Asingle Center Research Articles

Predictors of 7-day mortality in critically ill patients with hyperglycemic crisis : Asingle center retrospective analysis.

The main aim of the study was to identify point of care available laboratory and clinical predictors of 7‑day mortality in critically ill patients with a hyperglycemic crisis. Aretrospective study of 990 patients with the first hospitalization due to hyperglycemia was performed. Patients were classified as having diabetic ketoacidosis (DKA) or being in a hyperosmolar hyperglycemic state (HHS) according to the recommendations of the American Diabetes Association (ADA). Patients not fulfilling the ADA criteria for DKA or HHS were summarized in athird group (unclassifiable hyperglycemia, UCH). The primary outcome was 7‑day mortality, potentially relevant factors were analyzed as secondary outcomes. Overall, the 7‑day mortality was 7.5%, with no significant differences between DKA (7.8%), HHS (14.5%) and UCH (6.1%). Blood lactate levels were significantly higher in nonsurvivors than survivors in all three groups (mean level of 6.3 mmol/l vs. 3.4 mmol/l in DKA, 5.3 mmol/l vs. 3.1 mmol/l in HHS, 5 mmol/l vs. 2.5 mmol/l in UCH). Measured and calculated osmolality were significantly higher in nonsurvivors in the DKA group (measured osmolality 359 mosmol/kg vs. 338 mosmol/kg, calculated osmolality 315 mosmol/kg vs. 305 mosmol/kg) and patients with UCH (354 mosmol/kg vs. 325 mosmol/kg; 315 mosmol/kg vs. 298 mosmol/kg) but not in patients with HHS. Survival analysis for the DKA group showed no significant differences in 7‑day mortality when patients were compared by the ADA criteria of severity (severe, moderate, or mild). Patients with elevated calculated osmolality (> 320 mosmol/kg) and lactate (> 4 mmol/l) had the lowest 7‑day survival rate (66.7%). Our data showed that elevated lactate levels were associated with higher mortality in all types of hyperglycemic crises.

Thrombectomy Outcomes for Anterior Circulation Stroke in the 6-24 h Time Window Solely Based On NCCT and CTA: ASingle Center Study.

Since perfusion imaging may be unavailable in smaller hospitals, alternative imaging selection methods for acute ischemic stroke can improve outcomes and optimize resources. This study assessed the safety and effectiveness of using imaging criteria other than DEFUSE3 and DAWN for thrombectomy beyond 6 h from symptom onset in patients stroke in the anterior circulation. This is aretrospective, single-center analysis of consecutive patients with large vessel occlusion in the anterior circulation undergoing thrombectomy. Patients were categorized into two groups based on the collateral status (moderate collaterals and good collaterals). Among 198 patients, 106 (54%) met the inclusion criteria and were analyzed. Good collateral status was observed in 78 (74%) patients. Patients with good collaterals showed significantly lower mRS scores at discharge and at 90days compared to their counterparts with moderate collateral status (4 (3-4) vs.4 (4-5); p = 0.001 and 2 (0-4) vs.6 (3-6); p < 0.001, respectively). More patients with good collateral status achieved favorable outcomes at 90days compared to those with moderate status (48 (61.5%) vs.5 (17.9%); p < 0.001). Good collaterals were an independent predictor of good clinical outcomes at 90days (OR = 1.31, 95% CI: 1.13-1.53, p < 0.001). Selecting patients for endovascular treatment of acute ischemic stroke using non-contrast CT and CT angiography shows 90-day outcomes similar to the DAWN and DEFUSE-3trials. Using collateral status on CT angiography can predict favorable outcomes after mechanical thrombectomy in resource-limited settings where perfusion imaging is unavailable.

The Significance of Right-Sided Precordial ECG Leads (V3R and V4R) in Assessing Right Ventricular Dysfunction: ASingle Center Cross-Sectional Study.

Right ventricular systolic dysfunction is associated with poor prognosis and increased mortality rates. Our objective was to investigate ECG changes in patients with this condition, focusing on the right-sided precordial leads. In this cross-sectional study, 60 patients with right ventricular dysfunction were included from April 2020 to April 2021. Cardiac structure and function were assessed using 2D transthoracic echocardiography. Standard 12-lead electrocardiograms and right-sided precordial ECGs (V3R-V4R) were obtained and analyzed for QRS complex configuration, ST-segment elevation, and T-wave morphology. In our study, the majority were male (70.0%) with a mean age of 58.76 years. The most common initial diagnoses were pulmonary thromboembolism (43.3%), chronic obstructive pulmonary disease (26.7%), and pulmonary hypertension (25.0%). The predominant ECG finding in the right-sided precordial leads (V3R, V4R) was a deep negative T wave (90.0%). Patients with severe right ventricular systolic dysfunction often exhibited a qR pattern (41.2%), whereas those with nonsevere dysfunction showed rS and QS patterns (55.8%). Approximately 41.0% of severe RV dysfunction cases had ST segment depression in the right-sided precordial leads, and 28.0% of patients displayed signs of right atrial abnormality. The study found that qR, rS, and QS patterns were more prevalent in V3R and V4R leads among patients with severe and nonsevere right ventricular systolic dysfunction. The most common ECG feature observed was deep T-wave inversion in these leads. The study recommends using right-sided precordial leads in all patients with RV systolic dysfunction for early detection and risk stratification.

Pediatric crush-related acute kidney injury and risk factors: asingle center experience.

Crush injury, the most important trauma complicationencountered in earthquake victims, occurs as a result of prolonged compression of muscle mass. Crush syndrome, resultingfrom crushinjury, and acute kidney injury (AKI) are the most common causes of in-hospital deaths after earthquakes. The aim of this study is to convey our experience afterthe devastating Turkey-Syria earthquake and to identify the risk factors of crush syndrome and crush-related AKI. Of the 1134 children admitted to the emergency department, 265 with crush injury were included the study. Demographic information, laboratory and clinical data of the patients were retrospectively analyzed. Mean age of the patientswas 10.3 ± 4.9years (134 femalesand131 males). The median time spent under the rubble was 20h. Crush syndrome developed in 135 (50.9%). Patients with crush syndrome were older and had higher body weight, respectively (p = 0.014, p = 0.044). Acute kidney injury was present in 157 (59.2%) patients. Thirty-two patients (12.1%) received kidney replacement therapy (KRT). The risk factors for the development of AKI Stage 3 were crush syndrome, abdominal trauma, and age. This disaster taught us the importance of establishing in advancea national emergency disaster plan. Older pediatric earthquake victims with multiple trauma and severe crush syndrome should be closely followed-up for development of AKI and, if necessary, started on dialysis. Timely access to medical care, early fluid resuscitation, and effective use of dialysis treatment are essential.

Preoperative intra-aortic balloon pump in patients with ST-elevation myocardial infarction undergoing urgent cardiac bypass surgery.

In patients with ST-elevation myocardial infarction (STEMI), either with or without cardiogenic shock, mechanical circulatory support with an intra-aortic balloon pump (IABP) is not associated with lower mortality. However, in STEMI patients undergoing urgent coronary artery bypass grafting (CABG), preoperative insertion of an IABP has been suggested to reduce mortality. In this study, the effect of preoperative IABP use on mortality in STEMI patients undergoing urgent CABG was investigated. All consecutive STEMI patients undergoing urgent CABG in asingle centre between 2000 and 2018 were studied. The primary outcome, 30-day mortality, was compared between patients with and without apreoperative IABP. Subgroup analysis and multivariable analysis using apropensity score and inverse probability treatment weighting were performed to adjust for potential confounders. Atotal of 246 patients were included, of whom 171 (69.5%) received apreoperative IABP (pIABP group) and 75 (30.5%) did not (non-pIABP group). In the pIABP group, more patients suffered from cardiogenic shock, persistent ischaemia and reduced left ventricular function. Unadjusted 30-day mortality was comparable between the pIABP and the non-pIABP group (13.3% vs 12.3%, p = 0.82). However, after correction for confounders and inverse probability treatment weighting preoperative IABP was associated with reduced 30-day mortality (relative risk 0.52, 95% confidence interval 0.30-0.88). In patients with STEMI undergoing urgent CABG, preoperative insertion of an IABP is associated with reduced mortality.

Long-term Safety and Efficacy of the Derivo Embolization Device in a Single-center Series

PurposeThis study analyzes the long-term clinical and angiographic outcomes of the Derivo Embolization Device (DED), an advanced flow diverter device with an electropolished surface, for the treatment of intracranial aneurysms.MethodsA consecutive series of 101 patients (mean age: 58 years, 72% female) treated with the DED for 122 aneurysms at a single center between 2017 and 2023 was retrospectively analyzed for major (change in National Institutes of Health Stroke Scale [NIHSS] score ≥ 4 points) and minor (change in NIHSS score < 4 points) neurological events, procedural morbidity (increase of at least one point on the modified Rankin Scale), and angiographic results.ResultsThere were 14 (11%) recurrent aneurysms, 15 (12%) ruptured aneurysms, 26 (21%) posterior circulation aneurysms and 16 (13%) fusiform or dissecting aneurysms. Device deployment failed in 1 case (1%). Procedure-related symptomatic procedural complications consisted of 2 (2%) major events (1 major stroke and 1 vessel perforation with intracranial hemorrhage and infarction) and 6 minor events (6 minor strokes). Procedural morbidity was 5%. There were no late ischemic or hemorrhagic events during follow-up. Complete and favorable aneurysm occlusion was achieved in 54% (40/74) and 62% (46/74) at a mean of 5 months, 71% (27/38) and 87% (33/38) at a mean of 12 months, and 76% (25/33) and 97% (32/33) at a mean of 35 months, respectively.ConclusionThe results demonstrate progressive aneurysm occlusion beyond 12 months after DED implantation with an almost 100% favorable occlusion rate. Procedural morbidity was low and there were no late complications.

Survival outcomes and treatment experience of 124patients with primary central nervous system lymphoma.

Primary central nervous system lymphoma (PCNSL) is arare malignancy of the central nervous system with high invasiveness. There is little consensus on the treatment of PCNSL. This study retrospectively studied data from PCNSL patients in asingle center to summarize treatment experience and explore prognostic factors. Survival curves were drawn using the Kaplan-Meier method and prognostic factors were analyzed using Cox's hazards model. In multivariate analysis, cerebrospinal fluid lactic acid dehydrogenase (CSF LDH; p = 0.005 and p = 0.002), neutrophil to lymphocyte ratio (NLR; p = 0.014 and p = 0.038), and completion of four cycles of induction therapy (p < 0.001and p < 0.001) were significant and independent predictors of overall survival (OS) and progression-free survival (PFS), respectively. On the basis of this study, we propose that PCNSL patients should receive early induction therapy with sufficient cycles. Subsequent consolidation therapy can prevent relapses and improve survival. In patients with PCNSL, the independent prognostic factors for OS and PFS were CSF LDH level, NLR, and full cycles of induction therapy.

Primary Pancreatic GIST - A-Single Centre Case Series and Systematic Review of Literature.

GISTs arising from organs outside GI tract are defined as extragastrointestinal GISTs (EGIST). The majority of EGISTs arise from small intestinal mesentry, mesocolon, omentum, retroperitoneum, abdominal wall, liver and pancreas with pancreas comprising less than 5% of it. Due to limited data, it is unknown if the results of GIST can be generalised for EGISTs. We thereby present the largest single-centre case series of primary pancreatic GIST so far with review of existing literature. A total of 9 patients of primary pancreatic GIST were treated at our institute from September 2016 to February 2023. After literature search for all studies published before February 2023, 51 articles including 57 patients were identified. Their clinicopathological data and survival analysis were assessed. The median age of patients treated at our centre was 53years with a female predominance. The most common epicentre was pancreatic head with abdominal pain as the most common presenting symptom. All 57 patients documented in literature belonged to a similar age group with similar gender predilection. The factors impacting DFS were histologic type, mitotic index, NIH risk category and adjuvant therapy. The median DFS was 74months with a 5-year DFS being 71.9%, while the 5-year OS was 90.4%. Pancreatic GIST is a rare entity. Due to limited evidence and evolving literature, results cannot be generalised to a larger population. Larger case series with longer follow-up data are required to further understand the disease biology and long-term outcomes of pancreatic GIST.

Emotional and behavioural functioning in children with tyrosinaemia type 1.

Tyrosinaemia type I is arare hereditary metabolic disease caused by deficiency of the enzyme involved in the breakdown of tyrosine. Since the use of nitisinone in addition to diet in 1992, survival rates have increased significantly, but more and more socio-emotional problems have become apparent. The aim of the study was the assessment the relationship between variations in serum tyrosine and phenylalanine levels and measurements of socio-emotional functioning and determination of patients' IQs. was the assessment the relationship between variations in serum tyrosine and phenylalanine levels and measurements of socio-emotional functioning and determination of patients' IQs. Twelve children were studied, from asingle centre, born between 1994 and 2012, treated with nitisinone and alow-phenylalanine and -tyrosine diet. The psychological evaluation was conducted using the parent form of the Child Behaviour Checklist (CBCL)/4-18. Additionally, the patients' IQs were measured using the Stanford-Binet 5 (SB5) Intelligence Scale. Statistical analyses were performed using PAWS software suite version 26. We found that phenylalanine variability over time correlated with measures of emotional and behavioural functioning. This relationship holds true for externalising behaviour, associated with the experience of maladjustment and aggression. Total score intellectual and cognitive function was within the norm for all patients. To maintain better quality of life for patients and their families in terms of emotional and behavioural functioning, it may be important to avoid spikes (significant fluctuations) in phenylalanine levels. Regular, detailed psychological evaluations are recommended to detect potential problems and implement interventions aimed at achieving the best possible individual development and realise the intellectual and behavioural potential, thereby improving the patient's and her family's quality of life.

The sodium-glucose cotransporter-2 inhibitors in patients with chronic kidney disease with or without kidney transplantation - asingle centre study.

The sodium-glucose cotransporter-2 inhibitors (SGLT2i) represent the first-line treatment for chronic kidney disease. The question remains of their benefit and safety for patients after kidney transplantation. The study aimed to show the renoprotective effect and safety of use in patients with chronic kidney disease with or without kidney transplantation. This is aprospective monocentric study of the Transplant-Nephrology Department in Martin in whichpatients with chronic kidney disease with or without kidney transplantin therapy withdapagliflozinwere included (n=79). The changes in glomerular filtration rate, albuminuria and side effects associated with SGLT2i were studied in patients with chronic kidney disease with or without kidney transplantation and in patients with or without diabetes mellitus. Patients without diabetes mellitus achieved asignificantly higher decrease in albuminuria at the time of the third month of follow-up (p=0.0396), with the continuation of the decrease until the average follow-up (10.9 months) (p=0.7866) than patients with diabetes mellitus. During the observed period, we recorded the cessation of the primary decrease in glomerular filtration with areturn to the baseline values. In our group, we did not confirm asignificant occurrence of adverse effects associated with dapagliflozin. SGLT2i significantly reduces albuminuria and stabilizes glomerular filtration in patients with chronic kidney disease. Based on our analysis, treatment with gliflozins is effective and safe for patients after kidney transplantation (Tab. 4, Fig. 6, Ref. 16).

Comment on 'Development of chilblain lesions during the COVID-19 pandemic is strongly associated with cold weather: aretrospective analysis of patients from asingle centre in the USA'.

We read with great interest a retrospective cohort study recently published in Clinical and Experimental Dermatology exploring the association between chilblain lesion development and the COVID-19 pandemic and infection. Data on the role of COVID-19 infection on chilblain development are conflicting. Moreover, chilblains have also been reported following COVID-19 vaccination.

A single centre study of the level of parents' satisfaction with the COVID-19 telemedicine consultation.

Telemedicine is an effective tool for video consultation of COVID-19 patients in the setting of the COVID-19 pandemic. Weprospectively determined the level of parents' satisfaction with the COVID-19 telemedicine consultation. This was asingle centre prospective study. COVID-19 paediatric patients who were seen in the children's emergency department of KK Women's and Children's Hospital, Singapore, and deemed fit for home recovery were discharged with a COVID-19 telemedicine follow-up in two to three days' time. Paediatric patients who were seen in the COVID-19 telemedicine visits were included in the parents' satisfaction survey. We excluded patients who defaulted their telemedicine visits. The telemedicine satisfaction survey was conducted using an online form consisting of 16 Likert scale questions, sent via text messaging. Our primary outcome was telemedicine satisfaction scores. Our secondary outcome was children's emergency department reattendance or hospital admission within 10days after the telemedicine consultation. 1238 patients attended the COVID-19 video consultation clinic from 15 December 2021 till 25 March 2022, out of which 476 parents of the COVID-19 patients completed the survey questionnaire. The mean age of the COVID-19 patients was 3.6years. There was a high level of overall satisfaction among parents of the COVID-19 patients, with a mean score of 6.1 out of 7. 12 out of 16 questions had a positive response (mean score of 6 or more). There was a total of 9 reattendances to children's emergency department, out of which 3 cases needed hospital admission. Conclusion: There was a high level of overall satisfaction with the use of telemedicine in symptomatic COVID-19 paediatric patients. What is Known: • Telemedicine is a cost-effective and feasible mode of delivering health care for conditions such as diabetes, heart disease, and depressive disorder, especially in the setting of the COVID-19 pandemic. What is New: • To gauge the parents' satisfaction with the COVID-19 telemedicine visit, in order to improve the patient and caregiver experience with telemedicine, and to improve the telemedicine service delivery. • Information from this study is crucial in order to prevent unnecessary hospital reattendance due to parental concern from poor telemedicine delivery.

Frequency and Related Risk Factors of Refeeding Hypophosphatemia in Patients with Liver Cirrhosis: A Pilot Study.

Refeeding hypophosphatemia (RH) is associated with poor clinical outcomes and mortality. The presence of RH in patients with liver cirrhosis remains unclear. This study aims to determine the frequency of RH related to nutritional status and disease severity in liver cirrhosis. This study was prospectively conducted in a-single center gastroenterology clinic. Malnutrition was identified by Subjective Global Assessment (SGA). The disease severity was defined using Child score and MELD score. Serum phosphate levels <2.0 mg/dl are defined as hypophosphatemia. Twelve of 50 cirrhotic patients (24%) had RH during hospitalization. The most common RH was determined in 4 patients on day 4 during study follow up. The sharpest decline of serum phosphate levels was on day 4 (median: 2.3mg/dL). The Child score and MELD score were not significantly different between RH and Non-RH groups (p>0.05). The rate of malnutrition according to SGA was 56.0%. A total of 82%, 4%, 8%, and 4% of participants received regular diet and oral nutritional supplements, only enteral tube feeding, only parenteral nutrition, and combined enteral and parenteral nutrition, respectively. In the RH group, 32% of participants received only parenteral nutrition and had a higher presence of RH than patients receiving only oral or enteral tube feding (p<0.05). RH developed in ¼ of the study participants. This study also showed that artificial feeding carries a significant risk in terms of RH. Malnourished patients with liver cirrhosis receiving parenteral nutrition, closely monitored regarding high risk of RH.

Impact of antidepressant use on post-operative weight loss following bariatric surgery.

Antidepressant medication can be associated with weight gain. Consideration should be given to the specific agent prescribed to optimize bariatric surgery outcomes. The aim of this study is to investigate if patients treated with antidepressants stratified by risk of weight gain are associated with less weight loss at 1year postbariatric surgery. Asingle centre, retrospective analysis of all patients who underwent bariatric surgery between July 2018 and 2021 within St Vincent's University Hospital group. The exposure was antidepressant use, stratified for risk of weight gain, and the control group was patients who underwent surgery but no antidepressant use. The primary outcome was % TWL (total weight loss) at 6weeks, 6months and 12months post-surgery. Multivariate linear regression analysis was used to estimate the impact of antidepressant treatment on post-surgery weight loss at 12months using the variables of age, gender and pre-operative BMI. Of the total cohort (n = 315), 70 patients (22.2%) were taking antidepressants. At 12months, post-operatively patients taking medium risk for weight gain antidepressants had significantly less mean %TWL compared to those not taking antidepressants (p = 0.015). Overall, taking any antidepressant was not found to be a significant predictor of %TWL at 12months after surgery (β = - 2.590, p = 0.0836). Many patients undergoing bariatric surgery have concurrent psychiatric conditions. Given the complex relationship between bariatric surgery and mental health, psychotropic medications may be best managed by a specialist in the field such as a bariatric psychiatrist in order to optimize patient outcomes.

Urinary biomarkers associated with acute kidney injury in pediatric mechanical circulatory support patients.

In patients requiring mechanical circulatory support (MCS), the incidence of acute kidney injury (AKI) is between 37 and 63%. In this study, we performed an exploratory analysis evaluating the relationship of multiple urine biomarkers with AKI development in pediatric MCS patients. This is asingle center retrospective study in a pediatric cohort receiving MCS from August 2014 to November 2020. We measured 14 urine biomarkers of kidney injury on day 1 following MCS initiation and analyzed their association with development of AKI in the first 7days of MCS initiation. Sixty patients met inclusion criteria. Patients with AKI were more likely to be supported by venoarterial extracorporeal membrane oxygenation (65% vs. 8.3%, p < 0.001), compared to the no AKI group and less likely to have ventricular assist devices (10% vs. 50%, p < 0.001). There was a significant increase in the median urine albumin and urine osteoactivin in the AKI group, compared to the no AKI group (p = 0.020 and p = 0.018, respectively). When normalized to urine creatinine (UCr), an increased log osteoactivin/UCr was associated with higher odds of AKI development (OR: 2.05; 95% CI: 1.07, 4.44; p = 0.028), and higher log epidermal growth factor (EGF)/UCr (OR: 0.41; 95% CI: 0.15, 0.96) was associated with decreased odds of AKI. Early increase in urine osteoactivin is associated with AKI development within 7days of MCS initiation in pediatric patients. Contrary, an increased urine EGF is associated with kidney protection. A higher resolution version of the Graphical abstract is available as Supplementary information.

Prognostic Factors in Patients with Unruptured Vertebral and Basilar Fusiform Aneurysms Treated with Endovascular Procedures : ASingle Center Retrospective Analysis.

Large vertebral and basilar fusiform aneurysms (VFA) are sometimes difficult to cure by endovascular treatment (EVT). We aimed to elucidate indicators of poor outcomes of EVT in patients with VFAs. Clinical data from 48patients with 48 unruptured VFAs in the Hyogo Medical University were retrospectively analyzed. The primary outcome was defined as satisfactory aneurysm occlusion (SAO) according to Raymond-Roy grading scale. The secondary and safety outcomes were amodified Rankin scale (mRS) score of 0-2 at 90days, retreatment, major stroke, and aneurysm-related death after EVT. The EVT included stent-assisted coiling (n = 24; 50%), flow diverter (n = 19; 40%), and parent artery occlusion (n = 5; 10%). The SAO was less frequently observed in large or thrombosed VFAs at 12 months (64%, p = 0.021 and 62%, p = 0.014, respectively), especially when the aneurysms were both large and thrombosed (50%, p = 0.0030). Retreatment was more common in large aneurysms (29%, p = 0.034), thrombosed (32%, p = 0.011), and large thrombosed aneurysms (38%, p = 0.0036). Although the proportion of mRS 0-2 at 90 days and major stroke showed no significant differences, that of post-treatment rupture was significantly larger in large thrombosed VFAs (19%, p = 0.032). Aneurysm-related death occurred by aneurysm rupture and was more frequent in large thrombosed VFA (19%, p = 0.032). Multivariate analysis showed SAO at 12 months was less common (adjusted odds ratio, OR: 0.036, 95% confidence interval, CI 0.00091-0.57; p = 0.018), and retreatment was more common (adjusted OR 43, 95% CI 4.0-1381; p = 0.0012) in large thrombosed VFA. The large thrombosed VFAs were associated with poor outcomes after EVT including flow diverter.

26. Comparison of Electrocardiographic Criteria for The Diagnosis of Left Ventricular Hypertrophy in Patient with Hypertension

Background: Left ventricular hypertrophy (LVH) is an early cardiac complication in patient with hypertension. Several electrocardiographic (EKG) criteria have been identified for the diagnosis of LVH, the criterion that has the most diagnostic value is still unknown at this time. Objective: The objective was to analyse three electrocardiographic criteria for LVH compared with transthoracic echocardiography (TTE) finding. Method: This study was a-single centre, retrospective study, included 55 consecutive patients with hypertension who had visited the cardiology clinic. EKG and TTE were performed. The Peguero Lo-Presti criteria was calculated by adding deepest S amplitude in any precordial lead to the S amplitude in V4 (SD + SV4). Patients with valvular abnormalities, myocardial infarction, LV dysfunction, pericardial disease, bundle branch blocks, atrial fibrillation or flutter, and pulmonary disease were excluded from this study. Results: We found 31 hypertensive patients (56%) had LVH by TTE. Of the 55 patients, 18 patients had LVH based on Peguero Lo-Presti criteria with a sensitivity of 58.06%. Cornell Voltage criteria was positive in 8 out of 55 patients with a sensitivity of 25.81% and Sokolow-Lyon criteria was positive in 6 out of 55 with a sensitivity of 19.35%. The Peguero Lo-Presti EKG criteria had a higher sensitivity (58.06%) and specificity (91.67%) in the diagnosis of LVH than traditional criteria. Conclusion: Peguero Lo-Presti criteria for diagnosing LVH is more sensitive and specific than Sokolow-Lyon and Cornell voltage criteria. Perhaps it is due to the latter component of the QRS complex, which corresponds to the S wave, better represents voltage variations in patients with LVH.

33. Association between QT Dispersion and Left Ventricular Hypertrophy in Hypertensive Heart Disease Patients

Background: The variation in QT length reflects regional repolarization differences in the heart. An Increased in QT dispersion is associated with an increased left ventricular mass index in hypertensive individuals. Objective: The aim of this study was to investigate association between QT dispersion and left ventricular hypertrophy (LVH) in hypertensive heart disease (HHD) individuals. Method: This study was a-single centre, retrospective study, included 47 patients with hypertension who had visited the cardiology clinic. Electrocardiography (EKG) and trans-thoracal echocardiography (TTE) were performed. Patients were divided into LVH group (27) and control group (20) based on TTE findings. Patients with valvular abnormalities, myocardial infarction, LV dysfunction, pericardial disease, arrhythmia related, and pulmonary disease were excluded from this study. Results: LVH was diagnosed in 31 (56%) of the patients by 2D echocardiography. The QT interval maximum was higher at 414.00 ± 59.87, than 396.19 ± 37.75 in the control group. Corrected QT (QTc) maximum in HHD group also higher at 448.08 ± 54.83 compared to control group in 421.67 ± 35.61. QT minimum and QTc minimum both are higher in HHD group at 350.40 ± 53.27 and 378.32 ± 43.00 respectively than in controlled group, at 339.05 ± 43.12 and 361.29 ± 45.26. There was no significant association in QT dispersion (p = 0.582) and QTc dispersion (p = 0.265) between HHD group and controlled group. Conclusion: The QT dispersion trend was narrowly higher in hypertensive patient with LVH in HHD group than the controlled group but it was statistically insignificant.

CORRELATION BETWEEN THE PREOPERATIVE SERUM PROSTATE SPECIFIC ANTIGEN, GLEASON SCORE AND STAGING USING MRI WITH POSTOPERATIVEHISTOPATHOLOGICAL OUTCOME FOLLOWING ROBOT ASSISTED RADICAL PROSTATECTOMY.

Introduction: Prostate cancer is second most common cancer in Indian men1. Early detection may be the cause of this increasing trend in urban areas. In our study, we have tried to study correlation between preoperative serum PSA, Gleason score and staging using MRI with postoperative histopathological outcome following robot assisted radical prostatectomy (RARP). Objectives of the study: To correlate between preoperative PSA, Gleason score, and staging with MP-MRI with pathological outcome following RARP in men with clinically localized cancer prostate and assess accuracy of preoperative Gleason score and staging with MRI with post operative histopathology. Materials and Methods:Asingle center, hospital based prospective observational study of 87 patients with age &gt; 50 years with localized prostate cancer was conducted in department of urology at tertiary care center for study period between November 2019 to November 2021. Data collected from these patients' included demographic, clinical history, physical ndings, detailed investigations, operative details, postoperative ndings and results were analyzed. Results:Atotal of 87 localized carcinoma prostate patients were enrolled into the study. It was found that in nal histopathology report post RARP, organ conned disease was seen in 52 (59.77%) patients, capsular involvement in 35(40.22%), seminal vesicle invasion seen in 14(16%) and 2 (0.25%) had positive lymph node involvement. On correlating serum PSA, biopsy Gleason score and staging with MRI with postoperative pathology, it was found that in localized carcinoma prostate on MRI with higher serum PSA, raised Gleason score and higher stage, organ conned disease decreases linearly with signicant P value of (0.005), (0.005), (0.007). Conclusion: Based on data of our study we conclude that patients with localized prostate cancer on MRI, if they have higher preoperative serum PSA, higher Gleason score, and higher stage, then they have more chances of locally advanced disease on postoperative histopathology

46. Relationship between P Wave Dispersion and Left Ventricular Hypertrophy in Hypertensive Heart Disease Patients

Background: It is associated with target-organ damage in various organs and ECG changes. P-wave durations and P-wave dispersion (PWD) are considered to reflect the heterogeneous conduction in atria. Objective: The aim of this study was to investigate relationship PWD and P-wave duration and left ventricular hypertrophy in hypertensive heart disease patients. Method: This study was a-single centre, retrospective study, included 55 consecutive patients with hypertension who had visited the cardiology clinic. Elektrocardiography (ECG) and transthoracal echocardiography (TTE) were performed. Patient were divided into LVH group and control group baed on TTE findings. Patients with valvular regurgitation (moderate or severe), valvular stenosis, myocardial infarction, LV dysfunction, pericardial disease, chronic obstructive pulmonary disease (COPD), bundle branch blocks, atrial fibrillation or flutter were excluded from the study. Results: We found 31 hypertensive patients (56%) had LVH by TTE. The mean age for the HHD was 57 ± 11 years while the control group was 56 ± 11. In the HHD group, maximum P-wave duration was significantly increased at 119.31 ± 13.60 ms, compared to 97.14 ± 18.20 ms in the control group (p &lt; 0.001). There was also a significant increase in minimum P-wave duration in HHD group at 59.65 ± 15.56 ms, compared to control group with 53.33 ± 14.60 ms (p = 0.004). There was a significant increase in the PWD in the hypertensive group at 59.31 ± 19.62 ms, compared to controls with 43.80 ± 17.54 ms (p &lt; 0.001). Conclusion: PWD was significantly increased in hypertensive patient with left ventricular hypertrophy.