Integrating flipped/blended learning into the ultrasound clinical governance session

Education and training is one of the pillars of clinical governance that helps to maintain and improve the quality of patient care within the NHS. The impact of COVID-19 has disrupted the delivery of governance sessions. Original large departmental face-to-face sessions have changed because of social distancing, staff sickness or staff having to isolate. Furthermore, part-time staff often miss clinical governance sessions and do not have the opportunity to maintain training compared to full time staff. The need to deliver education and training is still crucial for staff development and optimising patient care and safety. This poster explores how flipped learning combined with blended learning that is used within academic institutions can also be used to deliver clinical governance within the ultrasound department. Considering the IMPALA framework and its components, the following format is an alternative provision that could be used to deliver governance: online presentation including a video/audio clip;selfdirected study/activity;face to face or online session. The format would ideally suit new guidelines being introduced into a department, for example the applying O-RADS to images. Similarly, the format would suit education and training in case studies, protocols and even departmental quizzes or discussion forums. Including video/audio allows staff to feel in touch and be included with their peers despite circumstances potentially not allowing all to be present. Pillars of governance are crucial to deliver optimal patient care. The education component is also very important to ultrasound practitioners. CPD is continuous and staff should be provided with equal opportunities despite working patterns or absence. Alternative methods to deliver governance sessions should be used as well as the traditional departmental/face to face session. The given format allows the ultrasound department to give education and training to all staff maintaining staff CPD and optimal patient care.

Decline in Colorectal Cancer Screening Rates in Federally Qualified Health Centers in Los Angeles County From 2019 to 2020

Introduction: Federally Qualified Health Centers (FQHCs) are funded by the Health Resources and Services Administration (HRSA) to provide primary care services to low-income and underinsured individuals. Los Angeles County (LAC) is a large, diverse county with greater than 10.2 million residents and 8 distinct Service Planning Areas (SPAs) that represent specific geographic regions with variable resources. We aimed to describe colorectal cancer (CRC) screening rates (CRCSR) and the screening rate change (SRCs) in LAC overall and for each SPA between 2019 and 2020 to determine where resources are most needed for CRCSR recovery following the COVID-19 pandemic. Method(s): Our data source was the Uniform Data System (UDS), which includes quality data for the FQHCs funded by HRSA. We determined 2019 and 2020 CRCSR for LAC FQHCs overall and for each FQHC, including average-risk patients age 50-74. We then separated FQHCs into quartiles based on SRC and performed mixed-effects logistic regression to determine FQHC-level characteristics associated with the largest decline in CRCSR from 2019 to 2020 (i.e., predictors of category SRC Q1). Lastly, we determined SRC for each SPA in LAC. Result(s): In 2019, there were 58 FQHCs in LAC with 326,473 patients eligible for CRC screening. In 2020, there were 59 FQHCs with 350,405 eligible patients. The median 2020 CRCSR in LAC FQHCs was 37.3%, down from 48.0% in 2019 (2020 median SRC= -9.6%) (Table). In the regression model among all LAC FQHCs, those with higher proportions of patients preferring a non-English language had significantly higher odds of having the largest decline in CRCSR from 2019 to 2020 (SRC Q1) (aOR=3.25, 95% CI=1.22-8.65;data not shown). CRCSR decreased from 2019 to 2020 in all SPAs with SRC ranging from -17.0% (South Bay) to -1.4% (West LA) (Figure). Conclusion(s): In Los Angeles County FQHCs, CRC screening rates were higher than the national FQHC average in 2019 however declined considerably between 2019 and 2020. The decline in CRC screening rates was highest in FQHCs serving a higher proportion of patients with a preference for a non-English language and varied by county region. Our findings highlight the need for targeted measures, including language-appropriate resources, to improve CRC screening uptake in FQHCs that provide care to some of the most historically marginalized individuals.

Hepatocellular Carcinoma Presenting as a Clival Mass

Introduction: Hepatocellular carcinoma (HCC) comprises the majority of primary liver cancer and has a poor prognosis. Clivus metastasis is rare with only a few reported cases in the medical literature. We report a case of a patient who presented with clival mass found to have metastatic HCC. Case Description/Methods: A 63-year-old woman presented for neurosurgical evaluation after she was found to have a skull base mass on computerized tomography (CT) of the head at an outside hospital. She endorsed dysphagia for three months, however denied headaches or visual disturbances. A magnetic resonance imaging (MRI) revealed a 5.4 cm by 2.9 cm by 3.6 cm mass in the clivus, which was deemed as the cause of dysphagia (Figure 1a). The patient subsequently underwent an endoscopic transsphenoidal resection of the clival mass. Histopathology from the tissue revealed a hepatoid carcinoma, concerning for metastatic HCC (Figure 1b and 2c). Immunohistochemical strains were positive for hepatocytic marker arginase-1 (Figure 1d). Laboratory studies revealed alpha fetoprotein (AFP) of 56,344 ng/mL, CA-125 of 376 ng/mL, normal B-HCG and carcinoembryonic antigen (CEA). Thereafter, a triple phase CT of the liver revealed two LI-RADS 5 lesions suggestive of HCC as the primary malignancy. Patient's case was discussed at multidisciplinary tumor board with recommendations for systemic immunotherapy with atezolimumab plus bevacizumab and radiation therapy to the clivus. Discussion(s): The incidence of HCC has almost tripled since the 1980s making it the fastest rising cause of cancer related deaths. Metastasis to the brain comprises 0.26% to 2.2% of cases and the skull base is the most rarely affected anatomical site. Although CNS presentation is rare, we may see more neurological manifestations of metastatic HCC with the persistence of chronic hepatitis infections, the rise of metabolic diseases such as NASH, and an increase in alcohol-related liver disease during the COVID-19 pandemic. Although exceedingly rare, metastasis to the clivus should be considered in the differential diagnosis of skull base masses. Despite detection and treatment, prognosis remains poor and emphasis should be placed on consistent HCC surveillance. This case emphasizes that skull masses must be evaluated diligently as they can be the first sign of underlying liver malignancy. Given the morbidity and mortality associated with HCC, recognition of atypical manifestations of HCC can lead to a prompt diagnosis and initiation of life-saving treatment. (Figure Presented).

Global Health: An Agile Open-Source Repository of Infectious Disease Outbreaks to Support Global Surveillance and Research Efforts

Intro: The COVID-19 pandemic highlighted a need for an open-source repository of line-list case data for infectious disease surveillance and research efforts. Global.health was launched in January 2020 as a global resource for public health data research. Here, we describe the data and systems underlying the Global.health datasets and summarize the project's 2.5 years of operations and the curation of the COVID-19 and monkeypox repositories. Method(s): The COVID-19 repository is curated daily through an automated system, verified by a team of researchers. The monkeypox dataset is curated manually by a team of researchers, Monday-Friday. Both repositories include metadata fields on demographics, symptomology, disease confirmation date, and others1,2. Data is de-identified and ingested from trusted sources, such as government public health agencies, trusted media outlets, and established openaccess repositories. Finding(s): The Global.health COVID-19 dataset is the largest repository of publicly available validated line-list data in the world, with over 100 million cases from more than 100 countries, including 60+ fields of metadata, comprising over 1 billion unique data points. The monkeypox dataset has over 35,000 data entries, from 100 different countries. 7,325 users accessed the COVID-19 repository and 3,005 accessed the monkeypox repository. Conclusion(s): The Global.health repositories provide verified, de-identified case data for two global outbreaks and are used by CDC, WHO, and other national public health organizations for surveillance and forecasting efforts. The repositories were utilized to share insights into the COVID-19 pandemic and track the monkeypox outbreak using real-time data3-6. We are collaborating with WHO Hub for Pandemic and Epidemic Intelligence to improve coordination, data schemas, and downstream use of data to inform and evaluate public health policy7. Future work will focus on creating a 'turnkey' data system to be used in future outbreaks for quicker infectious disease surveillance.Copyright © 2023

Typical and atypical chest computed tomography manifestations in COVID-19 patients

Background High-resolution computed tomography (CT) is the most reliable sensitive noninvasive imaging procedure recommended in the diagnosis, assessment, the severity, and follow-up of coronavirus disease 2019 (COVID-19).It has a qualitative and quantitative role. The COVID-19 Reporting and Data System evaluates the probability of COVID-19 pulmonary involvement, and the corresponding CT severity score, which evaluates the approximate percentage of each of the five lobes' involvement. Research question We aimed to illustrate chest CT typical and atypical manifestations in COVID-19 patients regarding their age, sex, patients' symptoms, and CT severity score. Study design and methods We conducted a cross-sectional study on 120 patients more than or equal to 18 years with confirmed COVID-19 infection (PCR positive) during the period from April 2021 to October 2021, who were admitted to Ain Shams University Isolation Hospitals, where all patients' clinical data and CT chest imaging for these patients will be collected.Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.

Trends in Covid-19 Admissions and Deaths among People with Hiv in South Africa

Background: South Africa experienced five COVID-19 waves and over 90% of the population have developed immunity. HIV prevalence among adults is 19% and over 2 million people have uncontrolled viral loads, posing a risk for poor COVID-19 outcomes. Using national hospital surveillance data, we aimed to investigate trends in admission and factors associated with in-hospital COVID-19 mortality among people with HIV (PWH) in South Africa. Method(s): Data between March 5, 2020 and May 28, 2022 from the national COVID-19 hospital surveillance system, SARS-CoV-2 case linelist and Electronic Vaccine Data System were linked and analysed. A wave was defined as the period for which weekly incidence was >=30 cases/100,000 people. Descriptive statistics were employed for admissions and mortality trends. Postimputation random effect multivariable logistic regression models compared (a) characteristics of PWH and HIV-uninfected individuals, and (b) factors associated with mortality among PWH. Result(s): 68.7% (272,287/396,328) of COVID-19 admissions had a documented HIV status. PWH accounted for 8.4% (22,978/272,287) of total admissions, and 9.8%, 8.0%, 6.8%, 12.2% and 6.7% of admissions in the D614G, Beta, Delta, Omicron BA.1 and Omicron BA.4/BA.5 waves respectively. The case fatality ratio (CFR) among PWH and HIV-uninfected was 24.3% (5,584/22,978) vs 21.7% (54,110/249,309) overall, and in the respective waves was 23.7% vs 20.4% (D614G), 27.9% vs 26.6% (Beta), 26.2% vs 24.5% (Delta), 18.2% vs 9.1% (Omicron BA.1) and 16.8% vs 5.5% (Omicron BA.4/BA.5). Chronic renal disease, malignancy and past TB were more likely, and hypertension and diabetes were less likely in PWH compared to HIV-uninfected individuals. Among PWH, along with older age, male sex and presence of a comorbidity, there was a lower odds of mortality among individuals with prior SARS-CoV-2 infection (aOR 0.6;95% CI 0.4-0.8);>=1 dose vaccination (aOR 0.1;95% CI 0.1-0.1);and those admitted in the Delta (aOR 0.9;95% CI 0.8-0.9), Omicron BA.1 (aOR 0.5;95% CI 0.5-0.6) and Omicron BA.4/BA.5 (aOR 0.5;95% CI 0.4-0.7) waves compared to the D614G wave. PWH with CD4< 200 had higher odds of in-hospital mortality (aOR 1.9;95% CI 1.8-2.1). Conclusion(s): In South Africa, mortality among PWH was less likely in the Delta and Omicron waves but PWH had a disproportionate burden of mortality during the two Omicron waves. Prior immunity protected against mortality, emphasizing the importance of COVID-19 vaccination among PWH, particularly PWH with immunosuppression.

Outcomes of transrectal ultrasound guided prostate biopsies amenable lesions on MRI prostate

Introduction & Objectives: With the introduction of new modalities for prostate biopsies, detection rates of prostate cancer have been increased on one hand but on the other hand there are still some institutions where transperineal prostate (TP) biopsies cannot be offered due to limitations such as lack of expertise, absence of facilities, financial limitations, immense pressure on health system and especially during Covid pandemic. The aim of our study is to look at the prostate cancer detection rates of mpMRI (multi-parametric) prostate lesions amenable to transrectal ultrasound prostate biopsies (TRUS) and whether or not it can be offered in institutions with limited options. Material(s) and Method(s): Retrospectively we looked at the results of 95 patients with mean age of 67.8 years, mean prostate volume 46.5 cc, median PSA 7.2 ng/mL. TRUS biopsies amenable lesions on MRI prostate comprised of all peripheral or posterior zone lesions with: PIRADS II with rising PSA (1 patient);PIRADS >3 with PSAD of > 0.12 (14 patients), PIRADS IV (42 patients) and PIRADS V (33 patients). In addition to these there were 5 patients where PIRADS category was not clear. All patients underwent prostate biopsies (from both lobes) as per departmental protocol. Result(s): We found 0%, 42.9%, 68.4% and 90.3% in PIRADS II, PIRADS >III with PSAD >0.12, PIRADS IV and PIRADS V, respectively. In those where no PIRADS category was given 2 (40%) patients had the positive histology for prostate cancer. Overall prostate cancer detection rate was 65.2%. A direct proportional link was found between PIRADS category and prostate cancer detection. Only 2 patients with negative prostate biopsies agreed to have TP prostate biopsies repeated, that showed Gleason score 6 in PIRADS IV lesion and benign histology in other patient with PIRADS V lesion. It is also found that 15-50% of lesions in contralateral lobe have not been picked up by the MRI scan that came positive for prostate cancer (see table).(Table Presented) Most common to least common, the following histology was note: Gleason score (GS) > 8 (36 patients, 58%), GS 4+3 (10 patients, 16.1%), GS 3+4 (12 patients, 19.3%), GS 6 (4 patients, 6.4%) and high grade PIN (1 patient, 1.6%). Conclusion(s): It can be concluded that TRUS prostate biopsies can be utilized in a productive way by achieving highly satisfactory results in patients who has MRI prior to biopsies. A careful selection and a proper reading of MRI are warranted to achieve the good outcomes. TRSU biopsies are helpful in those departments with limitations in carrying out TP prostate biopsiesCopyright © 2022 European Association of Urology. Published by Elsevier B.V.

Systematic Evaluation of Studies in the Fields of Diagnosis and Management of Prostate Cancer in Coronavirus Disease 2019 Era

Background: Prostate cancer is one of the most common cancers worldwide. The proper management of this cancer during the coronavirus disease 2019 (COVID-19) or similar outbreaks could be a serious challenge. Proper timing of surgery, radiotherapy, and other medical modalities are essential in providing the most effective treatment. Objective(s): This systematic review aimed at evaluating the proper management of prostate cancer during the COVID-19 outbreak. Method(s): This study was conducted from 2019 to 2022. An internet search was conducted using the keywords: Diagnosis, man-agement, radical prostatectomy, radiotherapy, hormone ablation therapy, chemotherapy and prostate cancer, and COVID-19. The visited databases included PubMed, Scopus, Web of Sciences, Google Scholar, and Scientific Information Database. The review was performed based on the preferred reporting items for a systematic review and meta-analyses (PRISMA) guidelines. Result(s): Postponing the biopsy for up to three months and adopting of non-invasive diagnostic methods were likely reasonable during the COVID-19 pandemic. Patients with cancer were more prone to severe injuries and were more likely to have serious compli-cations. Surgery, radiation therapy, brachytherapy, palliative radiation, hormone ablation therapy, and chemotherapy were among the pre-institutional treatments that had to be performed according to medical protocols as well as health and professional guide-lines. Conclusion(s): It was recommended that the prostate cancer screening should not be performed for asymptomatic men during the COVID-19 outbreak. It was also suggested that the treatment should be performed in the shortest possible time and in the safest way.Copyright © 2023, Author(s).

Study on the risk signal mining related to lopinavir/ritonavir based on the US FDA Adverse Event Reporting System.

Objective: To explore the clinical safety of lopinavir/ritonavir (LPV/r) by mining the risk signals of adverse events (AEs) related to LPV/r for the safe application of the drug in the treatment of novel coronavirus pneumonia (COVID-19). Method(s): The risk signals related to LPV/r in AE reports of US FDA Adverse Event Reporting System (FAERS) from the first quarter of 2010 to the third quarter of 2019 were mined by reporting odds ratio (ROR). An AE with reports more than 3 and 95% confidence interval (CI) lower limit of ROR greater than 1 was defined as a positive signal. AEs were counted and classified using the preferred system organ class (SOC) and preferred term (PT) of Medical Dictionary for Regulatory Activities (MedDRA). The PTs of top 50 adverse event reports and signal strength were selected and analyzed. Result(s): From the first quarter of 2010 to the third quarter of 2019, a total of 13 335 AE reports with LPV/r as the primary suspicious drug were reported in the FAERS database. Four hundred and fifty-five AE risk signals with reports more than 3 and the 95%CI lower limit of ROR greater than 1 were detected, involving 7 718 AE reports. The top 2 system organs involved in AE reports were "injury, poisoning and procedural complications" [13.6% (1 051/7 718)] and "pregnancy, puerperium and perinatal conditions" [11.7% (899/7 718)]. However, 998 (95.0%) of 1051 AE reports involved in "injury, poisoning and procedural complications" were related to drug exposure during pregnancy. The system organ with the highest signals was "congenital, familial and genetic disorders" [16.3% (74/455)]. In addition, 144 AEs caused by drug interactions were detected, which ranked the 7th in the AE reports. Conclusion(s): The risk signals of fetal, neonatal and infant abnormalities related to LPV/r during pregnancy were detected, suggesting that attention should be paid to the risk of using LPV/r in pregnant women and infants. The interaction between LPV/r and other drugs was also worthy of attention.Copyright © 2020 by the Chinese Medical Association.

Diagnostic Performance of Human Readers and Artificial Intelligence Model in Classification Task of Computed Tomography Images of Different Types of Viral Pneumonia

Purposes: Artificial Intelligence (AI) models are constantly developing to help clinicians in challenging tasks such as classification of images in radiological practice. The aim of this work was to compare the diagnostic performance of an AI classifier model developed in our hospital with the results obtained from the radiologists reading the CT images in discriminating different types of viral pneumonia. Material(s) and Method(s): Chest CT images of 1028 patients with positive swab for SARS-CoV-2 (n=646) and other respiratory viruses (n=382) were segmented automatically for lung extraction and Radiomic Features (RF) of first (n=18) and second (n=120) order were extracted using PyRadiomics tools. RF, together with patient age and sex, were used to develop a Multi-Layer Perceptron classifier to discriminate images of patients with COVID-19 and non-COVID-19 viral pneumonia. The model was trained with 808 CT images performing a LASSO regression (Least Absolute Shrinkage and Selection Operator), a hyper-parameter tuning and a final 4-fold cross validation. The remaining 220 CT images (n=151 COVID-19, n=69 non-COVID-19) were used as independent validation (IV) dataset. Four readers (three radiologists with >10 years of experience and one radiology resident with 3 years of experience) were recruited to blindly evaluate the IV dataset using the 5-points scale CO-RADS score. CT images with CO-RADS >=3 were considered "COVID-19". The same images were classified as "COVID-19" or "non-COVID-19" by applying the AI model with a threshold on the predicted values of 0.5. Diagnostic accuracy, specificity, sensibility and F1 score were calculated for human readers and AI model. Result(s): The AI model was trained using 24 relevant features while the Area under ROC curve values after 4-fold cross validation and its application to the IV dataset were, respectively, 0.89 and 0.85. Interreader agreement in assigning CO-RADS class, analyzed with Fleiss' kappa with ordinal weighting, was good (k=0.68;IC95% 0.63-0.72) and diagnostic performance were then averaged among readers. Diagnostic accuracy, specificity, sensibility and F1 score resulted 78.6%, 78.3%, 78.8% and 78.5% for AI model and 77.7%, 65.6%, 83.3% and 72.0% for human readers. The difference between specificity and sensitivity observed in human readers could be related to the higher rate of false positive due to the higher incidence of COVID-19 patients in comparison with other types of viral pneumonitis during the last 2 years. Conclusion(s): A model based on RF and artificial intelligence provides comparable results with human readers in terms of diagnostic performance in a classification task.Copyright © 2023 Southern Society for Clinical Investigation.

MaThAI: A MultiModal imaging combining Mammography and Thermalytix for better prioritization of mammography scans to detect early malignancies

Background: Breast cancer screening helps in early intervention and treatment. Post COVID, there is a huge backlog of women who missed their regular screening resulting in increased workload for radiologists, delayed reporting and intervention for malignant women. Thermalytix is an AI-based tool over thermal images that generates a 5 point score called B-Score where 5 is highest suspected risk for breast cancer and 1 is the lowest risk. In this study, we propose and evaluate a multimodal imaging modality called MaThAI that combines mammography and Thermalytix for prioritization of Mammography scans using B-Score. Material(s) and Method(s): Data from two clinical studies were pooled together and a total of 583 women who took both mammography and thermal scans were included in the study. Among them, 72 women were diagnosed to be malignant using mammography, ultrasound, and/or biopsy. Sensitivity and specificity of (i) Mammography alone (as reported by experienced radiologists), (ii) Thermalytix alone (using B-Score >=3 as positive) and (iii) MaThAI (considering a scan as positive if either Mammogram interpretation or Thermalytix interpretation or both were positive) were computed. As a second experiment, we assessed the benefit of MathAI prioritized mammography scans by estimating the reporting times for detecting 95% malignant patients. Result(s): The sensitivity and specificity of mammography were 81.9% and 98.8%, respectively, assuming BIRAD 0 as negative. Assuming BIRAD 0 as positive the sensitivity and specificity were 90.3% and 86.9%, respectively. Six malignancies were found in the 67 women with inconclusive reports (BIRADS 0). When Thermalytix B-Score was considered, the sensitivity and specificity were 94.4% and 81.0%, respectively. MaThAI showed an overall sensitivity and specificity of 98.6% (CI: 95.9%-100%) and 80.6% (CI: 77.2%-84.1%), respectively. The combo modality increased sensitivity over mammography alone by 16.7%, and Thermalytix alone by 4.2%, while decreasing the specificity of mammography by 6.3%. In the second experiment, we evaluated the benefit of MaThAI in prioritizing mammography scans using Thermalytix B-Score. Assuming mammography interpretation time is 20 minutes per exam and considering the order of the interpretation to be scan date + time, a single radiologist would have released the reports of 95% of the women with malignancy in 6720 minutes. Whereas using B-Score to reorder the scans for interpreting, the same radiologist would release the reports of 95% of the women with malignancy in 3080 minutes. Conclusion(s): MaThAI is a promising multimodal tool for breast screening that enables effective and efficient adjunct usage of thermal image along with mammography. It was effective in increasing the sensitivity of mammography by 16.7% and is estimated to reduce the reporting time for malignant patients by 54%. Conflict of interest: Ownership: Yes Board of Directors: Yes Corporate-sponsored Research: YesCopyright © 2022 Elsevier Ltd. All rights reserved

Lung Cancer Screening Program via Primary Care Clinics

Lung Cancer Screening (LCS) reduces lung cancer mortality by 20 to 24% however in the US only 5.7% of eligiblepatients participate. Increasing screening of individuals at risk for lung cancer is an unmet need. We started a LCSprogram using primary care physicians (PCP) visits where the intake nurse asked age appropriate patients abouttheir smoking status. If patients met criteria, the physician was alerted to perform shared decision making, offersmoking cessation and order a low dose screening CT scan (LDCT). The results were managed by a physician'sassistant dedicated to the LCS program. This quality improvement study analyzed all patients enrolled from June2019 to July 2021. The LCS program rolled out slowly beginning with 6 PCPs in June to November 2019, 26 PCPsfrom November 2019 to February 2020 and all 56 PCPs from February 2020 to July 2021. COVID-19 stopped LDCTsfrom March 2020 to August 2020. Use of a LCS program run through PCP clinics screened 1,247 (21.3%) eligibleveterans, a 3.7 fold increase over the national average. Of the 2,069 (35.3%) eligible patients initially identified by thecomputer based reminder, 1,824 (88.2%) accepted LCS, 1,383 (66.8%) completed the initial LDCT and 136 (9.8%)were ultimately found to be ineligible after completion of the LDCT. The 136 ineligible patients received 173 LDCTs ofwhich 91% were Lung-RADS 1 or 2 and 0.6% were Lung-RADS 4A. Within the appropriately screened patients, 12(1%) lung cancers and 1 papillary thyroid cancer were found and 26.5% of scans showed evidence of Chronic Obstructive Pulmonary Disease and 11.9% showed coronary artery disease. Use of PCP clinics increased enrollment 3.7 fold over national averages.

CO-RADS, COVID-PCR and prognosis relationship in patients followed in intensive care unit with the diagnosis of COVID-19

Introduction: The gold standard method in the diagnosis of COVID-19 is real-time reverse transcriptase-polymerase chain reaction (RT-PCR) however, its sensitivity is reported to be between 42-83% in different studies. Aims and objectives: In this study, we aimed to examine the relationship between CO-RADS levels and prognosis in patients followed in the intensive care unit with the diagnosis of COVID-19. Method(s): All consecutive adult patients with clinically, radiologically, and/or laboratory positive COVID-19 admitted to the Intensive Care Unit between January 2020 and October 2021 were evaluated. Clinical and laboratory data of the patients include characteristics, comorbidities, treatment protocol, respiratory support, hospital stay, RT-PCR status, laboratory test, CO-RADS scores, complications, and prognosis collected from the electronic hospital record system. Result(s): 375 patients were included in the study. In univariate analysis, age, intubation status, serum albumin, CRP, D-dimer, and CO-RADS score were found to be effective variables on mortality. In multivariate analysis, CO-RADS score, and serum albumin levels were found as independent variables affecting mortality (Figure 1). Conclusion(s): This study presents the prognostic value of the CO-RADS classification in patients with COVID-19.

Clinical Characteristics of Hemodialysis Patients Hospitalized with Covid-19: A Case Series of 70 Cases from Dominican Republic

Introduction: The Coronavirus disease (COVID-19) is more severe in patients with pre-existing comorbidities;therefore, dialysis patients fall into this category. Not to mention the risk among patients receiving in-center dialysis, since they are known to be at higher risk of contracting this disease. Information about the clinical characteristics among hemodialysis patients with COVID-19 in Latin America and low-and middle-income countries are limited. Considering the importance of this topic, the aim of this study was to describe the clinical characteristics along with the outcome of 70 hemodialysis patients hospitalized for COVID-19. Method(s): This is a retrospective study in chronic hemodialysis patients hospitalized with COVID-19. All patients diagnosed with COVID-19 from March 2020 to January 2022 are included. Result(s): The mean age of the patients was 58 (range 19-87), where 65.7% were male. The most prevalent comorbidities were hypertension (98.6%) and type 2 diabetes (54.3%). The most common presenting symptoms were dyspnea (71.4%), fever (68.6%) and cough (58.6%). In addition of abnormal pulmonary auscultation in most patients (78.6%). Lymphocytopenia and elevated inflammatory markers as procalcitonin, erythrocyte sedimentation rate (ESR), D-dimer and C-reactive protein (CRP) were the main prevalent lab findings. At admission 90.1% had ground- glass abnormalities in the CT findings, being CO-RADS 3 the most frequent category between these patients. The average hospital stay was 8.51+/- 6.39 days;35.7% of these patients were admitted to the ICU and only 4 (5.7%) required mechanical ventilation. Therapeutic management included statins and antithrombotic therapy for all the patients at prophylactic doses. Treatment options were remdesivir, corticosteroids, hydroxychloroquine, antibiotics, and other immunosuppressant drugs. A total of 8 (11.4%) patients died during hospitalization and 62 (88.6%) were discharged. Conclusion(s): Even though dialysis patients are at higher risk of death, especially in developing countries, our findings suggest that the mortality rate were lower in comparison with other studies in Latin America and similar to some developed countries. The use of statins and antithrombotic prophylaxis in all hospitalized patients seems to be associated with a lower risk of death in conjunction with other therapeutic regimens according to the guidelines. No significant adverse effects were observed with remdesivir in these patients, so we believe that its use is beneficial in conjunction with the use of statins and antithrombotic prophylaxis, based on the patient's requirements. No conflict of interestCopyright © 2023

Supply Chain Resilience of Mineral Resources Industry in China

Improving the supply chain resilience of the mineral resources industry is crucial for ensuring national economic security in China. Based on the supply and demand data of China's mineral resources industry from 2002 to 2018, this study adopts system dynamics model to simulate the supply chain resilience of the mineral resources industry, the mining industry, and the smelting and processing industry under the scenario of steady economic development and the scenario of supply chain crisis. From the simulation results, the reserves of the mineral resources industry and the smelting and processing industry under the two scenarios are nearly the same, indicating that they are weakly affected by the foreign market, and both have strong resilience. The mining industry has a high dependence on imports and a lack of supply chain resilience. Under the condition of steady economic development, the output of the mining industry needs to develop at a low speed to reduce production capacity. More attention should be paid to the high level of import dependence and insufficient supply chain resilience of the mining industry. In the stable international trade situation, reserves of important minerals should be increased to alleviate the resource shortage during the supply chain crisis.

Combined Shear Wave Elastography and EU TIRADS in Differentiating Malignant and Benign Thyroid Nodules.

Although multimodal ultrasound approaches have been suggested to potentially improve the diagnosis of thyroid cancer; the diagnostic utility of the combination of SWE and malignancy-risk stratification systems remains vague due to the lack of standardized criteria. The purpose of the study was to assess the diagnostic value of the combination of grey scale ultrasound assessment using EU TIRADS and shear wave elastography. 121 patients (126 nodules-81 benign; 45 malignant) underwent grey scale ultrasound and SWE imaging of nodules between 0.5 cm and 5 cm prior to biopsy and/or surgery. Nodules were analyzed based on size stratifications: <1 cm (n = 43); 1-2 cm (n = 52) and >2 cm (n = 31) and equivocal cytology status (n = 52), and diagnostic performance assessments were conducted. The combination of EU TIRADS with SWE using the SD parameter; maintained a high sensitivity and significantly improved the specificity of sole EU TIRADS for nodules 1-2 cm (SEN: 72.2% vs. 88.9%, p > 0.05; SPEC: 76.5% vs. 55.9%, p < 0.01) and >2 cm (SEN: 71.4% vs. 85.7%, p > 0.05; SPEC: 95.8% vs. 62.5%, p < 0.01). For cytologically-equivocal nodules; the combination with the SWE minimum parameter resulted in a significant reduction in sensitivity with increased specificity (SEN: 60% vs. 80%; SPEC: 83.4% vs. 37.8%; all p < 0.05). SWE in combination with EU TIRADS is diagnostically efficient in discriminating nodules > 1 cm but is not ideal for discriminating cytologically-equivocal nodules.

PP01.22 First Lung Cancer Screening Program in Greece - Initial Experience, Preliminary Data and Pitfalls

Background: Poor prognosis of lung cancer is linked to its late diagnosis, typically in the advanced stage 4 in 50-70% of incidental cases. Lung Cancer Screening Programs provide low-dose lung CT screening to current and former smokers who are at high risk for developing this disease. Greece is an EU country, returning strong from a long period of economic recession, ranked 2nd place in overall age-standardized tobacco smoking prevalence in the EU. In December 2020, at the Metropolitan Hospital of Athens, we started the 1st Screening Program in the country. We present our initial results and pitfalls met. Method(s): A weekly outpatient clinic offers consultation to possible candidates. LDCT (<=3.0mGy), Siemens VIA, Artificial Intelligence multi-computer-aided diagnosis (multi-CAD) system and LungRADS (v.1.1) are used for the validation of any abnormal findings with semi-auto measurement of volume and volume doubling time. Patients get connected when necessary with the smoking cessation and Pulmonology clinic. USPSTF guidelines are used, (plus updated version). Abnormal CT findings are discussed by an MDT board with radiologists, pulmonologists/interventional pulmonologists, oncologists and thoracic surgeons. A collaboration with Fairlife Lung Cancer Care the first non-profit organization in Greece is done, in order to offer the program to population with low income too. An advertisement campaign was organized to inform family doctors and the people about screening programs, together with an anti-tobacco campaign. Result(s): 106 people were screened, 74 males & 32 females (mean age 62yo), 27/106 had an abnormal finding (25%). 2 were diagnosed with a resectable lung cancer tumor (primary adenocarcinoma) of early-stage (1.8%). 2 with extended SCLC (lung lesion & mediastinal adenopathy). 1 with multiple nodules (pancreatic cancer not known until then). 3 patients with mediastinal and hilar lymphadenopathy (2 diagnosed with lymphoma, 1 with sarcoidosis). 19 patients were diagnosed with pulmonary nodules (RADS 2-3, 17%) - CT follow up algorithm. Conclusion(s): We are presenting our initial results, from the first lung cancer screening program in Greece. Greece represents a country many smokers, who also started smoking at a young age, with a both public and private health sector, returning from a long period of economic recession. COVID-19 pandemia has cause practical difficulties along the way. LDCT with AI software, with an MDT board and availability of modern diagnostic and therapeutic alternatives should be considered as essential. A collaboration spirit with other hospitals around the country is being built, in order to share current experience and expertise. Copyright © 2022

Metabolic characterization of structural lung changes in patients with suggestive COVID-19 pneumonia on 18F-FDG PET/CT

Aim/Introduction: Although pulmonary findings of COVID-19 on PET/CT have been previously described, a comprehensive metabolic characterization of diagnostic lung parenchyma changes of COVID-19 pneumonia is still lacking. Our purpose is to evaluate the metabolic uptake of different tomographic signs observed in patients with incidental structural findings suggesting COVID-19 pneumonia through 18F-FDG PET/CT. Material(s) and Method(s): We retrospectively analyzed 596 PET/CT studies performed from February 21, 2020 to April 17, 2020. After excluding 37 scans (PET with non-18F-FDG tracers and brain studies), we analyzed the metabolic activity of several individual structural changes integrated and beyond CO-RADS score through SUVmax of multimodal studies with18F-FDG. Result(s): 43 patients with 18F-FDG PET/CT findings suggestive of COVID-19 pneumonia were included (mean age: 68+/-12.3 years, 22 male). SUVmax values were higher in patients with CO-RADS categories 5-6 than in those with lower, nonspecific CO-RADS categories (6.1+/-3.0 vs. 3.6+/-2.1, p=0.004). Groundglass opacities, bilaterality, consolidations, patchy distribution and crazy paving pattern were associated with higher SUVmax values in patients with CO-RADS 5-6 scores (p-values of 0.01, 0.02, 0,01, 0.002 and 0.01, respectively). SUVmax was significantly associated with a positive structural diagnosis of COVID-19 pneumonia (odds ratio=0.63, 95% confidence interval=0.41-0.90;p=0.02). The ROC curve of the regression model aimed to confirm or discard the structural diagnosis of COVID-19 pneumonia showed an AUC of 0.77 (standard error=0.072, p=0.003). Conclusion(s): Multimodal18F-FDG PET/CT is a useful tool during the incidental detection of COVID-19 pneumonia in patients referred for standard oncological and nononcological indications (43/559;7.7%). CT findings characteristic of COVID-19 pneumonia, specifically CO-RADS 5-6, were associated with higher SUVmax.