AB1227 ATTITUDES AND BELIEFS ABOUT LOW BACK PAIN OF TUNISIAN PATIENTS: A KEY PREDICTOR OF RECOVERY

Background

Low back pain (LBP) is a common problem related with significant disability and psychosocial dysfunction. Unhelpful beliefs about it are associated with higher levels of pain and may cause a delay in recovery due to unsuitable behaviours. Therefore, studies targeting these beliefs are necessary to modulate messages delivered to the population in order to decrease the burden of LBP.

Objectives

The aim of the present study was to assess the attitudes and beliefs in the management of patients with LBP.

Methods

We applied a cross sectional study including Tunisian patients with LBP. The arabic version of Back Pain Attitudes Questionnaire (10-item Back-PAQ) was used to evaluate back beliefs as a clinical screening tool. We analysed patients’ attitudes in 5 domains: vulnerability of the back (items 1 and 2), relationship between back pain and injury (items 3 and 4), activity participation during back pain (items 5 and 6), psychological influences on back pain (items 7 and 8), prognosis of back pain (items 9 and 10). For each item, the scale ranges from “False” to “True” which is the option that represents unhelpful beliefs for recovery. Intermediate labels are: “Possibly False”, “Unsure”, “Possibly True”. Responses were scored from −2 (“True”) to +2 (“False”). Unhelpful beliefs attract negative scores and vice versa.

Results

The questionnaire was completed by 32 participants (27 women and 5 men) with a mean age of 56.6 years [45-69]. The mean LBP’s duration was 9.1 years [2-28].

The mean Body Mass Index (BMI) was 29.4 [25.5-46.8]. The mean Schober’s Test and Fingertip-to-floor (FTF) were respectively 2.8 [1.5-4] and 13.2 [0-50].

The mean Visual Analogue Scale of pain (VAS pain) was estimated at 69 [40-100]. The mean Oswestry Disability Index (ODI) and Short form Health Survey (SF36) were 42.4 [28-66] and 48.3 [20-80] respectively.

Unhelpful beliefs were widespread. The mean Back-PAQ-10 score was -4 [-13 -3]. Women had significantly a lower score compared to men (-4.1 [-13-2] versus -1.6 [-5-3]) (p=0.01).

Vulnerability of the back had an average score of -2[-3-1]. The relationship between back pain and injury had a mean score of –2.4 [-4-0]. The activity participation during back pain had a mean score of -4 [-4-1]. The psychological influences and prognosis of back pain had an average score of -2[-3-0] and -1.6[-2-3] respectively.

Conclusion

The results of this survey reveal that Tunisian patients have high levels of negative beliefs about LBP. As beliefs and attitudes have been recognised as significant predictors of recovery from LBP, we should promote cognitive behavioural therapy aiming at coping with unhelpful beliefs.

Disclosure of Interests

None declared

Correlation of left atrial reservoir function with diastolic filling and stroke volume of the left ventricle in patients with rheumatic mitral stenosis

Funding Acknowledgements

Type of funding sources: None.

Correlation of left atrial reservoir function with diastolic filling and stroke volume of the left ventricle in patients with rheumatic mitral stenosis

Introduction

It has been theoretically known that the left atrium (LA) plays a key role in compensating for the lack of diastolic left ventricular (LV) filling induced by mitral stenosis (MS). However, due to the lack of adequate tools to assess the LA function, proving this concept turned out to be difficult.

With the recent introduction of two-dimensional (2D) Speckle Tracking Echocardiography (STE) for exploring LA mechanics, this concept can be demonstrated.

Purpose

To assess correlation between LA reservoir function determined by 2D STE derived global strain and LV filling and stroke volumes.

Methods

We prospectively performed comprehensive trans thoracic echocardiography (TTE) in patients with rheumatic MS. Basic echocardiographic parameters were recorded, including indexed LA volume, mitral valve area (MVA) using planimetry and pressure half time (PHT), trans mitral mean gradient, maximal trans tricuspid velocity (MTTV), mitral inflow using continuity equation and LV stroke volume. Studied parameters represent the mean of at least three consecutive cardiac cycles.

LA global strain curve and peak reservoir strain data were obtained on a standard four-chamber view using STE technique.

Results

We enrolled a total of 186 patients with rheumatic MS between February 2018 and February 2021. The mean age of our cohort was 50.55 ± 12.07 yrs. A number of patients were thereafter excluded from the study due to impaired systolic LV function (n = 12), severe mitral or aortic regurgitation (n = 7, n = 1 respectively).

A total of 69.4% of our cohort were female (n = 129), 56.2% (n = 104) had history of percutaneous transvenous mitral commissurotomy (PTMC), 59.9% had permanent atrial fibrillation (n = 109) and 15,2% had history of ischemic stroke (n = 28).

The most prominent comorbidities were hypertension (16.3%, n = 30) and diabetes mellitus (15.8%, n= 29).

The mean 2D MVA was 1.40 ± 0.47 cm², mean PHT derived MVA was 1.47 ± 0.52 cm², mean gradient was 10.72 ± 5.82 mmHg, mean indexed LA volume was 80.70 ± 45.34 ml/m² and mean MTTV was (3.09 ± 0.62m/s).

The mean mitral inflow value was 85.80 ± 28.56 ml/beat and the mean stroke volume was 70.64 ± 25.51 ml/beat.

First, we found a statistically significant correlation between LV stroke volume and 2D mitral valve area (r = 0.284, p < 0.001).

Interestingly, LA peak reservoir phase correlated positively with mitral inflow (r = 0.377, p < 0.001) and LV stroke volume (r = 0.213, p = 0.008). It also correlated with MTTV (r= -0.234, p = 0.009).

However, we did not find any correlation between indexed LA volume and mitral inflow (r=-0.068, p = 0.359) and a weaker correlation with LV stroke volume was demonstrated (r=-0.184, p = 0.014).

Conclusion

LA reservoir function assessed by 2D STE is well correlated with diastolic mitral inflow and LV stroke volume in patients with rheumatic MS.

Quantification of mitral papillary muscle function using speckle tracking echocardiography in apparently healthy population

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiac mitral papillary muscle is a structure that has been long ignored. Recently, growing evidence from case reports showed an important role in the pathophysiology of many cardiac pathologies such as hypertrophic cardiomyopathy and dilated cardiomyopathy.

To our knowledge, there isn’t any approved standard technique nor any methodological descriptive study of papillary muscle function in the apparently healthy population.

Purpose

To investigate mitral papillary muscle function in apparently healthy population by speckle tracking echocardiography (STE) using a proposed standard method.

Methods

We prospectively performed standard transthoracic echocardiography(TTE) in an apparently healthy cohort. Posterior mitral papillary muscle(PPM) was visualized on a modified three chamber view. The anterior papillary muscle(APM) was visualized on a modified 4 chamber view. To measure the value of the papillary muscles longitudinal strain, tracing of PPM and APM was done by a drag and click technique using an ECHOPAC software. Good quality tracing was ensured before approving the measurements. Each papillary muscle was divided into three segments by the software.

2D longitudinal strain curves of each papillary muscle consisted in 3 solid lines of the three segments and a dashed line that represented the mean longitudinal strain of the whole papillary muscle. This latter line was used to derive peak values, post systolic shortening (PSS) and systolic stretch (SS). Time of aortic valve closure was determined on the LV outflow pulsed doppler.

Results

Our study included 57 apparently healthy individuals between May 2021 and August 2021. Two patients were excluded due to lack of echogenicity. 71.19% (n = 44) were male. Mean age was 36 ± 14 yrs. 15.7% (n = 9) had history of hypertension and 7% (n = 4) were diabetic. 3.5% (n = 2) had history of stroke. 91.2% (n= 52) had functional status NYHA class I, 12.2% (n = 7) had functional status class II.

All of our cohort had a left ventricular ejection fraction (LVEF) above 55%, did not have diastolic dysfunction and were on sinus rhythm.

PPM peak strain value was -15.49 ±4.69 %. PSS was present in 98.2% (n = 56) and SS in 62.5%(n = 36) of cases.

Anterior papillary muscle (APM) had a peak strain value of -15.61 ± 3.66, PSS was present in 78.5% (n = 45) and SS in 51.7% (n = 29).

Conclusion

Mitral papillary muscles echocardiographic study is feasible in routine scans with modified apical views.

Post systolic shortening and systolic stretch are present in the majority of individuals. Abstract Figure. posterior papillary muscle strain curve  Abstract Figure. anterior papillary muscle strain curve

Role of left atrial reservoir function in rheumatic mitral stenosis tolerance

Introduction

Rheumatic mitral stenosis (MS) is still frequent in low income countries.

Unlike the other left sided valvular heart diseases, symptoms' occurrence is still not well understood. Previous attempts to correlate mitral valve area (MVA), pulmonary hypertension and even mitral valve stenosis severity scores with symptoms' severity have failed to establish any strong relationship. Recent advances in the characterization of the left atrium (LA) function by echocardiographic strain technique, yielded a new understanding of symptoms genesis in MS.

Purpose

To assess the correlation between LA reservoir function determined by two-dimensional (2D) Speckle Tracking Echocardiography (STE) and New York Heart Association (NYHA) functional status in patients with MS.

Methods

We prospectively performed comprehensive 2D trans thoracic echocardiography (TTE) in patients with rheumatic MS. Echocardiographic parameters, such as indexed LA volume, trans mitral mean gradient, maximal trans tricuspid velocity (MTTV), valve area using planimetry and pressure half time (PHT) were recorded. All doppler parameters are expressed as a mean of at least three measurements. LA global strain curve and peak reservoir strain value were then obtained on a four-chamber view. NYHA functional status was assessed just before performing the echo procedure.

Results

We enrolled 186 patients with rheumatic MS, with a mean age of 50.55±12.07 years. 20 patients were excluded from the study because of the presence of impaired systolic LV function (n=12), severe mitral regurgitation (n=7) or severe aortic regurgitation (n=1).

A total of 69.4% of our cohort were female (n=129), 56.2% (n=104) had a history of percutaneous transvenous mitral commissurotomy (PTMC), 59.9% had permanent atrial fibrillation (n=109). The mean MVA was 1.40±0.47 cm2, PHT derived Area was 1.47±0.52 cm2, mean gradient was 10.72±5.82 mmHg, mean indexed LA volume was 80.70±45.34 ml/m2 and mean MTTV was (3.09±0.62m/s). 75 patients (39.9%) were in NYHA III or IV functional class. Mean LA reservoir strain value was 11.08±7.76%. Comparing the group in NYHA III or IV functional class with the group NYHA I or II functional class, there was no statistically significant difference in mean MVA by planimetry or PHT, nor in mean gradient, MMTV or indexed LA volume.

Interestingly, the NYHA III or IV functional status group had a significantly lower mean LA reservoir strain value compared to the NYHA I or II functional status group (8.94±5.57% vs 11.92±8.31%, p=0.011). Even in mild MS patients with a planimetry MVA ≥1.5cm2 (n=65), a significantly lower mean LA reservoir strain value was found in NYHA III or IV group compared to the NYHA I or II group (15.08±10.09% vs 9.76±4.35%, p=0.05).

Conclusion

LA reservoir function is highly correlated to the severity of symptoms in rheumatic MS.

Funding Acknowledgement

Type of funding sources: None.

[Necrotizing fasciitis complicating transthoracic biopsy]

INTRODUCTION

Necrotizing fasciitis is a rapidly progressive and often fatal infection of the soft-tissue fascia deep to the skin but superficial to the muscles. We report a case of necrotizing fasciitis of the anterior chest wall complicating a percutaneous needle biopsy.

CASE

A 49-year-old diabetic patient, presented persistent excavated right pulmonary opacities. A percutaneous biopsy was obtained and complicated by a necrotizing fasciitis. The patient underwent surgery for total resection of the necrotic tissues followed by antibiotic treatment. Outcome was favorable after 30 days of antibiotic therapy.

DISCUSSION

Necrotizing fasciitis is a life threatening complication of transthoracic percutaneous biopsy. Prognosis depends on rapid diagnosis and treatment.

Localisation cervico-thoracique d’un kyste hydatique

The authors report a case of cervico-thoracic region hydatid cyst suspected by the presence of a palpable right lower neck mass. This location is very rare. Neck ultrasound and computed tomography showed the cyst. Magnetic resonance imaging can be useful for diagnosis and provided the best anatomo-topographic evaluation before surgery.

[Tuberculous meningitis with pituitary abscess]

Although rare, the possibility of pituitary tuberculoma should be considered in the diagnosis of non-pituitary intrasellar masses, especially in an endemic area and if radiologic imaging shows pituitary stalk thickening. We describe the case of a 52-year-old patient who presented tuberculous meningitis complicated by a pituitary abscess. He was treated with antituberculous drugs. The follow-up MRI 16 and 48 months later showed the decreased size of the pituitary mass. Radiological features and a review of the literature of pituitary tuberculoma are briefly discussed.

Adrenal adenoma in a patient with Gardner's syndrome. A case report

Gardner's syndrome is an autosomal dominant condition characterized by multiple colorectal polyposis associated with various soft and hard tissue tumors. We report a case of adrenal adenoma in a 37-year-old woman with Gardner's syndrome. Although extraintestinal neoplasms, particularly adrenal lesions, are a rare association, an increased awareness is important.

Adrenal adenoma in a patient with Gardner's syndrome. A case report

Gardner's syndrome is an autosomal dominant condition characterized by multiple colorectal polyposis associated with various soft and hard tissue tumors. We report a case of adrenal adenoma in a 37-year-old woman with Gardner's syndrome. Although extraintestinal neoplasms, particularly adrenal lesions, are a rare association, an increased awareness is important.

[Lymphocytic hypophysitis]

Lymphocytic hypophysitis is a rare inflammatory disease of the pituitary gland which may be related to an autoimmune process. Only twenty cases are reported in male. Patients usually present with symptoms of an expanding intrasellar mass or varying degrees of hypopituitarism. Most of the cases are misconsidered preoperatively as pituitary adenomas. We report a case of lymphocytic hypophysitis which has occurred at a 37-year-old-man.