ObjectivesEffective oral therapies for hepatitis B and C have recently been developed, while there are no approved pharmacological therapies for alcoholic and non-alcoholic fatty liver diseases (ALD and NAFLD). We hypothesise that fewer advances in fatty liver diseases could be related to disparities in research attention.MethodsWe developed the Attention-to-Burden Index (ABI) that compares the research activities during 2010–2014, and an estimate of disease burden of these 4 major liver diseases. The resulting ratio reflects either overattention (positive value) or inadequate attention (negative value) compared with disease burden. The mean research attention and disease burden were calculated from 5 and 6 different parameters, respectively. The efficacy rate of current pharmacological therapies was assessed from published clinical trials.FindingsThe mean research attention for hepatitis B and C was 31% and 47%, respectively, while NAFLD and ALD received 17% and 5%. The overall burden was 5% and 28% for hepatitis B and C, and 17% and 50% for NAFLD and ALD. The calculated ABI for hepatitis B and C revealed a +6.7-fold and +1.7-fold overattention, respectively. NAFLD received an appropriate attention compared with its burden, while ALD received marked inadequate attention of −9.7-fold. The efficacy rate of current pharmacological agents was 72% for hepatitis B, 89% for hepatitis C, 25% for non-alcoholic steatohepatitis and 13% for alcoholic hepatitis. Importantly, we found a positive correlation between the mean attention and the efficacy rate of current therapies in these 4 major liver diseases.InterpretationThere are important disparities between research attention and disease burden among the major liver diseases. While viral hepatitis has received considerable attention, there is a marked inadequate attention to ALD. There is a critical need to increase awareness of ALD in the liver research community.

Objectives The current exploratory cross‐sectional study was designed to examine and characterize survivorship issues among patients treated with radiation for head and neck cancer with regard to dental health, shoulder‐neck dysfunction, and overall quality of life (QOL). Methods Patients (N = 58) being seen for follow‐up at a radiation oncology clinic at least 1 year beyond the end of treatment completed three survey questionnaires regarding general QOL as well as dental health issues and shoulder‐neck dysfunction. The questionnaires were scored and univariate analyses were performed using the variables of age, radiation dosage, definitive radiation + neck dissection versus definitive surgery + postoperative radiation, and chemotherapy. Results Median follow‐up was 2.5 years. Of 58 patients, 35% reported having more problems with their general dental health as compared to before treatment and 38% reported having pain at night in the neck/shoulder after treatment. With regard to pretreatment counseling, 79% of patients reported being counseled about their dental health prior to treatment, while 31% reported being counseled about possible shoulder‐neck dysfunction. Patients younger than 65, patients receiving higher doses of radiation, and patients undergoing definitive surgery + postoperative radiation reported more functional and symptomatic issues. Conclusion Patients treated with radiation for head and neck cancer face a number of survivorship issues, including problems with dental health and shoulder‐neck dysfunction, and are not necessarily thoroughly counseled about these issues prior to treatment. Patients younger than 65, patients receiving higher doses of radiation, and patients undergoing definitive surgery + postoperative radiation may experience more survivorship issues. Level of Evidence IV

Background: Millennial digital learners value meaningful work, immediate feedback, collaborative communication and technology implementation. A student-produced digital imaging teaching case file-centric flipped curriculum offers these benefits. Our questions included: (i) is a cloud-based website platform supporting the online publication of student-selected and studentsubmitted teaching cases feasible; and (ii) what were the impressions of students of this educational intervention?Methods: An open-source medical student-centric radiology website was created with limited-access cloud upload capability, with site analytics continuously recorded.

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e23064 Background: The current exploratory cross-sectional study was designed to better characterize survivorship issues among patients treated with radiation for head and neck cancer with regard to dental health, shoulder-neck dysfunction, and overall quality of life. Methods: Patients (n = 58) being seen for follow-up at a radiation oncology clinic at least one year beyond the end of treatment completed three survey questionnaires: the EORTC Core Quality of Life Questionnaire (EORTC QLQ-C30), the EORTC Head and Neck module (EORTC QLQ-H&N35), and an original 18-item Dental Health and Shoulder Function questionnaire. The questionnaires were scored and univariate analyses were performed using the variables of age, radiation dosage, definitive radiation + neck dissection vs. definitive surgery + postoperative radiation, and chemotherapy. Results: Median follow-up was 2.5 years. Of patients surveyed, 35% reported having more problems with their general dental health as compared to before treatment and 38% reported having pain at night in the neck and shoulder; 79% of patients reported being counseled about their dental health prior to treatment while 31% reported being counseled about possible shoulder-neck dysfunction. Patients younger than 65, patients receiving higher doses of radiation, and patients undergoing definitive surgery + postoperative radiation reported a higher burden of functional and symptomatic issues. Conclusions: Patients treated with radiation for head and neck cancer face a number of survivorship issues, including problems with dental health and shoulder-neck dysfunction, and many do not feel that they are adequately counseled about these issues prior to treatment. Subsets of patients who may experience a higher burden of functional and symptomatic issues include patients younger than 65, patients receiving higher doses of radiation, and patients undergoing definitive surgery + postoperative radiation. Increasing pre-treatment counseling for all patients and placing a particular emphasis on supportive care for these subsets of patients may allow us to better support this growing population of cancer survivors.

Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening syndrome of excessive activation of immune system. It frequently affects infants from birth to 18 months of age, but is also observed in children and adults of all ages. HLH can occur as a familial or sporadic disorder, and it is triggered by a variety of events, Infection being the most common trigger both in familial and in sporadic cases. Prompt treatment is very critical in cases of HLH, but the greatest barrier is often delay in diagnosis due to the rarity of this syndrome, variable clinical presentation, and lack of specificity of the clinical and laboratory findings. The key clinical features of HLH are high persistent fever, hepatosplenomegaly, blood cytopenia, elevated aminotransferase and ferritin levels, and coagulopathy. A diagnosis of HLH is mostly under-recognized, and is associated with high mortality, especially in adults; thus, prompt diagnosis and treatment are essential. We here present a rare case of HLH in an adult which was non-familial and infection being the trigger causing secondary hemophagocytic lymphohistiocytosis.

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Background: For individuals with epilepsy, adherence to medication is crucial in preventing or minimizing seizures and their cumulative impact on everyday life. Compliance studies in adult patients are many, but few in children with epilepsy. Objective: This study tries to find the prevalence of noncompliance in children with epilepsy and causes leading to it. Method: The study was conducted in a tertiary care super specialty children hospital of New Delhi. Children, age 1-12 years, who were already diagnosed cases of epilepsy and were all on drug therapy for at least 3 months were included in the study. After obtaining clearance from the hospital’s Ethical Committee, a total of 100 parents of epileptic children were interviewed as per the prepared questionnaire. Results: Out of 100 children (63 males, 37 females) with epilepsy, 71% were compliant. Most of the noncompliant parents (82.7%) felt that there is the harmful effect of long-term anti-epileptic drugs. They believed in stopping medications on their own once signs and symptoms disappear and did not like to give medication to their child in public place. No significant association of noncompliance could be seen with etiology of epilepsy, monotherapy versus polytherapy, and duration of disease, mother’s age and parental education (p>0.05). Conclusion: Compliance in this study group of children with epilepsy was 71%. Further improvement of health and well-being of children with epilepsy can be attempted by education of parents, distribution of written instructions in the form of pamphlets, counseling, group discussions, and exchange of personal experience. Public awareness drive should help in reducing the associated taboos.