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Objectives: Emergencies can occur at any time and be life-threatening or cause permanent damage. Accordingly, the management of emergency cases is an integral part of primary healthcare (PHC). This study aimed to estimate the proportion and types of emergency cases presented to PHC centres in Muscat, Oman. Methods: This retrospective cross-sectional study was conducted from March to August 2016 at five PHC centres in the Muscat Governorate. A total of 800 emergency cases (i.e. those labelled in the health information system as an accident and emergency) of Omani patients aged ≥5 years presented during this period. Every second case, based on arrival to the registration desk, was selected for analysis. Electronic medical records were reviewed to collect data regarding demographic features, presenting complaints, time and season of presentation, management provided and method of transportation if referred to tertiary care. Results: The proportion of emergency cases was

Objective: Cervical cancer is the third most common type of cancer among women in Oman. Although it can be detected early in the premalignant stages, there is as yet no national program for cervical cancer screening. This study aimed to estimate the prevalence of cytological abnormalities in Papanicolaou (Pap) smears and related risk factors among Omani women. Methods: A cross-sectional study was conducted from March to December 2019 at the gynecology and family medicine clinics of Khoula Hospital and Sultan Qaboos University Hospital in Muscat. All asymptomatic Omani women aged between 21–65 years were included. Data regarding the participants’ sociodemographic characteristics and known risk factors were collected using a selfreported sheet. Pap smears were performed and the results reported by a cytotechnologist and histopathologist. Results: A total of 442 women participated in the study (response rate: 100%). The mean age was 39.0 ± 9.7 years old. The prevalence of cervical cytological abnormalities was 3.7%. There was a significant association between human papillomavirus (HPV) infection and cervical cell abnormalities ( p = 0.017); however, there was no link with hormonal contraception use, pregnancy before the age of 17 years or parity ( p >0.050 each). Conclusions: The prevalence of cervical cell abnormalities in Oman was similar to that observed in Arab countries and relatively low in comparison to findings from Western countries. A screening program should be implemented at the primary care level. Moreover, the findings of this study highlight the need for a future vaccination program against HPV infections. Keywords: Cervical Cancer; Screening; Cytological Abnormalities; Pap Smear; Human Papillomavirus; Oman.

BACKGROUND: Complementary and alternative medicine (CAM) focuses on stimulating the body’s ability to heal itself through energy alignment, herbal supplementation, and other balancing techniques. AIM: The objective of the study was to investigate and compare the Knowledge Attitude Practice (KAP) of CAM among program’s residents in Tabuk region. METHODS: A cross-sectional CAP study was conducted among program’s residents in Tabuk region. All program’s residents of all specialties in Tabuk region were included in the study. Data were collected by predesigned electronic questionnaire covering the needed items. Collected data were coded and analyzed using SPSS Inc., Chicago, Illinois, USA. The Chi-square test was used as a test of significance and p = 0.05 or less was considered statistically significant. RESULTS: Most (95.8%) of the participants have heard about CAM, 25% have used CAM in treatment before, and 72.3% of them reported beneficial outcome, 25.7% strongly agree and 48.6% agree that CAM is a useful complement to pharmacological medicine, 38.2% believed that the results of CAM are usually due to the placebo effect, and 52.1% recommended using CAM. On the other hand, 79.9% have knowledge about acupuncture, 54.9% spiritual healing and herbal medicine, 43.1% massage, 41% yoga, 70.8% bloodletting cupping, and 56.3% about cauterization. More than third (38.2%) of the participants agreed that the use of herbal products is a valid form of drugs which can be used for the treatment of variety of diseases, 48.6% agreed that CAM is a useful complement to pharmacological medicine, while 36.1% strongly agreed that CAM treatments are not tested in a scientifically recognized manner. CONCLUSION: In our study, the majority of program’s residents in Tabuk region agree that CAM is a useful complement to pharmacological medicine and recommended using CAM while reasonable percentage of them believed that the results of CAM are usually due to the placebo effect.

Non-steroidal anti-inflammatory drugs (NSAIDs) are effective in reducing pain and inflammation in rheumatoid arthritis and other joint- and muscle-associated diseases. However, the extensive, long-term, and over the counter administration of NSAIDs may cause various side effects in the patients. In the present study, the chronological effect of NSAIDs on oxidative stress and antioxidant status in patients with rheumatoid arthritis was studied.The study included 100 female individuals categorized in four major groups: (1) control group consisting of age- and gender-matched healthy individuals, (2) NRA-NSAID individuals taking NSAIDs without any history of RA, (3) RA individuals with a history of RA but not taking NSAIDs, and (4) RA-NSAID individuals with chronic RA and taking NSAIDs for a long period. The sera of the participants were analyzed for the oxidative stress and antioxidant status.The RA-NSAID group showed the significantly highest oxidative stress, in terms of malondialdehyde content and lipid-reducing ability as determined in thiocyanate and hemoglobin-induced linoleic acid systems. However, the free radical scavenging ability of the RA-NSAID group, against 2,2-diphenyl-1-picrylhydrazyl, hydroxyl, superoxide, and 2,2-azino-bis-tetrazolium sulfate radicals, was found to be lower than those of the other study groups. The regression analysis of the experimental data showed a significant positive relationship between duration of NSAID intake and malondialdehyde production, lipid-reducing ability, and metal chelating ability in the RA-NSAID patients. The free radical scavenging abilities of the RA-NSAID group were negatively correlated with the duration of NSAID intake.The prolonged use of NSAIDs significantly increased the oxidative stress and decrease the antioxidant potential of both the RA patients and NRA individuals. The study provides awareness to the public particularly the RA patients regarding the risk of oxidative stress-associated abnormalities caused by the frequent and prolonged use of NSAIDs for temporary relief from pain. Key Points • The study presents the effects of long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) on antioxidant status of patients with rheumatoid arthritis. • The continuous administration of NSAIDs has been found to significantly increase the oxidative stress of the patients with rheumatoid arthritis as well as the individuals with no signs of rheumatoid arthritis. • The prolonged NSAID therapy also decreased the antioxidant potential of the patients with rheumatoid arthritis as well as the individuals with no signs of rheumatoid arthritis. • The study would be a significant and valuable contribution to the literature for the awareness regarding the use of NSAIDs.

Nuhour Ali Al Shidhani,1 Asma Ali Al Kendi,1 Maisa Hamed Al Kiyumi2 1Ministry of Health, Muscat, Oman; 2Department of Family Medicine and Public Health, Sultan Qaboos University Hospital, Muscat, OmanCorrespondence: Maisa Hamed Al KiyumiSultan Qaboos University Hospital, P.O.Box 35, P.C.123, Al-Khod, Sultanate of OmanTel +0096824141127Email maysa8172@gmail.comBackground: Domestic violence against women before and/or during pregnancy is a concerning public health issue. It has a deleterious impact on both the mother and the baby.Aim: The aim of this study is to identify the prevalence and predictors of emotional and physical domestic violence during three periods (lifelong, one year before pregnancy and during pregnancy). Moreover, it evaluates the effects of domestic violence on the outcomes of pregnancy, including miscarriages, birth weight of the baby, gestational age at delivery, and mode of delivery.Methodology: This is a prospective observational study of literate pregnant women, attending four primary health-care centers in Muscat, from 1st April 2019 to 31st March 2020. Subjects with twin pregnancies were excluded from the study. The validated Arabic NorVold Domestic Abuse Questionnaire (NORAQ) was used to determine the prevalence of emotional and physical domestic violence. The recruited subjects were re-evaluated for birth outcomes at 2– 4 weeks postpartum.Results: A total of 960 women participated in the study, with the mean age of 30.3 ± 5.4 years. Overall, experiences of lifelong domestic violence were reported by 161 women (16.8%), and the prevalence rate declined substantially in the one-year period preceding pregnancy and during pregnancy, 2.7% and 1.6%, respectively. Women who reported any type of domestic violence one year before pregnancy were at a higher risk of experiencing it again during pregnancy. A multivariate analysis of the obtained data revealed a strong association between physical domestic violence one year before pregnancy and unplanned pregnancy. Subjects with lifelong domestic violence reported higher rates of depression, insomnia, and somatic symptoms. No significant association was found between domestic violence, across any periods, and birth outcomes.Conclusion: The rates of domestic violence are relatively lower during pregnancy and one year before pregnancy compared to those of the lifelong period among Omani women. A significant association was found between domestic violence and depression, insomnia, somatic symptoms, and unplanned pregnancy. Screening for domestic violence during the perinatal period, using high-quality surveys, is of utmost importance.Keywords: domestic violence, women, pregnancy, risk factors, birth outcomes, Oman

Acan, Ahmet/0000-0001-7116-8773; GURSAN, ONUR/0000-0002-6356-3834 WOS: 000521139200019 PubMed ID: 32160503 Objectives: This study aims to determine if there is an axial plane coverage insufficiency in patients with symptomatic labral tears compared to the contralateral asymptomatic side and healthy control subjects. Patients and methods: This retrospective study was conducted between December 2017 and January 2019. Thirty patients (21 males, 9 females; mean age 28 years; range, 20 to 36 years) operated due to unilateral symptomatic acetabular labral tears secondary to femoroacetabular impingement were evaluated. Twenty asymptomatic patients (13 males, 7 females; mean age 27 +/- 9 years; range, 19 to 36 years) were included in the control group. The relationship between acetabular morphology and labral tear was investigated with the comparison of unilateral symptomatic hips with contralateral asymptomatic hips and the control group by using radiological parameters on plain radiographs and computed tomography. Results: When the patient group symptomatic side was compared to the control group, acetabular anteversion angle (AAA) and alpha (alpha) angle were higher, while posterior acetabular sector angle and horizontal acetabular sector angle were lower. When the asymptomatic side was compared to the control group. AAA was higher in the patient group. There was no difference between the symptomatic and asymptomatic sides in the patient group: the symptomatic side yielded a higher a angle. Conclusion: Posterior axial plane coverage deficiency in combination with cam deformity (increased alpha angle) seems to play a role in the pathogenesis of symptomatic acetabular labral tears, even creating a side-to-side difference in some individuals.

This research aims in measuring the level of knowledge, attitude, and practice towards COVID-19 on community pharmacists in Tripoli, Libya. A cross-sectional survey was performed utilising an online questionnaire from the 1st to 27th March 2021. Data were gathered from a random sample of 260 community pharmacists (CPs) in Tripoli. Of the 260 participants, most respondents (71.66%, n = 187) had a good knowledge level about COVID-19. Moreover, approximately (88.23% n = 229) of the participants had positive attitudes. Most of the participants (84.35%, n = 219) had good practice levels against COVID-19. Educational level was associated with knowledge attitudes and pharmacist practices (p

Objectives: Postmenopausal osteoporosis is a progressive metabolic bone disease resulting from oestrogen deficiency. Due to the silent nature of the disease, there is an urgent need for a simple, early predictive marker. This study aimed to assess the potential of three factors—neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR)—as inflammatory markers of bone mineral density (BMD) loss. Methods: A retrospective cross-sectional study was conducted among 450 postmenopausal Omani women undergoing dual-energy X-ray absorptiometry at the Sultan Qaboos University Hospital, Muscat, Oman, from January 2017 to December 2019. The participants were allocated to groups based on lumbar spine BMD t-score values. A receiver operating characteristic curve was used to determine the area under the curve (AUC). Multivariate logistic regression was performed to identify independent predictors of low BMD. Results: A total of 65 (14.4%), 164 (36.4%) and 221 (49.1%) women were allocated to the control, osteopenia and osteoporosis groups, respectively. No significant differences in PLR, MLR and NLR values were observed among the groups. BMD t-score values were reversely correlated with age (P = 0.007) and PLR (P = 0.004) and positively correlated with body mass index (BMI; P 65 years) and BMI (

Introduction COVID-19 transmission was significant amongst Qatar’s working population during the March–July 2020 outbreak. The study aimed to estimate the risk of exposure for COVID-19 across various workplace settings and demographics in the State of Qatar. Methods A cross-sectional study was conducted utilizing surveillance data of all workplaces with 10 or more laboratory-confirmed cases of COVID-19. These workplaces were categorized using a mapping table adapted from the North American Industry Classification System (NAICS) codes, 2017 version. The data was then analyzed to estimate and compare the positivity rate as an indicator of the risk of developing COVID-19 infection across various workplace settings in the State of Qatar. Results The highest positivity rate was reported amongst the Construction & Related (40.0%) and the Retail & Wholesale Trade sectors (40.0%), whereas, the lowest positivity rate was attributed to the healthcare workplace setting (11.0%). The highest incidence of COVID-19 infections occurred in South Asian nationalities and in the male gender. The private funded sector employees have seen higher positivity rate than employees of the governmental funded sector. Conclusion The elevated risk of infection in Construction and Retail & Wholesale Trade is probably due to environmental and educational vulnerabilities. The predominant labor force of those workplace categories is South Asian craft and male manual workers. Alternatively, the better containment of the healthcare workplace setting can be attributed to the enforcement of infection control and occupational safety measures. These findings imply the importance of using preventive and surveillance strategies for high-risk workplace settings appropriately.

Background: COVID-19 transmission was significant among Healthcare workers worldwide. In March 2020, Qatar started reporting numbers of COVID-19 positive cases among workers in Primary Health Care Corporation (PHCC). The study estimates the burden of the aforementioned infections and examines the demographic characteristics associated with the recorded positivity rates.Method: A cross-sectional descriptive study was conducted among Primary healthcare workers between March 1st and October 31st, 2020. The study examined the positivity rate of the different types of Primary healthcare workers and, analyzed the demographic characteristics of the infected persons.Results: 1,048 (87.4%) of the infected Health Care Workers (HCWs) belonged to the age group below 45 years, and 488 (40.7%) HCWs were females. 450 (37.5%) were HCWs clinical staff working in one of the 27 PHCC Health Centers (HCs) Despite the increased patient footfall and risk environment, the COVID dedicated HCs had an attack rate of 10.1%, which is not significantly different from the average attack rate of 8.9% among staff located in other HCs (p = 0.26). Storekeepers, engineering & maintenance staff, housekeeping staff, support staff, and security staff (outsourced non-clinical positions) had the highest positivity rates, 100, 67.2, 47.1, 32.4, and 29.5% respectively.Conclusion: The elevated risk of infection among outsourced non-clinical healthcare workers can be explained by environmental factors such as living conditions. Furthermore, better containment within clinical healthcare workers can be attributed to strict safety training and compliance with preventative measures which is recommended to be implemented across all settings.

Food insecurity, or limited access to nutritious foods, is a significant public health concern especially among vulnerable populations including infants and young children in low-income households. While literature to date has thoroughly examined the psychological and behavioral impacts of food insecurity on children, no known study to date has specifically synthesized the literature exploring the relationship between food insecurity and physiological health outcomes during early childhood. The purpose of this study was to review the literature on physiological health outcomes associated with food insecurity during early childhood among children aged 0–5 years in developed countries. Our literature search sources included PubMed, PsycInfo, CINAHL, and Embase databases. A total of 657 articles published up to September 2019 were reviewed for eligibility by two coders, with a third reviewer in cases of disagreement. Eighty-three articles remained after screening by abstract, with a final 27 studies ultimately included in the final synthesis. This review is registered with PROSPERO and adhered to PRISMA guidelines. In total, 20 articles (74%) noted significant relationships between food insecurity and physiological health outcomes in young children. Findings included an association with overweight or obesity (n = 9), anemia (n = 3), poor child health (n = 3), low birth weight (n = 3), chronic illness (n = 1), special health care needs (n = 1), and increased cortisol (n = 1), in young children who experience food insecurity. Identifying relationships between food insecurity and health outcomes during early childhood has the potential to inform future prevention interventions to reduce health disparities in these vulnerable populations.

Objectives: To evaluate the agreement between temperature measured at the axilla or tympanic to rectum using standard techniques. Patients and Methods: We studied 50 neonates and 50 infants admitted to special care baby unit and Pediatric Gastroenterology Department with or without fever. Preterm, sick, malnourished neonates and uncooperative and crying infants were excluded from the study. Verbal consent from mothers was taken before the measurements. To adjust for rectal temperature, 0.55°C added to neonates and 0.65°C to infants' axillary temperature, 0.1°C to neonates, and 0.45°C to infants' tympanic membrane temperature. Results: There was a strong correlation (r) between 0.79 and 0.89 for axillary temperature with rectal temperature in neonates and infants, males and females, and for tympanic temperature with rectal in male infants. However, moderate correlation (r) was between 0.73 and 0.76 for tympanic temperature with rectal temperature in overall neonates and male and female infants. Axillary temperature missed 1% of pyrexia cases, whereas tympanic membrane measurements overestimate pyrexia in 5% of cases. Conclusion: It is safe reliable and convenient to use the axillary route for measurements of temperature in neonates and infants with or without fever.

BACKGROUND: In many health services communities the scope of oral and maxillofacial surgery (OMFS) as a discipline is frequently not probably understood. Good awareness towards OMFS among different branches of health services providers is essential for better referral strategies and will be for the benefit of the patient. MATERIALS AND METHODS: The cross-sectional study was done using a specially prepared questionnaire distributed randomly to 125 general medical practitioners working in Jazan province. In this questionnaire, there were also some close-ended questions to evaluate awareness regarding a variety of conditions treated by the oral and maxillofacial surgeons.RESULTS: Out of 125 participants, 105 (84%) were aware of the oral and maxillofacial surgery as a speciality branch of dentistry. Only 52 (41.6%) participants were aware of the different treatment modalities coming under the scope of oral and maxillofacial surgery. Also in the referral of cases to the oral and maxillofacial surgeon, 50 (40%) participants referred their oral and maxillofacial region cases to OMS. Tooth removal was the only procedure where most of the medical practitioners knew it is a speciality procedure of the oral and maxillofacial surgeon. For facial fractures, 76 medical practitioners believe it comes under the scope of the orthopaedic surgeon. Similarly, for facial abscesses, 81 and 36 practitioners responded that it is a job of a general surgeon and OMS respectively.CONCLUSION: There is low awareness toward the scope of oral and maxillofacial surgery in the medical community. Knowledge and awareness of the scope of oral and maxillofacial surgery can improve the success and promptness of delivery of health services.

Objectives: The number of family physicians in Oman is far below that recommended by the World Health Organization. This study aimed to determine factors influencing junior doctors’ choice of a career in family medicine. Methods: This cross-sectional study was conducted between March and June 2018 and targeted applicants to Oman Medical Specialty Board residency programmes during the 2018–2019 academic year. Applicants were grouped according to their choice of either family medicine (n = 64) or other specialities (n = 81). A self-administered questionnaire was utilised to compare the applicants’ sociodemographic characteristics, factors influencing their choice of career and their Myers-Briggs Type Indicator® (MBTI) personality traits. Results: A total of 52 family medicine and 43 other residency applicants participated in the study (response rates: 81.3% and 53.1%, respectively). Most family medicine applicants were female (86.5%), married (65.4%) and resided in rural areas (73.1%); moreover, 19.2% were ≥30 years of age. Overall, emphasis on continuity of care, opportunity to deal with a variety of medical problems, the ability to use a wide range of skills and knowledge, early exposure to the discipline, opportunity to teach and perform research and the influence of family or friends were important factors in determining choice of a career in family medicine. Moreover, the MBTI analysis revealed that family medicine applicants were commonly extroverted-sensing-thinking-judging personality types. Conclusion: Knowledge of the factors influencing career choice among junior doctors may be useful in determining future admission policies in order to increase the number of family physicians in Oman. Keywords: Career Choice; Internship and Residency; Medical Specialty; Family Practice; Family Physicians; Myers-Briggs Type Indicator; Oman.

12101 Background: The Paxman scalp cooling device has been used for over 20 years to prevent CIA, obtaining FDA clearance in the U.S. in 2017. Prior studies reported 50-80% success and high patient satisfaction yet included few or no black patients. In the U.S. this may reflect disparities in access due to cost, awareness, or availability. We opened a prospective observational study combining patient-reported outcomes with clinical assessments of alopecia and planned to deliver scalp cooling to 30 black patients receiving chemotherapy for breast cancer. Methods: Patients who self-identified racially as black, had a new diagnosis of stage I-III breast cancer, and planned to receive chemotherapy with taxane-containing regimens were eligible. Anthracycline (AC) and non-anthracycline (NAC) chemotherapy agents were included; costs for the intervention were covered by Paxman and internal philanthropic funding. Patients who declined scalp cooling were approached for enrollment as controls. Primary endpoints were grade of alopecia as measured by providers and patient self-report using Modified Dean Scale and Visual Analog Scale (VAS) respectively. Hair preservation was defined as grade 3 alopecia). The 2 patients who used scalp cooling for the duration had >grade 3 alopecia before the last cycle of treatment. Conclusions: Scalp cooling is an important supportive therapy that can reduce chance of alopecia, a bothersome side effect for patients. Our experience indicates decreased efficacy in black patients with both AC and NAC regimens. This is an important negative result to explore. Discussions with the Paxman team and providers with expertise in alopecia are underway to explore contributing factors such as hair thickness, prior hair treatments, and cap design. [Table: see text]

11023 Background: Cancer survivors in the U.S. are expected to exceed 20 million by 2026. Most fellows do not receive formal training in survivorship during oncology fellowship despite cancer survivorship comprising 2% of the American Board of Internal Medicine's Oncology examination and the recent accreditation standards related to survivorship care from the Commission on Cancer. Methods: We developed a survivorship curriculum and a multidisciplinary survivorship clinic staffed by a medical oncologist and physiatrist in September 2018. Oncology fellows rotated during their ambulatory block and completed surveys assessing skills and perceptions of competence at the beginning and end of the academic year. Results: 8 fellows completed the pre-survey and 6 of them completed the post-survey. While only a quarter had delivered a survivorship care plan/treatment summary prior to starting clinic, all fellows had delivered these (median=2, range=2-8) at the end of the year. Most fellows had seen survivors of breast, colorectal and hematologic malignancies prior to starting clinic; few had seen survivors with lung (12.5%), GU (0%) or head and neck (25%) cancer. These numbers increased, particularly with fellows’ seeing survivors of GU (50%) and head and neck cancers (100%) at the end of the year. Prior to the rotation less than half the fellows had assisted with managing cancer survivors’ treatment consequences or provided continuity of care through a multidisciplinary team. Similarly, only 25% had counseled cancer survivors with psychosocial concerns. On the post-survey, 100% of fellows reported practicing and feeling experienced in these domains. Post- survey showed improvement in self-reported competence levels in caring for cancer survivors (see Table). Conclusions: Participating in a survivorship clinic has a positive impact on oncology fellows’ experience and competence in caring for cancer survivors. Future directions are geared toward expansion of fellows’ skills to include areas related to cardiovascular and physical medicine. [Table: see text]

e14032 Background: The Institute of Medicine and Commission on Cancer recommends delivery of comprehensive survivorship care to all cancer survivors. While models exist for high-quality survivorship care, institutions encounter barriers such as lack of resources and training in cancer survivorship. We introduce a shared-care model with physical medicine and rehab (PM&R) to provide comprehensive care to cancer survivors at MedStar Washington Hospital Center. Methods: We implemented a bimonthly survivorship clinic in September 2018, staffed by a medical oncologist, oncology fellow and a cancer rehabilitation fellow. We assessed patient reported outcomes through PROMIS short forms for physical functioning, companionship, satisfaction with social roles and depression. Physiatry assessments included the 6-minute walk test and the Timed Up and Go test. All patients received a treatment summary and survivorship care plan. Results: We evaluated 30 cancer survivors between Sept 2018 and December 2019; mean age was 55.6 years (SD = 10.6 years). Majority were female (60%) and Black (60%). Most patients were overweight or obese (93%) with a mean body mass index of 30.6 mg/m2 (SD = 4.7). Breast (43%) and hematologic malignancy (33%) were the most common cancer diagnoses. The median time between cancer remission and the clinic visit was 16 months (Range = 1 to 65 months). The average score for Timed Up and Go test was within the reference normal value of < 12 sec (8.22 seconds, n = 23). Average distance for the 6-minute walk test was 465.87 meters (n = 18). Survivor age was negatively correlated with the distance walked for the 6-min walk test (r = -0.51, p = 0.027). Better psychosocial functioning assessed with PROMIS were significantly associated with lower scores on the Timed Up and Go Test: satisfaction with social roles (r = -0.67, p = 0.033) and companionship (r = -0.64, p = 0.046); we identified a trend between Timed Up and Go scores and depression (r = 0.47, p = 0.099). Conclusions: An integrative survivorship clinic to provide multidisciplinary survivorship care is a feasible model and results suggest that patients’ physical functioning is significantly associated with psychosocial outcomes. Our approach highlights the importance of assessing both physical functioning and patient-reported outcomes. Future research can evaluate assessments of these outcomes over time.

Reason for withdrawal from publication A systematic review using individual participant data has recently been conducted by the Early Breast Cancer Trialists’ Collaborative Group. This represents a very high-quality review of the evidence and a Cochrane Review on the same topic would not significantly add to the knowledge base. Therefore, we direct readers to the systematic review published in The Lancet (2015, volume 386, pages 1341-1352).

Univ Sao Paulo InCorHCFMUSP Cardiol, Fac Med, Inst Coracao, Programa Posgrad Ciencias, Sao Paulo, Brazil

Background Breast cancer in young women (≤ 40) is associated with greater morbidity, both physical and psychological, and mortality than in older women. For women in their 20s and 30s we would expect the mother daughter relationship to be uniquely impacted by breast cancer. However, no study has apparently looked at the effects of a breast cancer diagnosis in this situation. We completed a pilot study to assess the clarity, content and sensitivity of a questionnaire that will be used in a comprehensive assessment of this relationship in young women with breast cancer. Methods: A questionnaire with a mixture of Likert and open-ended items was developed after a literature review, obtaining input from an interdisciplinary panel of experts in psychology, medical oncology, research methodology, and breast cancer, and informal interviews with 3 young breast cancer survivors. Topics covered include demographics, nature of the mother-daughter relationship pre and post diagnosis and sources of support to daughters and mothers. Ten breast cancer survivors (≤ age 40 at diagnosis and > 36 months after their diagnosis) were asked to assess the questionnaire. Results: Ten patients, median age 37 years (range 31–52), participated in the pilot study. The average time to complete the questionnaire was about 30 minutes. No questions were reported to be upsetting. All but 1 patient indicated that the questionnaire was clear. The questionnaire was modified based on patient feedback. The number of items was reduced from 51 to 38. Items concerning, for example, nature of the mother-daughter relationship during childhood or teenage years, and openness to discussing personal gynecological matters prior to breast cancer diagnosis were ultimately excluded. A question inquiring about the most difficult issues the daughter faced after diagnosis was added. Some questions were changed from open ended format to relevant tick box options after reaching response item saturation during the pilot phase. Of the 10 patients, 8 felt close to their mothers in the year prior to their diagnosis. Seven patients reported turning to their mothers for support when they first learned of the diagnosis, and 4 stated their mother was the first person they turned to. All 10 felt their mothers were emotionally and practically supportive. Five indicated that their relationship got closer postdiagnosis. One patient reported that her mother was not coping, and 3 indicated that their mothers did not have adequate support. Many patients felt that health care providers could help mothers by being empathetic, providing information, and linking mothers with supports. Discussion: The mother-daughter relationship is an important source of support for young breast cancer survivors. Our questionnaire will be used in 100 women ≤ age 40 and within 3 years of diagnosis to further study the impact of breast cancer in a young woman on the mother-daughter relationship and to determine whether any intervention targeted to the mothers (eg. information or support groups) might be helpful. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-17-06.

Background: Breast cancer in younger women (≤ 40) is associated with greater physical and psychological morbidity than in older women. No study to our knowledge has examined the effect of a breast cancer diagnosis in young women on their relationship with their mothers, or the support needs of these mothers. Methods: We developed and pre-tested a self-administered questionnaire on 10 survivors of breast cancer diagnosed ≤ age 40 for clarity, content and sensitivity (San Antonio, 2011). Then, consecutive recurrence-free women age ≤ 40 at diagnosis, within 4 years of a breast cancer diagnosis, whose mothers were alive at diagnosis, were asked to complete the modified questionnaire in a medical oncology follow-up clinic. Results: Of 110 eligible daughters approached from 07/2011–05/2012, 90 with a mean age 36 (range 21–43) participated in the study. Stage at diagnosis: 1–23 (26%), 2–46 (51%) 3–21 (23%). Ethnicity: Asian: 29 (32%), Caucasian 43 (48%), Black 2 (2%), Mix/Other 16 (18%). At diagnosis, 15 were living with their mothers, 44 were not living in the same city including 23 who were in different countries, 7 of whom were not informed of the diagnosis as the daughters did not want to worry them. Mean age of the 88 mothers alive at time of study was 64 (range 48–84) and 16 had previously had breast cancer. Illness attributions: Eight blamed their mothers for their developing breast cancer, and 22 believed their mothers felt responsible to some extent (overlap in 4). Supports: Of the 43 daughters who had turned to their mothers for emotional support over the year prior to diagnosis, all but one did so after diagnosis, as did 20% of those who had not turned to mothers over the year prior to diagnosis. In 11 cases, the daughters turned to their mothers before approaching anyone else for support. Of the 83 daughters who informed mothers of their diagnosis, 76 (92%) reported their mothers were emotionally and/or practically supportive. The 4 most difficult issues faced by daughters were fatigue, anxiety, breast loss and menopausal symptoms, with 70 daughters discussing at least some issues with their mothers. Of the 35 working mothers, 27 took time off to support their daughters. Nineteen mothers slept over or moved in with the daughters during their treatment, 8 of whom had been living in a different country. Forty-four (44/83=53%) daughters reported that the breast cancer diagnosis had a favorable impact on their relationship with their mothers. Formal supports for mothers: Thirty-two (32/83=39%) reported their mothers did not have adequate psychosocial support, and 59 (59/90=66%) indicated health care professionals could help mothers by providing brochures on caring for a daughter with breast cancer, having professionally led education sessions, as well as support groups. Conclusion: Mothers are an important source of support for young breast cancer daughters, and most daughters perceived that the diagnosis resulted in the mother-daughter relationship becoming closer. However, the physical and emotional toll on mothers appears to be high. Future studies should address the effects of a breast cancer diagnosis in a young daughter from the mothers' perspective, and the benefit of formal, culturally sensitive supports for these mothers. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-08-04.

Background For young women with breast cancer mothers might either be a source of support or of increased stress, depending on the premorbid relationship and on the psychological effect of the daughter's diagnosis on her mother. Objectives To examine the effects of a breast cancer diagnosis on young women's relationships with their mothers and the possible support needs of these mothers from the daughters' perspective. Patients and methods We developed and pre-tested a self-administered questionnaire on 10 survivors of breast cancer diagnosed ≤ age 40. Then, consecutive recurrence-free young women diagnosed with breast cancer were asked to complete the modified questionnaire. Results Of 110 daughters approached from July/11 to May/12, 90 (82%) participated. In 11 cases (13%), the daughters had turned to their mothers before approaching anyone else. Of the 83 daughters who disclosed their diagnosis to their mothers, 76 (92%) stated their mothers had been emotionally and/or practically supportive, and 43 (54%) reported that the breast cancer diagnosis had a favorable impact on their relationship with their mothers. Of the 35 employed mothers, 26 had taken time off from work to support their daughters. Nineteen mothers, eight of whom had been living in a different country, had slept over or moved in with daughters during their treatment. Twenty-two daughters believed their mothers felt responsible to some extent for their developing breast cancer. Fifty-nine daughters indicated that health care professionals could help mothers by providing information pamphlets, education sessions, and linking to support groups. Conclusion Mothers are an important source of support for young daughters with breast cancer, with the mother–daughter relationship frequently becoming closer after the diagnosis. However, the practical and emotional burden on mothers appears to be high. Future studies should address the effects of a breast cancer diagnosis in young daughters from the mothers' perspective, and the benefit of formal supports for these mothers.

Objectives: Human papillomavirus (HPV) is the most commonly known sexually transmitted agent. To date, few reports are available on the distribution of most prevalent and variant types of HPV in Arab women. Therefore, the aim of this study is to determine the age-specific distribution of HPV types among Arab women being subjected to routine pap smear tests in the State of Qatar. Methods: 1100 pap smears have been collected in ThinPrep vials (BD SurePath™) from Arab women seeking routine gynecological care at the Women's Hospital, Hamad Medical Corporation (HMC) in Doha, Qatar. All the samples were transported to the laboratory in an icebox container. Viral DNA from ThinPrep samples was extracted by QIAamp MinElute virus spin kit according to manufacturer's instructions and was screened for HPV DNA by real-time PCR using L1 HPV specific (GP5+/6+) primers. The type-specific distribution of the viruses was determined by HPV high and low risk typing RT-PCR kits (Sacace Biotechnology, Italy) and PCR-based sequencing. Real-time PCR amplification was carried out in ABI 7500 real-time PCR (Applied Biosystems). Results: Based on the collected data, HPV DNA was detected in 125 women (11.36%), and 15 different HPV genotypes were detected, comprising high-risk and low-risk genotypes. The prevalence of HPV infection was seen in 54.5% Qatari and 45.5% non-Qatari women. With regard to age, 33.5% of all HPVs were found in women 30-39 years of age, 24.8% in women 40-49 years of age, 15.8% in women 50-59 years of age, 5.5% in women over 60 years and 20.4% in women less than 30 years old. Implications and Impact: The study shows that the prevalence of HPV infection in Arab women in Qatar is among the highest in the Arab world compared with previous reports. However, more extensive population-based studies should be undertaken before implementing HPV vaccination.

bowel when positioning patients in prone without a belly board versus supine were analyzed. Furthermore, reproducibility of positioning was reviewed by plotting image guided shifts in both positions. Results: Preliminary results showed no statistically significant differences between supine and prone in V15 (p1⁄40.41) and V45 (p1⁄40.40) for the small bowel. However, the standard deviation of the supine population is smaller than the prone population. In addition, a smaller initial setup error from the daily CBCT was noted in patients positioned supine. A mean shift of 5.2 mm in the anterior to posterior plane for prone positioning versus 1.5 mm for supine positioning, in this study population. Conclusion & Discussion: Patient positioning appears more reproducible in the supine position, and there is no statistically significant difference in doses to organs at risk in the study population. However, given that our current protocol is to position all rectum patients prone, unless contra-indicated, the sample size for the supine position is small. Correspondingly, the patients positioned supine, are a biased sample (mainly ostomy patients). Furthermore, the datasets are all independent, thus not accounting for differences in individual patient anatomy.

1542 Background: PYNK: Breast Cancer Program for Young Woman is a novel program started in 2008 at our center to optimize management and promote research for women ≤ age 40 newly diagnosed with breast cancer. Clinical and epidemiological data including cancer family history (FH) is prospectively collected on each consenting patient. As Toronto’s population is uniquely multiethnic we sought to determine BRCA testing eligibility, uptake and results for PYNK patients. Methods: Of the 145 consecutive patients, data were available for 109, of whom 2 had testing prior to diagnosis. Our provincial BRCA testing criteria are age < 35 at diagnosis; suspicious FH; or Ashkenazi Jewish (AJ) and age < 50 at diagnosis. Results: Of the 107 previously untested patients, 40 were < 35 at diagnosis. In 5 of the other 67 testing eligibility could not be assessed. 66 of the 102 (65%) were eligible and of those 65 (98%) were offered referral for counseling. One declined counseling, 9 were not yet seen, 2 declined testing, and 53 were tested. Test results are available for 47 as follows: 30 (64%) no mutation, 4 (8%) variant of uncertain significance (VUS), 7(15%) BRCA1 mutations and 6 (13%) BRCA2 mutations including 1 of the 4 AJ women. Ethnicity of the other 12 mutation carriers was: 1 Hispanic, 2 European, 2 African, 4 Asians, 1 mix, 1 unknown and 1 not recorded. Two (15%) of the mutation carriers had no FH of breast or ovarian cancer. Four additional women opted for counseling and testing despite ineligibility and none had mutations. Conclusions: A specialized program for young women facilitates appropriate referral for genetic testing and encourages high testing uptake, which is important given the high prevalence of mutations (28% of tested women). Further research is necessary to assess the psychological and management impact of having a VUS on young women compared to their older counterparts.

Objective:This study aimed to determine the prevalence and ideal detection method for high-risk human papillomavirus (HPV) genotypes, in order to evaluate prevention strategies in cervical cancer and other HPV-related diseases in Qatar.The study compared performance of cervical cytology and HPV DNA test to detect high-risk HPV genotype (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) infections in a sample of Qatar's female population, using High Risk Screen Real-Time PCR test.Methods:A series of 95 women attending the Gynae-oncology clinic at Hamad Medical Corporation between August 2007 and May 2008 were enrolled in this study. Cervical smears isolated from patients were subjected to High Risk Screen Real-Time test to confirm the presence of HPV DNA. The smears were characterized as ASCUS; LGSIL and HGSIL.Results:The overall prevalence of high-risk HPV in our study population (n=95) was 64%, with HPV 52, 56 and 16 being the commonest types detected..Of the 95 samples in the study, 93 were tested...

Despite diagnostic and therapeutic advances in medical, surgical, and critical care, the mortality rate for Aspergillus endocarditis remains dismal (approaching 100%). We report a case of a 49 year old immunocompetent woman with recent aortic valve prosthesis who presents with fever, chills, sweats, left facial droop, left arm weakness, petechial rash and cyanotic toes. Initial trans-esophageal echo was normal but a repeat study revealed a 9 × 5 mm vegetation abutting the aortic pros- thesis. Microbiological correlation could not be documented despite the presence of persistent fever through serial blood cultures, and the diagnosis of Aspergillus fumigatus endocarditis was ultimately made on embolectomy specimen when she developed an ischemic right leg. Aggressive medical treatment was initiated with intravenous voraconazole, liposomal amphotericin-B and heparin. The timing of surgical intervention was contemplated, but was precluded by multiple comorbidities. She succumbed to her illness after developing cerebral herniation following intraparenchymal hemorrhage. The effectiveness of combined medical intervention and surgical valve replacement for Aspergillus endocarditis is therefore contingent on high diagnostic suspicion and early echocardiographic detection in a high risk individual with features of culture-negative endocarditis.