Genetic profiling of CAH Egyptian children: rapid guide to clinical interpretation of common mutations

OBJECTIVES

The prevalence of CAH in Egypt is reported to be ten times more than that of the worldwide prevalence. The study aimed at genetic screening of children diagnosed with 21-alpha hydroxylase deficiency congenital adrenal hyperplasia (21OHD-CAH). In addition, the study offers a rapid and easy guide for clinical reporting of common mutations for endocrinologists.

METHODS

A cohort of 174 unrelated Egyptian children with 21OHD-CAH were screened for 11 common CYP21A2 gene mutations using a strip hybridization assay, and then, bioinformatics analysis was done to report the pathogenicity of the common mutations for clinical classification.

RESULTS

The most common mutations were I2 splice and p.Q318X. Deletions/conversions comprised 45.9% of the cohort, whereas 7.4% of the cases were negative for all mutations. The least positively detected point mutations were p.P453S, cluster E6, p.R483P, and p.L307FS, which were detected in fewer than 5% of cases.

CONCLUSION

Strip hybridization assay is a rapid screening tool for the diagnosis of CAH. The authors hypothesized an easy and rapid scheme for clinical interpretation of the strip results to gain the highest value of the strip in diagnosis.

Microbiome of the Middle Meatus in HIV

BACKGROUND

Infection with Human Immunodeficiency Virus (HIV) leads to immune dysfunction with increased risk of developing varied infections including opportunistic infections. It may be that a change in the microbial community of HIV patients could be contributory to their development of rhinosinusitis. However, the normal sinonasal microbiome in HIV is yet to be thoroughly studied.

OBJECTIVE

To determine the bacteria in the middle meatus of HIV infected adults without features of rhinosinusitis.

METHODS

Middle meatal swab specimens were collected under endoscopic guidance from 141 HIV infected patients with no sign and symptoms of rhinosinusitis. Specimen were sent for microscopy and culture. 141 HIV negative individuals were used as controls.

RESULTS

Fourty eight point nine (48.9%) of swab specimen had bacteria isolated in the patients. Thirty-nine (56.5%) specimen yielded aerobes consisting of Staphylococcus epidermidis, Staphylococcocus aureus and Streptococcus; while thirty (43.5%) specimen yielded anaerobes consisting of Bacteroids and Peptostreptococcus. Staphylococcus epidermidis was the most frequently isolated bacteria. In the control group, forty-two (29.8%) of cultures were positive for bacteria. There was statistically significant difference in the bacteria isoltes (P=0.001) CONCLUSION: Bacteria isolated were similar to those isolated from the HIV negative control however there were greater number of isolates in the subjects.

Personalised management of Chronic Obstructive Pulmonary Disease (COPD): Malaysian consensus algorithm for appropriate use of inhaled corticosteroid (ICS) in COPD patients

BACKGROUND

Regarding the long-term safety issues with the use of inhaled corticosteroids (ICS) and the clinical predominance of dual bronchodilators in enhancing treatment outcomes in chronic obstructive pulmonary disease (COPD), ICS is no longer a "preferred therapy" according to the Global Initiative for Chronic Obstructive Lung Disease except on top of a dual bronchodilator. This has necessitated a change in the current therapy for many COPD patients.

OBJECTIVE

To determine a standardised algorithm to reassess and personalise the treatment COPD patients based on the available evidence.

METHODS

A consensus statement was agreed upon by a panel of pulmonologists in from 11 institutes in Malaysia whose members formed this consensus group.

RESULTS

According to the consensus, which was unanimously adopted, all COPD patients who are currently receiving an ICS-based treatment should be reassessed based on the presence of co-existence of asthma or high eosinophil counts and frequency of moderate or severe exacerbations in the previous 12 months. When that the patients meet any of the aforementioned criteria, then the patient can continue taking ICS-based therapy. However, if the patients do not meet the criteria, then the treatment of patients need to be personalised based on whether the patient is currently receiving long-acting beta-agonists (LABA)/ICS or triple therapy.

CONCLUSION

A flowchart of the consensus providing a guidance to Malaysian clinicians was elucidated based on evidences and international guidelines that identifies the right patients who should receive inhaled corticosteroids and enable to switch non ICS based therapies in patients less likely to benefit from such treatments.

320-multidetector cardiac computed tomography in the evaluation of conotruncal anomalies

Background

Multi-detector computed tomography (MDCT) has become an effective tool in the assessment of congenital heart disease in infants and children.

Purpose

To evaluate the role of 320-row MDCT in the assessment of conotruncal anomalies and compare it with echocardiography (echo) considering the operative and/or catheter findings as the gold standard.

Methods

The studied group included 50 patients having conotruncal anomalies. All patients were evaluated with 320-row MDCT angiography. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of MDCT and echo were calculated. The patient effective dose was reported.

Results

The overall sensitivity, specificity, accuracy, PPV and NPV for MDCT angiography in assessment of various abnormalities in patients with conotruncal anomalies were 98.97%, 100%, 99.75%, 100% and 99.67% for MDCT angiography. Sensitivity, specificity, PPV and NPV of MDCT angiography were 97.87%, 100%, 100% and 99.04% and 99.49%, 100%, 100% &99.86% for the detection of intracardiac defects and extracardiac vascular anomalies respectively. The mean absorbed radiation dose was 63.63 mGy-Cm per scan and the mean effective dose was 1.56±0.47 mSv.

Conclusion

320-MDCT angiography offers an excellent diagnostic procedure in the preoperative evaluation of the complex anatomy of the conotruncal anomalies.

Funding Acknowledgement

Type of funding source: None

[Present-day policy of surgical treatment for type A acute aortic dissection]

A surgical intervention for type A acute aortic dissection is the only effective method of treatment making it possible to prevent the development of life-threatening complications and to attain clinical recovery of the patient. Supracoronary replacement of the ascending aorta and the proximal portion of the aortic arch is considered to be the classical and most commonly used method of an open operative intervention. On the one hand, it is technically the simplest and shortest operation, and on the other, this surgical technique is often accompanied by long-term proximal and distal complications, and first of all those caused by a persistent false lumen. The accumulated surgical experience and contemporary operative techniques, as well as advances of intensive therapy in treatment of type A acute aortic dissection make it possible to currently perform more extensive primary resections in order to improve the remote results. Total aortic arch replacement, including the use of the 'frozen elephant trunk' technique leads to fast thrombosis of the false lumen, preventing progression of the disease of the thoracic aorta and promoting its positive remodelling. The article describes the perioperative therapeutic policy accepted and pursued in our medical facility, also presenting the authors' opinion on the role and place of the 'frozen elephant trunk' technique in rendering medical care for patients with type A acute aortic dissection.

A Food and Drug Administration analysis of survival outcomes comparing the Adjuvant Paclitaxel and Trastuzumab trial with an external control from historical clinical trials

BACKGROUND

Although the Adjuvant Paclitaxel and Trastuzumab (APT) trial has been adopted clinically, single-arm trials have limitations, and interest remains whether these patients with small node-negative human epidermal growth factor receptor 2 (HER2)-positive early breast cancer (EBC) would benefit from more intensive chemotherapy. This analysis explored whether external controls can contextualize single-arm studies to add to clinical decision making in the use of de-escalated therapy in patients with low-risk HER2-positive EBC.

PATIENTS AND METHODS

Patient-level data from five randomized trials supporting drug approval in adjuvant HER2-positive EBC were pooled, and patients with low-risk EBC were selected (n = 1770). Patients treated concurrently with trastuzumab and either anthracycline/cyclophosphamide/taxane/trastuzumab (ACTH) or taxane/carboplatin/trastuzumab (TCH; n = 1366) were matched (1:1) to patients treated with paclitaxel and trastuzumab (TH) in the APT trial (n = 406) using propensity scores. Patients treated with anthracycline/cyclophosphamide/taxane (ACT; n = 374) were also matched (1:1) to those treated with TH. Propensity scores were estimated using covariates of age, tumor stage, estrogen receptor status, progesterone receptor status, and histological grade.

RESULTS

After matching, the estimated probabilities of invasive disease-free survival (iDFS) at 3 and 5 years were 98.6% and 96.5% in the TH arm, and 96.6% and 92.9% in the ACTH/TCH arm, respectively. The estimated probabilities of overall survival (OS) at 3 and 5 years were 99.7% and 99.3% in the TH arm, and 99.0% and 97.4% in the ACTH/TCH arm, respectively. Comparing the TH arm with the ACT arm in the matched sample, the estimated difference in iDFS was 7.5% (TH 98.8% and ACT 91.3%) at 3 years and 12.6% (TH 96.1% and ACT 83.5%) at 5 years. The estimated difference in OS was 2.6% (TH 100% and ACT 97.4%) at 3 years, and 5.3% (TH 99.3% and ACT 94.0%) at 5 years.

CONCLUSIONS

Our analyses suggest that patients' outcomes in both arms were in general similar, thus providing additional reassurance regarding de-escalation of therapy.

Closure of the appendiceal stump in laparoscopic appendectomy: A systematic review of the literature

Background

Closure of the appendiceal stump is a key step performed during laparoscopic appendicectomy. Inadequate management of the appendiceal stump has the potential to cause significant morbidity. Several methods of stump closure have been described, however high-level evidence is limited. We performed a systematic review evaluating clinical outcomes and quality of the evidence for the methods of appendiceal stump closure.

Methods

A systematic literature search was performed using Medline, Embase, Cochrane Database and Google Scholar to identify studies comparing appendiceal stump closure methods in laparoscopic appendectomy for acute appendicitis from inception to October 2019. Data regarding operative duration, peri-operative complications, length of stay and costs were collated from all included studies.

Results

From 160 identified studies, 19 met the inclusion criteria. Endoloops and endoclips provide equivalent clinical outcomes at lower cost, while operative duration was shortest with endoclip closure. Endostapler devices have the lowest rate of peri-operative complications (3.56%), however their cost limits their regular use in many healthcare environments. Post-operative complication rate and length of stay were similar for all stump closure methods. Conclusion: Although there are no significant differences in method of stump closure in laparoscopic appendectomy, closure with endoclips provides the shortest operative duration. There is a need for robust and standardized reporting of cost data when comparing stump closure methods, together with higher level evidence in the form of multi-centre randomized controlled trials before firm conclusions can be drawn regarding the optimal method of stump closure.

•

Currently there is no robust higher order evidence which assesses clinical outcomes, cost and time efficiency of methods of stump closure in laparoscopic appendicectomy.

•

This is the first systematic review to investigate clinical outcomes, cost and quality of current evidence for all methods of laparoscopic appendiceal stump closure in acute appendicitis.

•

No difference was observed in methods of stump closure in complication rate, length of stay, cost, and time efficiency.

•

Endostaplers appear to provide most robust closure, albeit at a higher economic cost.

•

Endoloops appear to provide efficient and successful closure, and are currently the most frequently studied method of closure.

Radiomics for precision medicine: Current challenges, future prospects, and the proposal of a new framework

The advancement of artificial intelligence concurrent with the development of medical imaging techniques provided a unique opportunity to turn medical imaging from mostly qualitative, to further quantitative and mineable data that can be explored for the development of clinical decision support systems (cDSS). Radiomics, a method for the high throughput extraction of hand-crafted features from medical images, and deep learning -the data driven modeling techniques based on the principles of simplified brain neuron interactions, are the most researched quantitative imaging techniques. Many studies reported on the potential of such techniques in the context of cDSS. Such techniques could be highly appealing due to the reuse of existing data, automation of clinical workflows, minimal invasiveness, three-dimensional volumetric characterization, and the promise of high accuracy and reproducibility of results and cost-effectiveness. Nevertheless, there are several challenges that quantitative imaging techniques face, and need to be addressed before the translation to clinical use. These challenges include, but are not limited to, the explainability of the models, the reproducibility of the quantitative imaging features, and their sensitivity to variations in image acquisition and reconstruction parameters. In this narrative review, we report on the status of quantitative medical image analysis using radiomics and deep learning, the challenges the field is facing, propose a framework for robust radiomics analysis, and discuss future prospects.

Low dose bitter leaf improves sperm quality disrupted in immunosuppressed Wistar rats: An experimental study

Background

Synthetic prednisolone (PRED) is a widely used over-the-counter glucocorticoid. Glucocorticoids have inhibitory effects on the immune system and are often used as immunosuppressive agents. Suppressed immunity may impact fertility via the hypothalamic-pituitary-adrenal axis. Bitter leaf (BL) has been shown to improve sperm parameters, but its effects on immunosuppression-associated infertility have not yet been documented.

Objective

To determine the fertility effects of bitter leaf on immunosuppressed Wistar rats.

Materials and Methods

A total of 30 male adult Wistar rats were randomly assigned to 6 groups (n = 5/each). Group A served as a control and were given distilled water in addition to normal feeds, group B received 2 mg/kg PRED for 14 days and served as the standard immunosuppressed group, and groups C-F were immunosuppressed as in B but in addition received 50 mg/kg levamisole, low-dose (250 mg/kg) BL, high-dose (375 mg/kg) BL, and low-dose BL + levamisole, respectively. The CD4 counts, hematological parameters, and sperm parameters were analyzed and compared.

Results

There were significant decreases in sperm motility, progressive motility, morphology, and life/death ratio in the animals given PRED only compared to the controls (p = 0.002, 0.001, 0.001, and 0.01, respectively). These were significantly increased in the treated groups, and animals given levamisole and 250 mg/kg BL showed significantly increased sperm counts compared to the controls (p = 0.04 and p = 0.04, respectively).

Conclusion

Low-dose BL (250 mg/kg) restored the sperm parameters altered by prednisolone administration.

Privacy, confidentiality, security and patient safety concerns about electronic health records

AIMS

This study explored concerns among nurses working in the United Arab Emirates associated with the use of electronic health records, including privacy, confidentiality, security and patient safety.

BACKGROUND

Given the widespread implementation of electronic health records, there are concerns about data integrity that could jeopardize healthcare quality. Addressing nurses' concerns about data integrity and safety is critical to inform health policies and promote public trust.

METHODS

Nurses working in healthcare settings in the United Arab Emirates (N = 562) were invited to share their concerns about data integrity and patient safety using a mixed-method approach. Data were collected between January and June 2018 via questionnaires and focus group interviews. Following a survey of nurses' concerns about privacy, confidentiality, security and patient safety in electronic health records, six focus groups were held to gain deeper insights about their concerns. Major themes that emerged from the focus groups were extracted to align with the main sections of the questionnaire.

RESULTS

Nurses expressed concern over the security of electronic health records (n = 270, 48%). Administrative-related security, inadequate training and access by unauthorized users were the most frequently reported concerns. The main patient safety concerns were associated with non-technological factors, including lack of audit by staff, poor communication with technology vendors and length of time required for documentation. The focus group results reflected similar issues, with an additional theme being inconsistency in data integrity policies.

CONCLUSIONS AND IMPLICATIONS FOR NURSING/HEALTH POLICY

Frontline nurse managers need to integrate pragmatic policies to support staff compliance with the code of ethics when using online data. Nurses must follow workplace policies that foster reporting of risks to online incident systems to ensure data integrity. A unified health policy based on multidisciplinary partnership is critical to safeguard online data and promote public trust.

Brief report: Metabolic acidosis in newborn infants following maternal use of acetazolamide during pregnancy

 The information regarding fetal effects of acetazolamide use during pregnancy and lactation is sparse. We report the clinical and pharmacodynamic characteristics of maternal acetazolamide use and the timing of its effects on acid-base balance in three cases who presented with metabolic acidosis in the newborn period. We found that the infants' clinical status soon after birth was inconsistently correlated with maternal drug dose and concentrations of medication in maternal serum. However, there was low transfer of the drug in breast milk and its use did not affect clinical symptomatology. We also present a review of literature on this subject to help consolidate our current knowledge on this topic.

1233 Can speckle tracking echocardiography predict outcome in hypoplastic left heart syndrome patients?

Funding Acknowledgements

EACVI Training Grant

Introduction

Children with Hypoplastic Left Heart Syndrome (HLHS) have a high mortality (up to 95%) and morbidity. Systemic right ventricle (RV) dysfunction plays a key-role in their outcome.

Purpose

The aim of this study is to evaluate the accuracy of speckle-tracking echocardiographic (STE) assessment of RV deformation and 2D standard echo parameters in predicting death and need for heart transplantation (HT) in HLHS patients.

Methods

31 patients with diagnosis of HLHS successfully completed Norwood (n = 29) or comprehensive Norwood stage II (n = 2) at our Institution between 2015 and 2019. Survival at 6 months was 90.32%, survival at 18 months was 85.72%. We studied 29 HLHS patients (17 male). Patients with HLHS variant (n = 2) were excluded. All the studied patients underwent in-hospital interstage stay. Serial echocardiographic assessment was performed in all the included patients (baseline, one month after Norwood, three months after Norwood, one week before bidirectional cavopulmonary anastomosis [BCPA] and two months after BCPA). From the apical view we measured: tricuspid annulus peak systolic excursion (TAPSE), fractional area change (FAC), longitudinal strain (LS) and strain rate (LSR).

Results

After a mean follow-up of 1.83 ± 1.16 years, 8 out of 29 of the included patients met the composite endpoint of death/HT. At pre-Norwood assessment, there was no statistical difference in echo measurements between survivors and patients who reached the endpoint. In death/HT group TAPSE and LS declined already at one-month after Norwood procedure evaluation. At one-month evaluation, a TAPSE ≤ 5 mm had a good sensitivity for death/HT (85.71%) and a moderate specificity (66.67%), with an area under the curve of 0.789. Always at one-month evaluation, a Δ LS ([{baseline LS – one-month post Norwood LS}/ baseline LS] *100) of 8.7% showed a 100% sensitivity and good specificity (80.95%) for death/HT, with an area under the curve of 0.888. Multivariate analysis showed that one-month-after-Norwood Δ LS was the best predictor of worse outcome (p = 0.02).

Conclusions

HLHS patients with Δ LS of > 8.7% at one-month after Norwood procedure had a high likelihood of death or HT. These data encourage the routine use of LS to monitor cardiac function in HLHS patients.

Abstract 1233 Figure. HLHS LS and trend of TAPSE and LS.

P312The acute impact of a high altitude ultra-trail race on the ECG

Background

Ultra-endurance competitions are becoming increasingly popular but the consequences of ultra-endurance sports activity on the heart rhythm is still a debated issue. Some authors demonstrated that athletes engaging in ultra-endurance sports show a transient rise in cardiac biomarkers and right ventricular dysfunction after a competition, suggesting the possibility of an adverse arrhythmic remodeling and an increased risk of sudden cardiac death. The aim of our study was to evaluate the effects on heart rhythm of an ultraendurance high-altitude race.

Methods

The study was performed during the 2018 North Face® Lavaredo Ultra Trail mountain run. We recorded the ECG with the FDA-approved MyDiagnostick device. Recordings were performed at baseline the day before the run and immediately after the run in the available athletes. The ECG was analyzed for heart rate, QRS duration, QT interval duration corrected according to the Bazett formula and presence of at least one beat of presumed ventricular origin (PVB).

Results

A total of 545 athletes (83% males, mean age: 40±9 years), 241 running the 120 Km race and 304 running the 50 Km race, were included in the study. At baseline, athletes showed a mean heart rate of 64±14 bpm and a mean QRS duration of 92±18 ms. Three (0.5%) showed at least one PVB. Analysis of QTc interval duration showed a mean value of 412±25 ms. After the race, athletes showed a higher heart rate (91±13 bpm, p<0.001), a similar QRS duration (94±16 ms, p=0.32) and a longer QTc interval duration (447±25 ms, p<0.001), as compared to baseline data. The number of athletes showing at least 1 PVB significantly increased to 18 (3.3%, p=0.004) as compared to pre-race evaluation. Athletes engaged in the 120 Km run showed a slightly longer post-run QTc interval (450±24 versus 444±25 ms, p=0.009) while the post-run QRS duration was similar between the two groups. The presence of PVBs after the race was not correlated with the duration of QTc interval.

Conclusions

In this study we found an increased number of PVBs and a prolonged QTc duration after an ultra-endurance competition. Increased ventricular ectopic activity and QT prolongation recorded shortly after an intense and prolonged exercise could contribute to the increased risk of arrhythmias occurring after the finish line.

P2734Aortic regurgitation in paediatric patients: new echo parameter strongly correlates with CMR

Background

Aortic regurgitation (AR) continues to be an important cause of morbidity and mortality, particularly in paediatric patients. In the paediatric population the prevalence of AR has increased, also due to expanded use of new surgical and hemodynamic procedures. While echocardiographic parameters are well established for the adults, there are no clear cut-off values to assess AR severity in children. Cardiac magnetic resonance (CMR) imaging is widely used to assess diagnostic and prognostic information and is considered a “gold standard” for a quantitative evaluation of the aortic regurgitation.

Purpose

The aim of the study is to assess which echo parameters can accurately define AR severity as assessed by CMR in paediatric patients.

Methods

A total of 36 paediatric patients (12±3,2 years of age, age range 6–18) with different degree of AR underwent echocardiographic assessment within an average of 25 days from CMR (no therapeutic changes were made in this period). Heart rate and arterial blood pressure were comparable during echo and CMR. CMR included phase-contrast velocity-encoded imaging for the measurement of regurgitant fraction (RF) at the sinotubular junction. Severe AR was defined as RF>33%. Echocardiographic evaluation included vena contracta (VC), pressure half time (PHT), the ratio between the AR jet and the LVOT diameter (jet/LVOT), presence of holodiastolic reversal flow in abdominal aorta (abdAo), the ratio between the velocity-time integral of the reversal flow over the forward flow in descending aorta (dAo-ratio).

Results

Among the echo parameters studied, the strongest predictor of severe aortic regurgitation, as assessed by CMR with RF, was dAo-ratio. ROC curve showed, for a cut-off >0.38: AUC 0.882, p<0.0001, sensitivity 71.4%, specificity 96.6%. Correlation coefficient between dAo-ratio and RF was R=0.9183 with a p<0.0001.

ROC curves were performed for all the echo parameters. PHT <410 ms: AUC 0,800, p=0,0001, sensitivity 100%, specificity 62,1%; VC >4 mm: AUC 0.783, p=0.0004, sensitivity 71.4%, specificity 72.4%; jet/LVOT >0.35: AUC 0.813, p=0,0002, sensitivity 71,4%, specificity 86,2%; abdAo =1: AUC 0,734, p 0,026, sensitivity 57,1%, specificity 89,7%.

dAo-ratio: measurement and statistics

Conclusions

Our findings suggest that dAo-ratio is a strong marker of severe aortic regurgitation in the paediatric population. This parameter should be routinely added in the standard echo evaluation of paediatric patients with aortic regurgitation.

Geochemistry of uranium and thorium in phosphate deposits at the Syrian coastal area (Al-Haffah and Al-Qaradaha) and their environmental impacts

The aim of this research was to study the geochemistry of uranium and thorium in phosphate deposits in the upper Cretaceous phosphate deposits in the Syrian coastal area. The study covered three sites, namely Ain Al-Tenah, Ain Laylon, and Al-Mhalbeh. Petrographical study showed that phosphate deposits are of nodular type with micrit to microspaite cement, containing siliceous bone residues, and green grains of glauconite, which are increasing in abundance and volume in the south toward Al-Mhalbeh, reflecting the formation of phosphate in a shallow marine environment. In addition, uranium concentration varied between 3 and 112 ppm in Ain Laylon, 4.2-17 ppm in Ain Al-Tenah and 5-61 ppm in Al-Mhalbeh. Thorium concentration varied between 0.2 and 7.5 ppm in Ain Laylon, 0.3-1.4 ppm in Ain Al-Tenah and 0.3-4.4 ppm in Al-Mhalbeh. The average Th/U ratio in the collected samples was within the range 0.04-0.08 except for five samples which exceeded the value 0.1. Moreover, the ²²⁶Ra/²³⁸U ratios are lower than unity in all samples, while the ²¹⁰Pb/²³⁸U ratios ranged between 0.4 and 1.2 and the ²¹⁰Pb/²²⁶Ra ratios were found to be higher than unity. On the other hand, the impact of leaching and mobility of uranium and thorium from deposits to the surrounding agriculture fields in the area has been studied using the Radium Equivalent Activity Index (Ra_eq). The equivalent radium activity was 102 Bq kg^-1 in Ain Al-Tenah, 403 Bq kg^-1 in Ain Laylon, 407 Bq kg^-1 in Al-Mhalbeh and 749 Bq kg^-1 in agricultural soil samples. However, the data reported in this study can be considered as a baseline data for the phosphate deposits at the coastal area.

P2739Can cardiac mechanics predict outcome in hypoplastic left heart syndrome patients? A speckle tracking echocardiography study

Introduction

Hypoplastic Left Heart Syndrome (HLHS) still carries a high morbidity and mortality. Right ventricle (RV) dysfunction is one of the most important responsible of a worse outcome. Unfortunately, RV assessment is a challenge. Speckle tracking echocardiography (STE) demonstrated an excellent ability in the estimation of RV function.

Purpose

The aim of our study is to evaluate the ability of STE and standard 2D echo parameters in predicting death and need for heart transplantation (HT) in HLHS patients.

Methods

31 patients with diagnosis of HLHS successfully completed Norwood (n=29) or comprehensive Norwood stage II at our Institution between 2016 and 2018. Survival at 6 months was 93.3%, survival at 18 months was 81.1%. We present our preliminary data on 23 HLHS patients (13 male).

All the studied patients underwent in-hospital interstage stay. Serial echocardiographic assessments were performed in all the included patients (baseline, one month after Norwood, three months after Norwood, one week before bidirectional cavopulmonary anastomosis [BCPA] and two months after BCPA).

From apical view we measured: tricuspid annulus peak systolic excursion (TAPSE), fractional area change (FAC), longitudinal strain (LS) and strain rate (LSR).

Results

After a median follow-up of 2.2 years (1.7–2.6 years), 6 out of 23 patients met the composite endpoint of death/HT.

At pre-Norwood assessment, there was no statistical difference between survivor and death/HT patients.

In death/HT group TAPSE declined at one-month after Norwood procedure. LS decreased significantly at three-months after Norwood. After BCPA, death/HT patients had much lower FAC, TAPSE, LS and LSR than survived patients.

At one-month evaluation, TAPSE ≤5 mm had a good specificity for death/HT (80%) and a moderate sensitivity (70.6%) with an area under the curve (AUC) of 0.80. Still at one-month evaluation, Δ LS ([{baseline LS – one-month post Norwood LS}/ baseline LS] *100) >7.7% showed a 100% sensibility and moderate specificity (76.5%) for death/HT (AUC 0.841).

LS in HLHS patient and LS ROC curve.

Conclusions

HLHS patients with TAPSE ≤5 mm and Δ LS of >7.7% one-month after Norwood had a high likelihood of death or HT. These preliminary data encourage the routine use of TAPSE and LS to monitor cardiac function in HLHS patients and to identify subgroup patients at high risk.

P4627Presentation, management, and outcomes of STEMI in Egypt: results from the European Society of Cardiology registry on ST elevation myocardial infarction

Background

Apart from few small single-center studies there are limited data about STEMI patients in Egypt.

Patients and methods

The European Society of Cardiology (ESC) Registry on ST Elevation Myocardial Infarction is a prospective, multicenter and observational registry. Nineteen Egyptian centers (with and without PCI facilities) participated in this registry with 1356 patients who were compared to 7420 patients from other ESC countries. Patient recruitment started from March 2016 to February 2018.

Aims of the study

The aims of this study was to describe the characteristics of patients with STEMI, to assess STEMI management patterns, to evaluate in-hospital patient outcome and to compare Egyptian patients with other ESC countries.

Results

Compared to other ESC countries, Egyptian patients were younger (mean age 55.4±11.3 vs. 62.9±12.4; P<0.001 and 4.3% vs. 19.4%% were ≥75 years old; P<0.001) with fewer females (18.4% vs. 25.6%; P<0.001). Fewer Egyptian patients had history of myocardial infarction (7.9% vs. 12.6%; P<0.001), chronic heart failure (2.0% vs. 11.5%; P<0.001), but Egyptians had higher prevalence of current smoking (59.0% vs. 42.8% p<0.001), Diabetes mellitus (40.7% vs. 21.9%, p<0.001). Egypt had longer median time between symptoms onset and first medical contact: 120.0 (60.0; 240.0) vs. 100.0 (50.0; 240.0) p<0.001. Self-presentation rather than EMS presentation was the mode of admission in 86.0% in Egypt vs. 25.8% in EU countries (p<0.001). On qualifying ECG, anterior STEMI was in 57.0% in Egypt vs. 45.9% in other countries (p<0.001). Initial reperfusion therapy was 49.1%, 43.0% and 7.2% for Primary PCI, thrombolytic therapy and no reperfusion in Egypt vs. 85.4%, 7.2% and 7.8% for EU countries, respectively. Thrombolysis when given was in the CCU/ICU rather than EMS or ER in 97.2% in Egypt vs. 43.7% in other countries. Compared to thrombolytic therapy, patients who were treated with primary PCI had less Cerebrovascular accident (0.75% vs. 1.3%; P<0.001), killip Class IV (3.0% vs. 5.9%; P<0.001) or AF (2.5% vs. 3.6%; P 0.008). In hospital mortality was 4.6% in Egypt vs. 3.5% in other countries P 0.040 and was 18.7% in No reperfusion vs. 2.1% in Primary PCI vs. 4.9% in Thrombolysis (P<0.001) among Egyptians. Patients were discharged on Aspirin in 98.6%, Clopidogrel in 91.0%, Ticagrelor in 7.1%, DAPT in 97.6%, Beta Blockers in 82.8%, ACE inhibitors in 84.7%, MRAs in 10.0%, and Statins in 99.7%.

Conclusion

Egyptian STEMI patients were younger, more frequently obese, smokers and diabetics had significantly longer delay between symptoms onset and first medical contact with more self-presentation rather than the recommended EMS presentation. Primary PCI was offered to only half of the patients. In hospital mortality was significantly higher and was highest among non-reperfused patients. National plans for primary and secondary prevention are urgently needed in Egypt.

Acknowledgement/Funding

This registry was funded by the ESC. The Egyptian Society of Cardiology was given a grant of €12000 to help with the implementation of this national E

Anti-proliferative effects of mesenchymal stem cells (MSCs) derived from multiple sources on ovarian cancer cell lines: an in-vitro experimental study

Mesenchymal stem cells (MSCs) have surfaced as ideal candidates for treatment of different therapeutically challenging diseases however their effect on cancer cells is not well determined. In this study, we investigated the effect of MSCs derived from human bone marrow (BM), adipose tissue (AT), and umbilical cord derived MSCs (UC-MSCs) on ovarian cancer.Measurements of ovarian tumor marker proteins were computed by ELISA. Proliferative, apoptosis and anti-inflammatory effects of the MSCs were measured by Flow cytometry (FCM). MMPs expression was measured by RT-PCR.The co-culture of cancer cell lines OVCAR3, CAOV3, IGROV3 and SKOV3 with the conditioned media of MSCs (CM-MSC) and MSCs showed an increase in cellular apoptosis, along with a reduction in the level of CA-125 and a decline of LDH and beta-hCG. A decrease in CD24 of the cancer cell lines in co-culture with the CM-MSCs showed a reduction of the cancer tumorigenicity. In addition, the invasion and aggressiveness of cancer cell lines was significantly decreased by CM-MSC; this was translated by a decrease in MMP-2, MMP-9, and CA-125 mRNA expression, and an increase in TIMP 1, 2, and 3 mRNA expression. An increase in IL-4 and IL-10 cytokines, and a decrease in GM-CSF, IL-6, and IL-9, were also noted.In conclusion, mesenchymal stem cells derived from different sources and their conditioned media appear to have a major role in inhibition of cancer aggressiveness and might be considered as a potential therapeutic tool in ovarian cancer.