Antineutrophil cytoplasmic antibody-associated vasculitis with systemic sclerosis: a fatal case report

Introduction and importance

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a rare co-occurrence with systemic sclerosis, in around 2.5-9% of patients. The clinical manifestations and prognosis of vasculitis in systemic sclerosis depend on organ involvement. It presented with rapidly progressive acute renal failure without malignant hypertension, and with pitting hand and foot ulcers get along with purpuric vasculitis in some cases reports. Reports had found that survival in those with pulmonary-renal syndrome is poor. However, high-dose corticosteroids and cyclophosphamide increase the survival percent in those patients.

Case presentation

An 81-year-old female was admitted for newly diagnosed acute renal failure and highly elevated C-reactive protein levels. She was diagnosed with systemic sclerosis 8 years previously, with a 3-year history of interstitial lung disease, and a 2-year history of pulmonary hypertension. Treatment included home oxygen on demand, prednisone 5 mg/day, and azathioprine 75 mg daily. On physical examination, she had sclerodactyly, both extremities ulcers, severe livedo reticularis, and hyperpigmented papules on her hand and feet. Laboratory findings included a markedly positive MPO (p-ANCA), and anti-Scl-70. She was treated with pulse methylprednisolone without any improvement. After a day, she developed anuria and became comatose. Then, she developed cardiac arrest, leading to death.

Clinical discussion

The presence of ANCA in systemic sclerosis patients ranges from 2.5 to 9% of systemic sclerosis patients. It presented with rapidly progressive acute renal failure without malignant hypertension, and with pitting hand and foot ulcers. The treatment with high-dose corticosteroids and cyclophosphamide is benefit. Survival in those with pulmonary-renal syndrome is poor.

Conclusion

The presence of ANCA-associated vasculitis is rarely reported with scleroderma. It occurs most commonly in women with limited or Calcinosis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia (CREST) variants of scleroderma, as well as those with overlap features. Severe manifestations including pulmonary-renal syndrome and death may occur.

Fatal rhabdomyolysis caused by COVID-19 infection: a case report

COVID-19 is a systemic viral disease complicated with medical conditions. Severe rhabdomyolysis during the COVID-19 course is not until now well known.

Case presentation

The authors presented a 48-year-old female with fatal rhabdomyolysis caused by COVID-19 infection. She was referred to us with cough, generalized myalgia and arthralgia, and fever during the last week. Laboratory results showed an elevated erythrocyte sedimentation rate, elevated C-reactive protein level, and elevated creatine kinase. The nasopharyngeal swab confirmed the diagnosis of coronavirus 2 RNA infection. She was managed initially in the COVID-19 isolation department. Three days later, she was transferred to the intensive care unit and mechanically ventilated. Laboratory results were consistent with rhabdomyolysis. She died because of cardiac arrest due to continuous hemodynamic deterioration.

Clinical discussion

Rhabdomyolysis is a serious condition that can be fatal or cause disability. Rhabdomyolysis cases have been reported in COVID-19 patients.

Conclusion

Rhabdomyolysis cases have been reported in COV19 patients. Further studies are needed to understand the mechanism and to optimize the treatment.

Safety profile and outcomes of intraoperative ultrasound-guided remnant cholecystectomy

INTRODUCTION

Subtotal cholecystectomy (STC) is a safe approach in difficult cholecystectomies to prevent bile duct and vascular injury. However, the gallbladder remnant can become symptomatic, necessitating further surgical intervention. This study evaluates the safety profile and perioperative outcomes of remnant cholecystectomy (RC) performed under intraoperative ultrasound guidance.

METHODS

We retrospectively reviewed the records of all patients that underwent RC under intraoperative ultrasound guidance in 2009 and 2019. Pre-, intra- and postoperative details of patients who underwent RC were obtained from patients' electronic and paper copy records.

RESULTS

Ninety-seven patients underwent STC during the study period. Of this cohort, 16 patients (16.5%) presented with symptomatic gallbladder remnant over a median follow-up period of 14 months (interquartile range [IQR] 2-26). The median age was 64 years (IQR 54-69) with an equal male-to-female distribution. The median body mass index was 31kg/m2 (IQR 28-33). Twelve of 16 patients (75%) then proceeded to elective RC. Intraoperative ultrasound was used in all cases to identify the location of the remnant gallbladder and biliary anatomy. The median operative time was 88min (IQR 80-96), with 67% completed laparoscopically. No patients suffered bile duct injury. The median hospital stay was 3 days (IQR 1-5). During the follow-up period, eight patients (67%) reported symptom resolution.

CONCLUSIONS

RC is a safe operation that can be performed laparoscopically even after previous open subtotal cholecystectomy. We recommend the routine use of intraoperative ultrasound as an adjunct for identifying remnant gallbladder and biliary anatomy in all patients.

Subtotal cholecystectomy: is it a safe option for difficult gall bladders?

INTRODUCTION

Subtotal cholecystectomy (STC) is an alternative to total cholecystectomy (TC) in patients with severe inflammation/adhesions around the hepatocystic triangle. This study aimed to evaluate the safety profile of STC.

METHODS

We retrospectively reviewed all patients who had STC at our unit between February 2009 and August 2019. STC was divided into two types, reconstituting (R-STC) and fenestrating (F-STC), depending on whether the gall bladder remnant was closed or left open. Patients who had cholecystectomy for gall bladder malignancy or as part of another operation were excluded from the study.

RESULTS

A total of 5,664 patients underwent cholecystectomy during the study period. Of these, 97 (1.7%) underwent STC. The laparoscopic to open conversion rate was high at 48.8% (47 cases), as was the overall postoperative complication rate (45.4%, 44 cases). No patient suffered iatrogenic bile duct injury. Nineteen patients (19.6%) suffered postoperative bile leak. This was significantly higher in patients who had STC in the acute setting (41% vs 13% for elective STC cases; p=0.04). There was no significant difference in rate of bile leak or other complications between R-STC and F-STC types. The 90-day readmission rate was 8.2% (8 cases). No mortalities were recorded within 90 days post STC.

CONCLUSIONS

STC seems to be an effective technique to avoid bile duct injury in difficult cholecystectomy cases. However, the perioperative morbidity associated with STC is relatively high. Surgeons should be aware of the risks of STC and take appropriate steps to minimise them.

Use of a digital application to optimize the clinical trajectory of patients in a TAVI program

Background/Purpose

Application-based technology has been studied for patient engagement and collecting patient-reported outcomes (PROs) in several one-day surgical specialties with limited research in transcathether valve therapies program. The aim of study was to determine the effectiveness of app-based technology for collecting PROs, improving the patient experience, and reducing health services utilization in a transcatheter valve implantation (TAVI) program.

Methods

Patients accessed an interactive app via smartphones. Patients were guided from their visit to the TAVI clinic via reminders, tasks, PRO surveys, and evidence-based education. They received notifications and health surveys 2 days before the procedure to ensure they were ready for the procedure. In the postoperative period, patients were engaged with daily health surveys to track warning signs and recovery milestones for 7 days. Based on the patient's signs and symptoms, the app escalated lower risk issues to self-care education or higher risk issues to the care team (TAVI program's nurse coordinator). Follow-up surveys and Kansas City Cardiomyopathy Questionnaire (KCCQ12) were sent to patients at 1, 3, 6 and 12 months to evaluate their functional recovery. All data are reported with median and interquartile range.

Results

227 patients underwent a TAVI procedure at the MHI from December 2020 to October 2021. 99 patients (44%) accepted to use the application and formed the digital application group. The two groups (digital application group vs. non-digital application group) were comparable in terms of age (76 years old (72, 81) vs 77 years old (71,82)), STS (Society of Thoracic Surgeons' risk model) score (6,1% vs 6,7%), vascular complications (8,1 vs 7.8%) and post procedure pacemakers (10,1% vs 10.9%). In the digital application group, 93% recommended the application, 95% said it helped them feel more confident before the procedure and 84%, after the procedure. KCCQ12 score (PRO) improved from 34/70 (28, 41) at baseline to 54/70 (48,62) at 1 month after the procedure and remained stable over the 12 months. Digital application use helped to reduce emergency visits by 33.5% (7.9 vs 11.9%) and rehospitalizations related to the procedure by 50.1% (7.9% vs 15.9%) in the month following the TAVI procedure.

Conclusion

App-based technology for patient engagement is an effective modality to enhance the patient experience, better understand the trajectory of recovery, gather PRO and reduce unnecessary health services utilization in aging population of a TAVI program.

Funding Acknowledgement

Type of funding sources: None.

P01.18.B Structural abnormalities related to chemotherapy in cancer survivors: an ALE meta-analysis of neuroimaging studies

Background

Chemotherapy induced cognitive impairment (CICI) is a term used for the cognitive dysfunction reported with non-central nervous system cancer patients during or after chemotherapy. Recent neuroimaging studies have shown decreased activation in cancer patients during cognitive tasks post-chemotherapy. Structural changes are sought to be associated with cognitive decline in cancer survivors after chemotherapy. Here we aim to investigate the neuroimaging findings of structural abnormalities and gray matter alterations associated with chemotherapy in cancer survivors.

Material and Methods

A systematic search through PubMed database for peer-reviewed English-language studies yielded a total of 302 studies. Eligible studies were included in the activation likelihood estimation (ALE) meta-analysis if they reported coordinates in a stereotactic format (MNI or Talairach space) for voxel-based morphometric (VBM) studies on gray matter volume and post-chemotherapy cancer survivors compared to matched healthy controls. GingerALE (3.0.2) software from Brainmap.org was used to perform the ALE meta-analysis with threshold settings of uncorrected P-value < 0.001 for multiple comparisons.

Results

The study sample included 299 patients comprised of breast cancer survivors (BCS), childhood acute lymphocytic leukemia (ALL) survivors, ovarian cancer survivors (OCS) and lung cancer with 279 matched healthy controls from 12 studies and 21 experiments. ALE-maps for post-chemotherapy cancer survivors showed reduced gray matter volume in comparison to healthy controls in the left inferior frontal gyrus, right thalamus, right superior frontal gyrus, right medial frontal gyrus and right cerebellum (peak coordinates: [-43,40,-6], [23,-29,2], [14,30,55], [9,57,-16], [9,-78,-41] respectively, and cluster size of 544 mm3, 312 mm3 and 257 mm3, 296 mm3, 297 mm3 respectively).

Conclusion

This is the first ALE meta-analysis that studied the converged areas of reduced gray matter volume in post-chemotherapy cancer survivors. Our findings of reduced gray matter volume in frontal regions and cerebellum might be responsible for the cognitive dysfunction in executive function, attention, and memory observed in cancer survivors. Further studies are needed to assess the impact of different chemotherapeutic regimens related to CICI .

Female Genital Schistosomiasis (FGS) Associated with Well-Differentiated Squamous Cell Carcinoma of the Vulva: A Case Report

INTRODUCTION: A case description of a rare incidence of female genital schistosomiasis related to vulva squamous cell carcinoma in a 76-year-old woman from the schistosomiasis-endemic region of Gombe State, Nigeria. Physicians should be aware of the high incidence rate of female genital schistosomiasis (FGS) in women and girls in schistosomiasis-endemic areas, which is often related to gynecological morbidity and the risk of HIV infection to avoid unnecessary interventions.

Hyperplastic polyps after surgical management of Hirschsprung's disease in children treated with argon plasma coagulation: Case report

Introduction and importance

Case presentation

Clinical discussion

Conclusion

•

Argon plasma coagulation is a well-established method applies high-frequency current to tissue in a non-contact mode.

•

It aims to thermal coagulation of tissues.

•

It has rapidly gained importance in daily clinical practice.

•

It is an effective and safe technique in the endoscopic management of gastrointestinal conditions.

Development of cowpea thresher

A cowpea thresher that uses petrol engine was developed to overcome drudgery of threshing with manually operated thresher and also to replace motorized cowpea thresher that cannot be used in areas where there is no supply of electricity. The performance tests on the machine were replicated three times using 10000, 8000 and 6000 grams of kannanado cowpea pods at the threshing cylinder speed of 700, 800 and 900 rpm each and moisture contents of 11.05%, 13.65% and 14.75% respectively based on the following parameters; Threshing efficiency, throughput capacity and percentage seed damage. The findings of the tests showed that the thresher had highest threshing efficiency of 98% at moisture content of 11.05%, threshing cylinder speed of 900 rpm and feed rate of 6 kg/hr. The maximum throughput capacity was observed to be 46.18 kg/hr at the feed rate of 10 kg/hr, 11.05% grain moisture content and threshing cylinder speed of 900 rpm. A highest cleaning efficiency and grain damage of 93.06% and 4.90% respectively were observed. This revealed that as the cylinder speed increased the threshing and cleaning efficiency and the throughput capacity also increased whereas feed rate and moisture content were decreased. The test also showed that high moisture content has a tendency to reduce the mechanical seed damage for the variety (kannanado) of cowpea investigated. Therefore, cowpea moisture contents of 11.05 % and threshing cylinder speeds of 900 rpm are the crop-machine parameters combination for optimum thresher performance. The performance of the machine is satisfactory; small-scale farmers will find more comfort in using it for threshing.

Congenital lobar emphysema case report: A frequently misdiagnosed disease

Introduction and importance

Case presentation

Clinical discussion

Conclusion

•

Congenital Lobar Emphysema is a rare cystic lesion of the lung which poses a challenge in diagnosis.

•

It is misdiagnosed and managed as pneumonia or pneumothorax.

•

It requires a high index of clinical and radiological suspicion to make an early diagnosis so that timely treatment will be offered.

Possible autosomal recessive inheritance in a neonate with Nager syndrome: Case report

Introduction and importance

Nager syndrome is a rare inherited disorder characterized by craniofacial malformations occurring in association with abnormalities of the thumb and radial parts of the forearm.

Case presentation

We presented a 18-day-old boy with Nager syndrome. The diagnosis based on his clinical presentation. He was born to non-consanguineous healthy parents. He had three deceased siblings who had similar clinical features. This family gave further evidence for autosomal recessive inheritance. Nager syndrome can be detected using prenatal screening ultrasound.

Clinical discussion

The etiology of Nager Syndrome is poorly described. Most cases arise spontaneously, although autosomal recessive and autosomal dominant modes of inheritance have been reported. Nager syndrome is suspected to have an autosomal recessive inheritance pattern, when unaffected parents have more than one affected child.

Conclusion

Treatment required the coordinated efforts of a team of specialists. Many manifestations of the disease can be improved by surgery and other supportive treatments.

•

Nager syndrome is a rare inherited disorder characterized by craniofacial malformations associated with abnormalities of the thumb and radial parts of the forearm.

•

The etiology of Nager Syndrome is poorly described. Most cases arise spontaneously, although autosomal recessive and autosomal dominant modes of inheritance have been reported.

•

Treatment required the coordinated efforts of a team of specialists.

Use of Industrial Wastes as Sustainable Nutrient Sources for Bacterial Cellulose (BC) Production: Mechanism, Advances, and Future Perspectives

A novel nanomaterial, bacterial cellulose (BC), has become noteworthy recently due to its better physicochemical properties and biodegradability, which are desirable for various applications. Since cost is a significant limitation in the production of cellulose, current efforts are focused on the use of industrial waste as a cost-effective substrate for the synthesis of BC or microbial cellulose. The utilization of industrial wastes and byproduct streams as fermentation media could improve the cost-competitiveness of BC production. This paper examines the feasibility of using typical wastes generated by industry sectors as sources of nutrients (carbon and nitrogen) for the commercial-scale production of BC. Numerous preliminary findings in the literature data have revealed the potential to yield a high concentration of BC from various industrial wastes. These findings indicated the need to optimize culture conditions, aiming for improved large-scale production of BC from waste streams.

Trends in antimicrobial resistance in Malaysia

INTRODUCTION

Antibiotic resistance is a burgeoning problem worldwide. The trend of bacterial resistance has increased over the past decade in which more common bacteria are becoming resistant to almost all the antibiotics currently in use, posing a threat to humans and even livestock.

METHODS

The databases used to search for the relevant articles for this review include PubMed, Science Direct, and Scopus. The following keywords were used in the search: Antimicrobial resistance, Malaysian action plan, antibioticresistant bacteria, and Malaysian National Surveillance on Antimicrobial Resistance (NSAR). The relevant articles published in English were considered.

RESULTS

The antibiotic-resistant bacteria highlighted in this review showed an increase in resistance patterns to the majority of the antibiotics tested. The Malaysian government has come up with an action plan to create public awareness and to educate them regarding the health implications of antibiotic resistance.

CONCLUSION

Antimicrobial resistance in Malaysia continues to escalate and is attributed to the overuse and misuse of antibiotics in various fields. As this crisis impacts the health of both humans and animals, therefore a joined continuous effort from all sectors is warranted to reduce the spread and minimize its development.

736 Optimal Time for Cholecystectomy After ERCP

Introduction

Recent research on the management of cholecystolithiasis with co-existing choledocholithiasis suggests performing cholecystectomy within 24 hours after ERCP has favourable outcomes. However, this target can be difficult to achieve in the NHS due to limited resources.

Method

This retrospective study includes 444 patients who underwent successful ERCP before cholecystectomy. We examined the impact of the duration of ERCP to cholecystectomy and post ERCP complications on operative difficulty and patient outcomes. We also report on gallstone related readmissions and rate of retained stones.

Results

The median duration from ERCP to cholecystectomy was 75 days, with a 14% readmission rate between their first successful ERCP and cholecystectomy.

Our analysis showed a statistically significant negative correlation between ERCP-to-cholecystectomy duration and postoperative stay. Readmissions increased with time, but this did not reach statistical significance. The occurrence of post ERCP complications significantly increased postoperative stay and the open conversion rate.

Conclusions

In contrast to recent research, our analysis suggests that early cholecystectomy post ERCP is not associated with better outcome. However, the impact of gallstone related readmissions needs further analysis. Post ERCP complication could serve as a predictor for operative difficulty and longer postoperative stay. It should be considered when planning the cholecystectomy.

Kartagener syndrome: A case report

Kartagener syndrome is a rare, autosomal recessive genetic disorder that causes defects in the action of ciliary movement, comprises of triad situs inversus, chronic sinusitis, and bronchiectasis. We present the case of a 3-year-old boy with repeated respiratory infections and pneumonic infections presenting with acute respiratory failure. He was diagnosed with Kartagener syndrome based on his clinical presentation and imaging features. The current diagnosis was consistent with severe acute bronchitis. He was managed initially with conventional medical therapy, but he didn’t respond and was transferred immediately to the pediatric intensive care unit where noninvasive ventilation was administered. He had shown significant predictors of early noninvasive ventilation failure and was mechanically ventilated, after which, he was disconnected from the ventilator and discharged without complications. In patients presenting with recurrent upper and lower respiratory tract infections, Kartagener syndrome should always be kept in mind. The correct diagnosis of this disorder in early life is very important to prevent complications and improve patients’ quality of life.

Oral hygiene in stroke survivors undergoing rehabilitation: does upper extremity motor function matters?

Background: Traditionally, stroke rehabilitation outcomes are based on indicators of physical function, such measures may underrate the all-inclusive impact of stroke such as oral health.Objectives: To investigate the relationship between upper extremity motor function and oral hygiene status as well as the impact of stroke on Oral Health-Related Quality of Life (OHRQoL).Methods: Sixty stroke survivors were included in this cross-sectional survey. Spasticity and motor function/mobility of the affected upper extremity were assessed using the Modified Ashworth Scale and Action Research Arm Test, respectively. Oral hygiene was assessed using the Simplified Oral Hygiene Index and oral health impact was assessed using the 14-item Oral Health Impact Profile. Pearson's moment correlation coefficient was used to determine the relationship between oral hygiene and upper extremity motor function variables.Results: There were significant relationships between the oral hygiene index and Shoulder muscles spasticity (r = 0.374, p = .01), wrist muscles spasticity (r = 0.352, p = .01), as well as basic mobility (r = 0.423, p = .01). An estimated 8% (n = 5) of study participants have their QoL strongly impacted by their oral health.Conclusions: Upper extremity motor function variables such as spasticity and basic mobility matters in determining oral hygiene status after stroke. Stroke has little impact on oral health-related quality of life.

Susceptibility patterns of anaerobes isolated from clinical specimens in tertiary Hospital, Malaysia

INTRODUCTION

The susceptibility patterns of anaerobes are becoming less predictable due to the emergence of anaerobic resistance trends to antibiotics; hence increasing the importance of the isolation and antimicrobial susceptibility testing of anaerobes.

MATERIALS AND METHODS

This study investigated the isolation of anaerobes from the clinical specimens of Hospital Sungai Buloh, Malaysia, from January 2015 to December 2015. All isolates were identified using the API 20A system (bioMérieux, France). Antimicrobial susceptibility testing was performed using the E-test (bioMérieux, France).

RESULTS

The proportion of obligate anaerobes isolated from the clinical specimens was 0.83%. The Gram-positive anaerobes were most susceptible to vancomycin and imipenem, showing 100% sensitivity to these antimicrobials, followed by clindamycin (86.3%), penicillin (76.7%), and metronidazole (48.9%). Meanwhile, Gram-negative anaerobes were most susceptible to metronidazole (96%) followed by imipenem (89%), clindamycin (79%), and ampicillin (32%). The present study also showed that 3 out of 12 Bacteroides fragilis isolates were resistant to imipenem.

CONCLUSION

This study demonstrated the differences in the susceptibility patterns of anaerobes towards commonly used antimicrobials for the treatment of anaerobic infections. In summary, continuous monitoring of antimicrobial resistance trends among anaerobes is needed to ensure the appropriateness of treatment.

AB1090 BIOMARKERS TO DIFFERENTIATE EARLY INDISTINGUISHABLE CASES OF OSTEOARTHRITIS AND RHEUMATOID ARTHRITIS

Background:

Osteoarthritis (OA) and rheumatoid arthritis (RA) are the most frequent inflammatory diseases of the musculoskeletal system, which could not be differentiated in their early stages, and characterized by degradation of articular cartilage and impairment of joint function. Sometimes, criteria and radiography are not insufficient to distinguish early-stages of RA and OA and predict disease course, and therefor biomarkers that help clinicians to early diagnose disease are essential.

Objectives:

The aim of this study is to estimate serum level of Matrix metalloproteinase 3 (MMP3) and hrdroxyproline (HP) in early RA and OA patients to see if they can be used to differentiate both diseases at their early stages

Methods:

The aim of this study is to estimate serum level of Matrix metalloproteinase 3 (MMP3) and hrdroxyproline (HP) in early RA and OA patients to see if they can be used to differentiate both diseases at their early stages

Results:

We found a highly significant elevation of serum MMP3 in OA patients group compared to RA patients and control groups. We also found a highly significant elevation of MMP3 in RA patients than control group,(P < 0.001). Meanwhile, we found a highly significant elevation of HP in OA patients than in RA patients and control groups, (P < 0.001), whereas there was no significant difference between HP in RA patients and control groups (P > 0.05).

Table 1.

Demonstration of serum levels of MMP3 and HP in all groups.

“Enzyme”OA(n=40)RA(n=40)Control(n=40)p-valueMMP3 pg/mL559.92±1112.84153.25±162.0559.79±63.54<0.001HPµg/mL12.87±18.754.81±6.894.52±1.55<0.001HPµg/mL4.81±6.894.52±1.55> 0.05

Conclusion:

Our results suggest that serum levels of Hydroxyproline (HP) rather than MMP3 could be used as a potential biomarker for early differentiation between osteoarthritis (OA) and rheumatoid arthritis (RA) when diagnostic criteria failed to be fulfilled.

References:

[1]Benedetti S, Canino C, Tonti G, Medda V, Calcaterra P, Nappi G, Salaffi F, Canestrari F. (2010): Biomarkers of oxidation, inflammation and cartilage degradation in osteoarthritis patients undergoing sulfur-based spatherapies. ClinBiochem.; 43: 973-8.

[2]Fenton, S. A. M., Veldhuijzen van Zanten, J. J. C. S., Duda, J. L., Metsios, G. S., and Kitas, G. D. (2018). Sedentary behaviour in rheumatoid arthritis: definition, measurement and implications for health. Rheumatology. (Oxford) 57(2), 213-226.

[3]Murphy, G., and Nagase, H. (2008). Progress in matrix metalloproteinase research. Mol. Aspects Med. 29(5), 290-308.

[4]Bonnans, C., Chou, J., and Werb, Z. (2014). Remodelling the extracellular matrix in development and disease. Nat. Rev. Mol. Cell Biol. 15(12), 786-801.

[5]Hofman, K., Hall, B., Cleaver, H., & Marshall, S. (2011): High-throughput quantification of hydroxyproline for determination of collagen. Analytical biochemistry, 417(2), 289-291.

[6]Barranco, C. (2015): Osteoarthritis: activate autophagy to prevent cartilage degeneration? Nat. Rev. Rheumatol. 11, 127.

[7]M.S. Radha and Dr. M.R. Gangadhar (2015), Serum enzyme of matrix metalloproteinase-3 in patients with knee osteoarthritis, International Journal of Recent Scientific Research Vol. 6, Issue, 6, pp.4457-4460, June, 2015.

[8]Bassiouni, H. M., El-Deeb, M., Kenawy, N., Abdul-Azim, E., & Khairy, M. (2011). Phonoarthrography, musculoskeletal ultrasonography, and biochemical biomarkers for the evaluation of knee cartilage in osteoarthritis. Modern rheumatology, 21(5), 500-508.

[9]Ahmed, U., Anwar, A., Savage, R. S., Costa, M. L., Mackay, N., Filer, A., Raza, K., Watts, R. A., Winyard, P. G., Tarr, J., Haigh, R. C., Thornalley, P. J., and Rabbani, N. (2015). Biomarkers of early stage osteoarthritis, rheumatoid arthritis and musculoskeletal health. Sci. Rep. 5, 9259.

Acknowledgments:

We are indebted to Dr El Shaimaa Abdel Hakim, and Dr Asmaa Fouaad for their great help in this study

Disclosure of Interests:

None declared

P2743Right ventricular size in repaired tetralogy of Fallot: correlations between transthoracic echocardiography and cardiovascular magnetic resonance

Introduction

Right ventricular (RV) size informs about prognosis and need for pulmonary valve replacement in patients with repaired tetralogy of Fallot (rTOF). Cardiac magnetic resonance (CMR) is considered the reference standard for measurement of RV volumes. Despite known limitations for RV evaluation, 2D transthoracic echocardiography (TTE) remains the primary and most available imaging modality in the rTOF population.

Purpose

To determine which TTE RV size parameters best correlate with CMR-derived indexed RV end-diastolic (RVEDVi) and end-systolic (RVESVi) volumes in the rTOF population. We sought to determine the best TTE measurement thresholds to predict normal RV volume (RVEDVi ≤110 mL/m2) and significant RV dilatation by CMR (RVEDVi ≥150ml/m2).

Method

We retrospectively enrolled all rTOF patients followed at a single-center between 2010 and 2018 who had both TTE and CMR exams performed within a 12-month interval. All TTE exams were reviewed by an observer measuring RV areas, RV inlet and RV outlet at end-diastole and end-systole. Analyses of CMR studies were performed by 3 observers who measured RV area, RV inlet, RV outlet and RV volumes at end-diastole and end-systole. Correlations between TTE and CMR parameters were performed using Pearson correlation coefficients. Using the TTE RV parameters with the strongest correlation with CMR, we subsequently determined thresholds to predict a CMR RVEDVi ≤110ml/m2 and ≥150ml/m2 using ROC analysis.

Results

We enrolled 130 patients (59 women [45%], mean age 43±12.8 years). Median age at TOF repair was 4 [3–6] years; 18 patients (14%) had subsequent pulmonary valve replacement. Median interval between TTE and CMR exams was 114 [59–239] days. There were significant correlations between all TTE parameters and CMR RVEDVi. TTE indexed RV end-diastolic area (RVEDAi) most strongly correlated with CMR RVEDVi (r=0.73, p<0.0001). All TTE RV parameters significantly correlated with CMR RVESVi but indexed RV end-systolic area had the strongest correlation (r=0.77, p<0.0001). ROC analysis performed to predict RVEDVi of ≤110ml/m2 and ≥150ml/m2 using TTE RVEDAi revealed areas under the curve of 0.86±0.04 and 0.90±0.03, respectively. A TTE RVEDAi ≤17cm2/m2 predicted a normal CMR RV volume (≤110ml/m2) with a sensitivity of 90% and a specificity of 74%. A TTE RVEDAi ≥19cm2/m2 predicted a CMR RVEDVi ≥150 mL/m2 with a sensitivity of 93% and a specificity of 76%.

Conclusion

In rTOF patients, both diastolic and systolic TTE RV area best correlate with CMR-derived RV end-diastolic and end-systolic volumes. A cut-off value of TTE RVEDAi of 19cm2/m2 is 93% sensitive and 76% specific to predict a CMR RVEDVi ≥150ml/m2. Simple RV size measurement using TTE may help inform the need and frequency of CMR evaluations in rTOF patients.

Study of hepatic tyrosine aminotransferase from Schistosoma-infected mice

In the current study, tyrosine aminotransferase (TAT) as a target enzyme was purified from the liver of control and Schistosoma-infected mice that was subjected to catalytic investigation. The purified enzyme has a single band on SDS-PAGE with a molecular mass of almost 100 KD from control and infected mice. The kinetic studies of hepatic TAT towards its substrates showed no change in K_m, whereas V_max value was increased from 2.3 to 2.9 fold in the enzyme isolated from Schistsoma- infected mice. In addition, the K_cat/ K_m ratio displayed a higher value for the enzyme from infected mice, indicating that it is more efficient and specific. On the other hand, the in vitro effect of praziquantel showed a slight activation of hepatic TAT in both control and infected mice, whereas mirazid (MZD) has an inhibitory effect in a concentration-dependent manner. The response of TAT from infected mice towards MZD inhibition is less than that from controls. These data suggest that there is a change in the catalytic properties of hepatic TAT in schistosomiasis and the in vitro effect of the schistosomicidal drugs appears to have inductive or inhibitory effect.

Screening of Egyptian toddlers for autism spectrum disorder using an Arabic validated version of M-CHAT; report of a community-based study (Stage I)

BACKGROUND

Although there is a recommendation that toddlers be screened for Autism spectrum disorder (ASD) during their 18- and 24-month well-care child visits, diagnosis often occurs well after the child turns 4 years old. Such delayed diagnosis hinders the implementation of early intervention thus worsens the long-term prognosis of ASD.

OBJECTIVE

The current community-based study in its stage I aimed at early screening of Egyptian toddlers for ASD using an Arabic validated version of Modified Checklist for Autism in Toddlers (M-CHAT).

METHODOLOGY

A cross-sectional community-based descriptive study was carried out enrolling 5546 Egyptian toddlers. They were randomly recruited from those attending Primary Health Care Units in six Egyptian governorates with a fair representation of the urban, semi-urban, and rural Egyptian populations. An Arabic validated version of M-CHAT was used as a screening tool for ASD.

RESULTS

The current study revealed failure of M-CHAT (suspected to have ASD and needs further evaluation) in 1320 out of the enrolled 5546 Egyptian toddlers (23.8%).

CONCLUSION

M-CHAT as a screening tool for ASD has flagged a considerable percent of the enrolled toddlers that necessitates referral for further evaluation (stage II) to settle the diagnosis of ASD in the true positive cases. Perfecting the delicate balance between sensitivity and specificity for ASD screening tools is crucial in order not to miss early detection of ASD cases and at the same time, to avoid over-diagnosis with subsequent abuse of the limited healthcare resources in developing countries.

Identification and characterization of a highly pathogenic H5N1 avian influenza A virus during an outbreak in vaccinated chickens in Egypt

Highly pathogenic avian influenza A (HPAI) H5N1 viruses continue to be a major veterinary and public health problem in Egypt. Continued surveillance of these viruses is necessary to devise strategies to control the spread of the virus and to monitor its evolutionary patterns. This is a report of the identification of a variant strain of HPAI H5N1 virus during an outbreak in 2010 in vaccinated chicken flocks in a poultry farm in Assiut, Egypt. Vaccination of chickens with an oil-emulsified inactivated A/chicken/Mexico/232/94 (H5N2) vaccine induced high levels of hemagglutination inhibition (HI) antibody titers reaching up to 9 log2. However, all flocks irrespective of the number of vaccine doses and the resultant HI titer levels came down with severe influenza infections. The qRT-PCR and rapid antigen test confirmed the influenza virus to be from H5N1 subtype. Sequencing of the hemagglutinin (HA) gene fragment from ten independent samples demonstrated that a single H5N1 strain was involved. This strain belonged to clade 2.2.1 and had several mutations in the receptor-binding site of the HA protein, thereby producing a variant strain of HPAI H5N1 virus which was antigenically different from the parent clade 2.2.1 virus circulating in Egypt at that time. In order to define the variability in HPAI H5N1 viruses over time in Egypt, we sequenced another H5N1 virus that was causing infections in chickens in 2014. Phylogenetic analysis revealed that both viruses had further distanced from the parent virus circulating during 2010. This study highlights that the antigenic mutations in HPAI H5N1 viruses represent a definitive challenge for the development of an effective vaccine for poultry. Overall, the results emphasize the need for continued surveillance of H5N1 outbreaks and extensive characterization of virus isolates from vaccinated and non-vaccinated poultry populations to better understand genetic changes and their implications.