Impedance changes in cochlear implant electrodes one year after switch on: A cohort study at a tertiary referral hospital in Jakarta, Indonesia

INTRODUCTION

Monitoring of impedance field telemetry is crucial to maintaining optimal function of cochlear implants. This study aims to investigate impedance changes in cochlear implant electrodes one year after switch on.

MATERIALS AND METHODS

A retrospective repeated crosssectional study was conducted by recruiting patients with cochlear implants presenting to the Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia between 2017 and 2021. Basal (b1, b2) and apical (a1, a2) electrodes, representing the outermost and innermost parts of the cochlear implant electrodes, were measured at switch on and at 1 year post-implantation.

RESULTS

A total of 123 patients, with a total of 123 cochlear implant samples, were included in the analysis. We found a substantial change in electrical impedance between switch on and follow-up periods, where the impedance levels of basal electrodes decreased (b1: mean difference (MD) -1.13 [95% confidence interval (CI): -1.71, -0.54], p<0.001; b2: MD -0.60 [95%CI: -1.17, -0.03], p=0.041) and those of apical electrodes increased (a1: MD 0.48 [95%CI: -0.28, 0.99], p=0.064; a2: MD 0.67 [95%CI: 0.12, 1.22], p=0.017). We also found that the choice of surgical approaches for implant insertion may affect the electrode impedance. Cochleostomy approach resulted in a higher impedance than round window in basal (b1) and apical (a2) electrodes both at switch on and follow-up (b1 at switch on and at follow-up: p=0.019 and p=0.004; a2 at follow-up: p=0.012). Extended round window approach also resulted in a higher impedance than round window in basal (b1) and apical (a2) electrodes at follow-up (p=0.013 and p=0.003, respectively).

CONCLUSION

Electrical impedance of cochlear implant electrodes may change over time, highlighting the importance of regular impedance assessments for cochlear implant users to ensure optimal device function. The round window approach resulted in better initial and long-term impedance levels compared to cochleostomy, and better long-term impedance levels than extended round window. Extended round window approach also gives better impedance level than cochleostomy. Further research should investigate the potential interplay between surgical approach and other factors that may impact impedance levels to confirm our findings.

Potential antiviral effects of pantethine against SARS-CoV-2

SARS-CoV-2 interacts with cellular cholesterol during many stages of its replication cycle. Pantethine was reported to reduce total cholesterol levels and fatty acid synthesis and potentially alter different processes that might be involved in the SARS-CoV-2 replication cycle. Here, we explored the potential antiviral effects of pantethine in two in vitro experimental models of SARS-CoV-2 infection, in Vero E6 cells and in Calu-3a cells. Pantethine reduced the infection of cells by SARS-CoV-2 in both preinfection and postinfection treatment regimens. Accordingly, cellular expression of the viral spike and nucleocapsid proteins was substantially reduced, and we observed a significant reduction in viral copy numbers in the supernatant of cells treated with pantethine. In addition, pantethine inhibited the infection-induced increase in TMPRSS2 and HECT E3 ligase expression in infected cells as well as the increase in antiviral interferon-beta response and inflammatory gene expression in Calu-3a cells. Our results demonstrate that pantethine, which is well tolerated in humans, was very effective in controlling SARS-CoV-2 infection and might represent a new therapeutic drug that can be repurposed for the prevention or treatment of COVID-19 and long COVID syndrome.

Effects of preharvest factors on antidiabetic potential of some foods and herbal plants

Diabetes is a metabolic disorder with no definite treatment, but it can be controlled by changing lifestyle and diet. Consumption of high-fiber and nutrient-rich foods including vegetables have been shown to reduce risks of obesity and Type II Diabetes Mellitus (T2DM). Also, many herbal plants have been associated with reduced risks of T2DM because of their composition of secondary metabolites. Antioxidant activities of some secondary metabolites have potent inhibitory effects against inflammation linked with insulin resistance and oxidative stress. More than 800 known medicinal plants are used to control diabetes and its relevant complications. However, variations in preharvest factors including plant genotype, growing medium properties, climatic factors, and management practices can influence plant growth and their accumulation of phytochemicals with health-promoting properties. However, the effects of these preharvest factors on the antidiabetic properties of plant secondary metabolites are neither explicit nor easily accessible in the literature. Therefore, this review aims to document recent studies that reported on under-exploited medicinal plants with antidiabetic properties. We reviewed several important preharvest factors that can potentially affect the synthesis of phytoconstituents which possess antidiabetic properties. This review will help identify gaps for future research in phytomedicine and functional foods.

Comprehension of premarital screening and genetic disorders among the population of Riyadh

Objective

Premarital, unfortunately, does not cover all possible genetic diseases, such as deafness and congenital heart diseases, diabetes mellitus, and hypertension, nor does it cover unknown genetic mutations that may cause severe defects in subsequent generations. However, the Saudi population has limited knowledge regarding premarital screening tests, which do not detect all genetic disorders or diseases. Hence, we aimed to explore the knowledge and attitudes among the population of Riyadh toward premarital screening.

Methods

A cross-sectional observational study was conducted with a self-administered designed questionnaire. The survey included questions regarding sociodemographic data, genetics, genetic testing, and premarital screening. All data were entered and analyzed in the statistical package SPSS version 22.

Results

A total of 385 participants responded to the questionnaire, and good knowledge among most participants was significantly associated with education level (p < 0.001), sex (p < 0.001), and prior screening (p = 0.001). The overall attitude was positive toward premarital screening, and significant associations of sex and social/marital status with a positive response to premarital screening were observed.

Conclusion

Knowledge and attitudes among the population of Riyadh toward premarital screening must be improved through national awareness programs. In light of our results, a need exists to provide more information and education regarding screening. Further studies must be conducted in urban areas to investigate the level of satisfaction with existing programs.

Citizen engagement in health policymaking: challenges and recommended solutions

Background

Involving citizens in health policymaking leads to the development of policies that are tailored to their needs and enables them to exercise their right as citizens. Citizen engagement in health policymaking in low and middle-income countries (LMICs) is rarely practiced and so understanding barriers and facilitators to engagement and the factors that impede effective participation is crucial. This study aims to understand views from policy stakeholders and citizens on citizen participation in health policy making and solicit recommendations on how to improve this process in the context of Lebanon.

Methods

We conducted 29 individual in-depth interviews with stakeholders who work in fields relevant to health policy and/or have had experience in engaging citizens and four focus groups (average 8 to 10 participants each) with citizens from four municipalities in different governorates across Lebanon. Participants were purposively sampled through local Primary Healthcare Centers and municipality networks.

Results

Barriers to engagement were seen as a manifestation of a dysfunctional and top-down political system, weak culture of participation, and lack of formal processes and platforms for engagement. Citizens’ attributed lack of participation to mistrust with the political system while on the other hand, stakeholders thought that citizens lacked the needed skills for active engagement. Recommendations for improvement focused on the importance of implementing system level changes, developing contextualized citizen engagement processes, and ensuring its adoption and implementation.

Conclusions

Although participants identified many challenges to engagement, they acknowledged its value and were able to propose concrete solutions and recommendations for change. Those recommendations are useful for other LMICs of similar contexts whose mandates require participation.

Key messages

• By identifying and understanding barriers to citizen participation in health policymaking, public health professionals can work towards improving engagement.

• Strategies and methods such as implementing system level changes and developing contextualized citizen engagement processes can be applied to improve citizen participation were needed.

P-291 Positive effects of inactivated blood serum in stabilizing the activity of antioxidants in embryo-free culture media

Study question

Does addition of blood serum to embryo culture media supplemented with antioxidants (AOXs) helps maintain the AOX activity under in vitro culture conditions?

Summary answer

The addition of inactivated blood serum (IBS) before AOX supplementation resulted in AOX activity stabilization in embryo-free culture media (EFCM) for up to 48 hours.

What is known already

Supra-physiological levels of reactive oxygen species (ROS) in embryo culture medium (ECM) can disturb embryo development possible due to oxidative stress. Hence, AOX supplementation of ECM has been used to counteract the potential negative effects of high ROS on gametes and embryos. However, rapid consumption of AOXs via interaction with ROS may reduce the AOX protection capacity particularly during extended culture conditions. The aim of this study is to investigate the efficacy of IBS in stabilizing the AOX activity of a combination of AOXs (EmbryORP®) when added to EFCM.

Study design, size, duration

In this prospective study, oxidation reduction potential (ORP) was assessed in EFCM by MiOXSYS System (UAB Caerus Biotechnologies, Vilnius, Lithuania). The ORP results reflect the overall balance between oxidants and antioxidants. ORP levels in follicular fluid obtained from dominant follicles of 40 oocyte donors were used as control.

Participants/materials, setting, methods

All dishes containing culture medium (GlobalTotal®, LifeGlobal®, Connecticut, US) were incubated for 48 hours in 8% CO2, 20% O2, 37 °C. Culture dishes were divided into four groups: Group A: EFCM without AOX, Group B: EFCM+AOX, Group C: EFCM+AOX+IBS, and Group D: EFCM+IBS. Levels of ORP were assessed in EFCM before AOX supplementation (0), immediately after adding AOX (1) and 48 hours following AOX supplementation (2). ORP results are expressed as millivolts (mV).

Main results and the role of chance

At 48 hours of culture, ORP value in group C (96.7 mV) was significantly lower than group A (345 mV; p = 0.00001), and was found to be similar to the physiological ORP values found in follicular fluid from donors (89 mV±23.6 mV; p &gt; 0.05). Also, ORP value in group C (96.7 mV) was lower than group B (210 mV; p = 0.67) and group D (280.1 mV; p = 0.11).

Limitations, reasons for caution

This study only tested the efficacy of IBS as AOX stabilizer in EFCM over 48 hours. The efficacy and potential risks associated with the use of IBS during actual embryo culture were not examined.

Wider implications of the findings

The use of AOX stabilizers may represent an important novel finding to maintain sufficient AOX protective capacity during extended culture conditions.

Trial registration number

10112021-AOX

AB1146 SARS-Cov-2 VIRAL LOAD IN PATIENTS WITH AUTOIMMUNE RHEUMATIC DISEASE, A RETROSPECTIVE COMPARATIVE STUDY

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load and its impact on disease outcome in patients with autoimmune rheumatic disease (ARD) are lacking. Also, whether patients with ARD receiving immunomodulators have different viral loads compared to the general population is unknown.

Objectives

To compare the viral load of SARS-CoV-2 and its trending between patients without and with ARD.

Methods

Retrospectively, patients with ARD infected with SARS-CoV-2 were matched by age and sex at a ratio of 1:2 to patients without ARD and not receiving immunosuppression or immunomodulator drugs. Viral load was determined by the cycle threshold (CT) value measured by a number of platforms: (a) Automated Platforms - the Roche Cobas 6800 system using the Cobas SARS-CoV-2 Test targeting the E and orf1a/b genes (Roche, Switzerland) and the Xpert Xpress SARS-CoV-2 targeting the E and N genes (Cepheid, USA); (b) Manual platforms - EZ1 (QIAGEN, USA), QIAsymphony (QIAGEN, USA), and Bioneer ExiPrepTM 96 Virus DNA/RNA kits Catalogue No K4614 (Bioneer, South Korea) extraction with thermal cycling using TaqPath™ PCR COVID-19 Combo Kit targeting the N, S and orf1a/b genes (Thermo Fisher Scientific, USA) on ABI 7500 thermal cyclers. Independent samples t-test was used to compare the mean CT values of the study groups at baseline and at 5 subsequent intervals (1 – 5.9, 6 – 11.9, 12 – 17.9, 18 – 23.9 and 24 – 30 days).

Results

Mean age (SD) of 197 cases and 420 controls were 45.2 (11.8) and 44.1 (12.3) years, respectively. Females were predominant in both groups 60% vs. 52%, P=0.053. The most common ARD was rheumatoid arthritis in 82 cases (41.6%), followed by spondyloarthropathy in 33 (16.8%) and systemic lupus erythematosus in 31 (15.7%). Of the cases, 67% were on conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), 15.2% on biological DMARDs and 4.6% patients were on rituximab. The mean CT values was significantly lower in the ARD group at baseline and persisted till day 24.

Table 1.

demographic characteristics and comparison of the mean CT values in the study groups at baseline and at different intervals with the corresponding OR (95% CI)

Case (N=197)Control (N=420)OR (95% CI)Mean (SD) age, years45.2 (11.8)44.1 (12.3)1.008 (0.994–1.022)Sex, female N (%)120 (60.9%)221 (52.6)0.713 (0.505–1.006)Mean (SD) CT values at Baseline22.9 (5.5)30 (5.2)0.799 (0.745–0.858)1 – 5.9 days22.1 (4.6)25.7 (6.3)0.901 (0.842–0.963)6 – 11.9 days26.9 (4.9)31.5 (3.9)0.802 (0.724–0.888)12 – 17.9 days29.6 (4.1)32.3 (3.2)0.827 (0.743–0.921)18 – 23.9 days32.1 (4)32.9 (2.5)0.903 (0.728–1.119)24 – 30 days31.2 (1.2)32.7 (2.6)0.824 (0.589–1.151)

Conclusion

Compared to patients without ARD, the viral load of SARS-CoV-2 in patients with ARD is significantly higher at baseline testing and persists till day 24. This finding may indicate that patients with ARD are at higher risk of severe SARS-CoV-2 infection and prolonged potential transmission. Clinical outcome correlation is needed.

References

None

Disclosure of Interests

None declared

FRI0061 THE ADVERSE OBSTETRIC OUTCOMES WHEN RHEUMATOID ARTHRITIS IS CONTROLLED DURING PREGNANCY: IS THE DISEASE ITSELF A PROBLEM? DATA FROM A CASE-CONTROL COHORT OF 190 PREGNANCIES AT A MULTI-NATIONALITY SPECIALIZED CENTER IN QATAR

Background:

Rheumatoid arthritis is implicated in causing adverse pregnancy outcomes including high rates of prematurity and low birth weight. But little is known about the impact of the disease when it’s controlled as most of the information is extracted from retrospective data.

Objectives:

To examine the adverse obstetric outcomes after controlling disease during pregnancy. We also took into account many confounders that might affect the outcome.

Methods:

This is an ongoing Case-Control Prospective Cohort. It is implemented in a tertiary center where cases are recruited from a single specialized pregnancy and rheumatic disease clinic to ensure standardized management. These cases were fulfilling the ACR 2010 classification criteria for rheumatoid arthritis. Disease activity was measured using CDAI once before pregnancy and once in each trimester. We excluded subjects with chronic morbidities or twin pregnancy. Data were collected in pre-specified data sheets. Routine blood tests in addition to C-reactive protein were obtained. Cases were recruited at different disease activity stages, but treatment was escalated to reach remission as possible by the third trimester. Data were analyzed using SPSS software for descriptive and comparative analyses.

Results:

Since 2017 we have recruited 215 subjects. A total of 190 completed pregnancies were analyzed in this report (114 controls and 76 cases). Five subjects were excluded as their disease was not controlled by 27 weeks of gestation. Baseline characteristics of age, baseline BMI and anemia were similar. Exposure to passive smoking was significantly higher in the control group. There was no statistical difference in the incidence of gestational diabetes, pre-eclampsia and infections. Rates of abortions and cesarean sections were significantly higher in the cases group. The incidence of PROM & low birth weight was not statistically different. Three cases of IUFD were reported among controls versus none in the cases (Table 1). Prematurity rate was numerically higher in the control group but did not reach a statistical difference. Congenital anomalies and NICU admission rates were comparable between the groups. But the incidence of neonatal morbidities was significantly higher in the control group (p. value 0.006), but the majority of morbidities were due to jaundice that resolved with phototherapy. we have evaluated the incidence of group B streptococcal Agalactae as a possible contributor to morbidities but it was similar between the groups. All cases were on DMARDs during pregnancy. Hydroxychloroquine was the most commonly used (55%) followed by sulfasalazine (40%). Steroid was used for variable duration in pregnancy in 23 cases. In most of them, it was tapered and stopped by the end of pregnancy. Biologics were used in 15 cases with few adverse outcomes including: abortion (1 case), PROM (1), maternal UTI (1), repeated URT infection (1) and neonatal bronchiolitis (1).

Table 1.

Birth Outcomes

Birth OutcomeCases (n)Controls (n)P.valueAbortion910.001IUFD030.18PROM180.09Cesarean20170.02LBW680.68Premature8250.74

Conclusion:

From this ongoing cohort we conclude that controlled RA during pregnancy carries low risk of adverse obstetric outcomes in spite the regular use of DMARDs. Although these results are reassuring, further regression models are required after recruiting more subjects.

References:

[1]Johanna M. W. Hazes. (2011). Rheumatoid arthritis and pregnancy: evolution of disease activity and pathophysiological considerations for drug use.Rheumatology, 50:1955-1968

Disclosure of Interests:

None declared

Evaluation of reference values of standard semen parameters in fertile Egyptian men

The reference values of human semen, published in the WHO's latest edition in 2010, were lower than those previously reported. The objective of this study was to evaluate reference values of standard semen parameters in fertile Egyptian men. This cross-sectional study included 240 fertile men. Men were considered fertile when their wives had recent spontaneous pregnancies with time to pregnancy (TTP) ≤12 months. The mean age of fertile men was 33.8 ± 0.5 years (range 20-55 years). The 5th percentiles (95% confidence interval) of macroscopic semen parameters were 1.5 ml for volume and 7.2 for pH. The 5th percentiles of microscopic parameters were 15 million/ml for sperm concentration, 30 million per ejaculate for total sperm count, 50% for total motility, 40% for progressive motility, 62% for vitality, 4% for normal sperm forms and 0.1 million/ml for seminal leucocyte counts. In conclusion, fertile Egyptian men had higher reference values of sperm total motility, progressive motility and vitality, and lower reference values for total sperm counts as compared to those determined by the latest edition of the WHO laboratory manual in 2010. Other semen parameters were identical to those defined by the WHO 2010 manual.

Abstract P1-05-24: A head-to-head comparison of paraffin-embedded MammaPrnt versus oncotype DX: A Mcgill University Healh Center experience

Background: Breast cancer is the most common malignancy among women. With the introduction of improved imaging techniques and the general population's awareness of breast cancer, increasing numbers of patients are more frequently diagnosed at a very early stage. The Oncotype DX Recurrence Score (ODX) is commonly used to estimate recurrence risk and chemotherapy benefit in ER positive, node negative breast cancer. Earlier studies showed that women with Oncotype DX Recurrence score results of 11 or less had excellent outcomes which proved that thousand of patients worldwide can forgo chemotherapy and its harmful side effects based on a low Recurrence score. Now another test called the Mammaprint has been approved by the United States (US) Food and Drug Administration to assess the risk of cancer relapse. The primary study objective was to evaluate the concordance of patient results with Oncotype Dx (ODX) when compared to the 70-gene signature Mammaprint (MP), the 80-gene signature of BluePrint (BP) and TargetPrint (TP)

Methods: This retrospective clinical study was carried out in the Oncology Department at the Royal Victoria Hospital (RVH), part of the MUHC. Eighty-six consecutive patient-slides node negative hormone positive breast cancer tissue tested with the Oncotype DX between October 2008 and September 2014 were included. Further inclusion criteria were age &gt; 18. These same slides were then analyzed and classified with MammaPrint as low or high risk by Agendia Laboratories. BluePrint (BP) and TargetPrint (TP) analysis were also performed by Agendia Laboratories.

Results:

Of the 16 ODX RS between 0 and 11, 13 were low risk by MP (81 % agreement) and 16 were low risk by BP (100% agreement). Of the 50 ODX low RS cases, 33 were low risk by MP (66 % agreement) and of the 9 ODX high RS, 7 were high risk by MP (78 % agreement). Of ODX intermediate risk cases (27), 14 of were MP low risk (52 %), (48 %) 13 were MP high risk. Of BP low risk luminal tumors, 33/49 (67%) were ODX low, 14/49 (29%) ODX intermediate, and 2/49 (4%) ODX high risk. BP class was correlated with ER, PR and HER2 results. Overall agreement between clinical ER, PR, HER2 (IHC+FISH) results with TP results were 98% (81/83), 83% (69/83), 99% (82/83), and percent positive agreement for HER2 was 0/1 (of unequivocally HER2 positive cases identified correctly by TP).

Conclusion:

Our results show that there is a high concordance between ODX RS of 11 or less and low risk Mammaprint and Blueprint scores. When the ODX RS is above 11, our study shows that there are real differences in risk stratification between MP and ODX. At this point, there is no consensus seen when Oncotype DX is above 11.

Citation Format: Desforges P, Saleh R, Nathaniel B. A head-to-head comparison of paraffin-embedded MammaPrnt versus oncotype DX: A Mcgill University Healh Center experience [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-05-24.

LACC1 polymorphisms in inflammatory bowel disease and juvenile idiopathic arthritis

The function of the Laccase domain-containing 1 (LACC1) gene is unknown, but genetic variation at this locus has been reported to consistently affect the risk of Crohn's disease (CD) and leprosy. Recently, a LACC1 missense mutation was found in patients suffering from monogenic forms of CD, but also systemic juvenile idiopathic arthritis. We tested the hypothesis that LACC1 single nucleotide polymorphisms (SNPs), in addition to CD, are associated with juvenile idiopathic arthritis (JIA, non-systemic), and another major form of inflammatory bowel disease, ulcerative colitis (UC). We selected 11 LACC1 tagging SNPs, and tested their effect on disease risk in 3855 Swedish individuals from three case-control cohorts of CD, UC and JIA. We detected false discovery rate corrected significant associations with individual markers in all three cohorts, thereby expanding previous results for CD also to UC and JIA. LACC1's link to several inflammatory diseases suggests a key role in the human immune system and justifies further characterization of its function(s).

Oxidative status and histological changes in sea bass larvae muscle in response to high dietary content of docosahexaenoic acid DHA

In previous studies, we observed dystrophic alterations in muscle of 48-day-old sea bass fed imbalanced docosahexaenoic acid (DHA) and vitamin E diets. To understand the whole pathological process associated with oxidative stress, a histological study was performed by feeding 14-day-old sea bass larvae with microdiets containing different ratios of DHA/vitamin E (1/150, 5/150 and 5/300) for a period of 21 days. Larvae fed diet 1/150 showed no lesions in contrast to larvae fed diets 5/150 and 5/300 where the highest incidence of muscle lesions and thiobarbituric acid reactive substances (TBARS) content was observed. Semithin sections revealed focal lesions consisting of degenerated fibres with hypercontracted myofilaments and extensive sarcoplasm vacuolization affecting both red and white muscle. Ultrathin sections of degenerating muscle fibres showed diffuse dilatation of sarcoplasmic reticulum, disorganized myofilaments and autophagic vacuoles containing myelin figures and dense bodies. Additionally, some macrophages were observed among injured fibres as numerous satellite cells. Results from the study agree with those obtained from previous work, proving the pathological potential of free radicals in sea bass larvae musculature. Moreover, high vitamin E inclusion could not completely protect cell membranes from free radicals action.

Direct measurement of toxicants inhaled by water pipe users in the natural environment using a real-time in situ sampling technique

While narghile water pipe smoking has become a global phenomenon, knowledge regarding its toxicant content and delivery, addictive properties, and health consequences is sorely lagging. One challenge in measuring toxicant content of the smoke in the laboratory is the large number of simplifying assumptions that must be made to model a "typical" smoking session using a smoking machine, resulting in uncertainty over the obtained toxicant yields. In this study, we develop an alternative approach in which smoke generated by a human water pipe user is sampled directly during the smoking session. The method, dubbed real-time in situ sampling (RINS), required developing a self-powered portable instrument capable of automatically sampling a fixed fraction of the smoke generated by the user. Instrument performance was validated in the laboratory, and the instrument was deployed in a field study involving 43 ad libitum water pipe use sessions in Beirut area cafés in which we measured inhaled nicotine, carbon monoxide (CO), and water pipe ma'ssel-derived "tar." We found that users drew a mean of 119 L of smoke containing 150 mg of CO, 4 mg of nicotine, and 602 mg of ma'ssel-derived "tar" during a single use session (mean duration = 61 min). These first direct measurements of toxicant delivery demonstrate that ordinary water pipe use involves inhaling large quantities of CO, nicotine, and dry particulate matter. Results are compared with those obtained using the Beirut method smoking machine protocol.

Prevalence of female genital cutting in Upper Egypt: 6 years after enforcement of prohibition law

The objective of this study was to evaluate the prevalence of female genital cutting (FGC) in Upper Egypt, after 6 years of putting prohibition law into action. A total number of 3730 girls between the ages of 10-14 years were recruited to participate in this study. They were mainly preparatory school students (three urban and three rural areas). Social workers interviewed them as to whether they had undergone circumcision within the last 6 years or not. Subsequently, a questionnaire was sent to parents of girls who were positive for circumcision as to the circumstances surrounding the procedure. The prohibition law of FGC seems not to have altered the prevalence of this procedure. The majority of girls (84.9%) had had circumcision within the last 6 years with high prevalence in rural areas (92.5%). Circumcision was done for a combination of reasons, according to parents, with high rates of non-medical personnel participation (64.15%). This study's results indicate that the practice of FGC in Upper Egypt remains high despite enforcement of law. Extensive efforts are needed both to revise public awareness and to change attitudes regarding FGC.

Contrast-enhanced MR angiography at 3T in the evaluation of intracranial aneurysms: a comparison with time-of-flight MR angiography

The combination of 3T and parallel-acquisition techniques holds promise for improved performance of contrast-enhanced MR angiography (MRA), in terms of speed, spatial resolution, and coverage. We present a comparison of 2 MRA techniques, including time-of-flight (TOF) and contrast-enhanced MRA, for detection and evaluation of intracranial aneurysms. Our results show that contrast-enhanced MRA with highly accelerated parallel acquisition at 3T does not have the known drawbacks of TOF-MRA techniques, including prolonged acquisition time, spin saturation, and flow-related artifacts, with comparable aneurysm characterization.

Prevalence of hepatitis B virus among chronic schizophrenia patients

We aimed to determine the prevalence of hepatitis B surface antigen [HBsAg] among chronic schizophrenia patients in Jordan. Over a period of 12 months, 192 patients [106 male and 86 female] were tested for hepatitis B virus [HBV] by enzyme immunoassay. An equal number of age- and sex-matched healthy controls was also tested. Of the schizophrenia patients, 14 [10 male and 4 female] were positive for HBsAg while only 5 [4 male and 1 female] of the control subjects tested positive. The difference was not statistically significant but it indicates that chronic schizophrenia patients are a risk group for HBV infection and likely to benefit from preventive measures [health education and immunization against HBV].

Prevalence of hepatitis B virus among chronic schizophrenia patients

We aimed to determine the prevalence of hepatitis B surface antigen (HBsAg) among chronic schizophrenia patients in Jordan. Over a period of 12 months, 192 patients (106 male and 86 female) were tested for hepatitis B virus (HBV) by enzyme immunoassay. An equal number of age- and sex-matched healthy controls was also tested. Of the schizophrenia patients, 14 (10 male and 4 female) were positive for HBsAg while only 5 (4 male and 1 female) of the control subjects tested positive. The difference was not statistically significant but it indicates that chronic schizophrenia patients are a risk group for HBV infection and likely to benefit from preventive measures (health education and immunization against HBV).

Quantifying changes in regional myocardial perfusion with aortic contrast echocardiography

We developed a technique to assess regional myocardial perfusion by quantifying echocardiographic myocardial contrast appearance and intensity after aortic root injection of an agitated diatrizoate meglumine solution. The technique was validated by comparing digitized echocardiographic contrast parameters to regional perfusion in the circumflex bed determined by calibrated Doppler flow probe and antemortem monastral blue staining. Regional perfusion was altered by circumflex stenosis, occlusion, and reactive hyperemia. Contrast effects were measured in an initial subset of six dogs by peak intensity change, time to peak intensity, maximal rate of intensity rise, and mean intensity change integrated over 1, 2, or 3 seconds after contrast appearance (MI1, MI2, MI3). MI2 and MI3 best predicted regional perfusion (r = 0.93, standard error of the estimate [SEE] 0.38 ml/gm/min for each). These findings were confirmed in a second subset of six dogs (r = 0.84, SEE = 0.70 ml/gm/min). Although there was a relatively broad standard error for the prediction of absolute perfusion for the pooled data, for individual dogs data were internally consistent so that each had r greater than 0.88 for its varied flow states. The hyperemic ratio calculated by contrast echocardiography correlated well with the Doppler value (r = 0.85). Observer and study-to-study predictive variabilities were small (SEE 0.19 to 0.32 ml/gm/min). No alterations were seen in hemodynamics or reactive hyperemia after 25 consecutive injections over a 90-minute period. Contrast echocardiography with aortic root contrast injection tracks changes in regional blood flow. This approach can assess regional coronary reserve and detect changes in regional myocardial perfusion during acute ischemia and drug intervention.