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Background Strongiloides stercolaris can produce a life threatening illness in inmunosuppressed hosts. Treatment options are limited to oral formulations and there are few data on alternative therapies.PurposeTo describe the preparation of ivermectin enema and evaluate its effectiveness in the treatment of Strongyloides hyperinfection.Material and methodsBibliographic search in Medline (keywords: ivermectin, rectal, Strongyloides) to determine the main characteristics of ivermectin enema: concentration, composition, elaboration method, packaging material, stability and storage conditions. Review of the electronic medical records and follow-up of the patient during hospitalisation.ResultsA 57-year-old man of Brazilian origin, presnted to the emergency department with nauseas, vomiting and dizziness. Imaging tests show lesions in his brain, and consequently he underwent neurosurgery. After a month the patient has haemodynamic instability and was transferred to intensive care where he was diagnosed with Strongyloides hyperinfection by wet prep of bronchial suction on 18 August 2014. Treatment was initiated with ivermectin 200 µg/kg/24 h by nasogastric tube. On 19 August, Strongyloides was isolated in faecal cultures and ivermectin enema 200 µg/kg/24 h was added to the treatment on 22 August. Since the beginning of the treatment, several microbiological controls have been done: on 25 August Strongyloides larvas were observed in bronchial suction and on 27 August in faecal cultures but with no movement capacity in both samples. On 3 and 5 September, bronchial suction and faecal cultures were done and the results were negative. Treatment by nasogastric tube and rectal ivermectin finished on 5 September.Elaboration of ivermectin enema was required by the pharmacy service because it does not exist as a commercial presentation appropriate for rectal administration. A standardised protocol was made.Elaboration process: crush ivermectin 12 mg in a mortar until it is a fine powder. Wet the powder with a small quantity of carboxymethylcellulose 1.5% until a homogeneous mixture is achieved. Add small porportions of carboxymethylcellulose up to 30 ml. Concerning stability, the enema has to be used immediately.ConclusionA protocol for the elaboration of Ivermectin enema was stablished. Treatment with rectal ivermectin added to ivermectin oral administration is an effective therapeutic option for the treatment of Strongyloides hyperinfection.References and/or AcknowledgementsTarr PE, Miele PS, Peregoid KS, et al. Case report: Rectal administration of ivermectin. Am J Trop Med Hyg 2003;68:453-5No conflict of interest.

Introduction/BackgroundMisclassification of a triploid partial mole leaves women uncertain about the risk of Gestational Trophoblastic Neoplasia (GTN). Accurate diagnosis by histology alone is challenging, while cytogenetic analyses offers confirmation of triploidy. Our study examined GTN incidence in histopathologically diagnosed partial moles and cytogenetically confirmed triploid cases. Moreover, we investigated whether termination approach, i.e. medical versus suction curettage, affects this risk.MethodologyUp to December 2023, we searched MEDLINE and Embase for studies on partial moles and GTN. Inclusion required histopathological diagnosis and, if performed, diagnosis of triploidy by cytogenetic analysis. Studies lacking clear GTN criteria were excluded. Using bivariate random-effects models, we calculated GTN proportions for both histopathologically confirmed partial moles and cytogenetically confirmed triploid partial moles, presenting pooled incidence with 95% CIs. Additionally, we conducted a sub-analysis on termination approach and assessed statistical heterogeneity using I2 statistics.ResultsOf 1289 potential studies, 28 studies were included, comprising 8688 women with histopathologically confirmed partial moles and 1952 cytogenetically confirmed triploid ones. The pooled incidence of GTN in the first was 1.59% (95% CI 1.05–2.13) and 0.51% (95% CI 0.01–1.01) in the latter. In 566 women with partial moles (7 studies) suction curettage (SC) was performed in 79.5% (n=450), dilatation and curettage (D&C) in 19.4% (n=110) and prostaglandin in 1.1% (n=6). The pooled incidence of GTN in partial moles was 4.42% (95% CI 2.49–6.34) 0.75% (95% CI 0.00–2.91) and 0% (95%CI 0.00–20.75%) after SC, D&C and prostaglandin, respectively. GTN did not occur in 61 cytogenetically confirmed triploid partial moles.ConclusionPregnant women with a triploid partial mole have a low GTN risk (0.51%), and information about medical termination is limited. Whether medical termination is safe and raises GTN risk compared to suction curettage needs further study. This research will aid in counseling women on termination approaches, helping them weigh the pros and cons.DisclosuresNothing to declare.Abstract 613 Figure 1