3rd Degree Research Articles

TBCK GENE RELATED ENCEPHALOPATHY : A UNKNOWN ORPHAN DISEASE

Background : TBCK-related encephalopathy is a very rare condition recently diagnosed effecting the paediatric age group. It was rst discovered in 2015 by Saudi scientists who identied the role of TBCK gene mutation in a family of 13 members with ID. Mutations in this gene lends the children to have developmental delays, ID ranging from moderate to severe degree, hypotonia (low muscle tone) and seizures. Until this date only 35 cases have been reported worldwide. Our case describes a 3 year old female Case report: child hailing from Tadepalligudem, Andhra Pradesh, India. A rst order child of 3rd degree consanguineous marriage presented to us with complaints of repeated generalized tonic clonic seizures and showing physical traits of coarse face , over arching of eyebrows, anteverted nares ,cupid bow, bitemporal shrinking , atypical rash on the thigh region, at foot, hypotonia ,overall psychomotor delay and severe intellectual disability which resembled like storage disorder disease or chromosomal disorder . All the symptoms were taken into count and blood investigations were done which were inconclusive of any storage disorder that was known , upon more researching we read about TBCK disorder which was one of the causes of intellectual disorders, been recently diagnosed we gathered more information and an MRI, EEG and Genetic studies like Whole Exome Sequencing (on child and parents) were done . This came back conrmed case of TBCK gene defect, also known as TBCK gene syndrome This case is a very rare entity which causes intellect Conclusion: ual disability , more awareness of this might bring more light into the exact pathogenesis of this disease. Currently there is research about treatment options for this disease through increasing leucine which acts through mTOR pathway. Similar to supplementation of phenylalanine for phenylketonuria which improves the disease process decreases the chance of intellectual disability.

Impact of body mass index on the reliability of the CT0–4 grading system: a comparison of computed tomography protocols

BACKGROUND: The increased frequency of chest computed tomography utilization in the fight against COVID-19 has made usage of low-dose computed tomography necessary to reduce the radiation dose while preserving diagnostic quality. However, in the published literature, there were no data on the effect of body mass index on low-dose computed tomography accuracy in patients with COVID-19.
 AIM: To assess the effect of patient body mass index on the level of agreement between radiologists interpreting standard-dose computed tomography and low-dose computed tomography in COVID-19-associated pneumonia using visual semiquantitative CT 04 scale.
 MATERIALS AND METHODS: In this retrospective multicenter study, each participant underwent two consecutive chest scans at a single visit using standard-dose and low-dose protocols. Standard-dose and low-dose computed tomography with pulmonary and soft tissue kernels were interpreted using a visual semiquantitative CT 04 grading system. Data for each protocol were grouped by body mass index value (threshold value for pathology was equal to 25 kg/m2). Agreement was calculated based on binary and weighted classifications. One-way ANOVA analysis of variance was used to assess the presence of statistically significant differences in the mean for the groups.
 RESULTS: Two hundred thirty patients met the established inclusion criteria for the study. The experts processed 4 studies for each patient: standard-dose and low-dose computed tomography with pulmonary and soft tissue kernels. The proportion of normal-weight patients was 31% (71 subjects), and the samples median body mass index was 27.5 (18.3; 48.3) kg/m2. There were no statistically significant differences in intergroup pairwise comparisons for both the binary and weighted classifications (p values were 0.09 and 0.12, respectively). The group of overweight patients was further subdivided according to the degrees of obesity; however, the results were invariant to this division (no statistically significant differences: for the most different body mass index groups normal and 3rd degree obesity p-value 0.17).
 CONCLUSION: Body mass index does not affect chest standard-dose and low-dose computed tomography interpretation in COVID-19 using the visual semiquantitative CT 04 grading system.

3rd and 4th degree perineal tears that occurs during vaginal delivery

Objective: Perineal injuries are common in vaginal delivery. In this study, we aimed to investigate the factors affecting the degree of perineal injury and the effect of injury degree on incontinence. Methods: Fifteen patients, underwent sphincter repair by the general surgery unit, who had perineal tear during normal vaginal delivery between January 2018 and March 2019 in our hospital and were retrospectively evaluated. Those with grade 3a and 3b perineal tears were divided into 2 groups as group-1, and those with grade 3c and grade 4 perineal tears as group-2. Episiotomy type, fetal characteristics [head circumference and birth weight], early postoperative continence findings were compared in between groups. Results: The average age of the patients was 30 ± 8.7 years. When the groups were compared, there was no significant superiority of episiotomy in terms of perineal injury (p=0.07). 4 patients had 3a, 3 patients had 3b, 6 patients had 3c and 2 patients had fourth-degree perineal injuries. The average birth weight of the newborns was 3438 ± 492 g, and the head circumference was 34.33 ± 1.23 cm. There was no significant difference in incontinence between the groups (p=0.55). Conclusıon: The treatment of anorectal injuries is surgery. The method of treatment varies according to the time elapsed between injury and intervention, fecal contamination, degree of injury, general condition of the patient, presence of accompanying injury, experience and preference of surgeon. We think that sphincter damage during delivery can be looked after successfully with early diagnosis and intervention before tissue edema develops.

Recovery from Obstetric Anal Sphincter Injury in a Prospective Cohort of First Births.

To identify risk factors for obstetric anal sphincter injuries (OASIS) for primiparous women who gave birth vaginally and to compare recovery by OASIS status in three domains as follows: (1) physical health and functioning, (2) mental health, and (3) healthcare utilization. This secondary analysis used data from 2,013 vaginal births in the First Baby Study, a prospective cohort study of women with first births between 2009 and 2011. Interview data at multiple time points were linked to birth certificate and hospital discharge data. The key exposure of interest was OASIS (3rd or 4th degree perineal laceration, identified in the hospital discharge data; n = 174) versus no OASIS (n = 1,839). We used multivariable logistic regression models to examine the association between OASIS and a range of outcomes including physical health and functioning, depression, and health care utilization, assessed at 1 month and 6 months postpartum. Eight percent of women had OASIS. In adjusted models, there were no differences in general physical health and functioning measures by OASIS (such as fatigue and overall self-rated health), but women with OASIS had higher rates of reporting perineal pain (p < 0.001), accidental stool loss (p = 0.001), and bowel problems (p < 0.001) at 1-month postpartum. By 6-month postpartum, there were no differences in reported physical health and functioning. There were no differences in probable depression at 1- or 6-month postpartum. Women with OASIS were more likely to attend a comprehensive postpartum visit, but there were no other differences in health care utilization by OASIS. Women with OASIS were at increased risk of accidental stool loss, bowel problems, and perineal pain in the immediate postpartum period. Women who had OASIS had similar physical functioning across a range of general health outcomes to women who gave birth vaginally without OASIS. · Higher risk of bowel problems and accidental stool loss 1-month postpartum with OASIS.. · Higher risk of perineal pain 1-month postpartum with OASIS.. · No differences in health outcomes at 6-months postpartum by OASIS..

Racial variations of adverse perinatal outcomes: A population-based retrospective cohort study in Ontario, Canada.

IntroductionRacial differences in adverse maternal and birth outcomes have been studied in other countries, however, there are few studies specific to the Canadian population. In this study, we sought to examine the inequities in adverse perinatal outcomes between Black and White pregnant people in Ontario, Canada.MethodsWe conducted a population-based retrospective cohort study that included all Black and White pregnant people who attended prenatal screening and had a singleton birth in any Ontario hospital (April 1st, 2012-March 31st, 2019). Poisson regression with robust error variance models were used to estimate the adjusted relative risks of adverse perinatal outcomes for Black people compared with White people while adjusting for covariates.ResultsAmong 412,120 eligible pregnant people, 10.1% were Black people and 89.9% were White people. Black people were at an increased risk of gestational diabetes mellitus, preeclampsia, placental abruption, preterm birth (<37, <34, <32 weeks), spontaneous preterm birth, all caesarean sections, emergency caesarean section, low birth weight (<2500g, <1500g), small-for-gestational-age (<10th percentile, <3rd percentile) neonates, 5-minute Apgar score <4 and <7, neonatal intensive care unit admission, and hyperbilirubinemia requiring treatment but had lower risks of elective caesarean section, assisted vaginal delivery, episiotomy, 3rd and 4th degree perineal tears, macrosomia, large-for-gestational-age neonates, and arterial cord pH≤7.1, as compared with White people. No difference in risks of gestational hypertension and placenta previa were observed between Black and White people.ConclusionThere are differences in several adverse perinatal outcomes between Black and White people within the Ontario health care system. Findings might have potential clinical and health policy implications, although more studies are needed to further understand the mechanisms.

Care of Patients who Presented Severe Burns from Flammable Liquid Following the Explosion of a Gasoline Tank Truck on the Outskirts of Niamey

Aim of the study: To evaluate the care, at the National Hospital of Niamey, of patients who suffered severe burns following the explosion of a petrol tank truck. Patients and methods: It was a descriptive and analytical prospective study that took place from May 6 to August 8, 2019. All the patients, victims of the explosion, who were taken care at the National Hospital of Niamey were included in the study. Our data were entered and analyzed by computer software such as Epi info 7.2.3.1, Word Office and Excel Office 2016. Fischer and Pearson tests were used, with a significant value p&lt;0.05. Results: The explosion concerned 104 people of which 55 (52.95%) were died, charred and unrecognizable. There were 41 (39.4%) patients with burn injury and 8 (7.7%) with smoke intoxication. 35 (71.43%) of the patients were taken care at the National Hospital of Niamey. The average age of the patients was 23.45 years with a sex-ratio (M/F) of 16.5. The average skin burnt area (SBA) was 57.12%; 3rd degree burn predominated with 71.87%. Hydro electrolytic resuscutation according to Parkland Hospital formula was the most used in the care of the patients with 87.5%. The most frequent localisation concerned the pelvic limb with 84.37%, the death rate represented 57.14%. The extend of skin burnt area, the depth of the burn, the Baux score value and the time at which death occurred were all significant factors that are associated with the mortality with respectively p=0.008; p=0.002 et p=0.003. Conclusion: The explosion of the gasoline tank truck showed our limits in care at the HNN. The establishment of a white plan for the management of massive influxes, the creation of a burns center as well as prevention through information and education of the population is more than necessary.

PB1868: EXPERIENCE IN THE TREATMENT OF HAIRY CELL LEUKEMIA IN KAZAKHSTAN.

Background: Hairy cell leukemia is a rare oncohematological disease that manifests itself in damage to the bone marrow and spleen. One of the characteristic changes in the bone marrow are large cells, a rounded nucleus and thin outgrowths - “hairs” of the cytoplasm. The standard of care are drugs: cladribine and purine analogues-pentostatin. The complexity of therapy lies in the high risk of infections due to prolonged cytopenia during therapy. Aims: The aim of the study was to analyze the detection of hairy cell leukemia in Kazakhstan and the effectiveness of the cladribine regimen. Methods: In Kazakhstan 30 patients were diagnosed over the last 5-year period. All patients underwent cytological, histological examination of the bone marrow, bone marrow immunophenotyping. Thirty patient s were treated with cladribine intravenous infusion 0.1 mg/kg per day for 7 days. The average age was 54.6years (from 29 to 80 years), men-10, women-20. With a median follow-up of 4 years, the complete response (CR) was -25 patients, progression of disease – 3 patients, two patients die from infection. Results: Median duration of response was 38 months (range, 0.0+ to 52.0+). Median overall survival was not reached in all patients with CR. All patients had hematological complications in the form of grade 4 leukopenia - 30 patients, grade 4 thrombocytopenia - 28 patients, grade 3 thrombocytopenia – 2, patients grade 2 anemia - 9 patients. Emetic syndrome in the form of vomiting of the 3rd degree was in one patient, diarrhea of the 2nd degree in one patient. Eleven patients had febrile neutropenia. Two patients had a fatal outcome due to the development of pneumonia and subsequent sepsis. Summary/Conclusion: Treatment of patients with hairy cell leukemia with a purine analogue showed high efficiency, but was accompanied by prolonged cytopenia and frequent secondary infection. It is necessary to consider the issue of vaccination of this category of patients with anti-pneumococcal vaccine and also to conduct continuous monitoring. Ten patients with CR were vaccinated against coronavirus infection.

Short and long-term outcomes of children with autoimmune congenital heart block treated with a combined maternal-neonatal therapy. A comparison study.

The short and long-term outcomes of children with anti-Ro/La-related congenital heart block treated with a combined maternal-neonatal therapy protocol were compared with those of controls treated with other therapies. Sixteen mothers were treated during pregnancy with a therapy consisting of daily oral fluorinated steroids, weekly plasma exchange and fortnightly intravenous immunoglobulins and their neonates with intravenous immunoglobulins (study group); 19 mothers were treated with fluorinated steroids alone or associated to intravenous immunoglobulins or plasma exchange (control group). The combined-therapy children showed a significantly lower progression rate from 2nd to 3rd degree block at birth, a significant increase in heart rate at birth and a significantly lower number of pacemaker implants during post-natal follow-up with respect to those treated with the other therapies. The combined therapy produced better short and long term outcomes with respect to the other therapies studied.

P-210 Germline testing in pancreatic adenocarcinoma

Pancreatic ductal adenocarcinoma (PDAC) remains a challenging disease to treat. Despite advances in medical therapies, the 5-year survival rate remains below 9%. BRCA mutations have emerged as a target for the development of more effective therapies. Alterations in germline BRCA and PALB2 are detected in approximately 5-9% of patients with PDAC and can lead to homologous repair deficiency (HRD). PDAC with HRD is more susceptible to cytotoxic agents, that cause DNA damage and PARP inhibitors have emerged as an effective non-cytotoxic approach. Germline mutations in other genes involved in the homologous DNA repair pathway -such as ATM and RAD51- are potential targets. The aim of our study is to analyse the frequency of germline mutations in patients with PDAC and to evaluate the role of family history as a supportive criterion for genetic testing. Descriptive and retrospective study of the germline study of pathogenic variants (PV) and variants of unknown significance (VUS) in patients (p) with PDAC and those with 1st degree family history of pancreatic cancer studied at the Salamanca Genetic Counselling Unit (UCGS) from 2004 to 2022. The determination of BRCA1/2 and other genes in peripheral blood was carried out using Next-Generation Sequencing (NGS) techniques. We included 30 patients (p) with PDAC, studied as index case. Males (36.7%). Age (median): 68.5 years [28-84]. BRCA1/2 was performed in 26p and multiplex-gene panel (MGP) in 4p. Four PV were finding: 13.3% (2 in BRCA2 and 2 in PALB2) and 2 VUS in BRCA1 and BRCA 2. 1p carrier of the PALB2 mutation suffered pancreatic and gastric cancer. In patients carrying PV, 4 cases of breast cancer, 1 pancreatic cancer, 1 prostate cancer and 1 ovarian cancer were recorded as first-degree antecedents. Other oncological antecedents described in the family (2nd and 3rd degree): 3 breast cancer, 1 gastric cancer and 2 prostate cancer. In patients carrying VUS in BRCA1/2, familial aggregation was also described with 1 case of pancreatic cancer, 1 breast cancer and 1 breast cancer in immediate family. We collected 96p with cancer: breast cancer 64p (66.7%) followed by ovarian cancer 19p (19.8%), with 1st degree family history of pancreatic cancer. Age (median): 61.5 years [30-93]. BRCA1/2 was performed in 89p and MGP in 7p. Seven PV (7.3%) were found: 5 in BRCA1, 1 BRCA2 and 1 CHEK2. 16 VUS (16.7%) were found: 6 BRCA2, 5 BRCA1, 1 ATM, 1 MSH3, 1 POLE, 1 MLH1, 1 PABL2. In 2p, two variants were found in the same patient (1 of them 1PV in CHEK2 and 1 VUS in MSH1, and the other, 1 VUS in ATM and 1VUS in POLE). PDAC could be an inherited condition in around 10% of cases. Germline testing BRCA and other HRD genes will improve therapeutic strategies and precision medicine in PDAC. In addition, familial involvement due to the identification of a hereditary syndrome should be taken into account.

1060-P: Exploring Differences in the 24-Hour Glucose Cycle by Physical Activity Level in Women with Pregnancy Hyperglycemia

Physical activity (PA) improves glucose levels. PA’s impact on the 24-hour glucose cycle in pregnancy hyperglycemia is unknown. This study examined baseline data from women participating in a small pilot feasibility randomized controlled trial. At baseline, they completed a survey which included the Stanford Leisure-Time Activity Categorical Item (L-Cat) for comparison to national PA recommendations. PA over the past month was assessed. Dexcom G6 CGMs linked to blinded receivers were worn for 7 days. Typical 24-hour glucose functions were estimated with B-splines and generalized regression analyses controlling for gestational diabetes (GDM) conducted in JMP. CGM was available for 14 participants; 4 (29%) had GDM and 3 (21%) reported meeting PA recommendations. Mean glucose was 91.5 mg/dl (SD 17) for sufficient PA and 93.6 mg/dl (SD 20) for insufficient PA. Figure 1 displays the 24-hour glucose functions (3rd degree polynomials with 17 knots) for sufficient PA (red) versus insufficient PA (blue) . Lower glucose was observed in the early morning, i.e., from midnight through approximately 6am and likely fasted, in sufficient versus insufficient PA, but the difference did not attain statistical significance. Glucose was higher in those with GDM, controlling for PA (P &amp;lt; .05) . Findings in a small sample of women with pregnancy hyperglycemia suggest that PA may improve early morning glucose. Disclosure S.F.Ehrlich: None. B.G.Rand: None. N.Zite: None. K.B.Fortner: Other Relationship; Pfizer Inc. A.M.Paudel: None. C.Peterson: None. J.M.Maples: None. Funding K01DK105106

Разработка новой концепции оценки напряженности труда пилотов гражданской авиации

The article describes a concept for assessing labor intensity (LI) developed by the authors. This concept is based on the results produced by comprehensive assessment of the current working conditions, by analyzing the psychophysiological state of civil aviation (CI) pilots in flight, as well as by assessing a contribution made by flight loads and signs of fatigue to an increase in a risk of aviation accidents (AA). It has been established that, according to sanitary and hygienic profiles, LI levels at all workplaces of civil aviation pilots correspond to harmful working conditions, which are aggravated by exposure to four other harmful factors (noise, microclimate, vibration, and working posture) in 48 % of cases. The research results have shown that the risks of fatigue increase significantly after 5 hours of flight. This fatigue manifests itself in the growing number of gaze fixations by 11 %; an increase in an average latency period of a complex visual-motor reaction, by 12 %; the growing number of significant errors for flight safety, by 50 %. All these processes occur in the absence of physiological recovery of the cardiovascular system, p &lt; 0.05. Pilots who are in a state of fatigue and stress due to violated work and rest regimes tend to have more AA. This accounts for at least 8.4 % of cases from all others causes. It is proposed to introduce the 3rd degree of harmfulness for strenuous work, as well as new LI indicators for sensory, informational and intellectual loads, such as an increase in a time required to fix the gaze on a device (in %), the frequency of image / value change on a screen (times/min), the volume of information flows per unit of time (bps), and the number of multifunctional devices (more than 10 bits per second). It has been established that the assessment of LI should be supplemented with specific indicators of the flight load and work regimes. These indicators include the number of takeoffs and landings, the number of crossed time zones, the number of stress factors during a flight, and the number of night flight shifts per week. They are directly related to developing fatigue among pilots and an increased risk of AA occurrence.

LUNG FIBROSIS AND RECURRENT PNEUMOTHORAX REVEALING CHRONIC SEPTIC GRANULOMATOSIS IN AN ADOLESCENT

TYPE: Late Breaking Case Report TOPIC: Pediatrics INTRODUCTION: Primary spontaneous recurrent pneumothorax is uncommon in children. It may be life threatening and reveal a pulmonary serious disease. CASE PRESENTATION: A 16-year-old adolescent with 3rd degree cousin parents and a history of hypotrophy since his first months of life. At the age of 6 years, he developed chronic cough, wheezing and dyspnea with rapid progression to chronic respiratory failure, pulmonary arterial hypertension and dependence of the oxygen. Chest CT showed pulmonary fibrosis with diffuse septal thickening. Etiological assessment including sweat test, humoral and cellular immunity tests, immunological record and Broncho alveolar lavage was negative. Later, he suffered from spontaneous recurrent pneumothorax managed by pleural drainage despite pleurodesis. The diagnosis of chronic septic granulomatosis was made at the age of 16 years on the basis of a Nitroblue Tetrazolium test not previously performed. Thus, he was treated by corticosteroids and had a bone marrow transplantation wich allowed an improved quality of life. DISCUSSION: severe and recurrent respiratory manifestations require meticulous approach of investigations. Indeed, significant functional and vital complications may occur as a result of delayed diagnosis and treatment. In our case, a Nitroblue Tetrazolium test or a pulmonary biopsy could have accelerated the diagnosis and improved the prognosis of our patient. CONCLUSIONS: Recurrent pneumothorax and pulmonary fibrosis may be manifestations of primary immune deficiency in children. Thus, the etiologic assessment must be exhaustive before an idiopathic origin is considered. DISCLOSURE: Nothing to declare. KEYWORD: Pneumothorax

Development of a new concept for assessing labor intensity of civil aviation pilots

The article describes a concept for assessing labor intensity (LI) developed by the authors. This concept is based on the results produced by comprehensive assessment of the current working conditions, by analyzing the psychophysiological state of civil aviation (CI) pilots in flight, as well as by assessing a contribution made by flight loads and signs of fatigue to an increase in a risk of aviation accidents (AA). It has been established that, according to sanitary and hygienic profiles, LI levels at all workplaces of civil aviation pilots correspond to harmful working conditions, which are aggravated by exposure to four other harmful factors (noise, microclimate, vibration, and working posture) in 48 % of cases. The research results have shown that the risks of fatigue increase significantly after 5 hours of flight. This fatigue manifests itself in the growing number of gaze fixations by 11 %; an increase in an average latency period of a complex visual-motor reaction, by 12 %; the growing number of significant errors for flight safety, by 50 %. All these processes occur in the absence of physiological recovery of the cardiovascular system, p &lt; 0.05. Pilots who are in a state of fatigue and stress due to violated work and rest regimes tend to have more AA. This accounts for at least 8.4 % of cases from all others causes. It is proposed to introduce the 3rd degree of harmfulness for strenuous work, as well as new LI indicators for sensory, informational and intellectual loads, such as an increase in a time required to fix the gaze on a device (in %), the frequency of image / value change on a screen (times/min), the volume of information flows per unit of time (bps), and the number of multifunctional devices (more than 10 bits per second). It has been established that the assessment of LI should be supplemented with specific indicators of the flight load and work regimes. These indicators include the number of takeoffs and landings, the number of crossed time zones, the number of stress factors during a flight, and the number of night flight shifts per week. They are directly related to developing fatigue among pilots and an increased risk of AA occurrence.

Genetic risk assessment in primary care settings: An evaluation of NCCN guidelines.

10605 Background: Lynch syndrome (LS) and hereditary breast and ovarian cancer (HBOC) have a population prevalence of 1/2791 and 1/4002, respectively. Despite this, &gt;80% of patients referred for cancer genetic counseling report personal or family history of breast cancer3. This disparity may be due to increased media attention for HBOC, lower levels of provider awareness of LS, and less discussion of colorectal cancer within families compared to breast cancer4. However, potential biases in National Comprehensive Cancer Network (NCCN) criteria for genetics evaluation (GE) have not been studied. This project examined the performance of NCCN guidelines for identifying individuals meeting criteria for GE ascertained through primary care (PC) settings. Methods: Individuals scheduled for routine PC appointments at three Michigan Medicine affiliated practices from 10/24/18 through 1/24/22 were emailed a link to complete an online personal and family history (P/FHx) risk assessment module (INHERET) collecting information about cancer diagnoses (age/cancer type) in 1st, 2nd, and 3rd degree relatives. The module was written at a 4th grade reading level and could be accessed on any internet-connected device. NCCN guidelines were applied to determine if patients met criteria for GE of HBOC and/or LS. Results: A total of 465 individuals completed the module; nearly one in three (30.6%, 142/465) met NCCN criteria for GE of HBOC or LS. Of those meeting criteria, 132 (92.9%) had no personal history of cancer. The most common indication for GE was HBOC (29.5%, 137/465) and 30 patients (6.5%) met HBOC referral criteria solely based on Ashkenazi Jewish ancestry. Only 17/465 (3.7%) individuals met NCCN criteria for GE of LS. Interestingly, 12/17 (70.6%) who met criteria for GE of LS also met criteria for GE of HBOC. The completion rate was not 100% and cannot be determined; it is not known how many patients were offered the option of completing the module. This limits the study, as ascertainment bias cannot be assessed. Conclusions: Nearly one-third of PC patients who completed the P/FHx module met NCCN criteria for genetic evaluation of HBOC and/or LS. Referrals for HBOC outnumber those for LS, even though LS is just as common1, 2, 3. Further evaluation of NCCN criteria is needed to evaluate whether patients may be over-referred for HBOC and/or under-referred for LS. Unfortunately, we were not able to confirm receipt of email invitations or accurately calculate completion rate of the P/FHX risk assessment module, which limited our ability to assess for ascertainment/response bias. [Table: see text]

Prognostic value of low ankle-brachial index in patients with resistant hypertension

In the presence of resistant hypertension, patients have a significantly higher risk of stroke, myocardial infarction, kidney disease, heart failure, and death than patients with elevated blood pressure. Increased arterial stiffness is an important factor in determining cardiovascular risk. Peripheral artery damage is a target organ lesion, and its presence puts the patient at high or very high risk. The simplest non-invasive method of detecting peripheral vascular damage in patients is to determine the ankle-brachial index (ABI). Aim. To detect the frequency of damage to the lower extremity peripheral arteries by determining the ankle-brachial index and its impact on the subsequent prognosis in patients of older age (&gt;55 years) with resistant hypertension using automatic blood pressure monitors. Materials and methods. The object of the study were patients with hypertension aged 55 years – 150 people with elevated blood pressure of the 3rd degree and 20 healthy people of the same age. The study included only those patients who did not have clinical symptoms of peripheral vascular disease, type 2 diabetes mellitus. Determination of the ABI was performed by an automatic device. Results. The frequency of femoral artery lesions detection by measuring blood pressure on the brachial and legs in asymptomatic patients with resistant hypertension was 14.0 %. For a detailed analysis, we divided all patients with hypertension depending on the value of the ABI into two subgroups: subgroup A included patients (n = 129) with an ABI value &gt;0.9, subgroup B (n = 21) – with the value of ≤0.9. In patients with resistant hypertension and peripheral arterial disease, the more common factors were: longer duration of hypertension, the presence of isolated systolic hypertension and a lower level of glomerular filtration rate. Decreased ABI (≤0.9) in patients with resistant hypertension was associated with a 1.4-fold increased risk of adverse cardiovascular complications and a 1.9-fold increased risk of all-cause mortality. Conclusions. In patients with resistant hypertension, a reduced ankle-brachial index was associated with a 1.4-fold increased risk of adverse cardiovascular complications and a 1.9-fold increased risk of all-cause mortality.

Perceptions of third year degree nursing students at University of Namibia, regarding the causes of infant mortality rate in Windhoek, Havanna informal settlement, Namibia

Background: The purpose of the study was to determine the knowledge and attitude of 3rd year degree nursing students at UNAM regarding the causes of infant mortality rate in Windhoek, Havana settlement, Namibia.Methods: A cross sectional descriptive study was conducted on the 3rd year nursing students at UNAM. A sample size of fifty students was used. Questionnaires were used to obtain data; data collected included socio-demographic data, questions on knowledge and attitudes. The data obtained was analyzed using descriptive analysis and presented using narration, tables, pie charts and bar graphs.Results: A response rate of 100% was achieved. The majority of the participants were female 94% and 6% were male, with grade 12 certificates as highest level of qualifications. Overall participants had good knowledge on the causes of infant mortality in the Havana informal settlement, Windhoek Namibia.Conclusions: Participants displayed good knowledge and attitude regarding the causes of infant mortality rate in Havana informal settlement, Windhoek Namibia.

P92 ADVANCED CIRCULATORY SUPPORT IN A PATIENT WITH ISCHEMIC HEART DISEASE, SEVERE AORTIC STENOSIS AND CARDIAC TAMPONADE

Abstract The use of mechanical left ventricle assistance device in the context of severe aortic stenosis is far from routine. The clinical case we’re presenting highlights the possibility of achieving therapeutic success through appropriate patient selection and choice of the most useful strategy based on the clinical scenario. Our patient is a 70 years old man with several cardiovascular risk factors (DM2, hypertension, active smoker, overweight), CKD IV; his clinical history is characterized by NSTEMI in 2010, treated with PCI and subsequent implantation of 2 DES (on LAD and RM), and by an hospital admission in 2019 for AHF with diagnosis of severe AS. He refused any invasive treatment for underlying valvopathy. In January 2021, a dual–chamber pacemaker implant was required due to the finding of 3rd degree AV block: again, TAVI was refused. A few days after the last discharge, a new ER admission was necessary: the patients had dyspnea (NYHA III–IV) with severe EF depression (50–&amp;gt;25%) and slight troponin elevation: no significant lesions were discovered by coronarography exam. The patient finally agreed to start examinations preparatory to TAVI. After resolution of AHF and approximately 14 days after coronarography, the patient developed pericardial effusion to tamponade, of possible uremic etiology: in addition to compression on the right chambers, echocardiography showed a further dramatic decline in EF (10–15%); despite placement of pericardial drainage and IABP, the initiation of advanced amine support and mechanical ventilation, the patient was classified Intermacs 2. Following a collegial discussion (interventional cardiologist, cardiac surgeon and anesthesiologist), it was decided to perform procedure in the cath–lab in order to undertake an advanced support strategy as birdge–to–therapy: – Valver valvuloplasty with increasing balloon size (18 mm – 20 mm – 23 mm – 25 mm). Rapid pacing was performed through previously implanted PMK, resulting in subsequent hemodynamic benefit (mean gradient 45–&amp;gt;25 mmHg); – Placement of Impella CP (P8, output 3–3.2 L/min). The following post–procedural hospitalization, despite the need for antibiotic therapy and multiple transfusions, was characterized by a progressive hemodynamics improvement until feasibility of weaning from both mechanical and amine therapy and discharge to the rehabilitation center in anticipation of TAVR procedure, which will then be successfully performed in October 2021.

Burn Classifications with Its Treatment and Parkland Formula Fluid Resuscitation for Burn Management: Perspectives

Burns can be caused by flames, ultraviolet radiation, hot liquids, electricity, lightning and certain chemicals. All burns require immediate first aid treatment. Partial and full thickness burns require urgent medical attention. Full thickness burns often require skin graft surgery. Simple analgesics (such as ibuprofen and acetaminophen) and opioids such as morphine didn’t used in 3rd degree burn because the burnt place is painless. The "Wallace Rule of Nines" is the most common method of determining body surface area. The most commonly used resuscitation formula is the Parkland formula which calculates the amount of fluid required in the first 24 hours.

Effectiveness of Nifedipine in Preterm Labour Suppression

Objective: To understand the safety and effectiveness of nifedipine as a tocolytic agent in preterm labor. Study Design: A Quasi-experimental study. Place and Duration: The study was held in the Obstetrics and Gynecology Department of Riphah International Hospital Rawalpindi for one-year duration from January 2021 to December 2021. Methodology: 90 singleton pregnancies with cervical dilatation less than 3 cm and intact membranes with preterm labour occurred between 28-34 weeks of pregnancy were included and nifedipine was given as a tocolytic agent. Results: This study was performed on 90 patients, 55(61.1%) of whom were primigravida and 35(38.9%) were multiparty. 27.1 + 5.2 years was the mean age of patients (range 20 to 45 years), 74.4% were unbooked patients compared to 25.6% were booked patients. The tocolysis was obtained successfully in 76.7% of patients. The number of days obtained in delayed delivery was analyzed (Table 1B). Overall achievement in postponing delivery over 2 and 3 days is 76.7% (69/90). 21 patients (23.3%) were considered treatment failures. Of the patients who failed treatment (21/90), 18 patients gave birth in one day and 3 patients in two-days. The mean delay in delivery &lt;2 days was 1.0 + 0.3 days, while the delay &gt;2 days was 4.31 + 9.0, which is statistically important at&gt; p 0.008. The mean heart rate prior to treatment was 83.0 + 5.0, afterwards to treatment with nifedipine it was 92.0 + 5.0, indicating a difference of 9 bpm: statistically insignificant in heart rate. Conclusion: Nifedipine was effective in suppressing preterm delivery and delaying delivery long enough to achieve therapeutic effect and transfer the mother to the 3rd degree care unit. Keywords: Tocolysis, Premature labour, Nifedipine (calcium channel blocker).

Comparison of Haemorrhoidectomy Using Ligasure with Open (Milligan Morgan Haemorrhoidectomy)

Aim: To compare between haemorrhoidectomy using ligasure versus conventional haemorrhoidectomy in terms of operative time, bleeding and post-operative pain. Study design: Controlled randomized trial Place and duration of study: Department of Surgery, DHQ Hospital Abbottabad from 1stJuly 2018 to 31stDecember 2020 Methodology: One hundred and twenty patients were enrolled. Patients were allocated to two groups and haemorrhoidectomy done with ligasure (LS, group A) and conventional method i.e. Milligan Morgan haemorrhoidectomy (MMH, group B) and each group comprised 60 patients. In group A pedicals were coagulated with the ligasure rather than transfixed as in group B (MMH). Operative time and per operative bleeding recorded during surgery while postop pain score recorded using visual analogue score (0-10) especially during first defecation. Results: The mean age of 46±16.36 years were studied and 79.1% were males. In group A 72.5% patients were males and 27.5% females compared to 67.5% males and 32.5% females in group B. 87.5% of patients had 3rd degree hemorrhoids in group A while 89.4% had the same disease in group B. Operative time was between 20-35 minute in group A compared to 10-30minutes in group B. In group A 75% observed mild pain as recorded on VAS, 25% had moderate pain at time of first defecation while in group B 69.4% patients had moderate pain on VAS, 25.6% experienced mild pain and another 5% reported severe pain during defecation. Mean blood loss was 104.21±41.45 ml in both populations, in group A it was 83.59±34.34 ml while in group B it was 124.84±37.56 ml. Mean VAS of both populations was 3.55±2.05 while mean time of operation was 36.35±7.22.Using independent sample T test, there was statistically significant (P=0.000) difference on all three parameters between two groups. Conclusions: Haemorrhoidectomy using ligasure is safe and causes minimal bleeding, requires less operative time and is associated with less pain compared with conventional scissors dissection, and is a good alternative to diathermy excision. Keywords: Haemorrhoidectomy, Ligasure (LS), Conventional haemorrhoidectomy