P1857Risk calculator for prediction of iatrogenic atrial septal defect persistence following percutaneous mitral valve repair

Background

The rising number of new percutaneous interventions for left-sided heart disease leads to increased occurrence of iatrogenic atrial septal defect (iASD). The percutaneous mitral valve repair (PMVR) for severe, symptomatic mitral regurgitation (MR) also requires intraprocedural puncture of the interatrial septum. In some cases iASD is persisting and becomes haemodynamically relevant with enhanced right heart overload due to significant left-to-right-shunting.

Purpose

This study aimed to evaluate pre- and periprocedural factors that may favour persistence and haemodynamic relevance of iASD in patients after PMVR.

Methods

In 2015, 75 consecutive patients with severe MR (age 74.8±10.5y) and following PMVR were enrolled. After 12 months, 57 patients completed their follow up (FU) including clinical conditions, transthoracic echocardiography (TTE), and cardiovascular magnetic resonance (CMR) whenever feasible. We evaluated the impact of comorbidities as well as intraprocedural, haemodynamic and functional characteristics that may favour persistence of iASD by multivariate analysis. Haemodynamic relevance of iASD was defined as right heart overload with predominantly significant enlargement of the right atrium (RA), impairment of right heart function as defined by fractional area shortening (FAC), and ratio of pulmonary to systemic blood flow (Qp/Qs>1) when available.

Results

18 out of 57 patients (32%) showed a persistent iASD (+iASD), being associated with a specific combination of comorbidities as well as pre-procedural and periprocedural factors that can be summarised by a multifactorial iASD risk calculator (+iASD vs. -iASD: 6.3±2.9 vs. 3.9±2.7; p=0.0058). 11 iASD (61%) became haemodynamically relevant (+hd iASD) with a significant right heart overload (RA area +hd iASD vs. -hd iASD: baseline 23.1±4.1 vs. 23.2±4.3; FU 30.7±6.3 vs. 20.1±4.6; p<0.0001), reduced RV function (FAC +hd iASD vs. -hd iASD: baseline 41.0±10.3 vs. 29.9±7.2; FU 25.3±7.2 vs. 29.1±13.2; p<0.0156) and left-to-right shunting (Qp/Qs -iASD vs. +hd iASD vs. -hd iASD: 1.0±0.3 vs. 1.7±0.4 vs. 0.8±0.1 L/min; p=0.0011).

Conclusion

This study shows for the first time, that persistence of iASD can be predicted by pre- and periprocedural factors using a risk calculator that may additionally guide careful follow up imaging and therapeutic action after PMVR to avoid development of progressive heart failure.

Systematic comparative study of computational methods for T-cell receptor sequencing data analysis

High-throughput sequencing technologies have exposed the possibilities for the in-depth evaluation of T-cell receptor (TCR) repertoires. These studies are highly relevant to gain insights into human adaptive immunity and to decipher the composition and diversity of antigen receptors in physiological and disease conditions. The major objective of TCR sequencing data analysis is the identification of V, D and J gene segments, complementarity-determining region 3 (CDR3) sequence extraction and clonality analysis. With the advancement in sequencing technologies, new TCR analysis approaches and programs have been developed. However, there is still a deficit of systematic comparative studies to assist in the selection of an optimal analysis approach. Here, we present a detailed comparison of 10 state-of-the-art TCR analysis tools on samples with different complexities by taking into account many aspects such as clonotype detection [unique V(D)J combination], CDR3 identification or accuracy in error correction. We used our in silico and experimental data sets with known clonalities enabling the identification of potential tool biases. We also established a new strategy, named clonal plane, which allows quantifying and comparing the clonality of multiple samples. Our results provide new insights into the effect of method selection on analysis results, and it will assist users in the selection of an appropriate analysis method.

Association of seeking ophthalmic assessment in children with parental history of refractive errors

Objective:

To find out the association of seeking ophthalmic assessment in children with parental history of refractive errors.

Methods:

After the approval of ethical review board, an analytical cross-sectional study was conducted in eight high schools of public and private sector at Lahore during the period of seven months from August 2017 to March 2018. Multistage random sampling technique was opted and 2000 study subjects were recruited including 50% boys and 50% girls. Informed consent was obtained and data was collected on a structured questionnaire. The data was organized, entered in version 23 of IBM SPSS and analyzed by the use of statistical tools.

Results:

Age of the respondents ranged between nine to 18 years with a mean of 13.40 ± 1.82 SD.

Parental history of wearing spectacles was present in 21.3% of the fathers and 28.6% of the mothers. Moreover, 72.4% of the participants never visited eye care professional. Among private schools, an association was found between the visit of boys to eye care professional and maternal positive history of wearing spectacles (p-value 0.019). A significant association was found between the positive paternal history of wearing spectacles and visit of the female strudy subjects to an eye care professional (p-value 0.001). In public schools, there was an association between visit of children to eye care services and positive history of mothers about the use of spectacles (p-value 0.018).

Conclusions:

This study concludes that positive maternal history of wearing spectacles is associated with the ophthalmic examination of children in both public and private school.

Prevalence of refractive errors; an evidence from the public high schools of Lahore, Pakistan

OBJECTIVE

To assess the magnitude of refractive errors among high school children.

METHODS

The cross-sectional, descriptive study was conducted from April to August 2017 in four public-sector high schools in Lahore, Pakistan. Using multistage simple random sampling, all public sector high schools of the city were initially included. Screening of refractive errors was managed on the school premises. Data was collected on a pre-tested, structured questionnaire. SPSS 23 was used for data analysis.

RESULTS

There were 1000 subjects with an overall mean age of 13.78±1.72 years (range: 10-18 years). Refractive errors were present in 244(24.4%) and myopia 127(52%) was the major type of refractive error followed by astigmatism 93(38.1%) and hypermetropia 24(9.8%). Differece in the prevalence of refractive errors in urban and rural settings was significant (p=0.00002).

CONCLUSIONS

Uncorrected refractive errors were present in a considerable segment of public-sector high school students of Lahore.

Investigation of new quinoline derivatives as promising inhibitors of NTPDases: Synthesis, SAR analysis and molecular docking studies

Nucleoside triphosphate diphosphohydrolases (NTPDases), an important class of ectonucleotidases, are responsible for the sequential hydrolysis of extracellular nucleotides. However, over-expression of NTPDases has been linked with various pathological diseases e.g. cancer. Thus, to treat these diseases, the inhibitors of this class of enzyme are of interest. The significance of this class of enzyme encouraged us to synthesize a new class of quinoline derivatives with the aim to find selective and potent inhibitors of NTPDases. Therefore, a mild and efficient synthetic route was established for the synthesis of quinoline derivatives. The reaction was catalyzed by molecular iodine to afford the substituted quinoline derivatives. All the synthetic derivatives (3a-3w) were evaluated for their potential to inhibit the h-NTPDase1, 2, 3 and 8. Most of the compounds were identified as dual inhibitors of h-NTPDase1 and 8 with lower effects on h-NTPDase2 and 3. Two compounds i.e.3f and 3t were identified as selective inhibitor of h-NTPDase1 whereas the compound 3s inhibited the h-NTPDase8 selectively. Moreover, the compounds 3p (IC₅₀ = 0.23 ± 0.01 µM), 3j (IC₅₀ = 21.0 ± 0.03 µM) 3d (IC₅₀ = 5.38 ± 0.21 µM) and 3c (IC₅₀ = 1.13 ± 0.04 µM) were found to be the most potent inhibitors of h-NTPDase1, 2, 3 and 8, respectively. To determine the binding interaction, molecular docking studies were also carried out.

Schiff bases of tryptamine as potent inhibitors of nucleoside triphosphate diphosphohydrolases (NTPDases): Structure-activity relationship

Overexpression of NTPDases leads to a number of pathological situations such as thrombosis, and cancer. Thus, effective inhibitors are required to combat these pathological situations. Different classes of NTPDase inhibitors are reported so far including nucleotides and their derivatives, sulfonated dyes such as reactive blue 2, suramin and its derivatives, and polyoxomatalates (POMs). Suramin is a well-known and potent NTPDase inhibitor, nonetheless, a range of side effects are also associated with it. Reactive blue 2 also had non-specific side effects that become apparent at high concentrations. In addition, most of the NTPDase inhibitors are high molecular weight compounds, always required tedious chemical steps to synthesize. Hence, there is still need to explore novel, low molecular weight, easy to synthesize, and potent NTPDase inhibitors. Keeping in mind the known NTPDase inhibitors with imine functionality and nitrogen heterocycles, Schiff bases of tryptamine, 1-26, were synthesized and characterized by spectroscopic techniques such as EI-MS, HREI-MS, ¹H-, and ¹³C NMR. All the synthetic compounds were evaluated for the inhibitory avidity against activities of three major isoforms of NTPDases: NTPDase-1, NTPDase-3, and NTPDase-8. Cumulatively, eighteen compounds were found to show potent inhibition (Ki = 0.0200-0.350 μM) of NTPDase-1, twelve (Ki = 0.071-1.060 μM) of NTPDase-3, and fifteen compounds inhibited (Ki = 0.0700-4.03 μM) NTPDase-8 activity. As a comparison, the Kis of the standard inhibitor suramin were 1.260 ± 0.007, 6.39 ± 0.89 and 1.180 ± 0.002 μM, respectively. Kinetic studies were performed on lead compounds (6, 5, and 21) with human (h-) NTPDase-1, -3, and -8, and Lineweaver-Burk plot analysis showed that they were all competitive inhibitors. In silico study was conducted on compound 6 that showed the highest level of inhibition of NTPDase-1 to understand the binding mode in the active site of the enzyme.

Counseling in Medical Institutions; Challenges and Solutions

It is really hard to imagine the spectrum of challenges faces by Medical Students. The lack of organized counseling and relevant policy in Medical Institutions has worsened the existing situation for students facing problems in learning, adjustment in medical institutions and coping with increased stress of studies. The progress in lifelong learning notion is seriously hampered in practical situation for the young brilliant and energetic minds who face multi facet problems and challenges, and cannot find the way out on their own.

Demographic Characteristics of Tuberculosis Patients at Public Sector Health Facilities in Lahore, Pakistan

Tuberculosis (TB) is an infectious chronic bacterial disease caused by Mycobacterium tuberculosis (MTB). More than 95% of cases and deaths are reported in developing countries. Tuberculosis affects all age groups but adults are mostly affected in their most productive age. However, all age groups are at risks. In theworld, TB is one of the major killer infectious diseases, which place it in one of the top 5 causes of death for females aged 15 to 44. The death rate due to this isease has declined by 47% from 1990 to 2015.Objective: This study was conducted to determine the demographic parameters of patients of Tuberculosis at public sector health facilities Lahore, Pakistan.Methods: A cross sectional study was conducted in outpatient Department of chest Medicine in Public sector health facilities Lahore, Pakistan from 1st January 2017 to 30th June 2017 after informed consent from Tuberculosis patients. After simple random sampling 1120 patients coming from different parts of the Punjabprovince were included in this study. Data were collected and analyzed by SPSS version 22. Results: A total of 1120 patients were included in this study; the mean age of cases was 33 ± 16.76 years with minimum and maximum age of 15 and 100 years. The median and mode of ages was 27 and 15 years, respectively. The most common age group was 15-24 years that comprised of 473(42.23%) of the cases. A total of 529(47.23%) patients were male and 591(52.77%) were female in this study. In male and female cases, frequency of cases was decreased as age increased. Both male and female cases had almost similar distribution of age. There were 830(74.11%) cases those belonged to Lahore while 25.895% were from other cities. Approximately 48.96% males and 38.92% females were educated, 37.24% males and 52.79% females had monthly income 10,000 or less whereas 34.82% males and 25.04% females had monthly income between ten thousands and thirty thousands.38.75% males and 44.84% females belonged to lower class.1004 (89.64%) cases were relapsed and 116(10.36%) were new cases. 366(32.68%) cases had pulmonary tuberculosis (PTB) and 754(67.32%) cases had extra pulmonary tuberculosis.Conclusion: There were 830(74.11%) cases that belonged to Lahore while 25.895 were from other cities. Majority of the cases were relapsed after treatment. The extra pulmonary lymph node was the most frequent site for involvement.

Open Peer Reviews and Blind Peer Reviews: Merits and Demerits

The peer review process is essentially the quality control mechanism. Scientific discoveries and advancements have far reaching implications especially in health and medical publications. The quality assurance mechanism in medical journals has to be stringent and flawless. The peer review systems are continuously being criticized, debated and updated. It may be open peer review or blind peer review, both have advantages and disadvantages. Open peer review is performed for scientific quality after publication. It is also known as transparent peer review and public peer review.

Association between the antioxidant uric acid and depression and antidepressant medication use in 96 989 individuals

OBJECTIVE

In the last decade, several studies have suggested that depression is accompanied by increased oxidative stress and decreased antioxidant defenses. We tested the hypothesis that high levels of the antioxidant uric acid are associated with lower risk of hospitalization with depression and use of prescription antidepressant medication.

METHOD

We examined plasma levels of the antioxidant uric acid in 96 989 individuals from two independent cohort studies. Logistic regression and Cox proportional hazards regression models were multivariable adjusted for age, gender, alcohol, smoking, income, body mass index, C-reactive protein, hemoglobin, triglycerides, cardiovascular disease, diabetes, and intake of meat and vegetables. Results were performed separately in each study and combined in a meta-analysis.

RESULTS

In both studies, high uric acid was associated with lower risk of hospitalization as in-patient or out-patient with depression and antidepressant medication use. A doubling in uric acid was associated with an effect estimate of 0.57 (95% CI 0.49-0.65) and 0.77 (0.73-0.81) for hospitalization with depression and antidepressant medication use. The association was consistent across strata of all covariates. Results were attenuated in Cox regression analyses with less statistical power.

CONCLUSION

High plasma levels of uric acid were associated with low risk of depression hospitalization and antidepressant medication use.

Chemoselective synthesis and biological evaluation of arylated 2-(Trifluoromethyl) quinolines as nucleotide pyrophosphatase (NPPs) inhibitors

A new approach to arylated 2-trifluoromethylquinolines based on novel regioselective Suzuki-Miyaura coupling reactions has been developed. Moreover, site-selective, chemo-selective amination reactions were performed. The new 2-trifluoromethylquinoline derivatives were tested as potential NPPs inhibitors and evaluated for their potential to inhibit two families of ecto-nucleotidases, i.e. NPPs and nucleoside triphosphate diphosphohydrolases (NTPDases). Several derivatives were active on a nanomolecular concentration. The results were validated based on docking studies to study the active binding site of the molecules.

Frequency of Ovarian Tumors According to WHO Histological Classification and Their Association to Age at Diagnosis

Ovarian tumors, or ovarian neoplasms, are benign or malignant tumors arising from the ovaries. They may arise from any of the three components of ovary i.e. surface epithelium, germ cells and the stroma of the ovary including sex cords. Tumors in the ovary can also be secondary or metastatic tumors.Objective:  To determine the frequency of Ovarian Tumors according to WHO Histological classification and their relation to age at diagnosis in almost one year.Methods:  A cross-sectional study was carried out, that included all the consecutive cases of ovarian neoplasms diagnosed at the Pathology department of a public sector university in Lahore from 1 January 2015 to 13 February 2016.Results:  In 95 female patients diagnosed with ovarian tumors, the mean age was found to be 29.58 ±11.493 with a range of 3-65 years. Tumors were most common between the ages of 15 to 30 years. The highest rates of malignancy were in the 0-15 and 45-60 age groups (Figure 1). About 78.9% of the tumors (75/95) were benign, 1.1% (1/95) were borderline and 20% (19/95) were malignant (Figure 3), 72.6% (69/95) were epithelial tumors, 23.2% (22/95) were germ cell and 4.2% (4/95) were sex cord stromal tumors (Figure 4). Among the 95 cases, serous tumors were the most common (49.5%), followed by mucinous (16.8%) and teratomas (15.8%).Conclusion:  According to our study, ovarian tumors were common between the age of 15 to 29 years. Benign neoplastic lesions were more common than malignant neoplastic lesions. The frequency of malignant and benign ovarian neoplasms found in our research differed from other studies conducted in Pakistan. There is a significant association of ovarian tumors in age less than 30 year as compared to older age groups (P < 0.001).

Association of Internet Supported Physical Activity with Academic Performance of Medical Students

<p>Physical activity is known to decrease stress and improve academic performance (cognitive skills, attitudes and academic scores) in students as it increases the blood flow to the brain thereby increasing oxygenation of the neuronal tissues. This is specially applied in the students of medical universities where higher stress levels are recorded.</p><p><strong>Objective:  </strong>To determine the role of internet supported physical activity in academic performance of medical students. The study design is Quasi Experimental Study conducted in a Medical University, Lahore for 6 months.<strong></strong></p><p><strong>Methods:  </strong>A total of 100 students (age 18 – 25) were enrolled. Data were collected through pretested questionnaires and analyzed by frequency tables, cross tabulations and paired sample t-tests through SPSS version 16.</p><p><strong>Results:  </strong>After the intervention was carried out, 91% of the students had noticed significant increases in their physical energy levels and stress levels were reduced in 79% of the students. A total of 52% of students lost their weight after the intervention out of which 44% had also claimed a decrease in their stress levels. Academic Performance of students was determined by the following factors; Cognitive skills and attitudes, which further included attention span(an increase of 62% was seen), memory (improvement was seen in 62% of the students) and grasp on concepts (which was increased in 77%), Class room behaviors such as class attendance (increase was seen in 59% of the students) and Academic scores (improvement was not significant (p = .612) and increase was seen only in 43% of students of which 23 were female and 20 were male students). However, the physical activity and academic performance was statistically in significant (p = 0.612).</p><p> </p><p><strong>Conclusion:  </strong>The physical activity and academic performance was not found to be significant. In addition, physical activity was found to decrease stress levels and this decrease in stress was positively related to weight loss in these students.</p>

A Comparison of Quality of Life and Support Mechanisms After Childhood Burn Injures in Asian and European Countries: A Systematic Review

<p class="MsoNormal" style="margin: 0in; margin-bottom: .0001pt; text-align: justify; text-indent: 0in; line-height: normal; tab-stops: .25in;"><strong><span style="font-size: 11.0pt; color: #1f497d;" lang="EN-GB">Background:  </span></strong><span style="font-size: 11.0pt;" lang="EN-GB">Childhood burns are the leading cause of unintentional injuries, with more incidences in Asian than in European countries. This systematic review aims to compare the differences in extent and type of burns in children from Europe and Asia, along with the differences in the coping strategies and the quality of life these children possess after the event of the burn.</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; text-align: justify; line-height: normal; tab-stops: .25in;"><strong><span style="color: #1f497d;" lang="EN-GB">Methods:</span><span lang="EN-GB">  </span></strong><span style="font-size: 11.0pt;" lang="EN-GB">This systematic review was conducted along the PRIMSA guidelines. We systematically searched </span><span lang="EN-GB">DOAJ</span><span style="font-size: 11.0pt;" lang="EN-GB">, </span><span lang="EN-GB">Google Scholar</span><span style="font-size: 11.0pt;" lang="EN-GB">, </span><span lang="EN-GB">Ingentaconnect</span><span style="font-size: 11.0pt;" lang="EN-GB">, </span><span lang="EN-GB">Jurg</span><span style="font-size: 11.0pt;" lang="EN-GB">, </span><span lang="EN-GB">Popline</span><span style="font-size: 11.0pt;" lang="EN-GB">, </span><span lang="EN-GB">Prof Search</span><span style="font-size: 11.0pt;" lang="EN-GB">, </span><span lang="EN-GB">Pubmed</span><span style="font-size: 11.0pt;" lang="EN-GB">, </span><span lang="EN-GB">Pubmed Abstract, Pubpsych</span><span style="font-size: 11.0pt;" lang="EN-GB">, </span><span lang="EN-GB">Pakmedinet </span><span style="font-size: 11.0pt;" lang="EN-GB">and PMC on 10th May 2016. Studies were selected if they met the following criteria: (1) must be based in Asia or Europe (2) must be related to burns (3) must be related to children (4) must not be treatment specific (5) must be in English </span><span lang="EN-GB">(6) must be a published in a journal (not in a</span></p><h2 style="margin-top: 0in; margin-right: 0in; margin-bottom: 10.0pt; margin-left: 0in; text-align: justify; text-indent: 0in; line-height: normal; mso-pagination: widow-orphan; page-break-after: auto; tab-stops: .25in;">conference). A self-made proforma was used to extract data for mean duration of hospitalization, extent of burns, coping strategy, quality of life of paediatric burn victims, psychosocial effects, family of burn victims, educational impact post burn in children, posttraumatic stress disorder among burned children and altered pain sensations among burned children.</h2><h2 style="margin-top: 0in; margin-right: 0in; margin-bottom: 10.0pt; margin-left: 0in; text-align: justify; text-indent: 0in; line-height: normal; mso-pagination: widow-orphan; page-break-after: auto; tab-stops: .25in;"><strong><span style="color: #1f497d;">Findings:  </span></strong>European children are more likely to be burnt by scalds than Asian children. European children suffer from superficial burns whereas Asian children suffer from deep burns. Situation in Asian children is intensified by the fact that there are fewer burn centres per capita and have low funds for post-burn care. In addition to it, many burnt children are not hospitalized in Asian countries. Parents of burnt children from both continents show immense feeling of guilt and inadequacy. Almost one-fifth of European burnt children suffered from post traumatic stress disorder. There is altered perception of pain in children who had experienced burns. European burn centres are more concerned about psychological aspects of children whereas there is a trend of child abuse in Asian countries.</h2><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 10.0pt; margin-left: 0in; text-align: justify; text-indent: 0in; line-height: normal; tab-stops: .25in;"><strong><span style="color: #1f497d;" lang="EN-GB">Interpretations:</span><span lang="EN-GB">  </span></strong><span style="font-size: 11.0pt;" lang="EN-GB">A greater body of research is carried out on this issue in European countries, showing an eagerness on behalf of the health community to provide superior care for the victims of burns.</span></p><p class="MsoNormal" style="margin: 0in; margin-bottom: .0001pt; text-align: justify; text-indent: 0in; line-height: normal; tab-stops: .25in;"><strong><span style="font-size: 11.0pt; color: #1f497d;" lang="EN-GB">Background:  </span></strong><span style="font-size: 11.0pt;" lang="EN-GB">Childhood burns are the leading cause of unintentional injuries, with more incidences in Asian than in European countries. This systematic review aims to compare the differences in extent and type of burns in children from Europe and Asia, along with the differences in the coping strategies and the quality of life these children possess after the event of the burn.</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; text-align: justify; line-height: normal; tab-stops: .25in;"><strong><span style="color: #1f497d;" lang="EN-GB">Methods:</span><span lang="EN-GB">  </span></strong><span style="font-size: 11.0pt;" lang="EN-GB">This systematic review was conducted along the PRIMSA guidelines. We systematically searched </span><span lang="EN-GB">DOAJ</span><span style="font-size: 11.0pt;" lang="EN-GB">, </span><span lang="EN-GB">Google Scholar</span><span style="font-size: 11.0pt;" lang="EN-GB">, </span><span lang="EN-GB">Ingentaconnect</span><span style="font-size: 11.0pt;" lang="EN-GB">, </span><span lang="EN-GB">Jurg</span><span style="font-size: 11.0pt;" lang="EN-GB">, </span><span lang="EN-GB">Popline</span><span style="font-size: 11.0pt;" lang="EN-GB">, </span><span lang="EN-GB">Prof Search</span><span style="font-size: 11.0pt;" lang="EN-GB">, </span><span lang="EN-GB">Pubmed</span><span style="font-size: 11.0pt;" lang="EN-GB">, </span><span lang="EN-GB">Pubmed Abs-tract, Pubpsych</span><span style="font-size: 11.0pt;" lang="EN-GB">, </span><span lang="EN-GB">Pakmedinet </span><span style="font-size: 11.0pt;" lang="EN-GB">and PMC on 10th May 2016. Studies were selected if they met the following criteria: (1) must be based in Asia or Europe (2) must be related to burns (3) must be related to children (4) must not be treatment specific (5) must be in English </span><span lang="EN-GB">(6) must be a published in a journal (not in a</span></p><h2 style="margin-top: 0in; margin-right: 0in; margin-bottom: 10.0pt; margin-left: 0in; text-align: justify; text-indent: 0in; line-height: normal; mso-pagination: widow-orphan; page-break-after: auto; tab-stops: .25in;">conference). A self-made proforma was used to extract data for mean duration of hospitalization, extent of burns, coping strategy, quality of life of paediatric burn victims, psychosocial effects, family of burn victims, educational impact post burn in children, post-traumatic stress disorder among burned children and altered pain sensations among burned children.</h2><h2 style="margin-top: 0in; margin-right: 0in; margin-bottom: 10.0pt; margin-left: 0in; text-align: justify; text-indent: 0in; line-height: normal; mso-pagination: widow-orphan; page-break-after: auto; tab-stops: .25in;"><strong><span style="color: #1f497d;">Findings:  </span></strong>European children are more likely to be burnt by scalds than Asian children. European children suffer from superficial burns whereas Asian children suffer from deep burns. Situation in Asian children is intensified by the fact that there are fewer burn centres per capita and have low funds for post-burn care. In addition to it, many burnt children are not hospitalized in Asian countries. Parents of burnt children from both continents show immense feeling of guilt and inade-quacy. Almost one-fifth of European burnt children suffered from post traumatic stress disorder. There is altered perception of pain in children who had expe-rienced burns. European burn centres are more con-cerned about psychological aspects of children whe-reas there is a trend of child abuse in Asian countries.</h2><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 10.0pt; margin-left: 0in; text-align: justify; text-indent: 0in; line-height: normal; tab-stops: .25in;"><strong><span style="color: #1f497d;" lang="EN-GB">Interpretations:</span><span lang="EN-GB">  </span></strong><span style="font-size: 11.0pt;" lang="EN-GB">A greater body of research is car-ried out on this issue in European countries, showing an eagerness on behalf of the health community to provide superior care for the victims of burns.</span></p>

Safety and efficacy of transseptal puncture guided by real-time fusion of echocardiography and fluoroscopy

Aims

Visual guidance through echocardiography and fluoroscopy is crucial for a successful transseptal puncture (TSP) in a prespecified region of the fossa ovalis. The novel EchoNavigator system Release II (EchoNav II, Philips Healthcare, Andover, Massachusetts, USA) enables the real-time fusion of fluoroscopic and echocardiographic images. We evaluated this new imaging method in respect to safety and efficacy of TSP during MitraClip implantation and left atrial appendage closure.

Methods

Forty-four patients before (−EchoNav) and 44 patients after (+EchoNav) the introduction of real-time fusion were included in our retrospective, single-centre study. The primary endpoint was the occurrence of adverse events due to TSP. Secondary endpoints were successful puncture at the prespecified region and time until TSP (min).

Results

In both groups TSP was performed successfully in the prespecified region and no adverse events occurred during or due to the accomplishment of TSP. Time until TSP was significantly reduced in the +EchoNav group in comparison with the EchoNav group (18.48 ± 5.62 min vs. 23.20 ± 9.61 min, p = 0.006).

Conclusions

Real-time fusion of echocardiography and fluoroscopy proved to be as safe and successful as standard best practice for TSP. Moreover, efficacy was improved through significant reduction of time until TSP.

GENE-IS: Time-Efficient and Accurate Analysis of Viral Integration Events in Large-Scale Gene Therapy Data

Integration site profiling and clonality analysis of viral vector distribution in gene therapy is a key factor to monitor the fate of gene-corrected cells, assess the risk of malignant transformation, and establish vector biosafety. We developed the Genome Integration Site Analysis Pipeline (GENE-IS) for highly time-efficient and accurate detection of next-generation sequencing (NGS)-based viral vector integration sites (ISs) in gene therapy data. It is the first available tool with dual analysis mode that allows IS analysis both in data generated by PCR-based methods, such as linear amplification method PCR (LAM-PCR), and by rapidly evolving targeted sequencing (e.g., Agilent SureSelect) technologies. GENE-IS makes use of trimming strategies, customized reference genome, and soft-clipped information with sequential filtering steps to provide annotated IS with clonality information. It is a scalable, robust, precise, and reliable tool for large-scale pre-clinical and clinical data analysis that provides users complete flexibility and control over analysis with a broad range of configurable parameters. GENE-IS is available at https://github.com/G100DKFZ/gene-is.

Effective role of lady health workers in immunization of children in Pakistan

Objective:

To determine the association of Lady Health Worker’s role with immunization of children in Pakistan.

Methods:

Secondary analysis was conducted on data obtained from Pakistan’s Demographic and Health Survey. Children who did not receive all doses of vaccines were considered incompletely immunized or vice versa. The association between determinants was assessed by simple and multivariable binary logistic regression.

Results:

The mothers and fathers had a mean age of 32.7 (SD+8.6) years and 37.9 (SD +10.1) years, respectively. Age of mother greater than 35 (OR=0.93; 95% CI:0.70-1.25); born in Baluchistan (OR=3.47,95% CI:2.21-5.49); rural area dwellers (OR=2.04; 95% CI:1.65-2.51); female gender (OR=1.06; 95% CI:0.87-1.29); birth order (of last born child) greater than 7 (OR=2.21, 95% CI:1.60-3.06); delivered at home (OR=2.20, 95% CI:1.76-2.74); long distance to health care facility (OR=2.66, 95% CI:2.16-3.28); and no LHW visit in last 12 months (OR=1.91, CI:1.48-2.47) were significantly associated with incomplete immunization in bivariate analysis. In final model of multinomial regression analysis the absence of visit by LHW in last 12 months was the most significant factor when all risk factors were analyzed in last model

Conclusions:

This study has concluded that visit of LHW in last 12 months was significantly associated with immunization.