Non-endemic Areas Research Articles

Use of artesunate in the treatment of severe imported malaria in France: review of the effectiveness and real-life safety in two French university hospitals

BackgroundIntravenous artesunate (AS) is the first-line treatment for patients with severe imported malaria (SIM) worldwide. However, after 10 years of use in France, AS hasn’t yet received marketing authorization.The purpose of this study was to assess the real-life effectiveness and safety of AS in the treatment of SIM in two Hospitals in France.MethodsWe performed a bicenter retrospective and observational study. All patients treated with AS for SIM between 2014 and 2018 and 2016–2020 were included. The effectiveness of AS was evaluated by parasite clearance, number of deaths, and the length of hospital stay. The real-life safety was assessed by related adverse events (AE) and monitoring of biological blood parameters during the hospital stay and follow-up period.Results110 patients were included during the six-year study period. 71.8% of patients were parasite-negative of their day 3 thick and thin blood smears after AS treatment. No patients discontinued AS due to an AE and no serious AE were declared. Two cases of delayed post-artesunate hemolysis occurred and required blood transfusions.ConclusionThis study highlights effectiveness and safety of AS in non-endemic areas. Administrative procedures must be accelerated in order to obtain full registration and facilitate access to AS in France.

Phase 1 trial to model primary, secondary, and tertiary dengue using a monovalent vaccine

BackgroundThe four co-circulating and immunologically interactive dengue virus serotypes (DENV1-4) pose a unique challenge to vaccine design because sub-protective immunity can increase the risk of severe dengue disease. Existing dengue vaccines have lower efficacy in DENV seronegative individuals but higher efficacy in DENV exposed individuals. There is an urgent need to identify immunological measures that are strongly associated with protection against viral replication and disease following sequential exposure to distinct serotypes.Methods/DesignThis is a phase 1 trial wherein healthy adults with neutralizing antibodies to zero (seronegative), one non-DENV3 (heterotypic), or more than one (polytypic) DENV serotype will be vaccinated with the live attenuated DENV3 monovalent vaccine rDEN3Δ30/31-7164. We will examine how pre-vaccine host immunity influences the safety and immunogenicity of DENV3 vaccination in a non-endemic population. We hypothesize that the vaccine will be safe and well tolerated, and all groups will have a significant increase in the DENV1-4 neutralizing antibody geometric mean titer between days 0 and 28. Compared to the seronegative group, the polytypic group will have lower mean peak vaccine viremia, due to protection conferred by prior DENV exposure, while the heterotypic group will have higher mean peak viremia, due to mild enhancement. Secondary and exploratory endpoints include characterizing serological, innate, and adaptive cell responses; evaluating proviral or antiviral contributions of DENV-infected cells; and immunologically profiling the transcriptome, surface proteins, and B and T cell receptor sequences and affinities of single cells in both peripheral blood and draining lymph nodes sampled via serial image-guided fine needle aspiration.DiscussionThis trial will compare the immune responses after primary, secondary, and tertiary DENV exposure in naturally infected humans living in non-endemic areas. By evaluating dengue vaccines in a new population and modeling the induction of cross-serotypic immunity, this work may inform vaccine evaluation and broaden potential target populations.Trial RegistrationNCT05691530 registered on January 20, 2023.

Field study of parasitic contamination of fruits, vegetables and leafy greens in the Ecuadorian Andes.

Raw vegetables have been considered vehicles of enteroparasites. South American countries are among the most important exporters of fresh vegetables, including Ecuador, which has a tropical climate and soils rich in organic matter that allow it to harvest throughout the year for sale to different countries. The aim of the study was to assess the occurrence of the parasitic contamination of fruits, vegetables and leafy greens grown in an agricultural area of the Ecuadorian Andes. A cross-sectional field study was conducted with snowball sampling on 1,416 samples (516 fruits, 488 vegetables, and 412 leafy greens). Each sample were washed with water, and the resulting solution after removing the vegetables, was subjected to 24-hour sedimentation. The concentrated sediment underwent microscopic analysis. The overall positivity for parasitic contamination was 63.4%, with leafy greens having the highest contamination rate (76.9%) (P<0.0001), surpassing vegetables (67.8%) and fruits (48.4%). Cabbage (100%), onions (84%), and strawberries (60.2%) emerged as the most contaminated within their respective groups. Protozoa were more prevalent (49.6%) than helminths (15.5%) (P<0.0001). Blastocystis sp. (33.5%) ranked highest, followed by Eimeria spp. (26.3%), Entamoeba spp. (10.3%), Giardia spp. (8.3%), Balantidium spp. (6.9%), Cryptosporidium spp. (6.6%), Cyclospora spp. (4.4%), Cystoisospora spp. (0.5%), Strongylida (15.5%), and Ascaris spp. (0.4%). The study reveals that vegetables and fruits for human consumption from this area of the Ecuadorian Andes are highly contaminated with various parasites, constituting a possible source of infection for humans and animals in this area, or in non-endemic areas where these products are marketed. The finding emphasizes the need for strict hygienic measures in agricultural crops, which will be properly achieved through the treatment of soil, manure and water used for cultivation.

Fascioliasis associated with chronic cholecystitis in a woman from Sistan and Baluchestan province, a non-endemic region in Southeastern Iran

BackgroundFascioliasis, caused by Fasciola hepatica, is a neglected zoonotic food-borne trematodiasis. The Caspian littoral in northern Iran is endemic for the disease, and human fascioliasis is well-known in that region. In the present study, we report the diagnosis, identification, and clinical management of a human case of fascioliasis associated with common bile duct (CBD) obstruction from a non-endemic remote area in southeastern Iran.Case presentationA 42-year-old female was admitted to Afzalipour Medical Center hepatobiliary surgery ward in Kerman with abdominal pain for the past three months. Dilated biliary tract and an ill-defined mass in CBD were reported in abdominal ultrasonography and magnetic resonance cholangiopancreatography, respectively. During distal CBD operation, nine leaf-like motile flatworms were isolated. A morphological study confirmed all the isolates as Fasciola, and further molecular investigations, identified the flukes as F. hepatica using both pepck multiplex PCR and cox1 sequencing.ConclusionMolecular and morphological findings of the study indicated the presence of human fascioliasis in the southeastern province of Sistan and Baluchestan in Iran. Fascioliasis is among the etiologies of chronic cholecystitis, and physicians should consider chronic cholecystitis associated with fascioliasis in the differential diagnosis. In the present report, endoscopic ultrasound was usefully applied for the accurate diagnosis of biliary fasciolosis.

Treatment of loco-regional recurrence of nasopharyngeal carcinoma in a non-endemic area: oncologic outcomes, morbidity, and proposal of a prognostic nomogram.

The study assessed outcomes and toxicities of different treatment modalities for local and/or regional recurrent nasopharyngeal carcinoma (NPC) in a non-endemic area. Patients treated with curative intent for recurrent NPC with salvage surgery, photon-based radiotherapy, proton therapy (PT), with or without chemotherapy, at different Italian referral centers between 1998 and 2020 were included. Adverse events and complications were classified according to the Common Terminology Criteria for Adverse Events. Characteristics of the patients, tumors, treatments, and complications are presented along with uni- and multivariate analysis of prognostic factors. A survival predictive nomogram is also provided. A total of 140 patients treated from 1998 to 2020 were retrospectively assessed. Cases with lower age, comorbidity rate, stage, and shorter disease-free interval (DFI) preferentially underwent endoscopic surgery. More advanced cases underwent re-irradiation, fairly distributed between photon-based radiotherapy and PT. Age and DFI were independent factors influencing overall survival. No independent prognostic effect of treatment modality was observed. No significant difference in the morbidity profile of treatments was observed, with 40% of patients experiencing at least one adverse event classified as G3 or higher. Recurrent NPC in a non-endemic area has dissimilar aspects compared to its endemic counterpart, suggesting the need for further studies that can guide the choice of the best treatment modality.

Machine Learning for Early Diagnosis of ATTRv Amyloidosis in Non-Endemic Areas: A Multicenter Study from Italy.

Hereditary transthyretin amyloidosis with polyneuropathy (ATTRv) is an adult-onset multisystemic disease, affecting the peripheral nerves, heart, gastrointestinal tract, eyes, and kidneys. Nowadays, several treatment options are available; thus, avoiding misdiagnosis is crucial to starting therapy in early disease stages. However, clinical diagnosis may be difficult, as the disease may present with unspecific symptoms and signs. We hypothesize that the diagnostic process may benefit from the use of machine learning (ML). 397 patients referring to neuromuscular clinics in 4 centers from the south of Italy with neuropathy and at least 1 more red flag, as well as undergoing genetic testing for ATTRv, were considered. Then, only probands were considered for analysis. Hence, a cohort of 184 patients, 93 with positive and 91 (age- and sex-matched) with negative genetics, was considered for the classification task. The XGBoost (XGB) algorithm was trained to classify positive and negative TTR mutation patients. The SHAP method was used as an explainable artificial intelligence algorithm to interpret the model findings. diabetes, gender, unexplained weight loss, cardiomyopathy, bilateral carpal tunnel syndrome (CTS), ocular symptoms, autonomic symptoms, ataxia, renal dysfunction, lumbar canal stenosis, and history of autoimmunity were used for the model training. The XGB model showed an accuracy of 0.707 ± 0.101, a sensitivity of 0.712 ± 0.147, a specificity of 0.704 ± 0.150, and an AUC-ROC of 0.752 ± 0.107. Using the SHAP explanation, it was confirmed that unexplained weight loss, gastrointestinal symptoms, and cardiomyopathy showed a significant association with the genetic diagnosis of ATTRv, while bilateral CTS, diabetes, autoimmunity, and ocular and renal involvement were associated with a negative genetic test. Our data show that ML might potentially be a useful instrument to identify patients with neuropathy that should undergo genetic testing for ATTRv. Unexplained weight loss and cardiomyopathy are relevant red flags in ATTRv in the south of Italy. Further studies are needed to confirm these findings.

Chapter 7: TBE in special clinical situations

TBE often takes a severe clinical course in immuno-suppressed patients. In transplant patients TBE usually takes a fatal course. TBE vaccination in immuno-suppressed patients can be non-effective TBE in pregnancy has rarely been reported; from recent cases there is no evidence of transplacental infection of the offspring. The alimentary route of infection of TBE is still common in some European countries resulting in a high clinical manifestation index. TBEV can be infectious in milk and milk products for up to 14 days under optimal environmental conditions. TBE is an important travel-related disease. Increasing numbers of non-endemic countries report imported cases. Imported TBE cases in non-endemic areas pose challenges regarding the diagnosis of TBE.

Survival time and prognostic factors in canine leishmaniosis in a non-endemic country treated with a two-phase protocol including initial allopurinol monotherapy

BackgroundLeishmania infantum is an intracellular protozoan parasite which is endemic in countries of the Mediterranean Basin. Leishmaniosis is increasingly diagnosed in non-endemic areas due to the relocation of dogs from endemic areas and the travel of dogs to and from these areas. The prognosis of leishmaniosis in these dogs may differ from that of those in endemic areas. The aims of this study were (1) to determine the Kaplan–Meier estimated survival time for dogs with leishmaniosis in the Netherlands (a non-endemic country), (2) to determine if clinicopathological variables at the time of diagnosis predicted the survival of these dogs, and (3) to evaluate the effect of a two-phase therapy protocol of allopurinol monotherapy followed by meglumine antimoniate and/or miltefosine in the case of incomplete remission or relapse.MethodsThe database of the Department of Clinical Sciences of Companion Animals of the Faculty of Veterinary Medicine, Utrecht University was investigated for leishmaniosis patients. Patient records were reviewed for signalment and clinicopathological data at the time of diagnosis. Only treatment-naive patients were included. Follow-up was performed during the study by phone contact and included treatment received and date and cause of death. Univariate analysis was performed using the Cox proportional hazards regression model.ResultsThe estimated median Kaplan–Meier survival time was 6.4 years. In the univariate analysis, increases in monocyte, plasma urea and creatinine concentrations, and urine protein to creatinine ratio were all significantly associated with decreased survival time. The majority of patients only received allopurinol monotherapy.ConclusionsCanine leishmaniosis patients in our study population in the Netherlands, which is non-endemic for the disease, had an estimated Kaplan–Meier median survival time of 6.4 years, which is comparable to the outcome of other reported therapy protocols. Increased plasma urea and creatinine concentrations and monocyte concentration were statistically associated with an increased risk of death. We conclude that initial allopurinol monotherapy for 3 months should be effective in more than half of canine leishmaniosis cases, provided there is adequate follow-up, and that meglumine antimoniate or miltefosine therapy should be started as the second phase of the protocol in cases where remission is incomplete or there is a relapse.Graphical

A Case of Paratyphoid with Diarrhea as the Only Symptom in a 5 Year Old Boy from Southern Part of India

Paratyphoid fever is a systemic bacterial infection caused by bacteria Salmonella paratyphi serovars A, B, or C. It is most associated with travel to endemic areas but can occur sporadically in non-endemic areas. While the disease is more commonly seen in adults, it can occur in children, and the presentation can be variable. It is clinically difficult to differentiate Typhoid from Paratyphoid without isolation of organism. We present a case of a 5-year-old boy, from Telangana state of South India, who presented with watery diarrhea of 8 to 10 episodes per day and abdominal discomfort for 5 days. At presentation child had some dehydration and very poor oral intake. Child did not respond to standard acute gastroenteritis with some dehydration management and continued to have persistent loose watery stools. Routine blood investigations, urine and stool microscopy revealed normal study. Further evaluation in the second week of illness revealed paratyphi on stool culture, and the child started to respondwithsensitive antibiotic cefotaximeinjections after 3 days of starting. However the child did not have other classical symptoms caused by paratyphi, such as fever, vomiting, or rose spots. Other classical investigations like blood culture and urine culture were negative. This case highlights the importance of considering paratyphoid as a potential cause for persistent diarrhea, even in young children, and the importance of prompt diagnosis and treatment with appropriate antibiotics, especially in the absence of classical clinical or laboratory findings.

Complement-dependent mpox-virus-neutralizing antibodies in infected and vaccinated individuals

Mpox virus (MPXV) caused a multi-country outbreak in non-endemic areas in 2022. Following historic success of smallpox vaccination with vaccinia virus (VACV)-based vaccines, the third generation modified vaccinia Ankara (MVA)-based vaccine was used as prophylaxis for MPXV, but its effectiveness remains poorly characterized. Here, we applied two assays to quantify neutralizing antibodies (NAbs) in sera from control, MPXV-infected, or MVA-vaccinated individuals. Various levels of MVA NAbs were detected after infection, historic smallpox, or recent MVA vaccination. MPXV was minimally sensitive to neutralization. However, addition of complement enhanced detection of responsive individuals and NAb levels. Anti-MVA and -MPXV NAbs were observed in 94% and 82% of infected individuals, respectively, and 92% and 56% of MVA vaccinees, respectively. NAb titers were higher in individuals born before 1980, highlighting the impact of historic smallpox vaccination on humoral immunity. Altogether, our results indicate that MPXV neutralization is complement dependent and uncover mechanisms underlying vaccine effectiveness.

Tick-borne encephalitis epidemiology and surveillance in Poland, and comparison with selected European countries before and during the COVID-19 pandemic, 2008 to 2020.

BackgroundTick-borne encephalitis (TBE) is the most common viral central nervous system (CNS) infection in Poland. Previous research suggests that its incidence was underestimated in the pre-pandemic period. The COVID-19 pandemic caused a considerable burden on surveillance systems, which could further impact reporting.AimWe aimed to assess the completeness of reporting of TBE in the years 2008 to 2020 and explore the potential impact of the COVID-19 pandemic on reporting to the epidemiological surveillance system, compared with hospitalisations for TBEV and other viral neuro-infections.MethodsWe compared the Polish epidemiology of TBE and other viral infections of the CNS from national surveillance reports with data on hospitalisations from 2008 to 2020 and data from selected European countries.ResultsBetween 2008 and 2020, 3,016 TBE cases were reported to surveillance compared with 3,620 hospitalisations. There was an increasing trend in hospitalisations, while surveillance data demonstrated the opposite, with the largest discrepancy observed in the first pandemic year (354 hospitalisations vs 159 cases reported to surveillance). Serological testing for TBE was used more in the known endemic region of north-eastern Poland and less in non-endemic areas. Other European countries reported higher TBE case numbers and an increase during the COVID-19 pandemic, whereas Poland observed an opposite trend.ConclusionThe sensitivity of TBE surveillance in Poland requires improvement. There are considerable regional differences. Regions that test for TBE intensively report most cases. Policymakers should be made aware of the value of quality epidemiological data for planning prophylactic measures in risk areas.

Differential dengue antibody responses in recipients of a Zika DNA vaccine are governed by dengue immune history

Abstract Dengue virus (DENV 1–4) and Zika virus (ZIKV) are closely related flaviviruses that induce immunological cross-reactivity. The VRC5283 Zika virus wild type DNA vaccine is the first to complete a Phase 2b trial (NCT03110770). The objective of this study was to test if VRC5283 induced potent ZIKV-specific neutralizing antibodies (NAbs) while avoiding priming of cross-reactive antibodies that could potentially enhance dengue disease. Here, we measured NAbs to DENV1–4 and ZIKV in serum samples obtained from individuals living in dengue-endemic (Puerto Rico) and non-endemic areas (Texas) immunized with VRC5283 at weeks 0, 4, and 8. We performed plaque reduction neutralization tests (PRNT 50) with sera collected at weeks 0 and 16 after final vaccination. Sera were tested for ZIKV isolated in Brazil, and DENV1–4 isolated in Sri Lanka. Most individuals from dengue-endemic areas had NAbs &amp;gt;1:20 to DENV1–4 and ZIKV prior to vaccination, with the highest NAb titers to DENV2. VRC5283 boosted immunity across all flaviviruses in the dengue-endemic cohort, with an 8.47-fold increase in ZIKV, 2.76-fold increase in DENV1, 1.67-fold increase in DENV3 and 2.06-fold increase in DENV4 titers, but did not significantly boost DENV2 titers. Sera from non-endemic areas had no NAbs to DENV1–4 or ZIKV prior to vaccination, and a boost in NAbs following vaccination was observed only to ZIKV. Thus, VRC5283 only induces dengue cross-reactive NAbs in individuals with prior dengue immunity. Ongoing testing with binding assays will further evaluate whether vaccination induced beneficial or enhancing antibodies to DENV1–4. This work was supported by the Intramural Research Program of NIAID.

Monkeypox virus infection and myocarditis: A review of current evidence and possible pathogenesis.

The recent spread of the monkeypox virus (MPXV), causing monkeypox (mpox), to non-endemic areas, and the atypical and unusual clinical manifestations observed during its 2022 outbreak has focused international interest on the clinical features of the disease. Mpox is usually a self-limiting disease with mild symptoms with common manifestations, including fever and skin lesions; however, severe manifestations could occur in some vulnerable groups (children and those with impaired immune systems) and may present multisystem complications and fatal outcomes. In most cases, a fever is the first sign of disease, followed by the development of various inflammatory lesions on the skin, such as vesiculopustular rashes and ulcers. Pneumonitis, encephalitis, keratitis, secondary bacterial infections, acute kidney injury, and myocarditis are all possible outcomes of the infection. Myocarditis has been reported to be caused by orthopoxviruses, and it is a serious condition of which its pathophysiology is little understood. Recent reports have indicated myocarditis with cardiac involvement as a possible atypical and unusual consequence of the MPXV infection during present outbreak. This review provides an overview of the clinical manifestations of mpox with a special focus on its effects on the heart, including myocarditis. The evidence of the myocarditis in mpox patients and its possible pathogenesis are discussed.

Urine Metabolomic Signature of People Diagnosed with Balkan Endemic Nephropathy and Other Types of Chronic Kidney Disease Compared with Healthy Subjects in Romania

Metabolomic analysis methods were employed to determine biomarkers for various chronic kidney diseases (CKDs). Modern analytical methods were developed and applied successfully to find a specific metabolomic profile in urine samples from CKD and Balkan endemic nephropathy (BEN) patients. The aim was to explore a specific metabolomic profile defined by feasible/easy-to-identify molecular markers. Urine samples were collected from patients with CKDs and BEN, and from healthy subjects from endemic and nonendemic areas in Romania. Metabolomic analysis of urine samples, extracted by the liquid-liquid extraction (LLE) method, was performed by gas chromatography-mass spectrometry (GC-MS). The statistical exploration of the results was performed through a principal component analysis (PCA) evaluation. Urine samples were statistically analyzed using a classification based on six types of metabolites. Most urinary metabolites are distributed in the center of a loading plot, meaning that these compounds do not represent significant markers for BEN. One of the most frequent and higher-concentration urinary metabolites in BEN patients was p-Cresol, a phenolic compound that implies a severe injury of the renal filtration function. The presence of p-Cresol was associated with protein-bound uremic toxins, which have specific functional groups such as indole and phenyl. In prospective studies for future investigation, prevention, and disease treatment, we suggest a larger sample size, sample extraction using other methods, and analysis using other chromatography techniques coupled with mass spectrometry, which can generate a more significant data set for statistical analysis.

Current Situation and Prevention and Control Challenges of the Monkeypox

Since the first case of monkeypox was reported in the UK in early May 2022, by mid-July, more than 60 countries around the world had reported more than 10,000 confirmed cases of monkeypox, with deaths occurring in countries in non-endemic areas. Monkeypox is caused by monkeypox virus, the same orthopoxvirus as smallpox virus. It is necessary to review the history of the human fight against smallpox virus and to develop measures against monkeypox virus. The eradication of smallpox might make the public feel like the orthodox virus should not be a danger to humans anymore. However, the continually increasing number of confirmed monkeypox cases is telling us that people should always be aware of those potential threats. The clinical manifestations of monkeypox cases are mild, but there is still a lack of specific treatment options. Therefore, the essential information and basic diagnosis methods are gathered in this article for people to know about monkeypox and prepare well to combat and control the spreading of monkeypox.

Association between low fluoride exposure and children's intelligence: a meta-analysis relevant to community water fluoridation

ObjectivesPrevious meta-analyses have mainly focused on studies conducted in endemic fluorosis areas with relatively high fluoride concentrations. These are impoverished rural communities in China, India, and Iran, and the findings cannot be generalised to developed countries. Therefore, we investigated the association between fluoride concentrations relevant to community water fluoridation and children's cognition measured with IQ scores by synthesising effect sizes reported in observational studies. MethodsA previous meta-analysis and the National Toxicology Program database that included a search of multiple databases and the authors' search of PubMed, Google Scholar, and Mendeley provided the data. Cross-sectional and cohort studies examining the association between fluoride and children's cognition and intelligence scores were selected. Two reviewers abstracted data using standard procedures. We performed three meta-analyses to synthesise the effects using the random effects models. ResultsEight studies of standardized mean difference in IQ scores from non-endemic fluorosis areas found no statistically significant difference between recommended and lower levels of fluoride (standardized mean difference = 0.07; 95% confidence interval: −0.02, 0.17; I2 = 0%), and no significant fluctuation in IQ scores across the differences in fluoride concentrations by non-linear modeling with restricted cubic spline (P = 0.21). Meta-analyses of children's and maternal spot urinary fluoride associated pooled regression coefficients (Betachildren = 0.16; 95% confidence interval: −0.40, 0.73; P = 0.57; I2 = 0%, Betamaternal = −0.92; 95% CI: −3.29, 1.46; P = 0.45; I2 = 72%) were not statistically significant. Further regression analysis by standardizing absolute mean IQ scores from lower fluoride areas did not show a relationship between F concentration and IQ scores (Model Likelihood-ratio test: P-value = 0.34.) ConclusionsThese meta-analyses show that fluoride exposure relevant to community water fluoridation is not associated with lower IQ scores in children. However, the reported association observed at higher fluoride levels in endemic areas requires further investigation.

Primary Splenic Hydatid Cyst: Case Report

The rarity of splenic hydatid disease poses a challenge for clinicians, particularly in non-endemic areas. As the hydatid cyst can present as a simple cyst without having the classical symptoms and later can lead to life-threatening complications; Serology and featuring images are necessary for the diagnosis. The treatment is mainly surgical with, in particular the total splenectomy In this article, we report a case of Hydatic cyst of spleen treated at the Department of Visceral Surgery of the Hospital ibn tofail CHU Mohammad VI Marrakesh.

Neurocysticercosis in Non-Endemic Areas: The Experience in Qatar (P3-10.007)

<h3>Objective:</h3> To characterize Neurocysticercosis (NCC) in Qatar with a large database of a multiethnic population. <h3>Background:</h3> Qatar is a nation in the Gulf region of the Middle East with a predominantly immigrant population, making it a unique area of study for the epidemiology of NCC. Historically, NCC is not endemic in the region. <h3>Design/Methods:</h3> We retrospectively studied instances of NCC (n=420) recorded in Qatar from 2013–2018 through the national healthcare system. We analyzed the data and stratified it based on several variables such as symptoms, treatment, and outcome, as well as radiological features. <h3>Results:</h3> Out of the 420 patients, 93.6% were men, and 98.3% were immigrants from NCC endemic countries such as Nepal (63.8%) and India (29.5%). Eighty percent of patients presented with seizures, with the majority (69%) experiencing generalized tonic-clonic seizures. Five percent presented with status epilepticus. Headaches, the second most common complaint, were reported in 18% of subjects. On imaging, 50% had a single lesion while 63% were at the calcified stage. The lesions were parenchymal in 99.5% of cases, predominantly in the frontal lobe (59%). Thirteen percent were diagnosed incidentally on imaging, mainly in the form of isolated calcified non-enhancing lesions. Phenytoin was the most prescribed anti-seizure drug (57%), and albendazole was received by 55% of patients. When follow up information was available, clinical improvement was noted in 81% of patients. <h3>Conclusions:</h3> NCC is prevalent in Qatar and remains confined to the large proportion of Southeast Asian immigrants within the population. Given this, dissemination most likely occurred in their countries of origin where NCC is endemic. NCC is a significant contributor to the epilepsy burden in Qatar, often with a good outcome regarding seizure control. NCC with an intraparenchymal single lesion seems to be over represented in our cohort. <b>Disclosure:</b> Miss Nauman has nothing to disclose. Ms. Wahbeh has nothing to disclose. Dr. Shaheen has nothing to disclose. Dr. Abunaib has nothing to disclose. Dr. Melikyan has nothing to disclose. Dr. Mesraoua has nothing to disclose. Dr. Deleu has nothing to disclose. Dr. Al Hail has nothing to disclose. Ahmed El Sotouhy has nothing to disclose. Ziyad Mahfoud, 5273 has nothing to disclose. Dr. Haddad has nothing to disclose.

Characteristics of a single-center cohort of patients with hereditary transthyretin amyloidosis (P13-8.015)

<h3>Objective:</h3> To describe patients’ characteristics of a large cohort of patients with hereditary transthyretin amyloidosis (hATTR) seen at the Penn Amyloidosis Center between 2018 and 2022. <h3>Background:</h3> The characteristics of hATTR patients and their prognosis varies greatly depending on the type of TTR mutation and whether the patient lives in an endemic area versus a non-endemic area. There is a need for referring physicians to better understand characteristics of hATTR patients in the US. <h3>Design/Methods:</h3> We performed a retrospective chart review of all patients seen at the University of Pennsylvania between 2018 and 2022 with confirmed hATTR. Data was collected on patient demographics, TTR gene mutations, and symptomatology. <h3>Results:</h3> 164 patients with hATTR were identified. 98 patients (60%) were male, and 66 (40%) were female. The most common gene mutations were V122I (87 patients, 53%), T60A (32 patients, 20%), and V30M (17 patients, 10%), and Phe64 (12 patients, 7%). 122 (74%) patients were symptomatic. The average age for these patients at symptom onset was 64 years; average age at diagnosis was 67 years. 22 patients (13%) were deceased at the time of chart review, on average 20 months after diagnosis and 45 months after symptom onset. 47 symptomatic patients (39%) had only cardiac symptoms such as congestive heart failure, 15 patients (12%) had only neurological symptoms such as neuropathy, and 60 patients (49%) had both cardiac and neurological symptoms. 20 symptomatic patients (16%) had concurrent diabetes, and 54 patients (44%) had a history of carpal tunnel syndrome. <h3>Conclusions:</h3> This study summarizes characteristics of a large patient cohort at an urban academic referral center. These findings can help physicians taking care of hATTR patients discuss disease behavior and prognosis in their patient population. Overall, a trend in shorter diagnosis delay was observed in our study showing the possibility of increase awareness about hATTR among referring physicians. <b>Disclosure:</b> Mr. Sarmiento Bustamante has nothing to disclose. Dr. Qarni has nothing to disclose. Dr. Simoes Jones has nothing to disclose. Dr. Khella has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Ionis. Dr. Khella has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ionis. Dr. Khella has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Pfizer. Dr. Khella has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alnylum. Dr. Khella has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eidos. Brian Drachman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alnylam. Brian Drachman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Akcea. Dr. Pieretti has nothing to disclose. Dr. Karam has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alnylam. Dr. Karam has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ionis. Dr. Karam has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Karam has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Argenx. Dr. Karam has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Karam has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neuroderm.

Navigators’ KAP About Zika infection

This manuscript analyze the KAP about the infection by the Zika virus between navigators from Portuguese Navy ships. We developed a statistical analysis, a cross-sectional study that, splitting distinct groups under study those who will navigate in endemic areas of Zika virus, those that have traveled to endemic areas of ZIKV and navigators in non-endemic areas of ZIKV. The present study allows to describe knowledge, attitudes and practices related to ZIKV infection, also let us to stratify the different groups under study: those who will navigate in endemic areas of Zika virus, those that have traveled to endemic areas of ZIKV and navigators in non-endemic areas of ZIKV. The knowledge level about ZIKV reveals significant differences between the distinct groups. The preliminary results are similar other performed studies revealing an urgency to implement an educational health program about Zika infection, previous to a future outbreak by Zika virus.