency response of the microphones under test was observed to have nonsignificant effects on measures of the CPP and CPP F o, significant effects on the CSID in speech contexts, and strong and significant effects on the measure of spectral tilt (L/H ratio). However, the correlations between the various headset microphones and a reference precision microphone were excellent (rs > .90). CONCLUSIONS: The headset microphones under test all showed the capability to track a wide range of diversity in the voice signal. Though the use of higher quality microphones that have demonstrated specifications is recommended for typical research and clinical purposes, low-cost electret microphones may be used to provide valid measures of voice, specifically when the same microphone and signal chain is used for the evaluation of pre- versus posttreatment change or intergroup comparisons.

Comparison of Thrombotic Complications in Critically Ill Patients between COVID-19 and Mers-COV

Background: Several observational studies have reported the rate of thrombotic events in patients infected with coronavirus disease 2019 (COVID-19), with conflicting results 1. The conflicting results could be partially explained by different population critically ill vs non critically ill, different definition of thrombotic events, follow up period was variable, and different prophylaxis that were used. Middle east respiratory syndrome (MERS-COV) is another coronavirus had been initially reported in Saudi Arabia in 2012. A genome scan has shown a 50% similarity between COVID-19 and MERS-COV 2.A common features of covid-19 and MERS-COV including transmissibility, and MERS-COV clinical presentation have been identified 3. However, data about thrombotic complications in patients with MERS-COV are limited. The aim of this study was to compare the rate of thrombotic events between patients with COVID-19 and MERS-COV. Methods: Patients : We included all confirmed COVID-19 patients who were admitted to intensive care unit (ICU) in 3 major hospitals in Saudi Arabia between February and July 2020. We included all confirmed cases of MERS-COV who were admitted to ICU from these centers between March to May 2014. Patients were excluded if they were transferred in or out from one of these three hospital to another hospitals. Data were collected retrospectively from the first day of admission until discharge or death. Outcome: The primary outcome was the rate of venous thromboembolism (VTE). The secondary outcomes were the rate of arterial events, the rate of composite events (venous and arterial) and the rate of bleeding. VTE included all symptomatic or incidentally diagnosed cases of pulmonary embolism (PE), deep vein thrombosis (DVT) and thrombosis in unusual sites (cerebral, mesenteric, portal, splenic, hepatic, and renal veins). All VTEs were confirmed radiographically by appropriate imaging. Screening for VTE in asymptomatic patients was not performed. If more than on type of VTE occurred in the same patient, it was considered one event. Arterial events included cerebrovascular accidents (CVAs), mesenteric ischemia, and limb ischemia and were confirmed by the appropriate imaging modality. Myocardial infarction (MI) was diagnosed based on the suspicion of the attending physician using clinical criteria as well as biomarker elevations or electrocardiographic changes. Composite events were defined as any VTE or arterial event. Bleeding events were classified as major and nonmajor based on the definition of international society of thrombosis and hemostasis (ISTH) 4. Informed consent was waived. Statistical analysis: Characteristics and outcomes were compared between COVID-19 and MERS-COV groups using chi-square test, fisher exact test or t-test. The rates of thrombosis and bleeding are summarized as proportions, with the corresponding 95 % confidence intervals (CI). A P-value less than 0.05 was considered significant. Statistical analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC, USA) Result: After exclusion, 234 COVID-19 and 58 MERS-COV patients were included. The majority of patients with COVID-19 (98%, n=230) and more than (67%, n =39 ) of those with MERS-COV group received pharmacological prophylaxis. The most frequently prescribed regimen in both groups was enoxaparin (40 mg twice per day). Over a median length of stay in the COVID-19 group of 22 days, the rate of VTE 9.8%(CI;6.6-14.3) and was 3.4%(CI;0.95-11.7) in the MESR-COV group over median length of stay of 10 days. The rate of arterial events were 5.9 % (CI;3.6-9.7) and 8.6% (CI;3.7-18.6) in COVID-19 and MERS-COV respectively. Table 1 and 2. Conclusions: To our knowledge, this is the first study compared thrombotic risk between COVID-19 and MERS-COV. We found a similar rate of composite thrombotic events (venous and arterial ) between COVID-19 and MERS-COV with higher rate of venous thrombosis in COVID-19 and higher rate arterial thrombosis in MERS-COV. This may indicate that not only COVID-19 is a prothrombotic disease, but MERS-COV may ha e similar risk of thrombotic complication. These result needs to be confirmed in a larger studies. References 1- Al-Samkari, H, 2020. Blood, 136(4), Pp.489-500. 2- Lu, R, 2020. The Lancet, 395(10224), Pp.565-574. 3- Petrosillo, N, 2020. Clinical Microbiology And Infection, 26(6), Pp.729-734. 4- Schulman, S, 2005. Journal Of Thrombosis And Haemostasis, 3(4), Pp.692-694. [Formula presented] Disclosures: No relevant conflicts of interest to declare.

Acute Morbidity and Mortality Analysis of COVID-19 in Children Receiving Cancer Treatment

The aim of this study was to determine overall morbidity and mortality of COVID-19 infection in children on cancer treatment. It was an observational study, carried at Shaukat Khanum Cancer Hospital from 1st April 2020 to 31st July 2020. A total of 165 children on active cancer treatment were tested for COVID-19 with PCR;out of these, 17 were detected positive. Twelve children were symptomatic having fever with or without cough, sore throat, body aches, rash or diarrhea. Two children had concurrent gram negative bacteremia. Ten children (58.8%) required hospitalisation, 23.5% required oxygen and two had intensive care unit admission. One death was reported in this study. Chemotherapy was modified in five children, while elective surgery, chemotherapy and radiotherapy schedule were affected in eight children. Overall, the spread of Covid-19 was limited, the course of disease was mild, and anticancer treatment was provided and continued as per standard protocols. Key Words: Covid -19, Cancer, Anticancer chemotherapy, Immunosuppression, Children.