Ofthe Patients Research Articles

N-acetyl-β-D-glucosaminidase inclinically healthy German Shepherd dogs and dogs with early stages ofchronic kidney disease.

Urinary N-acetyl-β-D-glucosaminidase (NAG) activity isassociated with kidney disease. Inour study, wefocused onevaluating the ratio ofNAG tothe urinary creatinine concentration (NAG/Cr) inthe German Shepherd breed. Sixty-two healthy dogs and thirteen dogs with chronic kidney disease (CKD) were examined. The healthy dogs were divided into groups based ontheir sex and age (puppies and adolescent dogs under 2years, adult dogs from 2to 6years and seniors over 6years), while the dogs with CKD were divided based onthe disease stage (CKD stage1 and2). Nosignificant difference was detected between the males and females. Regarding theage dependence, significantly higher values were found indogs older than 6years (P=0.0203) compared todogs aged 2-6years. When comparing the healthy dogs tothe dogs with CKD, the lowest NAG/Cr ratio was observed inthe dogs with CKD stage2. The reference interval for NAG/Cr inthe German Shepherd was established intherange of0.78-7.86U/gCr. Weobserved nocorrelations with the commonly used markers ofkidney disease such ascreatinine, urea, orsymmetrical dimethylarginine. Nevertheless, weencourage the further investigation ofNAG inrelation toCKD, taking the breed, sex and age ofthe patients into account.

LOW-RISK GESTATIONAL TROPHOBLASTIC NEOPLASIA: INSIGHTS FROM A TERTIARY CARE INSTITUTE IN INDIA

Objective: To report clinical characteristics, treatment outcomes and chemotherapy-related toxicities in patients with low-risk GTN at tertiary care centre in India. Material and Methods: This retrospective observational study was conducted at the Department of Medical Oncology of Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi over 2 years. The clinical and treatment information of every patient diagnosed with GTN between December 2021 and December 2023 were examined retrospectively in their medical records. Methotrexate (MTX) was administered with folinic acid (FA) rescue to low-risk GTN patients. EMA-CO, multiagent chemotherapy, was administered every two weeks to patients with low-risk GTN who were resistant to first-line chemotherapy. Results: Only 35 of the 40 patients with low-risk GTN were able to be evaluated since five of them were lost to follow-up throughout the course of treatment.The study found that the majority of patients (71.4%) experienced a molar pregnancy before developing gestational trophoblastic neoplasia (GTN), with 91.4% developing GTN within the first 4 months. Of these, 32 patients achieved complete responses (91.4%)with MTX therapy, while 3 experienced treatment failure (8.5%). Following multiagent chemotherapy, all three ofthe patients who had not responded to initial MTX therapy experienced complete remission (CR). All patients with GTN who were at low risk had 100% overall survival (OS) and cure rates. Conclusion: With a complete response (CR) rate of 91.4% and no serious side effects, the MTX regimen proved to be highly effective in treating women with low-risk GTN.

Reasons for Requesting Ultrasonography: A Retrospective Study.

The aim of this study is to evaluate (i) the reasons for requesting ultrasonography (USG) in a dentistry faculty and (ii) the scanning regions, the type of probe used, and the use of Doppler USG. USG request forms of patients who applied to our radiology clinic for USG were analyzed retrospectively. According to the clinical information of the patients in the request forms, the reasons for requesting USG were divided into four groups: soft tissue swelling, soft tissue calcification, lymph node, and other examinations. Data were statistically compared between sex (female and male) and age groups (≤40-years-old and ˃40-years-old). The USG request forms of 50 patients were obtained. The mean patient age was 45.06±14.50 years. Twenty-six patients were female (52%), while twenty-four patients were male (48%). Soft tissue swelling, soft tissue calcification, lymph node, and other examinations were noted as the reasons for requesting USG in 42%, 26%, 18%, and 14% of the patients, respectively. The most scanned regions were the submandibular (56%), parotid (16%), and cheek (10%) regions. Extraoral probe was used more frequently than intraoral probe (78% vs. 22%). Doppler USG was used in most patients (98%). A statistically significant difference was found between age groups and calcification examination (p<0.05). The reasons for requesting USG were mostly soft tissue swelling, soft tissue calcification, and lymph node examinations. The most commonly scanned region and used type of probe were the submandibular region and extraoral probe, respectively. Doppler USG was used in most patients.

Intralesional Acyclovir for Cutaneous Warts

Cutaneous warts are a common skin problem in routine dermatological practice. There are many clinical modalities, but there are failure and recurrence. The current study aimed to evaluate the efficacy and safety of intralesional acyclovir in treating cutaneous warts. An analytic clinical trial study was conducted in Iraq/Baghdad/Al-Yarmouk Teaching Hospital from November 2021 to May 2022. The current study adopted A convenient sampling method to enroll 30 patients with cutaneous warts. The patients had intralesional acyclovir (70 mg/ml) injected into warts. The treatment was repeated at two-week intervals until complete clearance or for a maximum of 5 sessions. According to the current study's results, 30 patients were enrolled in the current study. The mean age was 23.7 (±12.7) years. Most of the patients had an age of more than 14 years. Females constituted more than half of the sample. Regarding the treatment outcome, 19 (63.3%) patients were cured, and 10 (33.3%) failed to cure. In comparison, one patient had a recurrence after being cured in three sessions. Regarding the patients who were cured, 8 (42.1%) patients were cured in two sessions, 6 (31.6%) were cured in three sessions, 2 (10.5%) were cured in one session, and 2 (10.5%) patients were cured in four sessions. In contrast, 1 (5.3%) patient was cured in five sessions. Severe pain during injection was the commonest side effect (66.6%), followed by bullous reaction (30%0), bleeding at the site of injection (20.0), and pain for a few days (16.7%). In conclusion, intralesional acyclovir was found to be effective and safe with few and transient side effects. Keyword: Cutaneous; Patients; Bleeding.

Retrospective Study of Autologous Arteriovenous Fistula Creation as Vascular Access for Hemodialysis

IntroductionAn autologous arteriovenous fistula (AVF) creation is a common vascular procedure forhemodialysis (HD) patients. This surgical procedure aim is to design a vascular conduct thatwithstands hemodialysis for a durable period. However, the functional outcome of this procedurevaries and depends on patients’ various predictors. .MethodsA retrospective observational study was carried out to evaluate the functional outcome of AVFcreation at the cardiothoracic vascular surgery unit of the surgery department of B.P KoiralaInstitute of Health Sciences from February 2019 to February 2020. The medical file of the patientswas studied, relevant data entered and analyzed in SPSS statistical software.ResultsThere were a total of 112 autologous AVF created during the study period. The mean age ofthe patients was 48.66±15.64 years. There were 75(67%) males and 37(33%) females. The mostcommon limb of fistula creation was left non-dominant upper limb 95(84.8%) and right upper limb17(15.2%). The most common type of AVF was radiocephalic fistula 66(58.9%) and brachiocephalicfistula 46(41.1%). There were 92(82.1%) mature fistula at eight weeks follow-up. These include54(48.2%) radiocephalic fistulas and 38(33.9%) brachiocephalic fistulas. There were 20(17.8%)delayed matured fistulas at 12 weeks (12 radiocephalic and 8 brachiocephalic AVF).ConclusionsThe creation of an autologous AVF for hemodialysis in the upper limb has fewer complications andthe maturation of the AVF depends on the vessel’s diameter. Radio-cephalic and BrachiocephalicAVF usually matures between six to eight weeks duration

LAPAROSCOPIC TRANSPERITONEAL PYELOPLASTY FORURETEROPELVIC JUNCTION OBSTRUCTION IN PAEDIATRICPOPULATIONGROUP

Background: The ureteropelvic junction obstruction (UPJO) is one of the most prevalent genitourinaryabnormalities in children. PUJO is considered as the most common cause of congenital hydronephrosis.Pyeloplasty is the main treatment method for patients with UPJO [5]. An ideal treatment should have thehighest success rate and be minimally invasive. There are many techniques for PUJO repair, but theDismembered AndersonHynes pyeloplasty remains thegoldstandardfor surgicalreconstruction[8].LaparoscopicAnderson-Hynes pyeloplasty has becomethegoldstandardinmanypediatriccenters Objectives: To assess the safety and efficacy of laparoscopic transperitoneal pyeloplasty in children withPUJ obstruction. Methods: The study included 30 consecutive cases of congenital unilateral PUJO with SRF &lt;40% managedduring the 24-month period from November 2020 to November 2022. All the patients were properlyevaluated before proceeding for procedure. Results: In our study the mean age of patients was 6.4 years. Most of the children affected were males(76.7%) andinvolvement of left pelvi-ureteric junction. The commonest cause of pelvi-ureteric junctionobstruction was an abnormal proximal segment (53.3%) followed by crossing vessel (20%).Thepre-opAPPD on ultrasonography was in range from 21mm to 50mm, with a mean pre op APPD of 36.26mm.Most of the patients (83%) had a pre-operative differential renal function in the range of 31-40%(34.8%).Mean operative time was 99.06mins. Mean post op APPD was 27.38mmand DRF was 40.72%. 96% ofthe patients had an indwelling catheter in situ for a period of less than one week. Out of total 30 patientsanastomoticdrainwaskeptfor6daysin28patients(93.34%).Meanhospitalstayindays was7.53days. Conclusion:Laparoscopictransperitonealpyeloplastyisasafeandeffective,minimallyinvasiveprocedure in pediatric patients, characterized by good surgical efficiency, reduced complications, fasterrecoveryand satisfactory followup results.

Severe hyponatraemia (P-Na < 116 mmol/l) in the emergency department: a series of 394 cases

AimTo evaluate the significance of severe hyponatraemia presented at the emergency department (ED).MethodsA retrospective hospitalrecords study of all patients with plasma sodium levels of < 116 mmol/l from 2016 to 2020 in a single tertiary referral centre.ResultsA total of 394 visits of 363 individual severely hyponatraemic patients represented 0.08% of all ED visits. Themean age was 68 years and the male-to-female ratio was 1:1.3. The symptoms and signs were diffuse and varying, while half ofthe patients had neurologic symptoms. The aetiology of hyponatraemia was often multifactorial. The aetiologies varied by age,and the most common ones were the syndrome of inappropriate antidiuresis (34%), diuretic use (27%), alcohol-related (19%)and dehydration (19%). The mean sodium correction rates were 6.6, 4.9 and 3.8 mmol/l/24 h at 24, 48 and 72 h, respectively.The mean maximum correction rate over any 24-h time interval was 10.2 mmol/l. The vital signs (National Early WarningScore, NEWS) of severely hyponatraemic patients were mostly normal. All-cause mortality was 18% for 1-year follow-up.Malignancies, especially small-cell lung cancer, and end-stage liver disease caused most of the deaths. Osmotic demyelinationsyndrome (ODS) was diagnosed in five (1.4%) patients.ConclusionPatients with severe hyponatraemia in the ED presented with non-specific complaints. The aetiology of hyponatraemia was often multifactorial and varied by age. The needfor intensive care was poorly predicted by NEWS. The one-year mortality rate was 18% and the incidence of ODS 1.4% afteran episode of severe hyponatraemia.

Direct-Acting Antiviral Treatment in Albanian Patients With Chronic Hepatitis C and Advanced Liver Fibrosis.

Background Treating chronic hepatitis C (CHC) with direct-acting antiviral (DAA) is very effective at clearing the infection. In Albania treatment with DAA is limited to patients with liver stiffness F3-F4, and with other co-infections. The objective of this study was to evaluate the efficacy of DAA in Albanian patients with genotypes 1-5, who mostly suffer from advanced liver fibrosis. Material and Methods This is a retrospective study carried out at the University Hospital Center "Mother Teresa", Tirana, during 2014-2019, including treatment-naïve and treatment-experienced patients with genotypes 1-5. All patients were evaluated with elastography and most of them were F3-F4. The primary endpoint involved the patients achieving SVR-12, or undetectablehepatitis C virus/ribonucleic acid (HCV RNA) 12 weeks after the end of treatment. In patients without a genotype, we have used a pangenotypic regimen. Results This study included 207 patients with a mean age of 48.9 ± 13.1 years, 56% male and 44% female; 152 (73%) were genotype 1, 24 were (11.5%) genotype 2, nine were (4.3%) genotype 3, 14 were (6.7%) genotype 4, one was (0.4%) genotype 5, and seven (3.8%) unassigned genotypes. The sustained virologic response (SVR) percentage according to genotype is discussed in the article. The overall SVR score of all the patients in our study was>93%. According to elastography, 127 (66%) were F3-F4, and 80 (38.6%) were F1-F2. Conclusion Treatment with DAA proved to be very effective in our patients; most of them had advanced liver fibrosisas well as compensatedor decompensated liver cirrhosis. The overall SVR score ofthe patients in our study was>93%. Our country needs to treat all patients with chronic hepatitis C without limitations to attain the WHO objectiveof eradicating this disease by 2030.

Correlation between presbycusis with quality of life based on hearing handicap inventory for the elderly screening version (HHIE-S)

Presbycusis is an age-related hearing loss caused by a degeneration process which is a cumulative effect of various risk factors. Hearing Handicap Inventory for the Elderly-Screening version (HHIE-S) questionnaire is a questionnaire that can be used to measure the quality of life in patients with hearing loss. This study aimed to determine the relationship between presbycusis with the quality of life. The research uses cross sectional analytical research methods. The data used in form of primary data is the result of filling in the guided questionnaire and the results of the audiogram, while secondary data is in the form of medical records of presbycusis patients at Dustira Hospital in the period January 2017-December 2018. Data were analyzed by Chi-Square and Spearman Correlation Test. The incidence of presbycusis in the period January 2017-December 2018 at Dustira Hospital was 2,6%. The result showed most of the patients were 65-74 years old (61,8%), male (52,7%), married (58,2%), economic were similar between moderate and low economic status (49.1%), had a history of chronic diseases (76, 4%), had a moderate degree of hearing loss (61,8%) and had a mild-moderate degree of quality of life (52,7%). Based on HHIE-S questionnaire the results showed that there was a significant and strong relationship between presbycusis and patients’ quality of life (p &lt;0.001) and r=0,509. In conclusion, degrees of hearing loss in presbycusis patients will correspond to degrees of decrease in quality of life.

Correlation between presbycusis with quality of life based on hearing handicap inventory for the elderly screening version (HHIE-S)

Presbycusis is an age-related hearing loss caused by a degeneration process which is a cumulative effect of various risk factors. Hearing Handicap Inventory for the Elderly-Screening version (HHIE-S) questionnaire is a questionnaire that can be used to measure the quality of life in patients with hearing loss. This study aimed to determine the relationship between presbycusis with the quality of life. The research uses cross sectional analytical research methods. The data used in form of primary data is the result of filling in the guided questionnaire and the results of the audiogram, while secondary data is in the form of medical records of presbycusis patients at Dustira Hospital in the period January 2017-December 2018. Data were analyzed by Chi-Square and Spearman Correlation Test. The incidence of presbycusis in the period January 2017-December 2018 at Dustira Hospital was 2,6%. The result showed most of the patients were 65-74 years old (61,8%), male (52,7%), married (58,2%), economic were similar between moderate and low economic status (49.1%), had a history of chronic diseases (76, 4%), had a moderate degree of hearing loss (61,8%) and had a mild-moderate degree of quality of life (52,7%). Based on HHIE-S questionnaire the results showed that there was a significant and strong relationship between presbycusis and patients’ quality of life (p &lt;0.001) and r=0,509. In conclusion, degrees of hearing loss in presbycusis patients will correspond to degrees of decrease in quality of life.

Correlation between presbycusis with quality of life based on hearing handicap inventory for the elderly screening version (HHIE-S)

Presbycusis is an age-related hearing loss caused by a degeneration process which is a cumulative effect of various risk factors. Hearing Handicap Inventory for the Elderly-Screening version (HHIE-S) questionnaire is a questionnaire that can be used to measure the quality of life in patients with hearing loss. This study aimed to determine the relationship between presbycusis with the quality of life. The research uses cross sectional analytical research methods. The data used in form of primary data is the result of filling in the guided questionnaire and the results of the audiogram, while secondary data is in the form of medical records of presbycusis patients at Dustira Hospital in the period January 2017-December 2018. Data were analyzed by Chi-Square and Spearman Correlation Test. The incidence of presbycusis in the period January 2017-December 2018 at Dustira Hospital was 2,6%. The result showed most of the patients were 65-74 years old (61,8%), male (52,7%), married (58,2%), economic were similar between moderate and low economic status (49.1%), had a history of chronic diseases (76, 4%), had a moderate degree of hearing loss (61,8%) and had a mild-moderate degree of quality of life (52,7%). Based on HHIE-S questionnaire the results showed that there was a significant and strong relationship between presbycusis and patients’ quality of life (p &lt;0.001) and r=0,509. In conclusion, degrees of hearing loss in presbycusis patients will correspond to degrees of decrease in quality of life.

OPTIMISING FUNCTIONAL OUTCOME IN SURGICAL RESECTION OF TONGUE BASE MALIGNANCIES USING LABIO-MANDIBULO-GLOSSOTOMY

AIM To highlight the advantages of median labiomandibulo glossotomy as a surgical approach for excision of tongue base malignancy. MATERIAL &amp; METHODS It is a case review of 5 cases with tongue base malignant tumours treated in a tertiary care centre. There were 3 female and 2 male patients in the age group of 18-50 years. Histopathology included muco-epidermoid carcinoma in 3 cases, squamous cell carcinoma in1 case and clear cell sarcoma in 1 case. Pre-operative assessment included endoscopic examination and MRI. Surgical excision was done via medianlabio-mandibuloglossotomy. Outcome was assessed in terms of oncologic adequacy and the functional impact. RESULTS Disease free resection margin could be achieved in all the 5 cases. Near normal functional recovery could be achieved within 2 weeks. 2 cases required speech therapy for few months. None of the patients developed recurrence during the follow up period. CONLUSION In selected cases of base of tongue malignant tumours, this approach provides complete disease clearance without any significant functional and cosmetic impact. KEYWORDS Labio-mandibuloglossotomy, oropharyngeal carcinoma, base of tongue malignancy, Chemoradiotherapy.

The Efficacy and Adverse Effects of Combining Sofosbuvir and Velpatasvir in Viral Hepatitis C Hemodialysis in Pakistani Population.

Purpose: The study objectives were to evaluate the efficacy and safety of SOF and VLP combination in HCV-infected patients on Hemodialysis (HD) in the local community as usual Pakistani practice.&#x0D; Methodology: In this study, 252 patients were given treatment who participated. Patients who maintain their hemodialysis are often given a combination of SOF and VLP. Before beginning the drug, the patient had testing that included an upper GI endoscopy, genotyping, measurement of the viral load, and a liver brow scan. Patients were administered SOF and VLP at dosages of 400 mg/day and 100 mg/day, respectively, for the duration of the study. Between March 2019 and March 2021, this study was conducted at the Department of Kidney Diseases at LRH Hospital in Peshawar, Pakistan, which was an observational, prospective, single-center study. 27 HCV-HD patients were on a SOF/VLP regimen during the experiment. The ICH-GCP criteria were surveyed in an intended manner. During the data analysis, a p-value of 0.05 or below was considered statistically significant.&#x0D; Results: Forty percent ofthe patients were male, and sixtypercent were female between the ages of 27 and ninety. According to the findings of 252 participants (n = female 14, 43.5 percent and n = male 18, 45.5 percent), 21 subjects were naïve, and six issues were in the treatment-experienced group (with SOF/RBV), with a mean age of 35.5 years and a standard deviation of 9.6 years. At the post-treatment follow-up visit after 12 weeks of therapy with SOF/VLP, the sustained virological response (SVR) rate was 100 percent (252 of 252), indicating that all of the patients had successfully recovered from their infection. During the study, not a single patient had a virological setback or was lost to follow-up. The most common adverse effects (AEs) recorded were nausea, headache, and tiredness; however, there were no reports of significant AEs. In addition, there were no cases of therapy being stopped prematurely owing to adverse effects.&#x0D; Conclusion: Patients in regular care in Pakistan who have HCV and are receiving HD are offered an extraordinarily efficient, risk-free, and well-tolerated treatment consisting of the total dosage of SOF-VLP given for 12 weeks.

Spanish National Registry of Paediatric Coeliac Disease: Changes in the Clinical Presentation in the 21st Century.

Over the last several decades, there has been a tendency towards a predominance of less symptomatic forms of coeliac disease (CD) and an increase in the patient age at diagnosis. This study aimed to assess the clinical presentation and diagnostic process of paediatric CD in Spain. A nationwide prospective, observational, multicentre registry of new paediatric CD cases was conducted from January 2011 to June 2017. The data regarding demographic variables, type of birth, breast-feeding history, family history of CD, symptoms, height and weight, associated conditions, serological markers, human leukocyte antigen (HLA) phenotype, and histopathological findings were collected. In total, 4838 cases (61% girls) from 73 centres were registered. The median age at diagnosis was 4 years. Gastrointestinal symptoms were detected in 71.4% of the patients, and diarrhoea was the most frequent symptom (45.9%). The most common clinical presentation was the classical form (65.1%) whereas 9.8% ofthe patients were asymptomatic. There was a trend towards an increase in the age at diagnosis, proportion of asymptomatic CD cases, and usage of anti-deamidated gliadin peptide antibodies and HLA typing for CD diagnosis. There was, however, a decreasing trend in the proportion of patients undergoing biopsies. Some of these significant trend changes may reflect the effects of the 2012 ESPGHAN diagnosis guidelines. Paediatric CD in Spain is evolving in the same direction as in the rest of Europe, although classical CD remains the most common presentation form, and the age at diagnosis remains relatively low.

Septic arthritis and osteomyelitis of the pubic symphysis – a retrospective study of 26 patients

Introduction: Septic arthritis and osteomyelitis of the pubic symphysis (SAS) are rare conditions with nonspecific symptoms leading to diagnostic delay and treatment. Aim: We draw awareness to this condition elucidating the diagnostic procedures, surgical intervention and antibiotic management. Methods: This entail a retrospective follow-up study of 26 consecutive patients, median age of 71 years (range: 48–89) surgically treated for septic arthritis of the pubic symphysis between 2009 and 2020. Patient files, diagnostic imaging and bacterial cultures were evaluated. Results: Before diagnosed with SAS, 21 of the patients had previous pelvic surgery (16 due to malign conditions, 5 due to benign conditions), while 5 of the patients were not previously operated. Median follow-up period after SAS surgery was 18.5 months (range: 8 to 144.5 months). Dominating symptoms were severe suprapubic/pubic pain ( 26), gait difficulties ( 10) and intermittent fever ( 9). Diagnostic delay was between 1 and 12 months. The diagnostic imaging included magnetic resonance imaging (MRI) ( 24), computer tomography (CT) ( 17) and/or PET-CT ( 10), predominantly displaying bone destruction/erosion of the symphysis ( 13), abscess ( 12) and/or fistula ( 5) in the adjacent muscles. All patients underwent surgical debridement with resection of the symphysis and received a minimum of 6 weeks antibiotic treatment. Fourteen patients presented with monocultures and 4 patients with polycultures. Five patients underwent at least one revision surgery. Twenty-three patients experienced postoperative pain relief at 6 weeks follow-up, and 19 patients were ambulant without walking aids. Conclusion: SAS are rare conditions and should be suspected in patients with infection, pubic pain and impaired gait, especially after pelvic surgery. Bone infection, abscess and fistula near the symphysis can be visualized with proper imaging, most frequently with MRI. For most patients in this cohort surgical debridement combined with a minimum of 6 weeks antibiotic treatment resulted in pain relief, improved walking ability and a low recurrence rate.

Clinical and epidemiological profile of elderly patients seen in a hypertensive emergency at a public hospital in the state of Rio de Janeiro – Hypertensive emergency in the elderly

Introduction: Hypertensive emergencies (HE) are clinicalentities characterized by an acute and significant increasein blood pressure (BP) associated with severe symptoms thatevidence target organ damage. Objective: To analyze the clinicaland epidemiological profile of elderly patients treated ina hypertensive emergency at a public hospital in the state ofRio de Janeiro. Method: This study is prospective and descriptive.Information was collected from August to October, 2020using medical records and processed using the Statistic Statsoftprogram. Pearson’s test was performed for univariate analysis.Results: The sample consisted of 109 patients. The averageage found was 73 years old, with a predominance of males(69.72%) and brown skin (36.69%). Approximately 72.48% ofthe patients had a history of Systemic Arterial Hypertension(SAH), however, (50.46%) reported that they did not regularlyuse antihypertensive medication. Target organ injuries wereischemic stroke (58.71%), followed by acute coronary syndrome(24.77%), hemorrhagic stroke (9.17%) and edema acutelung disease (7.33%). Regarding the BP values found at admission,the mean systolic pressure was 205.0 mmHg, while themean diastolic pressure was 127.0 mmHg. Conclusion: Ischemicstroke was the most frequent HE in the sample. It is necessaryto put in place measures to prevent risk factors associated withSAH, as well as to control blood pressure levels to reduce thenumber of consultations due to hypertensive emergencies andother complications of cardiovascular diseases.Keywords: Emergency; Hypertension; Prevalence.

Temporary epicardial pacing wires in isolated Coronary Artery Bypass Graft: Necessity or force of habit?

To determine the frequency of Temporary epicardial pacing wires usage and its predictors in the immediate postoperative period in isolated coronary artery bypass graft surgery. The longitudinal study was conducted at the Aga Khan University Hospital, Karachi, from September 2019 to August 2020, and comprised adult patients of either gender who underwent isolated coronary artery bypass graft in the Department of Cardiothoracic Surgery. Demographic, peri-operative and post-operative Temporary Epicardial Pacing Wires use data was extracted from patient's files and the institutional electronic database. Logistic regression models were built to explore predictors of Temporary epicardial pacing wires usage. Data was analysed using SPSS 22. Of the 322 cases evaluated, 27(8.4%) required the use of Temporary Epicardial Pacing Wires. Mean age of the patients requiring temporary epicardial pacing wires was 66.3±8.9 years compared to 58.7±8.9 years in those who did not require it (p<0.001), while the left ventricular ejection fraction percentage was 44.1±12.8 and 48.9±12.8 respectively (p=0.032). After adjusting for clinically plausible demographics and peri-operative variables, increasing age and low left ventricular ejection fraction were significantly associated with the use of temporary epicardial pacing wires in post-operative period of isolated coronary artery bypass graft patients (p<0.05). The frequency of temporary epicardial pacing wires usage in the post-operative period of coronary artery bypass graft was found to be low.

Diversity of HIV-1 Subtypes and Transmitted Drug-resistance Mutations Among Minority HIV-1 Variants in a Turkish Cohort.

The World Health Organization (WHO) recommends the surveillance of transmitted drug resistance mutations (TDRMs) to ensure the effectiveness and sustainability of HIV treatment programs. Our aim was to determine the TDRMs and evaluate the distribution of HIV-1 subtypes using and compared next-generation sequencing (NGS) and Sanger-based sequencing (SBS) in a cohort of 44 antiretroviral treatment-naïve patients. All samples that were referred to the microbiology laboratory for HIV drug resistance analysis between December 2016 and February 2018 were included in the study. After exclusions, 44 treatment-naive adult patients with a viral load of >1000 copies/mL were analyzed. DNA sequencing for reverse transcriptase and protease regions was performed using both DeepChek ABL single round kit and Sanger-based ViroSeq HIV-1 Genotyping System. The mutations and HIV-1 subtypes were analyzed using the Stanford HIVdb version 8.6.1 Genotypic Resistance software, and TDRMs were assessed using the WHO surveillance drug-resistance mutation database. HIV-1 subtypes were confirmed by constructing a maximum-likelihood phylogenetic tree using Los Alamos IQ-Tree software. NGS identified nucleos(t)ide reverse transcriptase inhibitor (NRTI)-TDRMs in 9.1 % of the patients, non-nucleos(t)ide reverse transcriptase inhibitor (NNRTI)-TDRMs in 6.8 % of the patients, and protease inhibitor (PI)-TDRMs in 18.2 % of the patients at a detection threshold of ≥ 1 %. Using SBS, 2.3 % and 6.8 % of the patients were found to have NRTI- and NNRTI-TDRMs, respectively, but no major PI mutations were detected. M41L, L74I, K65R, M184V, and M184I related to NRTI, K103N to NNRTI, and N83D, M46I, I84V, V82A, L24I, L90M, I54V to the PI sites were identified using NGS. Most mutations were found in low-abundance (frequency range: 1.0 % - 4.7 %) HIV-1 variants, except M41L and K103N. The subtypes of the isolates were found as follows; 61.4 % subtype B, 18.2 % subtype B/CRF02_AG recombinant, 13.6 % subtype A, 4.5 % CRF43_ 02G, and 2.3 % CRF02_AG. All TDRMs, except K65R, were detected in HIV-1 subtype B isolates. The high diversity of protease site TDRMs in the minority HIV-1 variants and prevalence of CRFs were remarkable in this study. All minority HIV-1 variants were missed by conventional sequencing. TDRM prevalence among minority variants appears to be decreasing over time at our center.

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Background:The COVID-19 pandemic has led to expansion of telepsychiatry services and formulation of telemedicine guidelines. However, the telemedicine guidelines are not very clear about psychiatric emergencies, such as suicidal behaviour, resulting in psychiatrists facing dilemma about handling such situations.Aim:To evaluate the prevalence of suicidal behaviour in new patients presenting to the Telepsychiatry services in a Tertiary Care centre and how patients with suicidal behaviour were handled during the initial consultation.Methods:All new adult patients (aged >18 years) registered with telepsychiatry services during 19th July to 20th of Sept 2021 were assessed for suicidal behaviour, in the form of death wishes, suicidal ideations, plans, attempts (lifetime/recent) and non-suicidal self-injurious behaviour (NSSI) (lifetime/recent).Results:The study included 1065 adult patients (aged≥18 years). In terms of suicidal behaviour, in the last few weeks prior to assessment 14.4% ofthe patients had death wishes, 2.4% had thoughts of killing themselves, 0.9% had attempted suicide in the lifetime and 0.6% in thelast few weeks, 1.1% had active suicidal ideations at the time of assessment, 0.6% had active suicidal plan, 1.3% had history of non-suicidal self-injurious behaviour (NSSI) in the lifetime and0.5% had NSSI behaviour in the last few weeks. Based on the suicidality, 1% of thepatients were asked to report to the emergency immediately, 1.4% were given an appointment within 72 hours for follow-up and 3.6% were explained high risk management.Conclusions:Suicidal behaviour, especially active suicidal ideations and suicidal plan is not very prevalent in patients seeking telepsychiatry consultation.

Clinical exome sequencing in Serbian patients with movement disorders: Single centre experience

The aim of the study was to analyze the genetic basis of a various range of neurodegenerative disorders manifesting by movement disorders (MD) using next generation sequencing (NGS) clinical exome panel. The study included a total number of 42 cases, 36 unrelated and 3 sibling pairs patients diagnosed with movement disorders, all negative after targeted genetic testing available at Neurology clinic, UCCS, Belgrade, Serbia. In a selection of respondents, preference was given to family cases with the early presentation, patients with a positive family history, or complex MD phenotype. Sequencing of a Clinical exome (CE) panel for 4813 genes with known associated clinical phenotypes was performed on an Illumina MiSeq NGS platform according to the manufacturer?s instructions. Sequence variants were analyzed by Illumina?s Variant Studio v3 software as well as using previously developed pipeline. Variants analysis and interpretation were based on phenotype gene target approach, literature and databases search, allele frequency, and pathogenicity prediction by in silico software. Causative variants were confirmed by Sanger sequencing. Whenever possible, additional family members were studied for segregation analysis. We identified a likely genetic cause of MD in 5 cases. CE panel analysis revealed 7 different missense and one splice site pathogenic/likely pathogenic variants in 5 genes related to rare neurodegenerative disorders. Detected pathogenic/likely pathogenic variants in the TUBB4A, PANK2, SETX, MFSD8, and ARSA genes have been compatible with the clinical phenotype of the patients. Furthermore, in additional three cases variants in the DCTN1, PDGFRB, and POLG genes have been detected as a possible cause of disease. In the rest of the studied cases, genetic diagnosis remains unclear. These results emphasize the significance of CE panel analysis in elucidating the diagnosis of neurodegenerative diseases manifesting by movement disorders and gave us insight into the complexity of the genetic background of this group of disorders.