Cancer statistics in Yemen: incidence and mortality, in 2020

BACKGROUND

The current cancer epidemiological profile in Yemen suffers from a lack of locally representative data and resources, posing a challenge in determining the real incidence, prevalence, survival and mortality rates, particularly data extracted from national hospitals. This study aims to provide a comprehensive overview of the cancer burden and trends in Yemen for 2020, including incidence and mortality rates.

METHODS

The current study provides cancer statistics and their trends in Yemen, including incidence and mortality, in 2020 by using descriptive statistics. The data was obtained using the Global Cancer Observatory (GCO) 2020 online database.

RESULTS

According to the (GCP) database in 2020, the crude incidence rate (CIR) of all cancers in Yemen was 55.2 per 100.000. The age-standardized rate (ASR) was 97.0 per 100.000, and the cumulative risk (0-74) was 22.0 per 100.000. The age-standardized rate (ASR) was 76.5 per 100.000, and the cumulative risk (0-74) was 19.6 per 100.000. Furthermore, the crude mortality rate (CIR) of all cancers was 40.6 per 100.000. Breast cancer was most prevalent in Yemen across all age groups and genders (31.1%), followed by colorectal cancer (7.7%) and leukemia (5.7%). Breast cancer also ranked as the primary cause of mortality at an estimated percentage of 13.5%, followed by colorectal cancer (8.8%) and stomach cancer (7.1%).

CONCLUSION

Cancer has become a significant life-threatening illness in Yemen with an increase in the disease burden of breast cancer in women. Furthermore, leukemia in children and colorectal cancer in both sexes have experienced a more significant burden as well. Therefore, it is imperative for initiatives for cancer control and prevention to be prioritised at national and regional levels.

Disclosure of genetic diversity of mackerel fish (Scomberomorus spp.) in Indonesian waters based on the mitochondrial cytochrome oxidase subunit II (COII) gene

Mackerel fish (Scomberomorus spp.) represents a significant marine fisheries commodity in Indonesia, characterized by its high commercial value and nutritional content. To understand the intraspecific interactions and genetic variability of Scomberomorus spp., a more extensive research of Scomberomorus spp. populations, including both cultivated and wild specimens, is required. This study aimed to explore the genetic diversity of mackerel fish in Indonesian waters, focusing on the mitochondrial DNA (mtDNA) cytochrome oxidase subunit II (COII) gene, which encodes the second subunit of cytochrome c oxidase (complex IV), is essential for aerobic respiration and energy transformation. Muscle tissue samples from 18 individual mackerel fish collected from various regions in Indonesia, including Palembang, Cilacap, Rembang, Banjarmasin, Ambon, and Fak-Fak Regencies, were utilized. The genomic DNA was isolated and amplified using specific primers: CO2TF (5'-ACCGCTCTGTCACTTTCTTC-3') and CO2TR (5'-ATGTCACTAAGGGTGGTTGG-3'). Subsequently, the obtained amplicons were subjected to sequencing. The sequence data were then analyzed using the MEGA11 and DnaSP 6 software. Our findings revealed 120 variable sites within the 691 base pairs of mtDNA COII sequences, resulting in a nucleotide diversity (Pi) of 0.07169. Furthermore, we identified eight haplotypes, demonstrating a haplotype diversity (Hd) of 0.8889. Remarkably, all mackerel samples from Palembang and Cilacap clustered into discrete haplotypes, specifically haplotype 1 and haplotype 2, respectively. Our phylogenetic analysis delineated three distinct clades. Clade I, closely related to Scomberomorus cavalla, encompassed all individuals from Ambon, Palembang, Rembang, and one from Banjarmasin. Clade II, associated with Scomberomorus niphonius, included individuals from Cilacap and two from Banjarmasin. Clade III, linked to Scomberomorus semifasciatus, exclusively consisted of individuals from Fak-Fak (Papua). In conclusion, Indonesian waters harbor diverse genetic variations within Scomberomorus spp., and population relationships based on the mtDNA COII gene exhibit notable complexities. Future research endeavors should focus on further elucidating the diversity and relationships among Scomberomorus spp. in diverse Indonesian populations.

Investigation on adaptations of broiler chickens to high dietary free amino acid levels in nitrogen utilisation and plasma amino acid concentrations

1. A reduction in crude protein (CP) in feed for broiler chickens necessitates elevated free amino acid (AA) levels to meet the requirement of each AA. This study investigated adaptations following a change to diets with increasing free AA concentrations and possible reasons for the limitation caused by the inclusion of more free AA.2. Male Ross 308 broiler hatchlings received a starter diet (164 g CP/kg containing 80 g/kg soy protein isolate (SPI)) until d 7. From d 7-22, birds received a diet almost identical to the starter diet or two other diets, where 50% or 100% of digestible AA in SPI were substituted with a free AA mixture. Birds were allocated to metabolism units located in the same barn to determine performance (n = 7 units) and blood traits (n = 14 birds). Total excreta collection was performed on d 7-8, 8-9, 9-10, 11-12, 14-15 and 21-22. Blood samples were collected on d 7, 8, 9, 11, 14 and 21.3. Average daily weight gain (ADG) and average daily feed intake (ADFI) was unaffected at 50% AA substitution but decreased at 100% AA substitution on d 7-22 (p ≤ 0.001). The 100% substitution led to a decline in ADG and ADFI consistently on all days (p ≤ 0.037) except on d 11-12. A 50% AA substitution resulted in lower ADFI on d 7-8 and 14-15 (p ≤ 0.032). Nitrogen utilisation efficiency (NUE) was on a level of ~ 0.74 and was only affected by treatment up to d 11-12 (p ≤ 0.008). Concentrations of 10, 9, 8, 10 and 4 plasma free AA were affected on d 8, 9, 11, 14 and 21, respectively (p ≤ 0.037).4. Following a change to diets containing high levels of free AA, NUE and free AA concentrations in the circulation became more balanced within 3 to 7 d. The results suggested that peptide-bound and free AA did not cause different NUE, particularly 3 and 7 d after the diet change.

Surgical Burden of Traumatic Lower Limb Amputations in the Pediatric Age Group

Although the burden of traumatic lower limb amputation (TLLA) has been well described when it concerns the adult population, there is an evident scarcity in literature concerning this matter in the pediatric population. Our objective is to review the surgical burden and long-term outcome of lower limb amputation among pediatric trauma victims who have experienced lower extremity amputation as the result of an accident or injury. A PICO format was utilized. The population of interest includes only children and adolescents suffering TTLA. The generation of data to be reviewed was executed using MEDLINE and PUBMED. Altogether, all data that includes trauma in the pediatric population in the timeframe 1949-2019 was revised and yielded 13 observational studies. This systematic review includes statistical comparisons between the group of interest of this review and the adult population. Other comparisons include those between the different sources. Our outcomes include a consistent pattern. This consistency between different studies was opposed by certain contradictions. Disparity between the different reviewed studies was displayed in terms of the distribution of the most cited complications of TLLA among different sources and the frequency of additional surgery. The dichotomy in the results of the reviewed studies highlights a gap in the data relevant to TLLA in the pediatric population. In addition to the discrepancies in the available literature, the significant physio-anatomical differences between the pediatric and the adult populations which are relevant to TLLA highlight a requirement for further studies regarding TTLA in the pediatric age group.

Development of assessment methods for photovoltaic module enhancing techniques using the lifespan parameter

The photovoltaic module (PV) enhancer is a technology used for improving the PV performance. Recently, much research has been conducted to propose new concepts of PV enhancer such as coolers and reflectors. The PV enhancer performance is assessed by the common existing methods available in the literature, which solely depends on total exergy or energy, volume, area, weight and the manufacturing cost. These assessment methods are useful but cannot assess the PV enhancer's performance when considering the lifespan parameter. Hence, this study is intended to solve the current problem by linking the lifespan parameter into the existing methods by proposing three enhanced assessment methods: yield times lifespan per cost per area, yield times lifespan per cost per volume and yield times lifespan per cost per weight. The PV enhancer with the highest values of these factors will have the optimum performance. The influential parameters and limitations of the enhanced assessment methods are investigated. It is shown that the proposed methods can assess and classify the performance of the PV enhancer with different models when the lifespan is considered in the analysis. These assessment approaches can be applied by manufacturers and designers of PV enhancers.

Validation study of AR Gynae endotrainer - a new mobile laparoscopic simulator

INTRODUCTION

In gynaecology, laparoscopy is the choice of treatment for a lot of procedures as it is considered safe and effective. However, laparoscopic surgery requires skills that are different from those required for open surgery. In order to acquire the skills, a surgeon needs specific training. The aim of this study was to validate the AR Gynae endotrainer, a new mobile laparoscopic simulator, as a comparable box trainer for gynaecology laparoscopic training, comparing it with the well-established Karl Storz SZABO-BERCISACKIER laparoscopic trainer.

MATERIALS AND METHODS

A randomised prospective crossover study was designed to compare the AR Gynae endotrainer versus Karl Storz SZABO-BERCI-SACKIER laparoscopic trainer as a tool for training gynaecology laparoscopic skills. Participants were assigned to perform two specially designed tasks used for laparoscopic training using both endotrainers. All subjects evaluated both simulators concerning their performance by the use of a questionnaire comparing: design, ports placement, visibility, ergonomics, triangulation of movement, fulcrum effect, depth perception, ambidexterity, resources for training, and resources for teaching. The overall score was defined as the median value obtained. The ability and time taken for participants to complete the tasks using both endotrainers were also compared. A total of 26 participants were enrolled in this study, including 13 Masters's students from the Department of Obstetrics & Gynaecology and 13 Masters's students from the Department of Surgery, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia.

RESULTS

A better performance was observed with AR Gynae as compared to Karl Storz endotrainer in five out of ten items evaluated in the questionnaire. Additionally, the overall score of AR Gynae endotrainer (median of 3.98) was comparable to that of Karl Storz endotrainer (median of 3.91) with p=0.519. For the items design and resources for teaching, the evaluation for AR Gynae endotrainer was significantly higher with p-values of 0.003 and 0.032, respectively. All participants were able to complete both tasks using both endotrainers. The time taken to complete both tasks was comparable on both endotrainers. Also, the AR Gynae endotrainer was cheaper.

CONCLUSIONS

The AR Gynae endotrainer was found to be a convenient and cost-effective laparoscopic simulator for gynaecology laparoscopic training and was comparable to the established Karl Storz SZABO-BERCI-SACKIER laparoscopic trainer.

EVALUATION OF MIDPALATAL SUTURE MATURATION IN THREE AGE GROUPS IN 10-25 YEARS USING CONE-BEAM COMPUTED TOMOGRAPHY

The decision to perform a palatal separation in cases of constricted maxilla has historically relied on the age of the patients. However, there is an increasing amount of literature suggesting that age should not be the only consideration in this decision.The primary objective of this study was to assess the prevalence of various stages of midpalatal suture maturation in age groups of adolescents, post-adolescents, and young adults. In addition, the objectives include the examination of potential correlations between maturation stages and different maxillary measurements.The sample comprised 180 CBCT scans of samples aged 10 to 25 years old consisting of 82 males and 98 females. According to Angelieri's method classification, in the cross-sectional axial slice, the midpalatal suture was categorized into five stages (A, B, C, D, E) based on the level of maturation observed. The samples were categorized into three distinct groups: adolescents, post-adolescents, and young adults. Stages A, B, and C were regarded as open midpalatal sutures, while stages D and E were regarded as partially or completely fused midpalatal sutures. Maxillary measurements were measured in the coronal slices at the level of maxillary first molar including buccal and palatal alveolar crest, palatal depth, palatal index and palatal vault angle.The most prevalent stage of MPS maturation was C (27.7%), followed by E (21.1%) and D (20.5%). The MPS was not fused in 105 of a total of 180 samples (58.3%) of the overall samples with stages A, B and C). In the males, the most prevalent Stage was D (23.1%); for females, the most prevalent stage was C (32.6%). within the age group 10-15 years. It was possible to determine the open midpalatal suture in (97.8%), but in the age group 16-20 years and 21-25 years the midpalatal suture was found opening in (44.3%) and (43.6%), respectively. Also, the maxillary width and depth were larger in males than in females. Conclusions: In a sample of 180, it was shown that the MPS was not united in 105 individuals, (CBCT) plays a crucial role in assessing the potential possibility of palatal disjunction. Positive correlation between stage and palatal depth.

Queen quality, performance, and winter survival of imported and domestic honey bee queen stocks

Canadian beekeepers have faced high colony mortality each winter over the last decade. Frequently citing "poor queen quality" as a top contributing factor to colony loss, Canadian beekeepers report needing to replace half their queens each year. Domestic queen production exists throughout Canada but is limited due to the short season and can be further limited when colony mortality is high. Consequently, Canadian beekeepers import over 260,000 queens annually, primarily from locations with warmer climates. In this study, newly mated imported queens from Hawaii (USA) and New Zealand were compared to domestic Canadian queens produced in British Columbia; these stocks were evaluated on their morphological and sperm storage characteristics. Stock quality was also evaluated in the field at two locations in Alberta, Canada over two production seasons. Our results show initial variation in queen morphology and fertility among imported and domestic queen stocks. Most striking, the New Zealand queens weighed 10-13% less than the Hawaii and British Columbia queens, respectively upon arrival. Colony performance over a two-year field study suggests: (1) brood pattern solidness has a positive nonlinear correlation with honey production regardless of queen stock and environment; (2) environment (i.e., apiary location) and queen stock variably predict colony health and productivity depending on year; specifically, apiary site appears to be a stronger predictor of colony health and productivity than queen stock in year one, but in year two, queen stock appears to be a stronger predictor than apiary site; (3) high clinical symptoms of chalkbrood may explain the prevalence of poor brood patterns in colonies headed by queens from New Zealand; (4) domestic queens are 25% more likely to survive winter in Alberta than imported queens. Therefore, it is important to consider possible mismatches in disease immunity and climate conditioning of imported queen stocks heading colonies in temperate regions that face drastically different seasonal climates and disease ecology dynamics.

PREDICTION OF IRON DEFICIENCY IN CHILDREN USING EASY LABORATORY TOOLS

Iron deficiency anemia is a common condition in children that can impair growth and development. This study aimed to evaluate the utility of easy, routinely available laboratory tests in predicting iron deficiency anemia. Medical records of 55 children (mean age 4.9±3.2 years) with laboratory evaluation of anemia were analyzed retrospectively. Parameters included complete blood count, serum iron, total iron binding capacity (TIBC), serum ferritin and transferrin saturation. Based on reference ranges, hemoglobin, hematocrit, serum ferritin and transferrin saturation were reduced below normal, indicating clear iron deficiency. Although within normal limits, red blood cell count, mean corpuscular volume, mean corpuscular hemoglobin and serum iron were close to lower limits, suggesting subtle deficiency. In contrast, red cell distribution width, platelet count, white blood cell count, TIBC and unsaturated iron binding capacity were unaffected. In conclusion, hemoglobin, and hematocrit from complete blood count, along with subtle changes in some of the red cell indices, can strongly suggest, iron deficiency anemia in children, Taking into consideration the increased body demand of iron in this age group with follow-up to ensure a desirable response, with less need for more advanced iron studies. These widely available, inexpensive tests may facilitate early detection and treatment of this common pediatric condition.

Intravenous thrombolysis for multi-ethnic Asians with acute ischaemia stroke in Malaysian public primary stroke centres versus acute stroke ready hospitals: Comparison of real-world clinical outcomes

INTRODUCTION

Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator is beneficial in acute ischaemic stroke (AIS). We aim to compare the realworld clinical outcomes and service efficiency of IVT in Malaysian primary stroke centres (PSCs) versus acute stroke ready hospitals (ASRHs).

MATERIALS AND METHODS

We conducted a multi-centre cohort study involving 5 PSCs and 7 ASRHs in Malaysia. Through review of medical records of AIS patients who received IVT from 01 January 2014 to 30 June 2021, real-world data was extracted for analysis. Univariate and multivariate regression models were employed to evaluate the role of PSCs versus ASRHs in post-IVT outcomes and complications. Statistical significance was set at p<0.05.

RESULTS

A total of 313 multi-ethnic Asians, namely 231 from PSCs and 82 from ASRHs, were included. Both groups were comparable in baseline demographic, clinical, and stroke characteristics. The efficiency of IVT delivery (door-toneedle time), functional outcomes (mRS at 3 months post- IVT), and rates of adverse events (intracranial haemorrhages and mortality) following IVT were comparable between the 2 groups. Notably, 46.8% and 48.8% of patients in PSCs and ASRHs group respectively (p=0.752) achieved favourable functional outcome (mRS≤1 at 3 months post-IVT). Regression analyses demonstrated that post-IVT functional outcomes and adverse events were independent of the role of PSCs or ASRHs.

CONCLUSION

Our study provides real-world evidence which suggests that IVT can be equally safe, effective, and efficiently delivered in ASRHs. This may encourage the establishment of more ASRHs to extend the benefits of IVT to a greater proportion of stroke populations and enhance the regional stroke care.

MRI TRAINING IN AFRICA

Introduction

This article presents an overview of MRI training in Africa, emphasizing its current status and the obstacles it encounters, with a report from a recent MRI workshop held in Uganda in September 2022. Africa's medical imaging sector faces unique challenges due to limited access to advanced technology, skilled professionals, and educational resources. While some regions have made notable strides in establishing MRI training programs, others struggle with a shortage of qualified MRI technicians and radiologists. These disparities underscore the urgent need for a more equitable distribution of resources and expertise across the continent. The aim of the MRI workshop was to initiate actions to address these challenges. This workshop leveraged the expertise of MRI clinicians and scientists to devise strategies for enhancing MRI training in Africa. The report outlines the key outcomes, recommendations, and initiatives resulting from this collaborative endeavor.

Conclusion

This report offers a crucial overview of MRI training in Africa, highlighting its challenges and disparities. It emphasizes the necessity of coordinated efforts to improve MRI education, ultimately contributing to enhanced healthcare outcomes for Africa's population.

Implementation and Effectiveness Outcomes of a Quality Improvement Intervention to Strengthen the Application of the World Health Organization Surgical Safety Checklist Tool in a Limited-Resource Setting

BACKGROUND

There is a disparity in the provision of quality and safe surgical care in Nigeria. The capacity to track surgical safety through the use of the surgical safety checklist tool is variable in this setting. This study aimed to assess the outcomes of training on this checklist and the results of its pilot implementation.

SUBJECTS, MATERIALS AND METHODS

A mixed-methods research comprising of quantitative and qualitative study designs was conducted to evaluate these 23 weeks intervention in our centre. Implementation was conducted in two phases: training of the surgical team and pilot testing of the intervention. Using the RE-AIM framework, implementation outcomes evaluated included reach of training, adoption of checklist and implementation challenges, while effectiveness outcomes evaluated included change in the knowledge score after the training and self-reported impact of the training and pilot test. Quantitative and qualitative data were collected and analyzed.

RESULTS

There was a 2.4-point significant increase in the knowledge score after the training. During the pilot testing phase, 843 patients had surgery. The weekly checklist utilization rate for elective surgery rose to 64% at project completion. Despite logistic and manpower-related implementation challenges, the training intervention facilitated the translation of participant knowledge into practice (81.5%) and the pilot phase had a high impact on the practice of checklist use (3.8 ± 0.9).

CONCLUSION

The quality improvement programme enhanced knowledge of checklist use and led to improved behaviour and positive organizational change. However, barriers need to be addressed to strengthen the sustainable use of the checklist tool.

Artificial Intelligence machine learning and conventional physical therapy for upper limb outcome in patients with stroke: a systematic review and meta-analysis

OBJECTIVE

The goal of this study was to compare the effect of different artificial intelligence (AI) machine learning and conventional therapy (CT) on upper limb impairments in patients with stroke.

MATERIALS AND METHODS

PubMed, PubMed Central, Google Scholar, MEDLINE, Cochrane Library, Web of Science, Research Gate, and Wiley Online Library were searched. Descriptive statistics about variables were reported to calculate standardized mean differences in outcomes of motor control (the primary outcome), functional independence, upper extremity performance, and muscle tone. The Physiotherapy Evidence Database (PEDro) Scale was used to assess qualitative papers. The primary outcomes of AI and CT have been included in the meta-analyses.

RESULTS

Ten papers with a total of 481 stroke patients were included and upper limb rehabilitation, upper limb functioning, and basic manual dexterity were examined. The heterogeneity test of the whole included measures (I2=45%) was medium. There were significant differences between the included measures (p-value=0.03) with a total SMD of 0.10 [0.01, 0.19]. According to the test for subgroup difference, it was found that there was a highly significant difference between the subgroups of the included measures (p-value=0.01) and the heterogeneity test (I2=59.8%).

CONCLUSIONS

AI is a feasible and safe method in post-stroke rehabilitation and improves upper-extremity function compared to CT. Significant AI post-treatment effects on upper-limb impairments have been observed. The findings showed that higher-quality evidence was detected in six assessment scales. However, a lower quality of evidence was detected in other scales. This indicated large or very large and consistent estimates of the treatment effects, and researchers were confident about the results. Therefore, the included observational studies are likely to provide an overestimate of the true effect.

Cryopreventive temperatures prior to chemotherapy

The superiority of oral cryotherapy (OC) for prevention of chemotherapy-induced oral mucositis (OM) has been demonstrated in several trials. In clinical settings, cooling is usually initiated prior to the chemotherapy infusion. It then continues during the infusion, and for a period after the infusion has been completed. While the cooling period post-infusion depends on the half-life of the chemotherapeutic drug, there is no consensus on when cooling should be initiated prior to the infusion. The lowest achieved temperature in the oral mucosa is believed to provide the best condition for OM prevention. Given this, it was of interest to investigate when along the course of intraoral cooling this temperature is achieved. In total, 20 healthy volunteers participated in this randomized crossover trial. Each subject attended three separate cooling sessions of 30 min each, with ice chips (IC) and the intraoral cooling device (ICD) set to 8 and 15 °C, respectively. At baseline and following 5, 10, 15, 20 and 30 min of cooling, intraoral temperatures were registered using a thermographic camera. The greatest drop in intraoral temperature was seen after 5 min of cooling with IC, ICD^8°C and ICD^15°C, respectively. A statistically significant difference, corresponding to 1.4 °C, was seen between IC and the ICD^15°C (p < 0.05). The intraoral temperature further declined throughout the 30 min of cooling, showing an additional temperature reduction of 3.1, 2.2, and 1.7 °C for IC, ICD^8°C and ICD^15°C, respectively.

The application of artificial intelligence in the detection of basal cell carcinoma: A systematic review

Basal cell carcinoma (BCC) is one of the most common types of cancer. The growing incidence worldwide and the need for fast, reliable and less invasive diagnostic techniques make a strong case for the application of different artificial intelligence techniques for detecting and classifying BCC and its subtypes. We report on the current evidence regarding the application of handcrafted and deep radiomics models used for the detection and classification of BCC in dermoscopy, optical coherence tomography and reflectance confocal microscopy. We reviewed all the articles that were published in the last 10 years in PubMed, Web of Science and EMBASE, and we found 15 articles that met the inclusion criteria. We included articles that are original, written in English, focussing on automated BCC detection in our target modalities and published within the last 10 years in the field of dermatology. The outcomes from the selected publications are presented in three categories depending on the imaging modality and to allow for comparison. The majority of articles (n = 12) presented different AI solutions for the detection and/or classification of BCC in dermoscopy images. The rest of the publications presented AI solutions in OCT images (n = 2) and RCM (n = 1). In addition, we provide future directions for the application of these techniques for the detection of BCC. In conclusion, the reviewed publications demonstrate the potential benefit of AI in the detection of BCC in dermoscopy, OCT and RCM.

Calcium-infused dehydrated pineapple

Mineral-infused dehydrated fruits could be an easy and most convenient way to healthy snacking for those who have mineral deficiencies. An attempt is made to impregnate selected minerals into fruit matrices by applying the vacuum impregnation process. Threelevel factorial experiment designs with two factors were used in this study. In order to increase stability and assure fruit preservation, impregnated pineapple samples were dehydrated to a water content below 10%. Calcium-infused dehydrated pineapple was compared with commercially available dehydrated pineapple. The sample contains 10 times and 2 times more calcium than their fresh counterpart and commercial dehydrated pineapple respectively. Yellow colour (b* value) was equal to commercial. Moisture content was 6-7%, compatible with both samples. Firmness (g) was far less by 117-point when compared to commercial. The sample had a liking score of 6 (out of 7). Four attributes had a greater liking score than commercial, except for chewiness (compatible with commercial). The panellists accept this product, and it could be a healthy snacking to enhance daily calcium intake.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

Sodium nitroprusside in acute heart failure: A multicenter historic cohort study

AIMS

Despite evidence of hemodynamic benefit of sodium nitroprusside (SNP) treatment for acute heart failure (AHF), there are limited data about its efficacy and safety. This study aimed to assess the effectiveness and safety of SNP treatment, to explore the impact of N-terminal pro-B natriuretic peptide (NT-proBNP) reduction on clinical endpoints and to identify possible predictors of clinical response.

METHODS AND RESULTS

Multicenter retrospective cohort study of 200 patients consecutively admitted for AHF in 2 Italian Centers. Primary endpoint was the reduction of NT-proBNP levels ≥25% from baseline values within 48 h from the onset of SNP infusion. Secondary and safety endpoints included all-cause mortality, rehospitalization for HF at 1, 3 and 6 months, length of hospital stay (LOS) and severe hypotension. 131 (66%) patients experienced a NT-proBNP reduction ≥25% within 48 h from treatment onset, irrespective of initial systolic blood pressure (SBP). Left ventricular end diastolic diameter (LVEDD) was the only independent predictor of treatment efficacy. Patients who achieved the primary endpoint (i.e., 'responders') had lower LOS (median 15 [IQR:10-27] vs 19 [IQR:12-35] days, p-value = 0.033) and a lower incidence of all-cause mortality and rehospitalization for HF at 1 and 3 months compared to "non responders" (p-value &lt;0.050). Severe hypotension was observed in 10 (5%) patients, without any adverse clinical consequence.

CONCLUSION

SNP is a safe and effective treatment of AHF, particularly in patients with dilated left ventricle. Reduced NT-proBNP levels in response to SNP is associated to shorter LOS and lower risk of 1- and 3-month re-hospitalizations for HF.

CLINICAL TRIAL REGISTRATION

http://www.

CLINICALTRIALS

gov. Unique identifier: NCT05027360.

Short-term risk prediction after major lower limb amputation: PERCEIVE study

BACKGROUND

The accuracy with which healthcare professionals (HCPs) and risk prediction tools predict outcomes after major lower limb amputation (MLLA) is uncertain. The aim of this study was to evaluate the accuracy of predicting short-term (30 days after MLLA) mortality, morbidity, and revisional surgery.

METHODS

The PERCEIVE (PrEdiction of Risk and Communication of outcomE following major lower limb amputation: a collaboratIVE) study was launched on 1 October 2020. It was an international multicentre study, including adults undergoing MLLA for complications of peripheral arterial disease and/or diabetes. Preoperative predictions of 30-day mortality, morbidity, and MLLA revision by surgeons and anaesthetists were recorded. Probabilities from relevant risk prediction tools were calculated. Evaluation of accuracy included measures of discrimination, calibration, and overall performance.

RESULTS

Some 537 patients were included. HCPs had acceptable discrimination in predicting mortality (931 predictions; C-statistic 0.758) and MLLA revision (565 predictions; C-statistic 0.756), but were poor at predicting morbidity (980 predictions; C-statistic 0.616). They overpredicted the risk of all outcomes. All except three risk prediction tools had worse discrimination than HCPs for predicting mortality (C-statistics 0.789, 0.774, and 0.773); two of these significantly overestimated the risk compared with HCPs. SORT version 2 (the only tool incorporating HCP predictions) demonstrated better calibration and overall performance (Brier score 0.082) than HCPs. Tools predicting morbidity and MLLA revision had poor discrimination (C-statistics 0.520 and 0.679).

CONCLUSION

Clinicians predicted mortality and MLLA revision well, but predicted morbidity poorly. They overestimated the risk of mortality, morbidity, and MLLA revision. Most short-term risk prediction tools had poorer discrimination or calibration than HCPs. The best method of predicting mortality was a statistical tool that incorporated HCP estimation.

Indocyanine Green to Visualize and Resect Pulmonary Sequestration in Adults

Pulmonary sequestration (PS) is a rare congenital pulmonary dysplasia which presents with recurrent chest infections and haemoptysis. Its diagnosis is difficult and suspected on contrast-enhanced chest CT. The definitive treatment of pulmonary sequestration is surgical resection or endoluminal occlusion of the abnormal feeding vessel. Here, we report an innovative technique in which per-operative indocyanine green guided excision of intra-lobar sequestrated lung parenchyma and ligation of abnormal feeding vessel. The first patient was a 44-year-old gentleman with recurrent bouts of cough for 2 years. Courses of antibiotics failed to resolve it. Fibreoptic bronchoscopy and routine blood tests did not show any abnormality. CECT chest showed multiloculated cystic solid and low density mass in the right lower lung. The area of the lesion received its blood supply from anomalous systemic artery originating from coeliac trunk. Intraoperative, indocyanine green was injected into the atypical vessel, and pulmonary sequestration turned green. A sequential atypical lung resection could be completely removed with parenchyma preservation. The second patient was a 53-year-old lady presenting with chest pain, cough and expectoration for 2 years not responding to general management and antibiotics. CECT showed a low-density mass in the right lower lung lobe, with a feeding arterial vessel arising from the abdominal aorta. This was diagnosed as PS and resected using per-operative indocyanine green with parenchymal preservation and ligation of feeding vessel. Both patients have been followed up for at least 1 year and are symptom free. The intraoperative use of indocyanine green could greatly facilitate the presentation of the extent of a lung sequestration and safe resection.

Memory, neurogenic protein and oxidative deficits of frontal cortex following chlorpyrifos/dichlorvos exposure in rats

Objective: The use of xenobiotics to boost agricultural productivity has led to toxic chemicals exposure including organophosphates, causing adverse health outcomes including behavioral and neuronal impairments. This study aimed to evaluate the memory indices, possible oxidative and cholinesterase outturnson the frontal cortices of rats exposed to organophosphates.Methodology: Thirty-two Wistar rats were grouped into four. They received 1ml/kg of Normal, 8.8 mg/kg dichlorvos, 14.9 mg/kg chlopyrifos, and 8.8 mg/kg dichlorvos plus 14.9mg/kg chlorpyrifos respectively. They had training trials in the Y Maze paradigm then spatial working memory assessment. They were euthanized 24hours following exposure and tissues excised for analysis.Results: A marked reduction in metabolic markers, Acetylcholine Esterase (AChE) activity, spatial memory indices and proliferative neuron marker (Ki67) were observed. Also, increase in oxidative stress markers in the frontal cortices of the organophosphates exposed rats.Conclusion: The findings demonstrated neurotoxic effects of organophosphates in rats.

community pharmacists’ experiences and beliefs towards providing pharmacy services to deaf and hard of hearing patients: a mixed-method study in Riyadh, Saudi Arabia

Introduction

Provision of pharmacy services to patients requires the pharmacist to well communicate with the patients. Research has shown that healthcare providers, including community pharmacists, face many challenges while providing services to deaf and hard-of-hearing patients (DHOH).

Aim

To investigate community pharmacists’ experiences and beliefs about providing pharmacy services to DHOH in Riyadh, Saudi Arabia.

Methods

This was a sequential explanatory mixed-method study involving a survey and semi-structured interviews. At first, a web-based, self-administered survey was disseminated to community pharmacists in Riyadh, Saudi Arabia during the period October to November 2020. The survey was disseminated through the official twitter account of Saudi Pharmaceutical Society. Two reminders were sent. It was made clear that the survey targeted community pharmacists working in Riyadh city. To calculate an appropriate sample size, according to Hair et al, the general rule to have a minimum sample size would be five observations per variable (5:1), and an acceptable sample size would be ten observations per variable (10:1). In this survey, there are 16 items, and hence the acceptable sample size was 160 participants. The semi-structured telephone-based interviews were conducted with a purposive sample of survey respondents to gather in-depth information on experiences, beliefs, and barriers about providing pharmacy services to DHOH. The interviews were conducted until saturation occurred. Survey data was analysed using Statistical Package for Social Sciences (SPSS version 24), and the semi-structured interviews were analysed by Framework analysis.

Results

A total of 175 community pharmacists completed the survey. The majority were: male (84.6%), aged between 25 to 35 years (74.9%). Of the respondents, 32.2% and 29.1% had experience in community pharmacy of 1-5 and 6-10 years, respectively. The number of DHOH patients the pharmacists met during the past 6 months were as follows: 68 (38.9%) pharmacists met 1-2 patients, 71 (40.6%) %) pharmacists met 3-4 patients, and 19 (11%) %) pharmacists met ≥ 5 patients. The provided services included: prescription medications (by 82.9%), counselling on prescription medications (by 56.6%), OTC medication dispensing (by 4.3%), and counselling on OTC medications (by 52.6%). Forty participants (22.8%) reported their awareness of the basics of Saudi sign language (SSL). Of the participants, 101 (57.7%) believed that they have handled communication barriers appropriately, while 61(35%) acknowledged unmanageable communication barriers. Among the main barriers identified were the lack of knowledge of the basics of SSL. (70.9%) and the inability to recognize disability (52.6%). The semi-structured interviews further explored pharmacists’ experiences and views on providing such a service. Of the main themes emerged were: (1) Experience; interviewees preferred written communication with DHOH patients regardless of their literacy level, while spontaneous hand gesturing was the least preferred method of communication, and they also acknowledged that their roles in providing services, to the DHOH, need to be improved (2) Beliefs; interviewees believed that awareness of the basics of SSL is important to ensure safe medication use. The barriers emerged from the interview were classified as pharmacist-related, system-related, and patient-related.

Conclusion

To our knowledge, this is the first study of its kind to be conducted in Saudi Arabia. The study highlighted that when providing pharmacy services to DHOH patients, community pharmacists encountered multiple barriers. These barriers need to be addressed for better support and provision of pharmacy services to DHOH. Further studies with large sample size, are warranted to better understand the situation.

References

(1) Hair J, Black W, Babin B, Anderson R. Multivariate data analysis. 7th ed. Harlow: Pearson Education Limited; 2014

(2) Scheier DB. Barriers to health care for people with hearing loss: a review of the literature. J N Y State Nurses Assoc. 2009 Mar 22;40(1):4-11.

(3) Ferguson MC, Shan L. Survey evaluation of pharmacy practice involving deaf patients. Journal of pharmacy practice. 2016 Oct;29(5):461-6.

257 Comparing Practice Testing to Restudying in the Dissecting Room: An Experimental Study

Aim

Medical students employ many strategies for learning, most commonly restudying. However, evidence suggests that restudying is not as effective as other strategies, namely practice testing. Different studies have compared restudying to practice testing on a variety of subjects. Few studies have assessed the effect of practice testing in anatomy courses. To the best of the authors' knowledge, no studies have investigated practice testing in the dissecting room (DR). In this study, we aim to measure the effect of practice testing in a DR setting, as compared to restudying.

Method

Second-year medical students learning the cardiovascular system were included in the study. Two groups were randomly selected to participate in practice tests taken at the end of DR sessions. The other two groups were asked to restudy the material. At the end of the four-week course, all students took a 15 points multiple-choice exam on learned material. Authors of practice tests were blind to the final exam content and vice versa.

Results

One hundred eight students participated in the study. Fifty-three students were in the practice testing group, and 55 were in the restudying group. The practice testing group performed significantly better than the restudying group (p = .008), with a mean of 8.57 +/- 2.3 for the practice testing group and 7.27 +/- 2.6 for the restudying group.

Conclusions

Practice testing significantly improved retention of Anatomy. We recommend that practice testing is implemented regularly at the end of DR sessions to enhance the learning experience.

259 Effect of Telegram Videos on Anatomy Education Among 2nd Year Medical Students, University of Khartoum, 2021

Aim

COVID-19 had major effect on the health and medical education. In order to oblige with the social distancing and quarantine, universities shifted to online learning. This study aimed to assess the effect of online education on anatomy DR (dissection room) teaching by the use of telegram software.

Method

This was a cross-sectional, prospective interventional study, which was carried out among 2nd year medical students in University of Khartoum. Students undertook initial tests on the heart and anterior abdominal wall modules. Telegram videos, prepared by the author, on the anatomy of the heart and the anterior abdominal wall were distributed to students. Students took a second test after watching the videos. A total number of 41 students attended heart sessions and 40 students attended the anterior abdominal wall sessions were included.

Results

The pre-test mean score for the heart and abdomen modules were 4.56 ± 2.335 and 6.15 ± 2.94, respectively. The post-tests means were 9.98 ± 2.877 and 8.95 ± 3.14, respectively. 90% and 75% of the students were satisfied with these videos, respectively.

Conclusions

This study revealed that Telegram videos as a method of online teaching had a positive effect on the students' performance, which was evidenced by the significant improvement in student's scores after watching the videos. Additionally, most of the students were satisfied with the videos and give positive feedback.

255 An Audit on the Knowledge of Junior Doctors About DKA at a Local Hospital, Khartoum, Sudan

Aim

DKA is the most common cause of death in pediatric patients with insulin-dependent diabetes mellitus (IDDM). Junior doctors have a significant role in the management of those patients. We conducted this audit to assess and improve the knowledge of house officers about the characteristic features and management of DKA.

Method

The audit was conducted in Alshuhada hospital, Khartoum. It consisted of two cycles (2019–2021). A 14 items questionnaire based on Sudan Diabetes Mellitus guidelines 2011 was used for the assessment. All house officers in the department of pediatrics were involved in this study. Teaching sessions were used as an intervention in the first cycle, while poster presentations and teaching sessions were used in the second cycle.

Results

Nine house officers participated in the first cycle, while seven house officers were involved during the second cycle. The correct choice of initial fluid correction was selected by 55.5%, 88.8%, and 100% of the house officers before the first cycle, after the first cycle, and after the second cycle, respectively. The figures for the initial management of cerebral edema also rose from 33.3% to 66.7% after the first cycle and reached 100% after the second cycle. The percentage of house officers who identified Investigations needed in suspected cases of DKA improved with each cycle, from 66% to 77% in the first cycle and increased to 100% after the second cycle.

Conclusions

Teaching sessions and posters helped to improve the knowledge of the House officers about the diagnosis and management of DKA.

Test-Retest Data for the Assessment of Breast MRI Radiomic Feature Repeatability

Background

Radiomic features extracted from breast MRI have potential for diagnostic, prognostic, and predictive purposes. However, before they can be used as biomarkers in clinical decision support systems, features need to be repeatable and reproducible.

Objective

Identify repeatable radiomics features within breast tissue on prospectively collected MRI exams through multiple test–retest measurements.

Study Type

Prospective.

Population

11 healthy female volunteers.

Field Strength/Sequence

1.5 T; MRI exams, comprising T2‐weighted turbo spin‐echo (T2W) sequence, native T1‐weighted turbo gradient‐echo (T1W) sequence, diffusion‐weighted imaging (DWI) sequence using b‐values 0/150/800, and corresponding derived ADC maps.

Assessment

18 MRI exams (three test–retest settings, repeated on 2 days) per healthy volunteer were examined on an identical scanner using a fixed clinical breast protocol. For each scan, 91 features were extracted from the 3D manually segmented right breast using Pyradiomics, before and after image preprocessing. Image preprocessing consisted of 1) bias field correction (BFC); 2) z‐score normalization with and without BFC; 3) grayscale discretization using 32 and 64 bins with and without BFC; and 4) z‐score normalization + grayscale discretization using 32 and 64 bins with and without BFC.

Statistical Tests

Features' repeatability was assessed using concordance correlation coefficient(CCC) for each pair, i.e. each MRI was compared to each of the remaining 17 MRI with a cut‐off value of CCC > 0.90.

Results

Images without preprocessing produced the highest number of repeatable features for both T1W sequence and ADC maps with 15 of 91 (16.5%) and 8 of 91 (8.8%) repeatable features, respectively. Preprocessed images produced between 4 of 91 (4.4%) and 14 of 91 (15.4%), and 6 of 91 (6.6%) and 7 of 91 (7.7%) repeatable features, respectively for T1W and ADC maps. Z‐score normalization produced highest number of repeatable features, 26 of 91 (28.6%) in T2W sequences, in these images, no preprocessing produced 11 of 91 (12.1%) repeatable features.

Data Conclusion

Radiomic features extracted from T1W, T2W sequences and ADC maps from breast MRI exams showed a varying number of repeatable features, depending on the sequence. Effects of different preprocessing procedures on repeatability of features were different for each sequence.

Level of Evidence

2

Technical Efficacy Stage

1

Inorganic nitrate attenuates endothelial dysfunction consequent to systemic inflammation

Introduction

Chronic cardiovascular diseases are characterised by low-grade systemic inflammation and attenuated nitric oxide (NO) bioavailability resulting in endothelial dysfunction. Inorganic nitrate augments NO bioavailability and improves markers of vascular dysfunction in patients with cardiovascular risk factors. However, the exact mechanism of this effect is uncertain.

Purpose

To determine whether inorganic nitrate supplementation alters systemic inflammation-induced endothelial dysfunction.

Methods

62 healthy male volunteers were randomised 1:1 to receive ∼8–10 mmol of dietary inorganic nitrate in beetroot juice or nitrate-free beetroot juice (placebo) once daily for 6 days. Measures of brachial artery flow-mediated dilatation (FMD), brachial blood pressure (BP), pulse wave analysis and carotid-femoral pulse wave velocity (PWV) by Vicorder were taken prior to and at 8 hours after a typhoid vaccine (to induce mild systemic inflammation). Plasma, urine and saliva samples were also collected. Clinicaltrials.gov: NCT02715635.

Results

Baseline characteristics were similar between the two groups. Inorganic nitrate significantly elevated plasma nitrite (placebo = Δ0.02±0.5 μM, inorganic nitrate = Δ0.63±1.2 μM; p=0.01) and nitrate levels (p&lt;0.0001) compared to placebo. There were significant increases in urine nitrite (p&lt;0.0001) and nitrate (p&lt;0.0001) in addition to salivary nitrite (p&lt;0.0001) and nitrate (p&lt;0.0001) compared to placebo. After 8 hours, typhoid vaccine induced an increase in circulating white cells (placebo = Δ3.34±3.37x109/L, inorganic nitrate = Δ2.9±2.78x109/L; p=0.58) that was similar in in both arms. However, there was a significant reduction in the FMD response in the placebo group at 8-hours post vaccine; an effect that was absent in volunteers treated with inorganic nitrate (placebo = Δ−1.33±1.53%, inorganic nitrate = Δ−0.07±1.84%, p=0.005). Importantly, there were no statistically significant differences in baseline vessel diameter (p=0.78), time to peak diameter in response to flow (p=0.87) and peak shear rate (p=0.57) between the groups. When comparing change from baseline to 8 hours after the vaccine, there were no significant differences in brachial systolic BP (p=0.12), central systolic BP (p=0.12) and PWV (p=0.60) between groups, but a significant reduction in brachial diastolic BP in the inorganic nitrate group (p=0.048).

Conclusions

Inflammation-induced endothelial dysfunction was prevented in those receiving dietary inorganic nitrate suggesting that elevating circulating nitrite and delivering NO to the blood vessel wall, through dietary approaches may offer potential therapeutic benefit in those cardiovascular diseases which typically exhibit low grade inflammation and deficiencies in bioavailable NO.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): British Heart Foundation

280 The Use of Telemedicine in Plastics Surgery During COVID-19: A Single-Centre Correlation Study with Patient Reported Outcome Measures

Aim

With enforcement of social distancing measures during the COVID-19 pandemic, face-to-face patient contact was shifted to telemedicine consultations. There is limited evidence evaluating patient experience of follow-ups and expectations into quality metrics. Our aim was to perform a service evaluation by prospectively evaluating the management and outcomes of plastic surgery patients.

Method

Patients were consecutively assessed over the COVID-19 lockdown period, from March to May 2020. They ranged from urgent cancer cases to burns and trauma. We used a questionnaire to evaluate initial treatment, wound care, complications, and overall service. A validated health-related quality of life (HRQL) survey was used to assess the impact of injury or wound on lifestyle and we also assessed patient enablement. Correlation analysis determined relationships between outcomes, service evaluations and HRQL variables.

Results

77 patients were consecutively treated in our unit, of which 46 completed the questionnaire. 42.2% used multimedia as mode of follow-up, including smart phones for messages and videocalls, and trust e-mails. There was a 3-fold increase in number of infections for non-face-to-face consultations, with a correlation significance of 0.043. We found no correlation between age and wound complication rates. 72.7% of patients found overall service very good or excellent. Although overall service satisfaction was similar for multimedia use and face-to-face consultations (p = 0.02), less patients were confident looking after their wound without face-to-face follow-ups.

Conclusions

COVID-19 has brought upon an unprecedented change in practice in our department. Implementing multimedia use and educating patients on wound care can significantly improve efficiency and service provision.

1255 Crowdedness and Consequences of Long Waiting Time in Public and Private Health Centers Among Patients in Khartoum State, Sudan - 2016

Aim

Waiting time (WT) reflects quality of services delivered by Primary health care level. Long waiting time is due to various causes, among which crowdedness is a main cause. This prolonged time has negative impacts on PHC services utilization as well as patients’ outcomes. The aim of this study is to measure the total WT, assess the crowdedness in PHC centers, and to determine the possible consequences of this long waiting time.

Method

Descriptive cross sectional– health institution-based study done in 40 Health centres across Khartoum state using randomized multi-stage sampling. Patients, doctors and lab technicians were interviewed using three different pre-tested structured questionnaires.

Results

A total of 477 patients were included in the study. The average waiting time was found to be 168 minutes. Crowdedness was one of the main causes of delay in waiting time. The lab was the most perceived crowded service (74.4% of the respondents). This long WT had health consequences on patients, ranging from backache, joint pain, and headaches to hypoglycemic symptoms. These symptoms affected patients' willingness to return to the same center. 36.4% of the affected patients were unwilling to revisit the same center.

Conclusions

WT in this study is longer compared to studies from other countries. Crowdedness is one of the main causes of long WT. Due to this prolonged time, patients experienced physical symptoms. It also affected their future attitude regarding PHC centers utilization. There is a need to understand the underlying causes of this issue and address them appropriately.

Seasonal bias in global ocean color observations

In this study, we identify a seasonal bias in the ocean color satellite-derived remote sensing reflectances (Rrs(λ);sr-1) at the ocean color validation site, Marine Optical BuoY. The seasonal bias in Rrs(λ) is present to varying degrees in all ocean color satellites examined, including the Visible Infrared Imaging Radiometer Suite, Sea-Viewing Wide Field-of-View Sensor, and Moderate Resolution Imaging Spectrometer. The relative bias in Rrs has spectral dependence. Products derived from Rrs(λ) are affected by the bias to varying degrees, with particulate backscattering varying up to 50% over a year, chlorophyll varying up to 25% over a year, and absorption from phytoplankton or dissolved material varying by up to 15%. The propagation of Rrs(λ) bias into derived products is broadly confirmed on regional and global scales using Argo floats and data from the cloud-aerosol lidar with orthogonal polarization instrument aboard the cloud-aerosol lidar and infrared pathfinder satellite. The artifactual seasonality in ocean color is prominent in areas of low biomass (i.e., subtropical gyres) and is not easily discerned in areas of high biomass. While we have eliminated several candidates that could cause the biases in Rrs(λ), there are still outstanding questions regarding potential contributions from atmospheric corrections. Specifically, we provide evidence that the aquatic bidirectional reflectance distribution function may in part cause the observed seasonal bias, but this does not preclude an additional effect of the aerosol estimation. Our investigation highlights the contributions that atmospheric correction schemes can make in introducing biases in Rrs(λ), and we recommend more simulations to discern these influence Rrs(λ) biases. Community efforts are needed to find the root cause of the seasonal bias because all past, present, and future data are, or will be, affected until a solution is implemented.

The efficacy and safety of a nurse-led electrical cardioversion service for atrial fibrillation over a two-year time period

Funding Acknowledgements

Type of funding sources: None.

Background & Purpose

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide, with a significant impact on morbidity, mortality and utilisation of healthcare resources. Electrical direct-current cardioversion (DCCV) is offered to patients with ongoing symptoms despite medical management. In this study we aim to evaluate the safety and efficacy of a specialised nurse-led DCCV cardioversion service. 

Methods

This was a retrospective cohort study analysing the outcome of patients presenting with atrial fibrillation or flutter, who were subsequently referred for a nurse-led DCCV procedure between August 2017 and December 2019. 

Results

Analysis included a total of 341 patients (mean age = 68.37; STDV = 10.96) who presented with either atrial fibrillation (N = 267; 78.30%) or atrial flutter (N = 74; 21.70%). Approximately 30% of patients were female (N = 101); and 70% were male (N = 240). Of the 341 patients who underwent DCCV, 299 were successfully cardioverted (87.68%), whilst 42 patients remained in AF (12.32%). Of those patients successfully cardioverted, 167 remained in sinus rhythm after 6 weeks (55.85%); 93 patients reverted back to AF (31.10%). 38 patients were lost to follow up (12.71%). Of all 341 patients who underwent DCCV, only 24 patients were admitted to hospital during the subsequent 3 month period (7.04%). Of these admissions, 11 were due to persistent AF (45.83%), and 13 were due to other non-related reasons (54.17%). Importantly, no patients were admitted as a direct complication of the DCCV procedure. 

Using a Chi-squared analysis, we found a significant difference in cardioversion success rates between patients presenting with atrial flutter (97% success rate) versus those in atrial fibrillation (85% success rate) (χ2 = 8.089; p = 0.004; α&lt;0.05). We did not find a significant difference in cardioversion success rates between males and females (χ2 = 1.651; p = 0.199; α&lt;0.05); nor did we witness a significant impact from the presence of ischaemic heart disease (χ2 = 1.545; p = 0.214; α&lt;0.05) or hypertension (χ2 = 2.075; p = 0.150; α&lt;0.05). Similarly, we found negligible impact of LV ejection fraction (χ2 = 1.494; p = 0.684; α&lt;0.05) or LA size (χ2 = 1.310; p = 0.727; α&lt;0.05) upon cardioversion success rates.  We witnessed a dramatic improvement in DC cardioversion success rates in patients taking antiarrhythmic medication in preference to a rate control strategy alone (χ2 = 11.825; p = 0.008; α&lt;0.05). 

Conclusion

Overall, data gathered from this study provides positive evidence to support the use of a nurse-led DCCV service. In addition to obtaining very successful cardioversion rates, we found low remission rates, with a very low hospital readmission rate for AF related issues after successful DCCV.

Changing susceptibility pattern of Neisseria Gonorrhoeae: A threat to management of sexually transmitted infections - Case series

Gonorrhoea is a sexually transmitted infection (STI) that increases the risk of infection with human immunodeficiency virus (HIV) and causes infertility and urethral stricture. We describe three cases of sexually active men, otherwise stable, who presented with a history of painful micturition and creamy white, urethral discharge. A clinical diagnosis of gonococcal urethritis was made and confirmed by microscopy, culture and 16SrRNA. Antimicrobial susceptibility revealed resistance to all the antimicrobial agents tested including ceftriaxone. A dual therapy was initiated using ceftriaxone and azithromycin, but at a higher dose for the patient with multi-drug resistant (MDR) Neisseria gonorrhoeae. Patients did well and were followed up for 5 months. Contact tracing was done for their sexual partners. While it is also important for healthcare workers to familiarize themselves with current treatment guidelines for gonococcal urethritis, the place of clinical laboratory in the management of STIs, with molecular techniques and the need for surveillance for MDR Neisseria gonorrhoeae cannot be overemphasized.

388 Detection of Cytomegalovirus Infection in Infants with Biliary Atresia: A Meta-analysis

Introduction

Biliary atresia (BA) is the most common indication of liver transplantation in children. Several reports attributed BA to both prenatal and perinatal aetiologies, including a viral infection-induced auto-immune response that targets the bile ducts. Cytomegalovirus (CMV) remains the most common virus being linked to BA. This meta-analysis estimates to what extent CMV infection is detected in patients with BA.

Method

This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases of MEDLINE/PubMed, WHO-Virtual Health Library (VHL), ScienceDirect, and Google Scholar were used for the systematic search. Random effects model was used to estimate the pooled prevalence estimate with the corresponding 95% confidence interval (CI) using StatsDirect statistical software.

Results

A total of 13 studies (covering 419 patients) that fulfilled the eligibility criteria were included in the meta-analysis. The pooled overall prevalence of CMV infection in patients with BA was 24.5% (95% CI 11.9 %– 33.9%).

Conclusions

The available data demonstrate that the detection of CMV infection is common in infants with BA. There is still a need for large studies with appropriate controls to examine various aspects of the association between CMV infection and BA.

Particulate Backscattering in the Global Ocean: A Comparison of Independent Assessments

How well do we know the particulate backscattering coefficient (b_bp) in the global ocean? Satellite lidar b_bp has never been validated globally and few studies have compared lidar b_bp to b_bp derived from reflectances (via ocean color) or in situ observations. Here, we validate lidar b_bp with autonomous biogeochemical Argo floats using a decorrelation analysis to identify relevant spatiotemporal matchup scales inspired by geographical variability in the Rossby radius of deformation. We compare lidar, float, and ocean color b_bp at the same locations and times to assess performance. Lidar b_bp outperforms ocean color, with a median percent error of 18% compared to 24% in the best case and a relative bias of -11% compared to -21%, respectively. Phytoplankton carbon calculated from ocean color and lidar exhibits basin-scale differences that can reach ±50%.

Detection of cardiac allograft vasculopathy by multi-layer left ventricular longitudinal strain in heart transplant recipients

Cardiac allograft vasculopathy (CAV) is an obliterative and diffuse type of coronaropathy that develops in the transplanted human heart, representing a major cause of graft failure and mortality. Nowadays the gold standard for the diagnosis of CAV is coronary angiography (CA). Non-invasive CAV detection, especially in the early stages of the disease, is still challenging. Our study aimed to investigate the role of speckle tracking echocardiography (STE), in particular three-layer STE, in predicting CAV at early stages, and if other traditional echocardiographic, clinical or biochemical parameters could relate to CAV. The study population was composed of a total of 33 heart transplanted patients, divided accordingly to the presence or absence of CAV (12 CAV+ , 22 CAV-). All subjects underwent a complete transthoracic echocardiographic examination on the same day of the CA, and all conventional parameters of myocardial function were obtained, including strain values assessed by STE. Strain values were significantly reduced in presence of CAV, at each myocardial layer but in particular the endocardial-epicardial gradient (- 4.15 ± 1.6 vs - 1.7 ± 0.4% < .0001) that was also highly predictive of CAV (AUC at ROC curve 0.97). Among diastolic parameters, the E wave deceleration time (DT) and the mean E/e' ratio were strongly positively associated with CAV. In our population, left ventricular global longitudinal strain (GLS), layer-specific GLS and the endocardial-epicardial LS gradient, E wave DT and E/e' ratio were the best independent non-invasive predictors of CAV.

Influence of the photoinitiating system on the properties of photopolymerized methylmethacrylate: the role of the ketyl radical in type II photoinitiators

The photopolymerization of methylmethacrylate using different initiating systems strongly affects its glass transition temperature and dispersity.

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.