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

External validation of a prognostic model to predict survival of patients with sentinel node-negative melanoma

Background

Identifying patients with sentinel node‐negative melanoma at high risk of recurrence or death is important. The European Organisation for Research and Treatment of Cancer (EORTC) recently developed a prognostic model including Breslow thickness, ulceration and site of the primary tumour. The aims of the present study were to validate this prognostic model externally and to assess whether it could be improved by adding other prognostic factors.

Methods

Patients with sentinel node‐negative cutaneous melanoma were included in this retrospective single‐institution study. The β values of the EORTC prognostic model were used to predict recurrence‐free survival and melanoma‐specific survival. The predictive performance was assessed by discrimination (c‐index) and calibration. Seeking to improve the performance of the model, additional variables were added to a Cox proportional hazards model.

Results

Some 4235 patients with sentinel node‐negative cutaneous melanoma were included. The median follow‐up time was 50 (i.q.r. 18·5–81·5) months. Recurrences and deaths from melanoma numbered 793 (18·7 per cent) and 456 (10·8 per cent) respectively. Validation of the EORTC model showed good calibration for both outcomes, and a c‐index of 0·69. The c‐index was only marginally improved to 0·71 when other significant prognostic factors (sex, age, tumour type, mitotic rate) were added.

Conclusion

This study validated the EORTC prognostic model for recurrence‐free and melanoma‐specific survival of patients with negative sentinel nodes. The addition of other prognostic factors only improved the model marginally. The validated EORTC model could be used for personalizing follow‐up and selecting high‐risk patients for trials of adjuvant systemic therapy.

Acoustic Characterisation of Phase Inversion in a Water-Oil System

The present paper is concerned with an experimental study of the acoustic signature of phase inversion in an oil-water mixture system. The system studied was used to correlate the process of phase inversion with the acoustic field generated during the two fluid mixing. The experimental results revealed that the relation between the acoustic fields produced by a water continuous dispersion and the phase inversion has a clear and different signature from an oil-continuous system using a batch mixing system. This dynamical characteristic of the phase inversion phenomenon could be of use in practical systems to detect phase inversion when it occurs based on the acoustic field measured in the subject process.

Atomistic analysis of the thermomechanical properties of Sn-Ag-Cu solder materials at the nanoscale with the MEAM potential

Sn-Ag-Cu, commonly known as SAC, is considered to be among the most promising of all lead-free solder alloys. Research aimed at making electronic components smaller has pointed to the possible use of nanosized solder joints in the future. In this study, for the first time, molecular dynamics simulations were used to analyze the thermomechanical properties of SAC solder materials at the nanoscale. The modified embedded-atom method (MEAM) potential was utilized in the simulations of the SAC solder materials. The dimensions of the structures considered were 55 × 55 × 59 Å. Four different SAC solders were studied, with Ag percentages ranging from 1% to 4% (SAC105, SAC205, SAC305, and SAC405). Thus, the effects of the Ag percentage on the thermomechanical properties of the solder at the nanoscale were identified. The impacts of the temperature on the uniaxial tensile properties and coefficient of thermal expansion (CTE) values of the SAC solder materials were investigated by performing simulations of the materials at different temperatures. Results suggest that as the Ag percentage increases, the uniaxial tensile strength and CTE of the solder increase whereas the failure strain and thermal conductivity decrease. The results presented should prove useful in the electronic packaging industry.

Myocardial calcification secondary to toxic shock syndrome: a comparative review of 17 cases

Myocardial calcification is a rare and life-threatening condition. It has been associated with a myriad of causes, including ischaemic heart disease, cardiac surgery, rheumatic fever, and myocarditis. However, this entity is less well recognised in the setting of toxic shock syndrome. Published medical literature is scarce with regard to the pathogenesis and clinical implications of this potential association. We chronicle here the case of a patient with myocardial calcification secondary to toxic shock syndrome from our clinical experience. Furthermore, a systematic literature search of the medical databases PubMed and Google Scholar was conducted. A total of 17 cases fulfilled the inclusion criteria. The data on patients' characteristics, epidemiology, clinical features, comorbid conditions, diagnosis, clinical course and outcome were collected and analysed. The present review outlines our current understanding of the epidemiology of and risk factors for sepsis-related myocardial calcification, the pathophysiology of this condition and currently available approaches to diagnosis.

No yield penalty under favorable conditions paving the way for successful adoption of flood tolerant rice

Flooding is one of the major constraints for rice production in rainfed lowlands, especially in years and areas of high rainfall. Incorporating the Sub1 (Submergence1) gene into high yielding popular varieties has proven to be the most feasible approach to sustain rice production in submergence-prone areas. Introgression of this QTL into popular varieties has resulted in considerable improvement in yield after flooding. However, its impact under non-flooded conditions or years have not been thoroughly evaluated which is important for the farmers to accept and adopt any new version of their popular varieties. The present study was carried out to evaluate the effect of Sub1 on grain yield of rice in different genetic backgrounds, under non-submergence conditions, over years and locations. The study was carried out using head to head trials in farmer’s fields, which enable the farmers to more accurately compare the performance of Sub1 varieties with their recurrent parents under own management. The data generated from different head to head trials revealed that the grain yield of Sub1 varieties was either statistically similar or higher than their non-Sub1 counterparts under non-submergence conditions. Thus, Sub1 rice varieties show no instance of yield penalty of the introgressed gene.

Evaluation of knowledge regarding gestational diabetes mellitus: a Bangladeshi study

OBJECTIVE

The aim of this study was to evaluate the level of knowledge about gestational diabetes mellitus (GDM) in Bangladeshi people.

STUDY DESIGN

Cross-sectional study.

METHODS

This study involving 1374 participants was conducted in 15 outpatient clinics of Diabetic Association of Bangladesh and its affiliated associations, Bangabandhu Sheikh Mujib Medical University and four medical college hospitals in Bangladesh from August 2015 to December 2015. A pretested interviewer-administered questionnaire was used to obtain information related to sociodemographic status, level of education, types of profession, and medical history. The questionnaire included eight questions on GDM. Level of knowledge (mean ± 1 standard deviation [SD]) was categorized as poor, average, and good. Descriptive, Chi-squared, and regression analysis were performed to express the results.

RESULTS

Of total knowledge score of 8, participants' mean knowledge score (±SD) was 2.7 ± 1.5. The levels of good, average, and poor knowledge were 26.3%, 63.1%, and 10.6%, respectively. In multivariate analysis, participants aged below 30 years (P < 0.001), male gender (P < 0.001), high-income group (P < 0.001), having university education (P < 0.001), health professionals (P < 0.001), capital Dhaka city residents (P < 0.001), those with family history of diabetes (P = 0.007), and participants with diabetes (P = 0.007) were found to be significantly associated with the good knowledge score.

CONCLUSIONS

Participants in this study had average knowledge about GDM. New innovative strategies should be developed to improve the knowledge of GDM among health professionals and general population.

Multidrug-resistant tuberculosis in Bangladesh: results from a sentinel surveillance system

BACKGROUND

Multidrug-resistant tuberculosis (MDR-TB) is a serious obstacle to successful TB control. The 2010-2011 Bangladesh Drug Resistance Survey (DRS) showed MDR-TB prevalence to be 7% overall, 1.4% in new and 28.5% in previously treated patients. We aimed to determine the rate of MDR-TB in selected sentinel sites in Bangladesh.

METHODS

Fourteen hospitals from the seven divisions in Bangladesh were selected as sentinel surveillance sites. Newly registered TB patients were systematically enrolled from August 2011 to December 2014. Sputum specimens were processed for culture and drug susceptibility testing by the proportion method using Löwenstein-Jensen medium.

RESULTS

Specimens from 1906 (84%) of 2270 enrolled patients were analysed. Isolates from 61 (3.2%) were identified as having MDR-TB. The proportion of MDR-TB was 2.3% among new and 13.8% among previously treated TB patients (P < 0.001). The overall proportion of MDR-TB was 3.2%:3.5% in males and 2.3% in females; by age, the MDR-TB rate was highest (5.2%) in those aged 65 years.

CONCLUSIONS

The high proportion of MDR-TB among new patients found in this sentinel surveillance significantly differs from that reported in the DRS. While the sentinel surveillance sites were not designed to be nationally representative, it is worrying to observe a higher number of MDR-TB cases among new patients.

Abdominal Obesity and Mobility Disability in Older Adults: A 4-Year Follow-Up the International Mobility in Aging Study

BACKGROUND

Abdominal obesity is related to the disability process in older adults, however, little is known about this relationship when adjusted for important confounders such as depression and physical performance measures in a diverse international aged population.

OBJECTIVES

To explore the longitudinal relationship between abdominal obesity and mobility disability controlling for physical performance and depression.

DESIGN AND SETTING

Longitudinal observational study using data from the International Mobility in Aging Study (IMIAS) Study.

PARTICIPANTS

1104 out of 2002 older adults aged 64-74 years old free of mobility disability at baseline (2012) and then reassessed in 2016.

MEASUREMENTS

Mobility disability was defined as reporting difficulty in walking 400 m or climbing stairs. Activities of daily living (ADL) disability was based on any self-reported difficulty in five mobility-related ADLs. Abdominal obesity was defined as waist circumference ≥ 88cm for women or ≥ 102 cm for men. Four meters gait speed, handgrip strength and depressive symptoms (CES-D) were assessed. Generalized Estimating Equations (GEE) and multinomial regressions were used to estimate associations between disability and abdominal obesity.

RESULTS

1104 free of disability participants were followed over 4 years, the mean age was 68.9 (±2.9) years among men and 68.7 (±2.6) years among women. Prevalence and incidence rates of mobility disability varied widely across research site and sex. The longitudinal associations between mobility disability and abdominal obesity remained significant even when adjusted by depressive symptoms, handgrip strength, gait speed, age, sex, education and research site. Participants with abdominal obesity had higher mobility disability (OR=1.68, 95% CI 1.23-1.76, p-value=0.01) and also increased risk for ADL disability (OR: 1.47, 95% CI 1.23-1.76, p-value=0.01). Abdominal obesity in baseline was also predictor of mobility disability in 2016 (OR: 1.93, 95% CI 1.17-3.17, p-value <0.01) but not for ADL disability (OR: 1.59, 95% CI 0.93-2.71, p-value =0.09) with accounting mortality.

CONCLUSION

Abdominal obesity is associated longitudinally and predicts mobility disability, even over a short period (4 years) in community-dwelling older adults from different epidemiological contexts.

ASSESSMENT OF RADIATION DOSE AND EXCESSIVE LIFE-TIME CANCER RISK FROM THE BUNAIR GRANITE, NORTHERN PAKISTAN

Natural radioactivity was measured in Bunair Granite using high purity germanium gamma-ray spectrometer and compared to world's granites and building materials to access its suitability for the construction purpose. Average gamma-activities of 226Ra, 232Th and 40K were found to be 52.41, 58.41 and 1130.12 Bq kg-1, respectively. The Indoor and outdoor radiation indices including excessive life-time cancer risk (ELCR) were calculated. The average indoor ELCR was estimated as 3.49 × 10-3. The average outdoor ELCR was assessed as 0.46 × 10-3. As a basic building material Bunair Granite should be on low propriety. For flooring, facing the buildings and as Table tops, in kitchens and other utilities it is safe.

The association of monocytes and Tregs with disease activity in rheumatoid arthritis

Background

Rheumatoid arthritis (RA) is an autoimmune condition characterised by inflamed joints. Disease-modifying anti-rheumatic drugs (DMARD) are ineffective in 30–40% of patients. CD169 (Siglec-1) is expressed by monocytes and correlates with disease activity in RA. It drives pro-inflammatory processes including the suppression of Tregs through its cognate ligand, CD169L. This study aims to define the relationship between CD169, CD169L and disease activity, as a potential early biomarker of treatment response.

Methods

Peripheral blood mononuclear cells were isolated from healthy controls and RA patients who failed DMARD treatment. FACS was used to: (i) immunophenotype CD169+ monocytes and CD169L+ Tregs, and (ii) assess levels of FoxP3 within Tregs.

Results

RA patients had a significantly higher percentage of CD169+ monocytes (28.47 ± 7.17, (mean ± SEM), n=19) compared to healthy controls (8.03 ± 1.48, n=19, p=&lt;0.01). A negative correlation was also observed between the percentage of CD169+ monocytes and CD169L+ Tregs in RA patients (r=−0.72, n=19, p=&lt;0.01). Furthermore, the ratio of CD169:CD169L percentages has a positive association with DAS28-ESR (r=0.77, n=9, p=0.02). FoxP3 is expressed at lower levels in RA patients (24.14 ± 1.87, n=25) compared with healthy controls (46.65 ± 6.16, n=13, p=&lt;0.01).

Conclusion

These results provide preliminary evidence of a relationship between CD169 and CD169L, and further define how their balance is associated with disease activity. Low levels of FoxP3 in RA patients indicates reduced Treg activation, which may cause increased disease activity. We postulate that this balance of cells is key in the immune response and could be used as a surrogate measure of disease activity.