Chilaiditi syndrome: The false pneumoperitoneum not to be ignored

The Chilaiditi syndrome is a set of clinical and radiological signs characterized by the interposition of the colon or the small intestine between the lower face of the diaphragm and the liver. It is a rare entity often fortuitously discovered. We report the case of two patients admitted to the emergency room, the first 74 years old for exploration of acute epigastric pain with dyspnea in a covid positive context while the second 66 years old for an occlusive syndrome with a history of chronic constipation. The scannographic exploration finds colonic anses in the interhepatodiaphragmatic space making evoke a Chilaiditi syndrome Chilaiditi syndrome represents the classic trap of false right pneumoperitoneum as it can mask a true pneumoperitoneum. The treatment is often conservative and surgery is reserved in case of complications.

Adenovirus-based but not mRNA-based vaccines transiently alter platelet count homeostasis in healthy subjects

Background: Nuclei acid-based COVID-19 vaccines have proved highly effective in reducing the risk of hospitalisation and death. As they were distributed for the first time on a large-scale population, the adenovirus-based vaccines were linked to a very rare thrombosis with thrombocytopenia syndrome and the interplay between vaccination and platelet activation gained increasing attention. Aim(s): To compare the effect of mRNA-based and adenovirus-based vaccines on platelets of young healthy adults. Method(s): We prospectively enrolled 15 healthy volunteers (53% females) who received two doses of the mRNA-based vaccine BNT162b2, 21 days apart, and 25 healthy volunteers (64% females) that received one dose of the adenovirus-based vaccine, AZD1222, followed by one dose of BNT162b2 and we studied their platelet response before and after each dose of the vaccine (3 and 10 days post-injection). Result(s): Subjects receiving the AZD1222 vaccine experienced a transient but significant 20% decrease of the platelet count 3 days after the first injection, which was not detected after the first dose of BNT162b2. The BNT162b2, but not the AZD1222, vaccine was followed by increased plasmatic thrombopoietin concentration and mean platelet volume, indicative of higher platelet turnover. Three days after the AZD1222 injection, basal platelet integrin activation was elevated, but P-selectin exposure was unchanged. Conversely, the BNT162b2 vaccine induced a gradual increase in platelet P-selectin exposure and platelet-leukocyte aggregate formation, which correlated with the ability of the vaccines to evoke neutralizing antibodies against the Sars-COV- 2 spike protein. Moreover, three days after the AZD1222 injection we detected a transient 10-fold increase of the plasmatic concentration of IFN-gamma, while BNT vaccination induced a progressive increase of IL-1beta. Conclusion(s): Based on these observations we propose that the adenovirus-based vaccines, not the mRNA-based vaccines, transiently impair platelet count homeostasis. Future studies will investigate how these distinct vaccine vectors and inflammatory profiles affect platelet consumption and platelet production.

Augmented Reality Technology in Neuromodulation Surgery: E-Poster Viewing

Introduction: The advancement of wearable integrated augmented reality (AR) devices has rapidly progressed over recent years. We describe the first use of AR goggles during a revision neuromodulation surgery, which enabled specialist consultant support from remote despite ongoing coronavirus pandemic restrictions. Materials / Methods: This case report describes a revision surgery case in a previously successfully implanted spinal cord stimulator (SCS) patient. The attempt, to revise the existing percutaneous SCS leads failed due to the patient's challenging anatomy, which left the patient without therapy. A further revision via hemi-laminectomy and insertion of a surgical paddle lead was being organised with specialist support due to expected further anatomical challenges. Due to ongoing coronavirus restrictions both in travelling as well as reduced staffing numbers in the operating theatre in particular for visiting staff, the decision was made to use AR goggles to enable an experienced specialist to attend virtually. Result(s): The use of AR googles enabled a specialist colleague to virtually attend the live surgery despite a 200 mile distance. This included being able to see the surgical field on their computer screen as well as all live radiographic imaging displayed on the operating theatre monitors, having live sound, stopping any live images of the surgery to annotate with drawings and writing, speak to the resident surgeon in real time and discuss as if being physically present. Annotated images could be sent back to the lens of the operating surgeon for review as well as live commentary via integrated microphone and speaker in the surgeons AR goggles. The technology enabled remote specialist support and valuable expert input resulting in successful insertion of paddle leads in an anatomically very challenging patient. The patient reported 90% pain reduction after programming of his new paddle leads. Discussion(s): AR technology opens up new exciting avenues in supporting neuromodulation surgeries remotely with expert advice for difficult operations without being locally present. This saves unnecessary travel, reduces the carbon footprint, downtime of the expert in their local institution resulting fewer potential local case cancellations, reduces the risk of spread of infections such as SARS-CoV-2, as well as gives the ability to teach in remote locations. Furthermore, this opens further opportunities for mentoring of novice implanters. Conclusion(s): Augmented reality technology is a new and exciting way of further promoting proctorship and mentoring and might be particularly useful in supporting novice implanters and those who need additional specialist input in selected cases. Supplemental Data: [Formula presented] [Formula presented] [Formula presented] Learning Objectives: 1. Advances in augmented reality technology - raise awareness of available technology and its use 2. Ability to delivery intraoperative live teaching remotely - opening new avenues for teaching opportunities and training in neuromodulation 3. Proctorship - assistance of a specialist without being physically present. Keywords: Augmented Reality, SCS, Teaching, Training, Paddle leads, Surgical paddle leads Copyright © 2022

INTRODUCING PROJECT ECHO TO SUPPORT END-OFLIFE CARE EDUCATION IN PRIMARY CARE DURING A PANDEMIC

Project ECHO is an innovative tele-mentoring programme designed to create virtual communities of learners by bringing together health care providers and subject matter experts using videoconference technology, brief lecture presentations, casebased learning, fostering an 'all teach, all learn' approach. In April 2020 a six-month pilot of Project ECHO was commenced to support end-of -life care education in primary care as a response to the COVID-19 pandemic. A scoping exercise was undertaken with the multidisciplinary primary care team across a defined geographical area. Following the scoping exercise a curriculum was devised. Speakers were arranged which included a palliative care medical consultant, a specialist pharmacist and speciality doctor who led the taught aspects of each of the six sessions drawing on their clinical expertise and previous teaching experience. The attendees had the opportunity to submit a case study for discussion during each ECHO session, the case studies were used to evoke discussion, promote shared learning and develop a community of practice. During the pandemic this format also created an opportunity for peer supervision and sharing of clinical knowledge and experience across a wider network of practitioners. Considering the project took place during a pandemic there was 83% attendance from those that had booked onto the sessions. At the end of each session an instant poll was available to be completed by the attendees to evaluate the session. Attendees fed-back how valuable they found the sessions especially the opportunity to discuss case studies, share best practice and debrief during what has been a particularly difficult time for the primary care sector. The online format allowed more people to attend than would normally be achieved in face-to-face training. Due to the project's success further funding was agreed to extend the project beyond the original sixmonth pilot.