Males Mean Age Research Articles

Laparoscopic Groin Hernia Repair Using the Totally Extraperitoneal Approach: A Retrospective Study and Our Experience.

Background Recently, laparoscopic totally extraperitoneal (TEP) inguinal hernia repair has been considered one of the most effective and widely performed techniques for repairing inguinal hernias by avoiding entry into the peritoneal cavity. Its indications have evolved and expanded to almost encompass the entire range of groin hernias. This retrospective study aims to determine the outcomes and postoperative complications in patients undergoing TEP inguinal hernia repairperformed by a single surgeon for groin hernias at a single center. Methodology We retrospectively evaluated the prospectively collected data of 900 patients who underwent elective TEP repair over 18 years at a single center performed by a single surgeon from April 2004 to February 2023. Patients were evaluated for age, sex, type of hernia, time taken for surgery, open from laparoscopy, intra and postoperative complications, hospital stay, and days taken to resume regular activity. Results The mean age of the 900 patients was 59 years (range = 21-83 years). The mean age of males and females was 59 and 56 years, respectively. The mean operative time was 40 and 55 minutes for a unilateral and bilateral hernia, respectively. In total, 369 (41%) patients had a right-sided groin hernia, 382 (42%) patients had a left-sided groin hernia, and 149 (16.5%) patients had bilateral groin hernias. A total of 121 (13%) patients had occult hernias, and 17 patients underwent concurrent TEP and transurethral resection of the prostate. Of the 900 patients, 20 (2.2%) had a recurrent hernia after a previous open inguinal hernia repair. Seven (0.8%) patients had a recurrence of hernias post-TEP and subsequently underwent open inguinal hernia repair. Seven (0.7%) patients needed conversion from TEP to the transabdominal pre-peritoneal approach. Only minor complications were noted intra and postoperatively. The average time of hospitalization was 24 hours. The time to resume normal activities was five (±1) days. Conclusions Our experience suggests that TEP repair with mesh fixation is a safe and effective procedure with a marginal recurrence rate. Apart from the obvious cosmetic benefits of minimal tissue invasion, a significant advantage of TEP is the visualization of the contralateral groin along with the surgical repair of a hernia, if required, in the same sitting and without the insertion of any extra trocars.

Fracture line and comminution zone characteristics, and rotator cuff footprint involvement in OTA/AO 11C3-type proximal humeral fractures: complex proximal humerus fracture map.

To identify fracture characteristics and zones of comminution as well as the relationship with anatomic landmarks and rotator cuff footprint involvement in OTA/AO 11C3-type proximal humerus fractures. Computed tomography images of 201 OTA/AO 11C3 fractures were included. Fracture lines were superimposed to a 3D proximal humerus template, created from a healthy right humerus, after fracture fragment reduction on 3D reconstruction images. Rotator cuff tendon footprints were marked on the template. Lateral, anterior, posterior, medial, and superior views were captured for the interpretation of fracture line and comminution zone distribution as well as to define the relationship with anatomic landmarks and rotator cuff tendon footprints. A total of 106 females and 95 males (mean age = 57.5 ± 17.7 [range 18-101] years) with 103 C3.1-, 45 C3.2-, and 53 C3.3-type fractures were included. On the lateral, medial, and superior humeral surfaces, fracture lines and comminution zones were distributed differently in 3 groups. Tuberculum minus and medial calcar region were significantly less severely affected in C3.1 and C3.2 fractures than C3.3 fractures. The supraspinatus footprint was the most severely affected rotator cuff footprint area. Specifically defining the certain differences for repeatable fracture patterns and comminution zones in OTA/AO 11C3-type fractures and the relationship between the rotator cuff footprint and the joint capsule may contribute to the decision-making process of surgeons.

Outcome of Surgical Treatment of Developmental Dysplasia of the Hip in Aden, Yemen

Background: Developmental dysplasia of hip is a common condition presenting to a pediatric orthopedic surgeon. Objective: To evaluate the outcome of surgical treatment of developmental dysplasia of the hip. Materials and Method: This retrospective study conducted at the Department of Orthopedic Surgery in Alnaqeeb private hospital in Aden. The study children were 52 who were operated in the period from January 2016 to December 2018. Patient charts were reviewed and the collected data were sex, age, side, avascular necrosis, stiffness, re-dislocations, persistent acetabular dysplasia, and infection. The operations were open reduction and Pemberton's osteotomy plus minus femoral osteotomy without rotation. Statistical analyses were performed using SPSS version 22. We expressed distribution of variables using means and standard deviation (SD). Fisher test was used and p-value ≤ 0.05 was considered as statistically significant. Results: The majority of study children were females (80.8%). The age of the children ranged between 18 – 72 months. The mean age of children at surgery was 37 ± 17.5 months. The mean age of females was 37.2 ± 18.9 months while the mean age of males was 37.5 ± 10.7 months. The most common side was in the left side (51.9%). The mean time of follow-up was 34.7 ± 6.4 (range 24-48) months. Avascular necrosis found in (5.8%) children and stiffness found in (3.8%) children. Re-dysplasia of the hip were found in (5.8%) children. Persistent acetabular dysplasia was found in (3.8%) children. Additionally, we found superficial infection in (5.8%) children. Conclusion: The open reduction approach produces a better clinical outcome. The outcome of treatment in our study was comparable to published studies. Keywords: Developmental Dysplasia, hip, surgical treatment, outcome.

Low length-for-age Z-score within 1 month after birth predicts hyperdynamic circulation at the age of 21 years in rural Malawi

Low birth weight predisposes to the development of hypertension in middle- and high-income countries. We examined the relation of early life length-for-age score (Z-score) on cardiovascular function in young adults in Malawi, a low-income country. Capture of supine, seated, and standing brachial pulse waveforms (Mobil-O-Graph) were performed in 223 females and 152 males (mean age 21 years), and analyzed according to the length-for-age Z-score tertiles during the first month of life. Plasma LDL cholesterol in young adulthood was slightly lower in the lowest versus highest tertile. Otherwise, blood hemoglobin and plasma chemistry were similar in all tertiles. Irrespective of posture, blood pressure, forward and backward wave amplitudes, and pulse wave velocity were corresponding in all tertiles. In the three postures, the lowest tertile presented with 4.5% lower systemic vascular resistance than the highest tertile (p = 0.005), and 4.4% and 5.5% higher cardiac output than the middle and highest tertiles, respectively (p < 0.01). Left cardiac work was 6.8% and 6.9% higher in the lowest tertile than in the middle and highest tertiles, respectively (p < 0.01). To conclude, in a low-income environment, low length-for-age Z-score after birth predicted hyperdynamic circulation at 21 years of age without changes in blood pressure and metabolic variables.

P-062 The influence of the ejaculatory abstinence period on semen parameters from the first diagnostic sample – results from analysis of 14000 samples

Abstract Study question Is ejaculatory abstinence period (EAP) associated with semen parameters in males undergoing preliminary fertility investigation? Summary answer Short EAP is associated with increased progressive motility (%), vitality but with reduced volume, concentration, total sperm count. No association was indentified with morphology, DNA fragmentation. What is known already It is known that semen parameters may present important intra-individual variations. At present, the last edition of the WHO Manual recommends ejaculatory abstinence from two to seven days for semen analysis. Nonetheless, this period is not supported by some relevant bodies in the reproductive field guidelines that limit abstinence period to three or four days. Recently published reviews on this matter support that the relationship between the abstinence time and sperm quality is not straightforward. Therefore the aim of this study is to analyze correlation between the ejaculatory abstinence time and sperm parameters in patients having initial work-up in our clinic. Study design, size, duration We conducted a retrospective cross-sectional study on the diagnostic semen samples from individuals having their initial fertility investigation in the Fertility Department of a University Affiliated Hospital between the beginning of 1997 and the end of 2022. Basic semen parameters and sperm deoxyribonucleic acid (DNA) fragmentation were registered in 14067 and 784 samples respectively. Sperm morphology was analysed in 4812 samples. Participants/materials, setting, methods We included exclusively results from the first diagnostic semen sample from males of any age undergoing preliminary infertility work-up. All samples were produced on-site and analysed “ad hoc” for basic semen parameters (according to 6th Edition of WHO Manual) or/and sperm DNA fragmentation (Sperm Chromatin Dispersion test). Samples were divided according to EAP: ≤2(A-group); 2-7(B-group); &amp;gt;7 days (C-group) and compared with ANOVA. Additionally, Spearman Correlation was used to confirm correlation between EAP and sperm parameters. Main results and the role of chance Semen analysis was performed either completely manually (23.4%) or with the use of Computer Assisted Semen Analysis (CASA) system (76.6%) with the exception of morphology which was always assessed manually. Overall, 661 samples were produced after ≤2 days of abstinence, 12734 after 2 to maximum 7 days and 690 after &amp;gt;7 days of which ones 330(50%), 6798(53%) and 336(49%) were normozoospermic, respectively. Mean male age was 39 years (SD 6.5) and EAP 4.5 days (SD 1.9). We found the following parameters positively correlated with EAP in both normozoospermic and abnormal samples: volume (A-2.6ml; B-3.6ml; C-4ml, p &amp;lt; 0.05), concentration (A-72M/ml; B-93M/ml; C-127M/ml, p &amp;lt; 0.05), total sperm count (A-161M; B-285M; C-472M, p &amp;lt; 0.05), total motile count (A-111M; B-186M; C-270M, p &amp;lt; 0.05), straightness coefficient (STR) (A-73.1; B-75.7; C-77.8%, p &amp;lt; 0.05) and Zinc concentration (A-14277; B-17375; C-22538µg/dl, p &amp;lt; 0.05). The following parameters were negatively correlated with EAP in both normozoospermic and abnormal samples: progressive motility (A-46; B-43.6; C-36.6%, p &amp;lt; 0.05), vitality (A-60.5; B-60.3; C-53.7%, p &amp;lt; 0.05). We did not find any correlation with leucocytes, fructose, morphology or DNA fragmentation in unselected patients. However, in the group of abnormal samples there was a negative correlation between EAP and morphology (A-3.7; B-3.1; C-2.8%, p &amp;lt; 0.05) and DNA fragmentation, in generalized additive model (Spearman-Correlation, R2 0.01, p &amp;lt; 0.05). Limitations, reasons for caution This is a cross-sectional study which demonstrates only association and does not allow establishment of a cause-effect relationship between EAP and sperm parameters. Additionally, despite significant correlation between EAP and some sperm parameters, its clinical usefulness remains unclear. Wider implications of the findings To our knowledge this is first study correlating EAP with semen parameters only from diagnostic semen samples produced on-site, which confirms that the abstinence time should be seriously considered when analysing ejaculates, especially when borderline results are obtained. Additionally, different clinical strategies may be considered for normo and non-normozoospermic patients. Trial registration number not applicable

Hypertension Linked to Worse Upper Tract Urothelial Cancer Outcomes

Hypertension Linked to Worse Upper Tract Urothelial Cancer Outcomes

Full-endoscopic removal of third ventricular colloid cysts: technique, results, and limitations.

Colloid cysts (CCs) are rare benign lesions that usually arise from the roof of the third ventricle. They may present with obstructive hydrocephalus and cause sudden death. Treatment options include ventriculoperitoneal shunting, cyst aspiration, and cyst resection microscopically or endoscopically. This study aims to report and discuss the full-endoscopic technique for removing colloid cysts. A 25°-angled neuroendoscope with an internal working channel diameter of 3.1 mm and a length of 122 mm is used. The authors described the technique of resecting a colloid cyst by a full-endoscopic procedure and evaluated the surgical, clinical, and radiological results. Twenty-one consecutive patients underwent an operation with a transfrontal full-endoscopic approach. The swiveling technique (grasping the cyst wall and rotational movements) was used for CC resection. Of these patients, 11 were female, and ten were male (mean age, 41 years). The most frequent initial symptom was a headache. The mean cyst diameter was 13.9 mm. Thirteen patients had hydrocephalus at admission, and one needed shunting after cyst resection. Seventeen patients (81%) underwent total resection; 3 (14%), subtotal resection; and 1 (5%), partial resection. There was no mortality; one patient had permanent hemiplegia, and one had meningitis. The mean follow-up period was 14 months. Even though microscopic resection of cysts has been widely used as a gold standard, successful endoscopic removal has been described recently with lower complication rates. Applying angled endoscopy with different techniques is essential for total resection. Our study is the first case series to show the outcomes of the swiveling technique with low recurrence and complication rates.

Uptake of Cardiac Rehabilitation in Te Whatu Ora – Counties Manukau During the Pandemic

Cardiac rehabilitation (CR) is an evidence-based range of interventions to support people with several cardiac issues. The impact of the COVID-19 pandemic created many challenges for health services and communities. Using the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZAC-QI) CR database this study tracked referral, mode, and level of engagement from 2013 to 2023. Over 10 years, 9,134 referrals were identified, with a steadily decreasing number every year (1,040 in 2023 vs 672 in 2022; 35% decrease). The majority (70%) was male; mean age for males was 66 years, for females 67 years; and ethnicity was Māori 12%, Pacific 25%, Indian 12%, others 51%. Attendance of any program was 71%, with a 600% increase in clinics vs group interventions. The average uptake of the exercise program was 24%; Māori compared with Pacific and Euro/others (61% vs 71% vs 73%, p>0.001); and younger people (<60 years, 66% vs older >61 years, 73%, p>0.001) were least likely to attend, with no gender differences (male 71% vs Female 69%, p=NS). There has been a significant decline in CR referrals over the last 10 years, with a shift from group-based education to individualised clinic contacts. Uptake of exercise programs remains low. Novel interventions to support Māori and younger patients have been implemented.

Clinical Features and Outcomes of COVID-19 Infections at a Teaching Hospital in Kingston, Jamaica

Abstract Objective We examined the demographic, clinical characteristics and indicators of poor outcomes among hospitalised adults with COVID-19 infection at the University Hospital of the West Indies, Jamaica. Methods A retrospective medical record review between March 10 and December 31, 2020 was done and demographic clinical data were collected. Results There were 218 males (mean age 59.5 years) and 144 females (mean age 55.7 years). Hypertension, diabetes mellitus, cardiovascular disease, obesity and chronic kidney disease were the most common comorbidities. Cough, shortness of breath, fever and malaise were the most common presenting complaints. Fifty-one per cent of patients were moderately to severely ill on admission; 11% were critically ill; 18% were admitted to the Intensive Care Unit (ICU). Death occurred in 62 (17%) patients (95% CI 13.6-21.4). Among obese participants, there were increased odds of developing respiratory failure (OR 5.2, p &lt; 0.001), acute kidney injury (OR 4.7, p &lt; 0.001), sepsis (OR 2.9, p =0.013) and the need for ICU care (OR 3.7, p &lt; 0.001). Factors independently associated with increased odds of death were age (OR 1.03 per year, p = 0.013) and obesity (OR 2.26, p = 0.017). Mortality also correlated significantly with D-dimer &gt; 1000 ng/mL (OR 2.78; p = 0.03), serum albumin &lt; 40 g/L (OR 3.54; p = 0.03) and serum LDH &gt; 485 U/L OR 1.92, p = 0.11). Conclusions Comorbidities were prevalent among COVID-19 cases in this study. Significant correlates of mortality were older age and obesity. Hypoalbuminaemia, elevated D-dimer and serum LDH at admission also portend a poor prognosis. Keywords: SARS-CoV-2, COVID-19, Jamaica, outcomes, mortality

ST-segment elevation myocardial infarction and the clinical significance of differentiated electrocardiogram

Aim. To evaluate the markers of changing dynamics recorded by digital processing of routine ECG using own diagnostic complex software “Smart-ECG” in patients with ST-segment elevation myocardial infarction (STEMI) based on the results of a 40-day follow-up. Materials and methods. The main group consisted of 20 patients with STEMI according to the ESC guidelines (2017) (mean age of males 56.11 ± 11.62, n = 10; mean age of females 58.22 ± 13.11, n = 10). ECG were analyzed using own developed diagnostic complex software “Smart-ECG” on the 1st, 10th, 40th day after STEMI. The first derivative of T wave – ratio of maximum velocity (MVR), inclination angle (β) and inclination height (H) of ST segment was calculated. The control group – 20 apparently healthy people. Results. MVR indicators decreased by 61.90 %, 68.20 % and 51.48 % on the 1st, 10th and 40th day, respectively, after STEMI as compared to those of the control group (p &lt; 0.01). At the moment of the maximum ST segment elevation, the height (H) of ST inclination was 347.7 % increased (p &lt; 0.01); on the 40th day, H was 25 % increased, close to control indicators, with ST segment shift to isoline (р &gt; 0.05). During the acutest period, the angle β increased by 172.2 % (p &lt; 0.01) and then decreased by 15.8 % at the recovery phase, but insignificantly. Conclusions. Self-developed medical software “Smart-ECG” for qualitative evaluation of ECG is an effective tool to diagnose pathological changes in the myocardium, makes it possible to improve the specificity, sensitivity and prognostic significance of ECG in STEMI. The significant decrease in MVR has been detected at all stages of STEMI, which was associated with a violation of electrogenesis in the repolarization phase; the critical increase in ST slope indicators (angle β and height H) on the 1st day has been found as a characteristic of ST elevation, as well as its decrease on the 40th day as a sign of reduced potential difference between healthy and damaged areas of the myocardium during the recovery stage.

Lugol's iodine and methylene blue as an adjunctive tool for early diagnosis of premalignant oral lesions.

Objective: To compare Lugol’s Iodine and Methylene blue as an adjunctive tool for early diagnosis of premalignant oral lesions by taking histopathology as the gold standard. Study Design: Cross-sectional descriptive. Setting: Outpatient Department of Isra Dental College Hospital, Isra University Hyderabad. Period: January 2021 to July 2021. Material &amp; Methods: All patients with oral premalignant lesions were selected. Methylene blue and iodine staining were used in the lesion area. The dye was applied directly with a cotton bud for 10–20 seconds, and the mouth was resigned with tap water. The dye retention pattern was evaluated by the stain retention intensity on the lesion. Incisional biopsy was performed simultaneously at that site as a gold standard. Results: Out of 60 cases, males were 49 (81.6%) and females were 11(18.3%). The mean age of males and females was 41.910.7 years and 39.87.74 years, respectively. Out of all patients, 65.0% had more than one addictive habit of mainpuri, gutka, or supari. The commonest region of oral lesions was the buccal mucosa among 61.6% of patients, followed by the alveolus in 16.6%, lips 8.3%, tongue 6.6%, and retro molar area 3.33%, while the palate and floor of the mouth were involved in 1.66% of patients. According to the diagnostic accuracy of methylene blue, the sensitivity was 89.4% and the specificity was 66.6%. According to the Lugol’s, iodine sensitivity was 83.3% and specificity was 50%. Conclusion: It has been determined that methylene blue and lugols iodine staining are the best, easy, and noninvasive screening tools to detect the early diagnosis of malignancy.

Impact of the introduction of minimally invasive treatments of the thyroid (MITT) for benign thyroid nodules in an Italian hospital: a cost-minimization analysis.

Prevalence of thyroid nodules is high in the adult population, approaching 60% in women and older people. Most thyroid nodules are benign and asymptomatic. However, a not negligible part of them causes compressive symptoms and/or cosmetic concerns and need to be treated. In the last two decades, minimally-invasive treatments of the thyroid (MITT) have been proposed in routine clinical practice as a reliable cost-effective alternative to surgery in patients with symptomatic benign thyroid nodules (SBTNs). To perform a cost-minimization analysis comparing direct, indirect and intangible costs of radiofrequency (RFA) and laser thermal ablation (LTA) with traditional surgery in patients with SBTNs. Data of patients treated by MITT for SBTNs from October 1st 2019 to September 30th 2022 in a single Italian tertiary Center were analyzed. Costs were compared to those of traditional surgery reported in the 2022 Associazione Medici Endocrinologi Guidelines on the Management of SBTNs. In the study lapse, 157 MITT of SBTNs were performed in 148 patients, 114 females and 34 males (mean age: 59 yrs; median age: 57 yrs). Before MITT, the mean thyroid nodule volume was 19 ml; 1 year after MITT, volume reduction rate >50% and symptom relief were achieved in 89% and 93% of patients, respectively. No major complications occurred. Adding up pre-operative, operative and post-operative costs, total direct costs per single procedure are the following: 1361.43 € for LTA when using one optic fiber; 1761.43 € for LTA when using two optic fibers; 1968.53 € for RFA; 3338.39 € for hemithyroidectomy plus isthmectomy; 4034.99 € for total thyroidectomy. Surgery was impactful on direct-i.e., preoperative, operative and postoperative-costs, due to longer operating room occupation time and hospital stay. Overall, a total saving for the Italian National Health Service of 285,377.15 € has been obtained treating the 148 patients by MITT instead of surgery. Likewise, MITT was advantageous also for indirect costs-i.e., those related to "loss of productivity" caused by time off work due to hospital stay and recovery time-, for both the self-employed workers and the Government, the latter saving 53,838.50 € overall. Finally, intangible costs, related to patients' quality of life-e.g., residual surgical scar, stress related to general anesthesia, convalescence, and life-long intake of L-Thyroxine replacement therapy-were all in favor of MITT. This real-life cost-minimization analysis demonstrates that LTA and RFA are safe and cost-effective procedures for the treatment of SBTNs. In our 3 years experience, adding the savings of 285,377.15 € for direct costs to those of 53.838,50 € for indirect costs, in total 339,215.65 € were saved. The saving concern patients, the National Health System and the Government.

A Quantitative Investigation of Gender-Related Variations in Coronary Artery Diameters

Objective: To evaluate the association between gender and coronary artery diameter at the cardiac ward of a tertiary care hospital. Background: Understanding the normal structure of the coronary arteries is essential for accurately describing the amount of coronary atherosclerosis. However, studies on the true normal coronary arteries' luminal diameters are scarce. Although numerous studies have assessed the post-mortem coronary artery dimensions. A few studies have been conducted in living patients with presumed normal arteries utilizing quantitative coronary arteriography techniques Study Design: A cross-sectional study Place and Duration: This study was conducted at Peoples University of Medical and Health Sciences for women Nawabshah from December 2021 to December 2022. Methodology: The study has 121 participants. The statistical analysis was performed using SPSS version 23. We used the t-test to analyse the connection between numerical and categorical variables. A P value of 0.05 or less was considered statistically significant in every case. The patient identification number was substituted for the patient's name, angiography film number, and medical record number in the proforma, and each patient's identity was kept private. Films from coronary angiography that were deemed to be normal were gathered and examined. Results: In the present study, males were in higher proportion compared to the females with 53.72 % against 46.28%. The mean age of females was 54.9 ± 8.3 and the mean age of males was 58.7 ±9.1 Years. The mean body surface area (BSA) for males was 1.79 ±0.07 and the mean BSA for females was 1.73 ±0.02. Conclusion: Although multiple alternative explanations for the difference in coronary dimensions with gender and age have been discussed, however, in our results, coronary dimensions didn’t show a significant association with gender. There is still huge space for large-scale studies on the subject. Keywords: Coronary artery diameters, Gender Association, comparison

Secondary prevention of Coronary Heart Disease (CHD) in the Moroccan population. Survey of Risk Factor (SURF) CHD II Morocco

Abstract Funding Acknowledgements Type of funding sources: None. Background Global Cardiovascular (CV) mortality is highly increasing, mainly in low and middle-income countries because of lifestyle change and the rise of cardiovascular risk factors. Controlling these risk factors is very important to reduce cardiovascular disease morbidity and mortality. Risk factor control is particularly important in patients with established cardiovascular disease since these patients are at very high cardiovascular risk. SURF is an international and simple clinical audit that aims to record and manage cardiovascular risk factors in patients with established coronary heart disease (CHD). The goal of this analysis is to investigate risk factor recording and management in secondary prevention of CHD in the Moroccan population, a country considered as a very high CV risk according to the European Society of Cardiology. Methods Data of Moroccan patients with documented coronary heart disease (including stable angina pectoris, acute coronary syndrome, PCI and CAGB) were collected via an online survey during routine clinic visits. Patients’ demography, risk factors, physical and laboratory measurements, and medications were recorded. Results A total of 324 patients were recruited in 3 different centers in Morocco. There was a male predominance (81.5%) and mean age was 66.5 (SD 10.6) years. Recording of risk factors was high for smoking (96.7%), physical activity (97.3%) and blood pressure (87.8%). However, for some risk factor measurements like LDL cholesterol (recording 29.9%), information was often missing. Risk factor recording in Morocco was higher than the North Africa and Eastern Mediterranean (NAEM) regional and global estimates for smoking and physical activity; similar for blood pressure; and lower for LDL levels. Considering the attainment of risk factor goals defined by clinical guidelines, 79.6% of patients never smoked or quit smoking, and 25.0% were practicing physical activity at least 30 min 3-5 times a week. Regarding risk factor measurements, 38.2% had blood pressure &amp;lt;140/90mmHg and 27.3% had LDL &amp;lt;1.8mmol/L. Cardiac rehabilitation programs were attended by 3.5 % of participants. The level of target attainment in Morocco was like regional and global levels for smoking; like regional but lower than global results for physical activity; and lower than regional and global estimates for blood pressure and LDL. Conclusion The patients enrolled in our registry have multiple modifiable risk factors, with a poor control. The results underline the need for interventions to improve secondary prevention of CHD in Morocco.

The critical isthmus of left atrial anterior wall flutter is mostly circumscribed into a small area immediately behind the aortic root. Implications for catheter ablation

Abstract Funding Acknowledgements Type of funding sources: None. Background Left atrial flutters (LAFL) are typically observed in patients with previous ablation lines or surgery in the left atrium (LA). Less frequently, scar-related left atrial anterior wall (LAAW) flutters may occur. Although the presence of low-voltage areas (LVAs, a surrogate of scar) in the LA is considered an arrhythmogenic substrate and a marker of atrial cardiomyopathy, the pathophysiologic factors responsible for its formation remain unclear. We hypothesized that compression of the LAAW by the aortic root could be responsible of LVAs found in the LAAW, and therefore, be the substrate for the development of LAAW flutter. Purpose We aimed to describe: 1) the relationship between the aortic root and the presence of LVAs in the LAAW, which is the substrate for reentry; and 2) the clinical and electrophysiological characteristics of LAAW atrial flutter. Methods Consecutive patients referred for LAFL ablation between April 2019 and September 2022 in a single center were retrospectively collected. Among 55 patients with LAFL, 10 (18%) demonstrated a macroreentrant circuit with a critical isthmus identified in the LAAW, in the absence of previous ablation lines or surgery, and were included in the analysis. Previous pulmonary vein isolation (PVI) was not an exclusion criterion. All patients underwent a multidetector computerized tomography (MDCT) prior to the procedure and the images were analyzed using ADAS 3DTM imaging platform. Activation mapping was performed in all patients using a multielectrode mapping catheter and CARTO 3 navigation system. Results 9 of 10 patients were male (mean age 74,3 ± 6,3 years). LA enlargement was present in all patients (48,3 ± 4,7 mm) and the mean aortic root diameter was 34,8 ± 3,4 mm. The mean LAAW flutter cycle length was 293,4 ± 68,3 ms. In 9 of the patients (90%), the LAAW flutter critical isthmus was just behind the aortic root, separated by &amp;lt; 1 mm according to the LA-aortic root fingerprinted isodistance map (mean fingerprinted isodistance area was 5,8 ± 2,5 cm2). The remaining patient had the critical isthmus just below the aortic root, between the area in contact with the latter and the mitral annulus. Furthermore, in all cases, the critical isthmus was immersed in LVAs. All but 1 LAAW flutter terminated during radiofrequency (RF) energy applications and rendered it non-inducible. After a median follow-up of 13,6 months (IQ range 5,3-21,6), 7 patients (70%) remained without recurrences. Conclusion In patients with LAAW atrial flutter, the presence of LVAs and the critical isthmus of the tachycardia are mostly circumscribed into small areas immediately behind the aortic root. Knowledge of this close relationship and the use of the isodistance map could be useful when mapping and ablating LAAW flutter, helping to straightforward the ablation procedure.

Morphometric analysis of odontoid process among Arab population: a retrospective cone beam CT study.

This study aims to evaluate the feasibility of using cone beam computed tomography (CBCT) scans to assess the odontoid process diameter in the Arab population and to determine whether one or two cortical screws can be used for treating odontoid fractures. The odontoid process of 142 individuals aged 12-75 years, including 72 males (mean age: 35.5) and 70 females (mean age: 36.2), were analyzed using CBCT scans. The sagittal and coronal CBCT views were used to evaluate the antero-posterior (AP) and transverse diameters of the odontoid process. Males had substantially bigger transverse and AP diameters of the odontoid process than females (p<0.05 & P<0.01 respectively). Among the sample, 97 individuals (67.4%) had external transverse diameter (METD) of less than 9 mm which is slightly bigger than that of Indians and 48 individuals (31.83%) had enough room for two 3.5 mm or two 2.7 mm screws as their METD was more than 9 mm like that of Greek and Turkish. Age had no significant impact on the morphometric measurements of the odontoid process. More than sixty percent of the sample had METDs of less than 9 millimeters, indicating that a single 4.5-mm Herbert screw may be suggested for fixing fractured odontoid processes in the Arab population.

(019) Longitudinal Observation on the Prevalence and Impact of Psychological Distress Among Patients Treated for Erectile Dysfunction During the COVID Pandemic

Abstract Introduction The COVID global pandemic has significantly affected the delivery of the healthcare system with valued resources diverted to cope with more urgent clinical services. Erectile dysfunction (ED) is considered a non-urgent medical condition and hence, males with ED were not prioritised and invariably faced long delays in clinical management including postponement in surgical waitlist during this pandemic. Objective To assess the prevalence and impact of psychological distress among males with ED during the COVID pandemic based on changes in the outcomes of validated questionnaires such as the International Index of Erectile Function (IIEF), Depression and Anxiety Stress Scales (DASS-21), Sexual Distress Scale (SDS) and Decisional Engagement Scale (DES-10), as well as perceived availability of medical support. Methods Following ethics approval, this prospective longitudinal study tracked males with ED at a tertiary medical centre between June 2020 and June 2022. Inclusion criteria included males aged 20 to 70 years, who have pre-existing ED (greater than 6 months), receiving medical therapies for ED, and had enrolled in the prospective database at the time of the study. Exclusion criteria were those who have undergone penile prosthesis implantation or received major abdominopelvic surgery during the study period that may preclude sexual activity. All patients completed validated questionnaires at 0, 6, 12, 18 and 24 months with additional data collected during the peak periods of local COVID social measure lockdown. Results A total of 80 patients were identified during the 24 months and 20 patients dropped out due to surgery (15 patients) and incomplete follow-up (5 patients). The mean age of males was 46.8 (21-69) years, and the duration of ED was 14.5 (6-33) months. Almost one-third of the patients showed increased DASS scores on depression (38 patients) and anxiety (42 patients) subscales and one-quarter on stress (29 patients) subscales, with worse DASS scores during the peak periods of social measures. On the SDS questionnaire, higher concerns were registered across all domains apart from the question on regrets about your sexuality. The analyses showed a worsening of the IIEF scores (p&amp;lt;0.021), anxiety and stress (DASS score with p=0.045 and p=0.038, respectively) as well as SDS score (p=0.048) during this pandemic. However, the DES-10 scores were more positive with most patients reporting a score above 7 out of 10 in terms of items on accepting current arrangement (75%) and confidence in clinician decision-making about the treatment (80%) although most patients (92%) indicated the desire to be kept updated and provided with more detailed information on their clinical care. Conclusions The COVID pandemic has caused an adverse psychosexual impact on many patients’ erectile function and mental well-being, and social measures lockdown invariably heightened patient psychosexual distress. Our study showed regular clinical contact and medical reassurance coupled with an explanation of reasons for clinical delays in the non-urgent medical condition resulted in a high level of confidence in clinicians and potentially minimised emotional adjustment in the patients. Disclosure No

Effects of inaudible binaural beats on visuospatial memory.

Binaural beats are auditory beat stimulation that produces sounds and induces a specific state of brain wave based on the difference in the frequency of stimulation. This study aimed to investigate the effects of inaudible binaural beats on visuospatial memory at 18 000 Hz reference and 10 Hz difference frequencies. Eighteen adult subjects in their twenties were enrolled, including 12 males (mean age: 23.8 ± 1.2) and 6 females (mean age: 22.8 ± 0.8). An auditory stimulator providing 10 Hz binaural beats stimulation via 18 000 Hz to the left and 18 010 Hz to the right ears was used. The experiment consisted of two 5-min phases, including a rest phase and a task phase involving task performance without (Task-only) and with binaural beats stimulation (Task+BB). A 3-back task was used to measure visuospatial memory. Cognitive ability measured by task performance (accuracy and reaction time) with and without binaural beats, as well as variations in alpha power across different brain domains, were compared using paired t-tests. Compared to the Task-only condition, the Task+BB condition had significantly higher accuracy and significantly shorter reaction time. The electroencephalogram analysis showed that the reduction level in alpha power for the task performance under the Task+BB condition was significantly lower in all brain areas except the frontal, compared to that under the Task-only condition. The significance of this study lies in having verified the independent effects of binaural beats stimulation without any auditory influence, based on visuospatial memory.

Immunohistochemical analysis of the ligamentum mucosum is the key to understand its clinical usefulness

Ligamentum Mucosum(LM) is a ligamentous structure within the synovial layer of the knee joint capsule. For a long time LM was perceived as the vestigial remnant from the embryological development of the knee. Being treated as an irrelevant structure LM was often the first victim of shaver during arthroscopy. However, last years have shown increased interest in this structure due to its potentially significant clinical role. Our aim was to classify LM based on its morphological characteristics and examine its microanatomy usingimmunohistochemical analysis to reveal the potential clinical value for surgeons. We have examined sixteen fresh frozen lower limbs, 6 females (mean age 83.1 ± 3.4 years) and 10 males (mean age 84.2 ± 6.8 years). Classical histological H+E stain was routinely conducted. Subsequently, CD31 antibody (DAKO, Monoclonal Mouse Anti-Human, Clone JC70A) was used to mark vascular epithelium. Monoclonal Mouse Anti-Human Neurofilament Protein (NFP) antibody (DAKO, Clone 2F11) was used to expose the nerves. Moreover, we have conducted arthroscopic visualizing and suturing LM to the torn ACL during routinely performed arthroscopic suturing of the ACL. The dissection process has revealed that LM was present only in 75% of cases.Histological examination confirmed the presence of longitudinal collagen fiber bundles in all samples. Tiny nerves were confirmed by NFP, along the subsynovial layer in all samples. CD-31 immunostain revealed the presence of many vascular vessels along the entire ligament, especially well developed at its distal end. Our study has revealed that LM contains rich vascular network. Thus, it may be a donor for the revascularization process after ACL tear or reconstruction which may improve the recovery. Another great advantage of the LM is the presence of nerves along the subsynovial layer, hopefully they may serve as the source of reinnervation and hence better clinical outcome. Based on our results we believe that seemingly irrelevant LM may be very useful during surgical procedures in the knee region. Suturing LM to the ACL may not only prevent the infrapatellar fat pad from subluxation but also improve the blood flow and reinnervation of the injured ACL. Until now there are only a few studies examining microanatomy of the LM. This basic knowledge may serve as the foundation for surgical procedures. Hopefully our findings may be useful for surgeons while planning surgical procedures or clinicians while diagnosing patients who suffer anterior knee pain.

Abstract #1413022: Diabetes Related Hypoglycemia, Contributing Factors and Glucagon Prescriptions in Two Community Hospitals

Hypoglycemia has long been recognized as a dangerous adverse effect of the treatment of diabetes mellitus with insulin or insulin secretagogues. Our study was aimed to identify the number of diabetic patients presenting to the emergency department (ED) with hypoglycemia, contributing risk factors for hypoglycemia (including antidiabetic medication regimens), the number of episodes of hypoglycemia requiring medical attention, and how many patients were prescribed glucagon at discharge. Our study is a retrospective analysis across two hospitals from October 2019 to March 2022, including the population of adult persons with diabetes mellitus, above 18 years of age, presenting to the emergency department with hypoglycemia. Patients without a diagnosis of diabetes mellitus, as well as those presenting with hypoglycemic episodes due to other etiology or hypoglycemia episodes during the hospital stay, were excluded. We extracted data from a sample size of 194 patients after excluding patients based on the exclusion criteria. Of the women were 2 African Americans, 25 Caucasians, 17 Hispanics, and 39 from other ethnicities. Of the men were 8 African Americans, 32 Caucasians, 27 Hispanics, and 44 from other ethnicities. The mean age of males was 66.2 years, and females was 72.9 years. 131 patients had no prior visits for hypoglycemia. Of the 194 patients, 54 were discharged from the ED, and 140 were admitted to the hospital. The most common risk factors associated with hypoglycemia requiring medical attention were: age >65, having more than one comorbidity, decreased oral intake, and poor socioeconomic status. Regarding recurrent presentations with hypoglycemia, there was a significant association with insulin use (p-value=0.0007), with a higher-than-expected number of insulin users having a previous visit for hypoglycemia. Only 16.7% of non-insulin-using patients had prior visits, compared to 40.6% of insulin users. Pairwise Chi-square testing did not reveal a significant association between any other medication class and prior visits for hypoglycemia, nor was there an association between risk factors and prior visits. No patients were prescribed glucagon at the time of discharge. To obtain optimal glycemic control, early identification of hypoglycemia risk factors, self-monitoring of blood glucose, and proper selection of anti-diabetic regimens are important to prevent long-term complications. Unfortunately, the three elements that would prevent subsequent severe hypoglycemic events (i.e., education, adjustment of medication, and glucagon prescription) are underutilized. Hypoglycemia is more common in the elderly population which remains an unmodifiable risk factor. Identifying patients with persistent poor oral intake is extremely important as they may be prone to hypoglycemic episodes on their current antidiabetic regimen and will need medication adjustments accordingly. Our future research focuses on whether giving glucagon prescriptions to patients with diabetes mellitus at discharge prevent recurrent ED visits for hypoglycemia.