Nutrition research is limited by inadequate infrastructure for assessing diet and nutrient intake specifically in older Indians. To support the analysis of food frequency questionnaire (FFQ) data from wave 2 of the Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD), a food composition database (FCDB) was developed using nutritional expertise and dietary software. The Indian Food Composition Tables (IFCT) provided the core nutrient data and missing foods and nutrients were mapped to other international FCDBs. Where needed, the nutritional composition of raw foods in IFCT was adjusted for nutrient retention following cooking. These cooked nutrient values were compared descriptively to other international FCDBs for consistency. Most food items were matched to the IFCT (63%) of which almost half (48%) were raw foods which required cooking adjustment. Nutrients were gap-filled using United Kingdom food tables (GB21-0 and GB15; n = 74%), followed by United States and Singapore food tables. A coding file for conversion of food frequency to gram weights and unique food codes was generated for linkage to the FCDB for nutrient analysis. This FCDB helps provide an important methodological foundation for nutrition infrastructure and allow researchers to determine nutrient intake in older Indians and investigate diet-related disease research.

OBJECTIVES:To investigate the association between tooth loss and the incidence of mild cognitive impairment (MCI) and dementia, focusing on diet quality as a potential mediator. DESIGN:Prospective cohort study. SETTING AND PARTICIPANTS:Community-dwelling older men enrolled in the Northern Ireland PRIME study (Prospective Epidemiological Study of Myocardial Infarction). MEASUREMENTS:A group of men, aged 58-71 years, underwent dental examinations in 2001-2003. Surviving participants were invited to attend a cognitive rescreening in 2016-2020, which included a food frequency questionnaire. Cognitive outcomes were categorised as normal, MCI or dementia, based on standardised neurocognitive tests. Dietary diversity scores (DDS) were calculated based on the frequency of intake of food groups. Analyses included multiple logistic regression to evaluate the associations between tooth loss, defined as <20 remaining natural teeth, and MCI/dementia incidence adjusting for potential confounders. Mediation analysis assessed the role of diet quality in this relationship. RESULTS:A total of 628 men were included, with a mean baseline age of 63.2 years (SD 2.8) and a median follow-up of 15.0 years (IQR 14.2-17.0). At rescreening, 485 (77.2%) were cognitively normal, 112 (17.8%) had MCI, and 31 (4.9%) had dementia. In fully adjusted models, tooth loss was significantly associated with MCI/dementia (OR = 2.06, 95% CI 1.20-3.55, p < 0.01). DDS partially mediated this relationship, explaining approximately 23% of the total effect. CONCLUSION:In this cohort of older men, tooth loss was associated with incidence of MCI/dementia over 15 years, and diet diversity partially mediated this association. These findings highlight an important pathway connecting oral health, dietary quality, and cognitive outcomes.

It is predicted that low-and- middle-income countries like India will bear the maximum brunt of global aging in the near future. Aging societies are increasingly facing higher incidence of cognitive decline and dementia. Research on the potential of dietary patterns as a modifiable lifestyle factor for protection of cognitive health has gained momentum. This study aims at developing a dietary assessment tool-food frequency questionnaire (FFQ) for older Indian adults in the community. An FFQ was developed for the diverse, older population in India to collect data on their food intake over the past 12 months. This was pre and pilot tested leveraging the sample of an ongoing longitudinal study of late life cognition in older adults in India – Longitudinal Aging Study in India- Harmonized Diagnostic Assessment of Dementia (LASI-DAD). The FFQ was pilot tested during the first wave of the study (2017–2020) on a sample of 1125 respondents, updated and modified and finally implemented in the second wave of the study on 4465 respondents (2022–2024). An electronic Computer Assisted personal interview (CAPI) system with the use of tablets was implemented. The LASI-DAD FFQ was translated to 12 Indian languages for collecting accurate data from different regions of the country. A diverse range of food products and list of local food from different parts of India were included. The challenges faced, lessons learnt and modifications helped shape the final LASI-DAD FFQ. This was implemented in 24 Indian states. It had 4 sections: (A) Food consumption habits (B) Food frequency section (C) Herbal /non herbal/ayurvedic supplements (D) Spice intake. The final questionnaire had 88 food items and median time taken to complete was 31 min. Response rate varied from 97 to 100

Background:The need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by the World Health Organization and the United Nations Educational, Scientific and Cultural Organization.Objectives:To evaluate the effects of If I Were Jack on the avoidance of unprotected sex and other sexual health outcomes.Design:A cluster randomised trial, incorporating health economics and process evaluations.Setting:Sixty-six schools across the four nations of the UK.Participants:Students aged 13-14 years.Intervention:A school-based, teacher-delivered, gender-transformative RSE intervention (If I Were Jack) versus standard RSE.Main outcome measures:Self-reported avoidance of unprotected sex (sexual abstinence or reliable contraceptive use at last sex) after 12-14 months. Secondary outcomes included knowledge, attitudes, skills, intentions and sexual behaviours.Results:The analysis population comprised 6556 students: 86.6% of students in the intervention group avoided unprotected sex, compared with 86.4% in the control group {adjusted odds ratio 0.85 [95% confidence interval (CI) 0.58 to 1.26], p = 0.42}. An exploratory post hoc analysis showed no difference for sexual abstinence [78.30% intervention group vs. 78.25% control group; adjusted odds ratio 0.85 (95% CI 0.58 to 1.24), p = 0.39], but more intervention group students than control group students used reliable contraception at last sex [39.62% vs. 26.36%; adjusted odds ratio 0.52 (95% CI 0.29 to 0.920), p = 0.025]. Students in schools allocated to receive the intervention had significantly higher scores on knowledge [adjusted mean difference 0.18 (95% CI 0.024 to 0.34), p = 0.02], gender-equitable attitudes and intentions to avoid unintended pregnancy [adjusted mean difference 0.61 (95% CI 0.16 to 1.07), p = 0.01] than students in schools allocated to receive the control. There were positive but non-significant differences in sexual self-efficacy and communication skills. The total mean incremental cost of the intervention compared with standard RSE was £2.83 (95% CI -£2.64 to £8.29) per student. Over a 20-year time horizon, the intervention is likely to be cost-effective owing to its impact on unprotected sex because it would result in 379 (95% CI 231 to 477) fewer unintended pregnancies, 680 (95% CI 189 to 1467) fewer sexually transmitted infections and a gain of 10 (95% CI 5 to 16) quality-adjusted life-years per 100,000 students for a cost saving of £9.89 (95% CI -£15.60 to -£3.83).Limitations:The trial is underpowered to detect some effects because four schools withdrew and the intraclass correlation coefficient (0.12) was larger than that in sample size calculation (0.01).Conclusions:We present, to our knowledge, the first evidence from a randomised trial that a school-based, male engagement gender-transformative RSE intervention, although not effective in increasing avoidance of unprotected sex (defined as sexual abstinence or use of reliable contraception at last sex) among all students, did increase the use of reliable contraception at last sex among students who were, or became, sexually active by 12-14 months after the intervention. The trial demonstrated that engaging all adolescents early through RSE is important so that, as they become sexually active, rates of unprotected sex are reduced, and that doing so is likely to be cost-effective.Future work:Future studies should consider the longer-term effects of gender-transformative RSE as students become sexually active. Gender-transformative RSE could be adapted to address broader sexual health and other settings.Trial registration:This trial is registered as ISRCTN10751359.Funding:This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (PHR 15/181/01) and will be published in full in Public Health Research; Vol. 11, No. 8. See the NIHR Journals Library website for further project information.

Dementia prevalence is a global public health concern. Adherence towards a healthy dietary pattern (DP) may reduce the risk of cognitive decline and dementia. This narrative systematic review aimed to synthesise prospective and intervention study data to evaluate the impact of a-posteriori and a-priori derived DPs on cognitive ageing, from cognitive decline to incident dementia. Ninety-three studies were included: 83 prospective studies and 10 randomised controlled trials (RCT). Most prospective studies (77%) examined a-priori DPs, with the Mediterranean diet examined most frequently. A total of 52% of prospective and 50% of RCTs reported a protective relationship between 'healthy' DPs and global cognitive decline. Overall, 59% of prospective studies reported positive associations between healthy DPs and risk of cognitive disorder. Incident cognitive disorder was examined by only one intervention study (subgroup analysis) which reported a beneficial effect of a low-fat diet on risk of probable dementia in women. Unhealthy DPs were examined less frequently (n = 17; 21%), with 41% of these studies reporting associations between adherence and poorer cognitive outcomes. Overall, there were mixed results for healthy and unhealthy DPs on cognition, likely due to between-study heterogeneity. Standardisation of diet exposure and cognitive outcome measurement would help to reduce this. Future research would benefit from investigating effects of culturally appropriate DPs on individual cognitive domains and incident cognitive disorders in diverse and high-risk populations.

BACKGROUND:Epstein-Barr virus (EBV) frequently is measured at high levels in COPD using sputum quantitative polymerase chain reaction, whereas airway immunohistochemistry analysis has shown EBV detection to be common in severe disease. RESEARCH QUESTION:Is valaciclovir safe and effective for EBV suppression in COPD? STUDY DESIGN AND METHODS:The Epstein-Barr Virus Suppression in COPD (EViSCO) trial was a randomized double-blind placebo-controlled trial conducted at the Mater Hospital Belfast, Northern Ireland. Eligible patients had stable moderate-to-severe COPD and sputum EBV (measured using quantitative polymerase chain reaction) and were assigned randomly (1:1) to valaciclovir (1 g tid) or matching placebo for 8 weeks. The primary efficacy outcome was sputum EBV suppression (defined as ≥ 90% sputum viral load reduction) at week 8. The primary safety outcome was the incidence of serious adverse reactions. Secondary outcome measures were FEV1 and drug tolerability. Exploratory outcomes included changes in quality of life, sputum cell counts, and cytokines. RESULTS:From November 2, 2018, through March 12, 2020, 84 patients were assigned randomly (n = 43 to valaciclovir). Eighty-one patients completed trial follow-up and were included in the intention-to-treat analysis of the primary outcome. A greater number of participants in the valaciclovir group achieved EBV suppression (n = 36 [87.8%] vs n = 17 [42.5%]; P < .001). Valaciclovir was associated with a significant reduction in sputum EBV titer compared with placebo (-90,404 copies/mL [interquartile range, -298,000 to -15,200 copies/mL] vs -3,940 copies/mL [interquartile range, -114,400 to 50,150 copies/mL]; P = .002). A statistically nonsignificant 24-mL numerical FEV1 increase was shown in the valaciclovir group (difference, -44 mL [95% CI, -150 to 62 mL]; P = .41). However, a reduction in sputum white cell count was noted in the valaciclovir group compared with the placebo group (difference, 2.89 [95% CI, 1.5 × 106-7.4 × 106]; P = .003). INTERPRETATION:Valaciclovir is safe and effective for EBV suppression in COPD and may attenuate the sputum inflammatory cell infiltrate. The findings from the current study provide support for a larger trial to evaluate long-term clinical outcomes. TRIAL REGISTRY:ClinicalTrials.gov; No.: NCT03699904; URL: www. CLINICALTRIALS:gov.

Investigating diet-related disease in India’s ageing population is challenging due to poor dietary assessment infrastructure and limited capacity for nutritional analyses. We developed a semi-quantitative Food Frequency Questionnaire (FFQ) to capture dietary intake among older Indian adults. Nutrient analysis of FFQ data requires linkage to a nutrient database preferably based on local food composition. However, the Indian Food Composition Tables (IFCT) provided only partial coverage for FFQ items, nutrient data for cooked foods were unavailable, and some important nutrients were missing, e.g., iodine and vitamin B12. The objective was to develop a nutrient database maximising the IFCT to allow for the analysis of FFQ data. The development of the nutrient database involved: (1) the creation of a core dataset within the Nutritics (2019) software platform comprising analytical data for matched foods in the IFCT reference database; (2) the selection of suitable matches for additional foods/beverages consumed in the FFQ informed by local dietetic expertise; (3) the import of nutrient profiles for additional foods/beverages from international food composition tables (UK, USA, and Singapore) to provide full coverage for all FFQ items; (4) the filling of nutrient data gaps in the core IFCT dataset to ensure all foods/beverages have a value for each nutrient; and (5) the generation of a conversion file for food frequencies to daily intakes (in servings and grams) to facilitate FFQ linkage with the nutrient database. The complete nutrient database provides full coverage of FFQ raw and cooked food/beverages and has the capability to analyse 53 nutrients. Overall, 53% of the FFQ items were matched to the IFCT, whilst 28% were matched from the UK (GB21-0), 15% from the USA (FNDDS), and 4% from the Singapore food tables. All FFQ items matched to the IFCT had missing nutrients mapped from matches in other databases, with GB21-0 being the first preference. For cooked FFQ items matched to the IFCT (n = 21), an appropriate cooking method was applied using established nutrient retention factors. The bespoke nutrient database developed through the integration of nutritional expertise and dietary assessment software will allow for the nutrient analysis of FFQ data. The next step is to automate the nutrient analysis process from computer-assisted FFQ data collection in Wave 2 of LASI-DAD.

Introduction Lower tidal volume ventilation, facilitated by veno-venous extracorporeal carbon dioxide removal (vv-ECCO 2 R), does not improve 90-day mortality in patients with acute hypoxaemic respiratory failure (AHRF). The aim of this analysis was to evaluate the effect of this therapeutic strategy on long-term outcomes. Methods This was a prespecified analysis of the REST trial, a UK-wide multicentre randomised clinical trial that compared lower tidal volume ventilation, facilitated by vv-ECCO 2 R (intervention), with standard care in the treatment of patients with moderate-to-severe AHRF. Mortality to 2 years was assessed, while respiratory function, post-traumatic stress disorder, cognitive function and health-related quality of life were evaluated in survivors at 1 year using standardised questionnaires. Results Of 412 patients enrolled into the REST trial, 391 (95%) had 2-year mortality outcome data available. There was no difference in the time to death between intervention and standard care (HR 1.08 (0.81, 1.44); log-rank test p=0.61). 161 patients alive at 1 year provided at least one questionnaire response. There was no difference in respiratory function, post-traumatic stress disorder, cognitive dysfunction or health-related quality of life between patients allocated to intervention or standard care. Conclusion Lower-tidal volume ventilation facilitated by vv-ECCO 2 R does not affect 1-year mortality in patients with moderate-to-severe AHRF. Of the patients who provided questionnaire responses, there was no treatment effect on long-term respiratory function, post-traumatic stress disorder, cognitive dysfunction or health-related quality of life. Trial registration number ClinicalTrials.gov identifier: NCT02654327 .

Background The need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by WHO. We aimed to test an intervention which used a gender-transformative approach to engage adolescents in RSE to prevent unprotected sex. Methods This cluster-randomised trial with process and economic evaluations tested a school-based intervention entitled If I Were Jack versus standard RSE (control) for students (aged 14-15 years) in UK schools. Schools were randomly allocated (1:1) and masked to allocation at baseline. The primary outcome was self-reported avoidance of unprotected sex (sexual abstinence or use of reliable contraception at last sex) after 12-14-months. We analysed the data using intention-to-treat mixed effects regression models. Findings Of 803 schools assessed for eligibility, 263 schools were invited by letter, of which 66 schools agreed to be randomly assigned, of which 62 schools completed follow-up. The trial was done between Feb 1, 2018, and March 6, 2020. 8216 students participated at baseline in 2018; 6561 (79.85%) provided 12-14 months follow-up. There was no significant difference in the primary outcome of avoidance of unprotected sex: 2648 (86.62) of 3057 in the intervention group avoided unprotected sex versus 2768 (86.41%) of 3203 in the control group (adjusted odds ratio [aOR] 0.85 [95% CI 0.58-1.26], p=0.42). Exploratory post-hoc analysis of the two components of the primary outcome showed that significantly more intervention students used reliable contraception at last sex compared with control students and there was no significant difference between the groups for sexual abstinence. No adverse events were reported. Interpretation The intervention had a null effect on the primary outcome of preventing unprotected sex (increasing sexual abstinence or use of reliable contraception) in the whole student population. However, the results showed significant increases in use of reliable contraceptives for sexually active students. Engaging all young people early through RSE is important so that as they become sexually active, rates of unprotected sex are reduced. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.

Background The PolyPrime intervention is a theory-based intervention aimed at improving appropriate polypharmacy in older people (aged ≥65 years) in primary care. The intervention consists of an online video which demonstrates how general practitioners (GPs) can prescribe appropriate polypharmacy during a consultation with an older patient and a patient recall process, whereby patients are invited to scheduled medication review consultations with GPs. The aim of the process evaluation is to further examine the implementation of the PolyPrime intervention in primary care. This will involve investigating whether the PolyPrime intervention can be delivered as intended across two healthcare systems, how acceptable the intervention is to GPs, practice staff and patients, and to identify the intervention’s likely mechanisms of action. Methods The PolyPrime study is an external pilot cluster randomised controlled trial (cRCT) which aims to recruit 12 GP practices across Northern Ireland [NI] (n=6) and the six counties in the Republic of Ireland (ROI) that border NI ( n =6). Practices have been randomised to intervention or usual care. An embedded process evaluation will assess intervention fidelity (i.e. was the intervention delivered as intended), acceptability of the intervention to GPs, practice staff and patients and potential mechanisms of action (i.e. what components of the intervention were perceived to be effective). Quantitative data will be collected from data collection forms completed by GPs and practice staff and a feedback questionnaire completed by patients from intervention arm practices, which will be analysed using descriptive statistics. Qualitative data will be collected through semi-structured interviews with GPs and practice staff and audio-recordings of medication review appointments from the intervention arm practices which will be transcribed and analysed using the framework method. Quantitative and qualitative data will be triangulated to provide an overall assessment of intervention fidelity, intervention acceptability, and mechanisms of action. Discussion This process evaluation will add to feasibility data from the pilot cRCT by providing evidence on the fidelity of implementing the intervention package across two healthcare systems, the acceptability of the intervention and potential mechanisms of action. Trial registration ClinicalTrials.gov ISRCTN41009897 . Registered on 19 November 2019. ClinicalTrials.gov NCT04181879 . Registered 02 December 2019.

Objectives: To explore whether nutritional salivary biomarkers could be used to aid nutritional status assessment and/or support traditional dietary assessment methods for patients. Data and Sources: Searches were performed using four electronic databases; MEDLINE, EMBASE, Scopus and Web of Science. Trial registers (i.e. Cochrane), grey literature and reference lists were searched. Study Selection: Studies which measured nutritional salivary biomarkers related to nutritional status and/or dietary intake outcome were included. No restrictions on participants' age, study design, publication date, setting or health status. Animal studies, non-English language studies, commentaries, and conference abstracts were excluded. Results: Study titles and abstracts were screened (n = 7982), full-texts assessed (n = 176) and 85 studies were included in a narrative synthesis. The most promising salivary biomarkers for nutritional status included: glucose, where saliva and serum levels were positively correlated in those with type 2 diabetes (T2D), higher salivary calcium levels in post-menopausal women in general and specifically those with lower bone mineral density (BMD), and salivary vitamin D to assess vitamin D status in healthy volunteers. Higher salivary total antioxidant capacity (TAC), nitrate/nitrite and fluoride were observed with increased antioxidant, nitrate/nitrite and fluoride dietary intake, respectively. A meta-analysis found significantly higher mean salivary glucose (n = 12) in T2D compared with healthy controls, but there was substantial heterogeneity (I2=94%) and evidence of publication bias. Conclusions: The most promising salivary biomarkers identified in this systematic review were, glucose, vitamin D, calcium, TAC, nitrate/nitrite and fluoride. However, this was based on a small number of studies of varying quality, with many lacking a salivary assay performance assessment. Clinical Significance: At present, nutritional salivary biomarkers cannot be used alone to assess nutritional status or dietary intake. Further research into the most promising nutritional salivary biomarkers is required.

AbstractIntroduction:Full nutritional assessments are currently complex and invasive. There is a need for a non-invasive, timely and cost-effective method to assess nutritional status. Evidence indicates the usefulness of saliva in diagnosing oral or systemic disorders. Saliva is suggested to be a reliable and non-invasive matrix in which to measure nutritional biomarkers. The aim of this work was to systematically review the evidence for salivary biomarkers as indicators of nutritional status.Materials and Methods:Studies identifying salivary biomarkers in relation to nutritional status or dietary intake outcomes were included. A search strategy combined terms “saliva” AND “biomarkers” AND “nutrition”. Four databases were searched, MEDLINE, EMBASE, Web of Science and Scopus. All study designs conducted in humans of all ages, from all countries and settings were included. Non-English and animal studies were excluded. Risk of bias was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool where applicable. (PROSPERO Registration Number:CRD42018107667)Results:6585 papers were identified, 4836 papers remained after removing duplicates, 4715 were irrelevant, 134 full-texts were assessed for eligibility and 64 papers included in the final analysis. A number of potential salivary biomarkers related to nutritional status were identified including: total protein, albumin, prealbumin, transferrin, ferritin and iron. Total protein levels in saliva in malnourished individuals were significantly different to controls in 7/10 studies (70%). In one study conducted in individuals with iron deficiency anaemia (IDA), total protein was significantly different to controls. Albumin levels in malnourished individuals were significantly different to controls in 5/8 studies (62.5%). Prealbumin and transferrin levels in malnourished individuals were significantly different to controls in 3/3 studies (100%). In one study conducted in malnourished individuals, salivary ferritin levels was significantly different to controls. Ferritin levels in individuals with IDA were significantly different to controls in 3/3 studies (100%). Iron levels in individuals with IDA were significantly different in 2/2 studies (100%). However, even within the studies above where significant differences existed, the direction of salivary biomarker differences was sometimes inconsistent. For example, total protein in malnourished individuals was significantly lower than controls in three studies, higher in three studies and one showed mixed findings. In addition, overall the quality of evidence available was very poor.Discussion:Despite conflicting evidence in salivary nutritional biomarkers in individuals with malnutrition or IDA, saliva may be a useful non-invasive matrix to assess nutritional status. Further high quality research exploring the utility of these biomarkers is required.

Objectives: This study investigated whether oral health status, defined as number of natural teeth and subsequent prosthodontic rehabilitation, was associated with future dietary intake and diet quality in older adults in The Prospective Epidemiological Study of Myocardial Infarction (PRIME). Methods: PRIME was originally established to explore cardiovascular risk factors in 50-59 year old men in Northern Ireland (1991-1994). A rescreening phase assessed oral health (2001-2004), while diet was assessed in 2015. Diet quality was characterised by the Dietary Diversity Score and Mediterranean Diet Score. In the current analysis, associations between oral health status, dietary intake and quality were assessed using regression models in 1096 participants. Results: Amongst study participants, the overall mean number of teeth was 18.5, 51.5 % had >= 21 natural teeth and 49.6 % wore dentures. Oral health status was categorised into five groups: 21-28 teeth with (n=111) and without (n=453) dentures, 1-20 teeth with (n=354) and without (n=99) dentures and edentate with dentures (n=79). After full adjustment, men with >= 21 teeth and dentures had a higher future intake of fruit, vegetables, and nuts, and diet quality scores, compared to those with < 21 teeth with dentures. Edentate men with dentures were less likely to achieve the future fruit dietary recommendation. Conclusions: Having >= 21 natural remaining teeth positively affected the future intake of fruit, vegetables, and nuts, as well as diet quality. Dentures may be beneficial in men with >= 21 natural remaining teeth, as they were associated with an increased future intake of fruit, vegetables, and nuts and better diet quality. Clinical significance: Oral health status is associated with dietary intake, after an average time period of 13 years, with those with a larger number of natural teeth having a better diet quality. Further research is required to investigate this relationship in larger, diverse populations with more detailed dietary assessment.

SESSION TITLE: Medical Student/Resident Lung Cancer Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Miliary pattern is a term used to describe randomly distributed nodules seen on both chest x-ray and CT. Traditionally we have associated this distribution with tuberculosis, especially in patients with appropriate risk factors. Non-tuberculous etiologies should also be included in the consideration of a miliary pattern imaging. Other various infections include Cryptococcosis, Histoplasmosis, Blastomycosis. Malignancies are also worth bearing in mind; the usual culprits are hematogenously spread such as melanoma and renal cell carcinoma (2). However, we must also consider primary lung adenocarcinoma that have a specific mutation within the epidermal growth factor receptor (EGFR) gene that has been associated with a metastatic miliary pattern behavior. CASE PRESENTATION: 64-year-old Mexican female, lifetime non-smoker presented to the emergency room with 3-4 months of progressively worsening shortness of breath. CT chest showed innumerable bilateral pulmonary nodules in a miliary distribution with moderate right sided pleural effusion. She was placed on respiratory isolation due to the need to evaluate for tuberculosis. She required minimal oxygen support at 2 liters/minute via nasal cannula. She underwent bronchoscopy with broncho-alveolar lavage that was negative for acid fast staining and had a negative QuantiFERON test. Transbronchial biopsy was positive for adenocarcinoma. Subsequently, the patient was found to have exon 19 mutation on next generation genomic sequencing. She was placed on a third generation epidermal growth factor receptor tyrosine kinase inhibitor. After 3 months of therapy patient was noted to have decreased opioid need and improved imaging scans. DISCUSSION: A miliary pattern of primary lung cancer is considered a rare finding. Previously, a miliary pattern of malignancy would be considered a metastasis of unknown primary and further oncologic work up would be warranted. However, a few case reports have supported the association between miliary pattern behavior of primary adenocarcinoma of the lung in non-smokers and EGFR mutation. A case series by Laack et al described five patients with miliary pattern imaging who underwent gene sequencing analysis which showed deletion in exon 19 of EGFR gene. It is unclear what causes this association; however, theories include the genetic deletion perhaps codes for a particular phenotype that allows for homing of the tumor cell in the lung leading to the unique miliary pattern not seen otherwise (1). Patients who are treated with tyrosine kinase inhibitors can have dramatic response with reduction of tumor burden on serial imaging as in this case depicted above. CONCLUSIONS: As clinicians, it is important to approach miliary pattern on imaging with a broad differential. We now need to consider primary lung disease with specific genetic mutations early as an additional etiology given the potential for favorable therapeutic response. Reference #1: 1.Laack E, Ronald S. Miliary Never-smoking Adenocarcinoma of the Lung: Strong Association with Epidermal Growth Factor Receptor Exon 19 Deletion. Journal of Thoracic Oncology 2011. Volume 6, Issue 1. 199-202. Reference #2: 2.Dawlat K. Adenocarcinoma of the Lung Mimicking Miliary Tuberculosis. Case Reports in Oncology.2020;13:139-144 Reference #3: 3.A.K. Pannu, K.P.K Aditya. CT thorax miliary pattern-our differential. An International Journal of Medicine. 2018; 819-820 DISCLOSURES: No relevant relationships by Maged Doss, source=Web Response No relevant relationships by Amyn Hirani, source=Web Response No relevant relationships by Danielle Logan, source=Web Response

SESSION TITLE: Medical Students/Residents' COVID-19 SESSION TYPE: Med Student/Res Case Report PRESENTED ON: October 18-21, 2020 INTRODUCTION: The novel Coronavirus-2019 pandemic brings a largely unfamiliar landscape and continual quest for understanding of the spectrum of presentation for this disease. Recent studies have shown endothelial injury as the trigger for the cytokine storm seen in Covid-19 infection. Hypercoagulability and excessive complement activation can lead to a diffuse thrombotic angiopathy and organ dysfunction CASE PRESENTATION: 40 year old Hispanic male with no past medical history presented to the emergency room with weakness, AMS, recurrent hematemesis. Upon arrival, he was immediately intubated for airway protection. On exam pertinent findings included fever of 102°F, response to noxious stimuli only, and scleral icterus. Laboratory data revealed creatinine 8.08 mg/dL, LDH >2500 IU/L, haptoglobin <10 mg/dL, bilirubin 1.2 mg/dL, hemoglobin 6.8 g/dL, platelets 7,000/L with presence of 3+ schistocytes and positive test for COVID-19. PCR was negative for STEC and shigella. Given a PLASMIC score of 7, a presumptive diagnosis of thrombotic thrombocytopenic purpura (TTP) was made and daily plasma exchange (PEX) with dialysis was urgently initiated. A normal ADAMTS13 level led to discontinuation of PEX after 3 sessions; however, after 4 days hemolysis worsened with low C3 complement, therefore PEX was restarted. A complement panel was suggestive of alternative pathway dysregulation. Patient underwent 15 additional sessions of PEX with resolution of hemolysis, improved renal function and mental status. DISCUSSION: Endothelial injury results in exposure of collagen, vWF, fibrinogen. This serves as a trigger for the hypercoagulability and TMA. TMA encompasses a group of disorders characterized by MAHA, thrombocytopenia with varying degrees of end organ damage. One subtype is TTP usually relating to endothelial dysfunction with formation of microthrombi from large platelet-vWF subunits. Another entity is hemolytic uremic syndrome, which is characterized by excessive complement activation often caused by shigella-toxin. Neither of which were seen in this patient. We suspect this patient’s presentation to be a manifestation of complement mediated TMA (CM-TMA) due to COVID. Previous review articles propose the possibility of viral infections including H1N1 causing dysregulation of complement cascade leading to TMA. Autoantibodies can form to complements that regulate complement cascade such as Factor H or Membrane Cofactor Protein. This can lead to dysregulation leading to C3 consumption, endothelial damage and formation of platelet microthrombi. His improvement with PEX poses a probable mechanism of removing cytokines, activated complements and antibodies. CONCLUSIONS: Complement mediated thrombotic microangiopathy could be the final pathway in critical illness. Our case shows that PEX may provide therapeutic benefit by normalization of the complement pathway while awaiting clearance of COVID viremia. Reference #1: Lopes R. Viral-associated thrombotic microangiopathies. Hematol Oncol Stem Cell Ther. 2011;4:51-9. Reference #2: Bitzan M, Zieg J. Influenza-associated thrombotic microangiopathies. Pediatr Nephrol. 2018;33:2009-25. Reference #3: Magro C, Mulvey J, Berlin D, et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases. Transl Res. 2020;S1931 5244(20)30070-0. DISCLOSURES: No relevant relationships by Usha Anand, source=Web Response No relevant relationships by John French, source=Web Response No relevant relationships by Mehrin Jawaid, source=Web Response No relevant relationships by Danielle Logan, source=Web Response No relevant relationships by Vijay Nath, source=Web Response

Evidence linking oral health status with dietary intake and quality in older adults is inconsistent and limited by few prospective studies conducted to date. This study investigated whether oral health status, defined as number of natural teeth and prosthodontic rehabilitation, had an impact on future dietary intake and dietary quality in older Northern Irish (NI) men. This study involved older men [n = 1096, mean = 63.5(2.9) years] from the Prospective Epidemiological Study of Myocardial Infarction (PRIME). A dental examination was undertaken at baseline (2001–2006) and oral health status was defined as: 21–28 teeth without dentures (n = 453), 21–28 teeth with dentures (n = 111), 1–20 teeth without dentures (n = 99), 1–20 teeth with dentures (n = 354), and edentate with dentures (n = 79). A food frequency questionnaire administered in 2015 derived intakes of major food groups and diet quality scores were characterised by the Dietary Diversity Score (DDS) and Mediterranean Diet Score (MDS). Associations between oral health status, food intake and diet quality scores were assessed using regression models adjusted for potential confounders including, age, socio-economic status, smoking and alcohol. In fully adjusted models, the mean dietary intake of fruit, vegetables and nuts significantly differed between oral health status groups. In comparison to edentate men with dentures, the mean fruit intake was significantly higher in each dentate group: 21–28 teeth without dentures (P = 0.001), 21–28 teeth with dentures (P = 0.001), 1–20 teeth without dentures (P = 0.04), and 1–20 teeth with dentures (P = 0.03). The mean DDS was significantly higher amongst men with 21–28 teeth without dentures, compared to those with 1–20 teeth without dentures (P = 0.001), 1–20 teeth with dentures (P < 0.001), and edentate with dentures (P < 0.001), and mean MDS results were similar. Compared to men with 21–28 teeth without dentures, edentate men with dentures were 64% less likely to achieve the dietary guideline of 2 portions/day (P = 0.01). A greater number of natural teeth was associated with a higher future intake of fruit, vegetables and nuts, as well as higher dietary quality scores, in older NI men. Interventions should optimise retaining natural teeth to help improve dietary intake and quality in older adults. Department of Economy funded PhD.

Prenatal and postnatal determinants in shaping offspring

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