Judged 3-Minute Oral Presentation Session III

Background/Significance:

Coronavirus disease 2019 (COVID-19) remains a relatively new condition, with its complications still under investigation. Previous studies have identified SARS-CoV-2 as a possible trigger for autoimmunity through immune system hyperstimulation and molecular mimicry. Therefore, one potential complication of COVID-19 is the development of autoimmune diseases, including autoimmune liver diseases (AILD) such as primary sclerosing cholangitis (PSC), primary biliary cholangitis (PBC), autoimmune hepatitis (AIH), and IgG4-related hepatobiliary disease (IgG4-HD). Identifying COVID-19 as a risk factor for AILD could hold significant clinical implications, particularly if the incidence of these conditions increases in the wake of the pandemic.

Purpose:

This study aims to determine whether prior COVID-19 positivity is associated with new diagnoses of AILD.

Methods:

A retrospective case-control study was conducted using the electronic medical records of Advocate Health Care and Aurora Health Care. Patients with ICD-10 codes for PSC, PBC, AIH, and IgG4-HD who sought care between January 2020 and January 2023 were identified. Manual chart review confirmed diagnoses based on clinical, serologic, and/or histologic findings and verified COVID-19 testing status by PCR in a healthcare setting. Cases were matched 1:1 to controls by age, sex, and race, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the association.

Results:

Of 2,739 patients identified, 434 met inclusion criteria after manual review (188 PBC, 61 PSC, 162 AIH, 8 IgG4-HD, 13 PBC-AIH overlap, 2 PSC-AIH overlap). The OR for any AILD diagnosis following a positive COVID-19 test was 1.94 (95% CI 1.17–3.22, p=0.01). ORs for PSC, AIH, and PBC were 1.85 (95% CI 0.51–6.67, p=0.34), 1.99 (95% CI 0.86–4.61, p=0.10), and 1.70 (95% CI 0.78–3.71, p=0.18), respectively. Due to small sample sizes, ORs for overlap syndromes and IgG4-HD were not calculated.

Conclusion:

This study observed a statistically significant association between prior COVID-19 positivity and a diagnosis of an AILD. However, individual conditions did not achieve significance, possibly due to limited sample sizes. Because these findings suggest a possible association between COVID-19 positivity and a diagnosis of an AILD, further investigation of this potential relationship is warranted.

Background/Significance:

Post-transplant cyclophosphamide (PTCy) is an effective prophylaxis (ppx) for graft-versus-host disease (GVHD) as shown in the BMT CTN 1703 trial. However, there is limited reporting of significant adverse events such as cardiotoxicity (CT) and hemorrhagic cystitis (HC). One study noted a day +100 CT incidence of 19% and > 2 times higher risk with PTCy versus not. Another identified a lower incidence of 7.4%, but non-PTCy patients had similar rates. Furthermore, they determined risk factors for CT based on pre-existing comorbidities (age, hypertension, cardiac history, diabetes) and discovered risk stratification scores 2-4 increased CT risk (HR 2.2 - 5.6).

Purpose:

The primary objective was to describe PTCy-related adverse events and outcomes when utilizing reduced PTCy doses.

Methods:

This retrospective, single-center review evaluated patients who received an allogeneic stem cell transplant from any donor type with PTCy-based GVHD ppx between December 6, 2022, and June 1, 2024. Patients were evaluated at day +100 for CT, HC, and select viral infections. Day +180 assessments reported the incidence of acute and chronic GVHD, relapse, and survival. Descriptive statistics, Kaplan-Meier methods, and cumulative incidence were calculated using R (V.2023.12.1).

Results:

Eleven patients were evaluated following exclusion of three who received full dose PTCy (100 mg/kg). Baseline characteristics included a median age of 65.3 years (40.4-76), 91% male, 81% AML/MDS, and 81% received a reduced intensity conditioning. Cardiac risk scores were 0-1 (64%), 2 (36%), and 3-4 (0%). All received PTCy 80 mg/kg total. Overall, 63.6% developed CT, nearly all of which were grade 2 pericardial effusions, and 36.4% experienced HC. Grades 1-2 acute GVHD and relapse were 45.5% (0% 3/4) and 33.3%, respectively, with an estimated day +180 overall survival of 90%. Cytomegalovirus and Epstein-Barr virus reactivation cumulative incidence was 18.2% and 0%, respectively.

Conclusion:

Despite utilizing lower dose PTCy, CT, and HC incidence was high compared to references despite no high cardiac risk scores, but efficacy remained comparable. While most CT may be trivial incidental findings during routine post-transplant surveillance, two severe events occurred in patients with low cardiac risk scores. Further studies are needed to uphold proposed CT risk stratification and determine optimal PTCy doses.

Background/Significance:

The Accreditation Council on Graduate Medical Education (ACGME) requires GME learners/faculty to engage in quality improvement (QI) in education and clinical care. To support this QI, the Alliance of Independent Academic Medical Centers (AIAMC) launched 18-month national initiatives (NIs), each with a unique focus. Aurora Health Care’s GME programs have successfully completed multiple NIs, which are time/resource intensive. Yet no systematic assessment of their overall value (e.g. percent of projects that achieve aims, project alignment with ACGME requirements, lessons learned) has been done.

Purpose:

To determine the value (return on investment [ROI]) of Aurora’s AIAMC NI participation to inform Advocate Health’s (AH) multiple GME institutions’ future NI participation.

Methods:

AIAMC required final reports for five Aurora NIs (which includes multiple projects/NIs) across 10 years were analyzed. A coding sheet based on the common AIAMC final report elements consistent with QI efforts (e.g., degree to which projects achieved their aims, barriers, success elements, lessons learned) and ACGME items (e.g., number of project team members, recognition, scholarly activity) was created. All project reports were coded yielding descriptive statistics; narrative responses were analyzed to identify common themes across projects and initiatives.

Results:

Aurora participated in 22 unique NI projects over the last five NIs, involving 114 participants (54% residents/fellows, 18% faculty, 23% academic affairs, 23% others). Projects were either residency/fellowship-specific or GME-wide. Over 90% met their aims, except during the pandemic. Success stemmed from alignment with AH’s priorities and ACGME requirements. Recognized projects within AH included early pilots (e.g., well-being, expanded diversity data) and system product rollouts (e.g., residency clinic selected for online advance directive software; HTN control in underserved). Many projects earned national awards (2) or recognition (9). Key lessons: be agile, patient, and persistent. Scholarly activity included 60 peer-reviewed presentations/publications.

Conclusion:

Our AIAMC NI participation has created multiple wins yielding a strong ROI. Residency programs repeatedly participate and meet ACGME QI, diversity, wellbeing, teamwork, and scholarly requirements. Improved clinical outcomes via alignment with AH priorities and inspiration due to the team’s “resilience, agility, and persistence to continue to seek ways to improve…”

Background/Significance:

Zinc is an essential micronutrient crucial for various physiological processes such as protein synthesis, gene expression, hormonal regulation, and tissue differentiation. Preterm infants have an increased demand for zinc due to its pivotal role in cellular growth and brain development. Zinc deficiency, even if mild, can impair growth despite sufficient caloric and protein intake. Emerging evidence suggests that subclinical zinc deficiency may elevate the risk of neonatal complications like necrotizing enterocolitis (NEC), bronchopulmonary dysplasia, and retinopathy of prematurity.

Purpose:

This study aims to assess the impact of zinc supplementation on the growth and nutritional status of preterm infants by comparing weight-for-age z-score changes between supplemented and non-supplemented groups.

Methods:

On July 1, 2023, our Level IV NICU implemented a zinc supplementation protocol for preterm infants weighing ≤1250 grams. Eligible infants received 1 mg/kg/day of elemental zinc (zinc sulfate) enterally for 30 days, beginning upon achieving full enteral feeding. We conducted a retrospective cohort study comparing weight-for-age z-score changes from birth to discharge in the supplemented group versus a historical control group. One hundred and two infants received zinc supplementation, with seven excluded due to non-survival, leaving 95 infants for analysis. A randomly selected control cohort of 100 infants from our NICU’s nutrition database was used for comparison. Both groups were similar in gestational age, sex, birth weight, length, head circumference, and discharge anthropometrics. Other factors such as time to initiation of feeds, NEC incidence, breastmilk provision at discharge, postmenstrual age at discharge, and length of stay were also comparable.

Results:

The zinc-supplemented infants achieved full enteral feeds more rapidly, regained birth weight sooner, and required fewer days of total parenteral nutrition and central line use compared to controls. The zinc-supplemented group showed fewer infants with severe growth decline and more infants classified with no or mild/moderate growth decline.

Conclusion:

Zinc supplementation in preterm infants is associated with quicker attainment of goal feeds, faster birth weight recovery, and improved growth trajectories. Although causality cannot be definitively established, these findings suggest that zinc supplementation may have a beneficial impact on growth and development in this vulnerable population.

Background/Significance:

Emerging research has indicated drastically different rates of cancer types in people with Down Syndrome (DS) compared to people without DS. Given the increased life expectancy of individuals with DS in recent decades, assessing risk of cancer is critical for screening guidelines and approaches to prevention and treatment to be tailored. Our healthcare system’s dedicated Adult Down Syndrome Center serves a large number of individuals with DS, providing a unique opportunity to assess prevalence of various cancer types among patients with DS.

Purpose:

We hypothesize that cancer prevalence looks different in people with DS compared to the people without DS. Unnecessary screening tests can be particularly detrimental for people with DS. Our goal for this research is to inform cancer screening recommendations specific to the DS population.

Methods:

We conducted a retrospective cohort study examining cancer prevalence among 5,853 individuals with DS who received care at a large Midwestern health system between May 1991–September 2019. In collaboration with a clinician and expert in the field, we identified 44 distinct cancer conditions using International Classification of Diseases (ICD)-10 codes and systematically extracted diagnoses coded from each patient’s electronic health records. We calculated individual cancer prevalence rates among our study population and summarized demographic information using percentages for categorical variables and means with standard deviation (SD) for continuous variables. All analyses were done using R version 4.4.

Results:

Our study population was largely non-Hispanic white (70%), with a mean age of 29.6 years (SD=18.9) and Medicare as their primary insurance provider (38%). Among the 44 cancer types examined, neoplasms of uncertain behavior/myelodysplastic syndromes were the most prevalent (2.29%), followed by lymphoid leukemia (0.53%), myeloid leukemia (0.51%), and benign neoplasms (0.41%). Notably, 18 (41%) cancer types occurred at a rate of less than 0.1%, and 13 (30%) cancer types had no reported cases within our study timeframe.

Conclusion:

Individuals with DS had a low prevalence of 44 cancer types assessed. Prevalence data should be included in review of cancer screening guidelines with consideration for modifying the guidelines for people with DS.