World Health Organization Criteria Research Articles

Association between hemoglobin level and food consumption among female nursing students at King Faisal University, Saudi Arabia

Anemia exerts significant adverse impacts on health and the economy, both in developing and developed nations across the globe. The physiological and physical changes that transpire during adolescence and early adulthood necessitate heightened nutritional requirements. Among teenagers and young adults, anemia manifests as a frequent condition. The objective of our study was to determine the prevalence of anemia and its contributing factors among female nursing students enrolled at King Faisal University in Al Hasa, located in the Eastern Region of Saudi Arabia. Employing a cross-sectional design, we conducted an investigation involving a cohort of 83 nursing students who were in good health. To ensure adherence to COVID-19 safety protocols, we employed a practical sampling method to collect the samples. Hemoglobin (Hb) levels were assessed using a finger-stick capillary blood sample. According to the World Health Organization (WHO) criteria for diagnosing anemia, hemoglobin levels exceeding 12.0 g/dL indicate the absence of anemia. The study findings revealed that 59% of the participants were diagnosed with anemia due to their low hemoglobin levels. Substantial associations were observed between hemoglobin levels, anemia, and clinical factors such as chronic illnesses, heavy menstrual cycles, and dietary supplements. Based on these outcomes, anemia is highly prevalent among female university students. Furthermore, the research population may be susceptible to anemia if they engage in practices such as tea or coffee consumption, irregular meal patterns, or the intake of foods that impede iron absorption.

17th International Conference on Malignant Lymphoma, Palazzo dei Congressi, Lugano, Switzerland, 13 - 17 June, 2023.

Introduction: Bispecific antibodies (BsAbs) are a promising therapeutic approach for the treatment of B-cell lymphoproliferative disorders. Limited data is available regarding the impact of COVID-19 in patients treated with BsAbs. We assessed the impact of COVID-19 infection on BsAbs treatment and evaluated the severity of COVID-19 infection and the seroconversion rate. Methods: Patients treated with BsAbs at our institution were reviewed from March 2020 to January 2023. Severity of COVID-19 infection was defined according to World Health Organization (WHO) criteria. Seroconversion rate was assessed using chemiluminescence immunoassays for the determination of antibodies against SARS-CoV2 spike glycoprotein (cutoff, 40 BAU/mL). Patients who received convalescent plasma, sotrovimab or AZD7442 (cilgavimab and tixagevimab) were excluded from the seroconversion analysis. Results: One hundred and nine patients (median age, 62 years old) were included. Most frequent diagnoses were Diffuse Large B-Cell Lymphoma (73%) and Follicular Lymphoma (18%). Median number of previous lines was 2. Ninety-four patients (86%) received an anti-CD20/CD3, 13 (12%) an anti-CD22/CD3 and 2 (2%) an anti-CD19/4-1-bb. Anti-CD20 agents in the prior 6 months had been administered alone or in combination in 61 patients (56%). Twenty-two (20%) patients had received prior CAR-T cell therapy for a median of 5 months. Eighty-six patients (79%) were vaccinated (in general with Spikevax), with an average of 3 doses. COVID-19 infection was diagnosed in 61 patients (56%); 23 (38%) presented mild COVID-19 infection, 20 (33%) moderate, 11 (18%) severe and 7 (11%) critical. Ten patients were diagnosed with a second COVID-19 episode; of these, sequencing results confirmed a reinfection in 2 patients and a persistent infection in 8 patients. Median time to first negative PCR was 34 days and 62 days for those who presented a second infection. Twenty-five patients became infected during treatment causing 84% delays and 20% discontinuations. At the time of infection, 76% of the patients had negative serology. A higher seroconversion rate was observed in the post treatment setting with BsAbs after a median of 6 months. No differences were evidenced according to recent exposure to an anti-CD20 agent (figure 1D). Patients with positive serology (24%) presented milder infection (p = 0.009). After a median follow up of 34.3 months, 32 patients died (29%), 19 due to progressive disease, 6 from COVID-19 pneumoniae (10%, 5 of which were in complete response), 5 from other infections and 2 of unknown causes. Keywords: Aggressive B-cell non-Hodgkin lymphoma, Immunotherapy, Indolent non-Hodgkin lymphoma Conflicts of interests pertinent to the abstract. A. Serna Consultant or advisory role: Pharmore Research M. Jiménez Honoraria: GSK, Sanofi A. Cabirta Honoraria: Jazz, AstraZeneca, Janssen A. Albasanz Consultant or advisory role: Gilead, GSK Honoraria: Gilead, GSK, Pfizer I. Ruiz-Camps Consultant or advisory role: GSK, AstraZeneca, BMS, MSD, Gilead, Pfizer, Janssen Honoraria: GSK, AstraZeneca, BMS, MSD, Gilead, Pfizer, Janssen T. García Consultant or advisory role: Janssen, Roche, Gilead, Celgene Research funding: Janssen, AbbVie C. Carpio Consultant or advisory role: Regeneron Pharmaceuticals, Takeda Honoraria: Gilead, Novartis, AstraZeneca, BMS S. Bobillo Consultant or advisory role: Janssen, Roche, Gilead Honoraria: Janssen, Roche, Gilead Educational grants: Gilead G. Iacoboni Consultant or advisory role: Novartis, Kite/Gilead, BMS/Celgene Honoraria: Novartis, Kite/Gilead, BMS/Celgene, AstraZeneca, Roche, AbbVie, Janssen, Miltenyi A. Marín-Niebla Consultant or advisory role: Lilly, Kite, Kiowa Kirin, Takeda, AstraZeneca, Roche, Janssen Honoraria: Lilly, Kite, Takeda, Janssen F. Bosch Consultant or advisory role: Novartis, Celgene/BMS, Roche, AstraZeneca, Takeda, Mundipharma, Gilead, AbbVie, Lilly, Beigene Honoraria: Novartis, Celgenes/BMS, Roche, AstraZeneca, Takeda, Karyospharm, Mundipharma, Gilead, AbbVie, Lilly, Beigene P. Abrisqueta Consultant or advisory role: Roche, AbbVie, BMS, AstraZeneca, Janssen, Incyte Honoraria: Roche, Abbvie, BMS, AstraZeneca, Janssen, Sandoz

A phase II randomized trial of talimogene laherparepvec (T-VEC) oncolytic immunotherapy with or without radiotherapy for patients with cutaneous metastases from solid tumors.

2639 Background: Talimogene laherparepvec (T-VEC) is an oncolytic immunotherapy made from a modified herpes virus expressing granulocyte-macrophage colony-stimulating factor and is FDA approved for the treatment of advanced melanoma. Laboratory studies suggest radiotherapy (RT) may interact with oncolytic immunotherapy to facilitate an immune-mediated anticancer response. We hypothesized that the combination of T-VEC+RT would produce tumor responses in distant (non-irradiated and non-injected) metastases. Methods: A prospective phase II, randomized, Simon two-stage clinical trial of T-VEC with or without RT was conducted with the primary objective of determining if the response rate of the largest non-injected and non-irradiated metastasis was ≥27%. Eligible patients had ≥1 cutaneous metastasis from a solid tumor amenable to T-VEC and RT and 1 measurable metastasis that would not be treated with T-VEC or RT. Using type I and II error probabilities of 10% and 20%, it was calculated that 9 patients would be enrolled in each arm, and if at least 1 of 9 patients subjects exhibited a response, then 6 additional patients would be enrolled in the second stage. Tumor and overall response was assessed using modified World Health Organization (mWHO) and immune related response criteria (irRC). Treatment-emergent and treatment-related adverse events (TEAEs and TRAEs) were characterized using CTCAE v4.0. Results: 19 patients were enrolled and randomized to receive T-VEC alone (n=9) or T-VEC+RT (n=10). One patient in each arm demonstrated a complete response in the largest non-irradiated and non-injected metastasis but progressed in new metastases. The composite response rate in target tumors not injected or irradiated was 13% and 0% in the T-VEC alone and T-VEC+RT arms, respectively. The composite response rate in target tumors treated with T-VEC alone or T-VEC+RT was 7% and 22%, respectively. Because no patient exhibited an overall mWHO or irRC defined response and due to slow accrual, the trial was closed after the first stage of enrollment despite meeting the prespecified response rate to continue enrollment in the second stage. Grade 3-4 TEAEs and TRAEs occurred in 9 and 2 patients, with similar frequencies between study arms. The most common AE was fever and occurred in 47% of patients. Peripheral blood-based immunologic analyses will be presented. Conclusions: The response rate in the largest non-injected or non-irradiated metastasis following T-VEC with or without RT given to a cutaneous metastasis from solid tumor could be ≥27% but was not determined in this trial due to premature closure, in part due to slow accrual rate and no observed mWHO defined overall responses. Cutaneous metastases responded more often after TVEC+RT than T-VEC alone, but the response in non-injected and non-irradiated tumors was more frequent after T-VEC alone. Clinical trial information: NCT02819843 .

0251 Sex differences in the associations of childhood obesity with sleep characteristics, access to screens, and nocturnal melatonin

Abstract Introduction Insufficient sleep and circadian rhythm alterations are associated with metabolic disorders including obesity, with increasing evidence that these associations can emerge in childhood. In parallel, screen media access in the bedroom at night has negative effects on circadian rhythms, sleep, and other behaviors, which can contribute to obesity development. In the current work, we analyzed the associations of childhood obesity with self-reported sleep characteristics, access to screens in the bedroom, and nocturnal melatonin, considering potential sex differences. Methods The study cohort is composed of 244 children 7-16 years old, among which 140 have a body mass index z-scores >2, characterized as obesity according to world health organization criteria. There are 124 girls (11.21 ± 2.42 years) and 120 boys (11.19 ± 2.22 years). Melatonin was measured through immunoassay in saliva samples, which were collected at three time points of the evening of a school day: 4h before sleep, 2h before sleep, and 1h after sleep start. The chronotype score was obtained using the Horne and Ostberg questionnaire. Participants reported the number of screens present in the bedroom at night, and their bedtimes and wakeup times during both weekdays and weekend. The sleep disturbance scale for children and an abbreviated pediatric sleep questionnaire about sleep apnea symptoms were completed by a parent. Results BMI z-scores were significantly correlated with more parent-reported sleep disturbances (p< 0.01), higher sleep apnea scores (p< 0.01), shorter sleep duration during weekdays (p< 0.01), and the number of screens in the bedroom (p=0.05) in boys but not in girls (p=0.52, p=0.15, p=0.83, and p=0.37). On the other hand, BMI z-scores were significantly correlated with melatonin level at +1h after sleep onset (p=0.05) in girls but not in boys (p=0.96). No significant correlations were observed between the BMI z-score and the pre-sleep melatonin measures. Conclusion According to our findings, there is some differentiation by sex in relationships between body weight and various sleep and circadian measures. Specifically, in boys, obesity was associated with shorter and disturbed sleep with more sleep apnea, whereas in girls, obesity was linked with lowered nocturnal melatonin expression. Support (if any)

Cardiometabolic risk factors in young adults diagnosed with acute myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background/introduction Morbidity and mortality associated with atherosclerotic cardiovascular diseases are prevalent in young patients. Meanwhile, traditional cardiovascular risk calculators underestimate disease risk in young adults. Purpose To characterize cardiometabolic risk factors and lipid levels in young adults with acute myocardial infarction. Setting: A multicenter, population-based analysis of patients diagnosed at our hospitals in Arizona, as well as our clinic health system spanning Minnesota and Wisconsin. Methods This is a retrospective cohort study including patients 18 to 50 years old diagnosed with acute myocardial infarction from October 1, 2015, to December 31, 2018. Parameters obtained included: Age, sex, ethnicity, body mass index, tobacco use, comorbid medical conditions, fasting blood glucose, hemoglobin A1c, lipid levels, and prescribed lipid-lowering therapy. Results Among 553 young patients diagnosed with acute myocardial infarction, the mean age at the time was 44.4 years, with men accounting for 69.1% of cases. The mean body mass index was 32.2 kg/m2. Hypertension, diabetes mellitus, and tobacco use were present in 64.7%, 25.9%, and 36.2% of patients. Insulin resistance, elevated triglycerides, and low HDL-C were present in 29.8%, 51.0%, and 62.8% of patients, respectively. Approximately 61.3% of patients within this cohort met World Health Organization criteria for diagnosis of metabolic syndrome. Mean LDL-C was 116 mg/dL and mean triglycerides were 190 mg/dL. Statin therapy was prescribed to 92 (16.6%) of patients prior to diagnosis of acute myocardial infarction, whereas 359 (67.3%) of patients met ACC/AHA criteria for lipid-lowering therapy. Within this subgroup receiving statin therapy, the mean serum LDL-C was 101 mg/dl, 26.1% had levels below 70 mg/dL, and 56.5% had LDL-C levels below 100 mg/dL. Thirty-four patients (6.1%) with LDL-C levels greater than 190 mg/dL, and 29 (85.3%) were not on lipid-lowering therapy. Conclusions and Relevance Multiple treatable risk factors were present in most young adults with acute myocardial infarction, including many with LDL-C levels below 100 mg/dL. Being overweight or obese was the most prevalent risk factor, while elevated non-HDL cholesterol was the most common lipid panel abnormality. In addition to known cardiometabolic risk factors, these findings build upon a growing body of evidence implicating triglyceride-rich lipoproteins in non-HDL and remnant cholesterol as an independent risk factor of ASCVD, which were common in this cohort of young patients presenting with myocardial infarction. In this cohort, lipid-lowering therapy was underutilized in young patients with known cardiometabolic risk factors, elevated estimated 10-year ASCVD risk, and individuals with phenotypic Familial Hypercholesterolemia.

Allelic burden of Janus kinase 2 in a 6-month course of therapy for myeloproliferative neoplasms.

Janus kinase 2 (JAK2) V617F gene mutation is an important marker for the diagnosis of Philadelphia negative Myeloproliferative neoplasms (MPN) which is subdivided into Polycythemia Vera (PV), Primary Myelofibrosis (PMF), and Essential Thrombocythemia (ET). The aim here is to investigate the JAK2 allele burden of the patients diagnosed with the subgroups of MPN and to demonstrate the alterations of hematological parameters and spleen size between diagnosis and 6 months of treatment. A total of 107 patients with the diagnosis of MPN and negative Philadelphia chromosome, 51 males and 56 females with a mean age of 59,74 ± 16,41 years, were included in the study. Diagnosis of MPN was based on the World Health Organization (WHO) criteria. Subgroups of MPN distributed as 49,5% ET, 46,7% PV, and 3,8% PMF. Findings such as the age of the patients, JAK-2 allele burden, and laboratory findings of splenomegaly were examined at the time of diagnosis, 3rd month, and 6th month. JAK2 allele burden and spleen size were re-evaluated in 6th month. Our study confirmed the findings of high Hb, HCT, and RBC but low platelet values in PV patients with high JAK2 allele burden with respect to other groups, a positive correlation between JAK2 allele burden and LDH. A novel finding of our study is, that there is not any reducing effect of the phlebotomy on JAK2 allele burden in PV patients whether they receive phlebotomy or not. Evaluation of the spleen size alteration during 6 months within the subgroups demonstrated a decrease in PV and ET groups whereas no statistically significant difference was found in the PMF group.

Prevalence trends and disease burden of diabetes and prediabetes in Chinese adults of Shanghai.

To estimate secular trends and disease burden of diabetes and prediabetes among Chinese adults. Three population-based surveys were performed among Chinese adults in Shanghai in 2002-2003 (n = 12 302), 2009 (n = 7414), and 2017 (n = 18 960). Diabetes and prediabetes were defined using the 1999 World Health Organization (WHO) criteria. Cochran-Armitage trend test was used to examine the trends in prevalence, awareness, and glycemic control status. Disability adjusted life years (DALYs) were estimated to evaluate the disease burden of diabetes-related complications using the population attribution fraction approach based on published data. The age-adjusted prevalence of diabetes increased during the 15-year period (p for trend <.001) and reached 23.0% (95% CI: 22.1 ~ 24.0%) in men and 15.7% (95% CI: 15.1 ~ 16.4%) among women in 2017. The prevalence of impaired glucose tolerance peaked in 2009, whereas that of impaired fasting glucose increased continuously (p for trend <.001). The awareness of diabetes was found to increase and the glycemic control rates decreased over the three surveys. The estimated DALYs of diabetes complications were found to have increased rapidly due to the increasing prevalence of diabetes and the decreasing glycemic control rates. Prediabetes and diabetes affect a considerable proportion of Chinese adults in Shanghai. Our results highlight the necessary to strengthen the community healthcare system in China to guarantee extensive management of diabetes and prediabetes.

Core indicators related to the elimination of hepatitis B and C virus infection in South Korea: A nationwide study.

To eliminate hepatitis B virus (HBV) and hepatitis C virus (HCV) according to the World Health Organization (WHO) criteria in 2021, this study investigated the national core indicators representing the current status of viral hepatitis B and C in South Korea. We analyzed the incidence, linkage-to-care, treatment, and mortality rates of HBV and HCV infection using the integrated nationwide big data of South Korea. According to data from 2018-2020, the incidence of acute HBV infection in South Korea was 0.71 cases per 100,000 population; tthe linkage-to-care rate was only 39.4%. Among those who need hepatitis B treatment, the treatment rate was 67.3%, which was less than 80% reported in the WHO program index. The annual liver-related mortality due to HBV was 18.85 cases per 100,000 population, exceeding the WHO target of four; the most frequent cause of death was liver cancer (54.1%). The annual incidence of newly diagnosed HCV infection was 11.9 cases per 100,000 population, which was higher than the WHO impact target of five. Among HCV-infected patients, the linkage-to-care rate was 65.5% while the treatment rate was 56.8%, which were below the targets of 90% and 80%, respectively. The liver-related annual mortality rate due to HCV infection was 2.02 cases per 100,000 population. Many of the current indicators identified in the Korean population did not satisfy the WHO criteria for validation of viral hepatitis elimination. Hence, a comprehensive national strategy should be urgently developed with continuous monitoring of the targets in South Korea.

Outcomes with high dose cytarabine and mitoxantrone induction for adults with mixed phenotype acute leukemia

The optimal induction strategy for mixed phenotype acute leukemia (MPAL) is unknown, though retrospective data has shown improved remission rates and overall survival with acute lymphoblastic leukemia (ALL)-based regimens. At Memorial Sloan Kettering Cancer Center (MSKCC), the most utilized induction regimen for MPAL is high dose cytarabine plus mitoxantrone (“ALL-2”), though outcomes with this regimen are not well described. In this study, outcomes to first-line induction chemotherapy in 24 patients at MSKCC with MPAL classified by 2016 World Health Organization criteria are reported. The overall response rate was 94 % (16 of 17) in patients receiving ALL-2, including 86 % (6 of 7) in patients with extramedullary disease. Thirteen patients who received ALL-2 induction proceeded to allogeneic hematopoietic cell transplant (allo-HCT). The most common toxicity associated with ALL-2 was febrile neutropenia, documented in 12 patients. With a median follow-up of 37 months, median overall survival was not reached in the ALL-2 cohort, and 3-year overall survival was 62 %. In multivariate analysis, age ≥ 60 years and MPAL with isolated extramedullary disease were associated with significantly worse overall survival (P = .009 and P = .01, respectively). These results support further prospective investigation of ALL-2 as a front-line induction regimen for adults with MPAL.

Association between locomotive syndrome and anemia among community‐dwelling older adults

To investigate the association between locomotive syndrome and anemia among community-dwelling older adults. This cross-sectional study was conducted at specific health checkup centers in Japan between 2019 and 2020. We sent a questionnaire to older adults aged ≥65 years who participated in health checkups. A total of 2507 community-dwelling older adults were included in this study (mean age = 72.3 years, 51.4% women). Locomotive syndrome was measured using a 25-question Geriatric Locomotive Function Scale with a score range of 0-100, and was defined as ≥16 points. Anemia was defined using World Health Organization criteria, as a hemoglobin concentration of <13.0 g/dL in men and <12.0 g/dL in women. Logistic regression analyses were performed to investigate the association between locomotive syndrome and anemia, adjusted for age, sex, body mass index, depression symptoms, self-reported comorbidities (cancer, rheumatoid arthritis, knee osteoarthritis, fractures, and spinal disease), hypertension, and renal function. Of all the participants, 11.6% had locomotive syndrome and 12.8% had anemia. Even after adjustment, a relationship between locomotive syndrome and anemia was observed (adjusted odds ratio = 1.9, 95% confidence interval = 1.3-2.7). Community-dwelling older adults with anemia had a significantly higher prevalence of locomotive syndrome than those without. This finding suggests that older adults with anemia are at risk of locomotive syndrome, and appropriate measures should be taken for prevention. Geriatr Gerontol Int 2023; ••: ••-••.

Optimization of treatment of patients of older age groups with osteoporosis and fractures of the proximal femur

BACKGROUND: Osteoporosis is mainly found in elderly people, often leading to fractures of the proximal part of the femur, and can worsen the patients quality of life. The article describes approaches to the choice of tactics and techniques of medical assistance to patients of older age groups (elderly, senile age, and centenarians according to World Health Organization criteria) with fractures of the proximal femur (S72.0, S72.1, S72.2. according to International Classification of Diseases 10th Revision) and with concomitant osteoporosis.&#x0D; AIM: To improve the treatment results of patients of older age groups with fractures of the proximal femur by modernizing and developing new methods for implant fixation.&#x0D; MATERIALS AND METHODS: 322 patients with fractures of the proximal femur with the presence of II and III degree of osteoporosis, who were treated at the Hospital for War Veterans in Saint Petersburg from 2017 to 2020 were included for the analysis. All the patients were divided into two groups depending on the methods of the treatment used. The first group consisted of 145 patients treated with the proposed method. The patients of the 2nd group (177 people) were treated using the traditional method. To assess the immediate results, the anatomical and functional result and possible complications (false joint, delayed consolidation of fragments, shortening of the damaged lower limb, dislocation of the endoprosthesis, migration of metal structures, osteomyelitis) were studied. The results were evaluated according to Lekens functional index, and the quality of life was assessed according to the World Health Organization scale.&#x0D; RESULTS: In 52.5% of the paients from the first group, good outcomes were obtained after 6 months according to the Lekens scale, while in group 2 such results were demonstrated only in 21.6% of the patients, and a year later, in 53.7% and 19.1%, respectively. In the first group, 13 patients (12.0%) had unsatisfactory outcomes after a year, 12 (13.5%) after 3 years, while in the second group 36 patients (31.3%) had unsatisfactory outcomes after a year, and 38 (35.8%) after 3 years.&#x0D; CONCLUSIONS: As a result, the use of the proposed method for providing care to patients with fractures of the proximal femur ensures significant improve (p 0.01) of the treatment outcomes for this category of patients.

The Influence of Obesity in the Autonomic Nervous System Activity in School-Aged Children in Northern Portugal: A Cross-Sectional Study.

Obesity is one of the most prevalent chronic diseases in childhood, being an important public health issue. Excessive weight has been associated with autonomic dysfunction but the evidence in children is scarce. Therefore, the aim of this study was to assess the effect of overweight and obesity on the autonomic nervous system activity, in children. Data from a cross-sectional study of 1602 children, aged 7 to 12 years, was used and 858 children were included in the analysis. Body mass index was calculated and classified according to criteria of the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC) and the International Obesity Task Force (IOTF). Body composition was characterized by bioelectrical impedance. Linear regression models were used to determine the association between body mass index, body composition and the autonomic nervous system activity, assessed by pupillometry. Average dilation velocity was higher among children with obesity, according to the CDC and percentage of body fat criteria (β = 0.053, 95% CI = 0.005 to 0.101 and β = 0.063, 95% CI = 0.016 to 0.109, respectively). The same trend was observed for WHO and IOTF criteria (β = 0.045, 95% CI = -0.001 to 0.091, and β = 0.055, 95% CI = -0.001 to 0.111, respectively). CDC and WHO body mass index z-scores were also positively associated with the values of average dilation velocity (rs = 0.030, p = 0.048; and rs = 0.027, p = 0.042, respectively). Our findings suggest an association between body mass and changes in the autonomic activity, Moreover, this study provides proof of concept for interventions targeting the prevention/treatment of obesity in children that may offer some benefit in re-establishing the balance of the autonomic nervous system, and subsequently preventing the consequences associated with the autonomic nervous system dysfunction.

PO-02-225 LATE GADOLINIUM ENHANCEMENT AT CARDIAC MAGNETIC RESONANCE YIELDS HIGH NUMBER OF FALSE POSITIVE DIAGNOSES IN ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY

New diagnostic criteria have been proposed for arrhythmogenic right ventricular cardiomyopathy (ARVC). These proposed “Padua criteria” include late gadolinium enhancement (LGE) on cardiac magnetic resonance for the left ventricle (LV) and right ventricle (RV). Yet, the potential of LGE to distinguish ARVC from differential diagnoses remains unknown. Assess the diagnostic value of LGE to distinguish ARVC from its differentials. We included 130 subjects (57% male, 46±17 years) clinically diagnosed with ARVC as per 2010 Task Force Criteria (n=32, 84% PKP2 carriers), familial dilated cardiomyopathy as per World Health Organization criteria (n=25), myocarditis as per 2013 ESC position statement (n=13), sarcoidosis as per 2014 HRS expert consensus statement (n=20), biopsy-proven cardiac amyloidosis (n=19) and RV outflow tract-ventricular tachycardia (n=21). Presence and distribution of LGE was evaluated by an experienced radiologist using a 17-segment LV and 7-segment RV model. Presence of LGE was determined as per Padua criteria. Diagnostic value of RV-LGE and LV-LGE as per Padua criteria in ARVC vs. non-ARVC patients was evaluated with specificity, false positive rate (FPR) and accuracy. Distributions of LGE per subgroup are shown in the Figure. The RV-LGE criterion was equally often fulfilled in ARVC (n=16, 50%) vs. non-ARVC (n=43, 44%) patients, p=0.546. ARVC patients most often had RV-LGE in the RV inlet region (n=14/32, 44%). Consequently, the RV-LGE criterion yielded specificity 56%, FPR 44% and accuracy 55% for right-sided disease. In contrast, the LV-LGE criterion was significantly more often fulfilled in non-ARVC (n=71, 72%) vs. ARVC (n=11, 34%) patients, p<0.001. ARVC patients most often had LV-LGE in the inferolateral (n=10/11, 91%) wall, whereas it was more global in non-ARVC groups (median segments n=2 [IQR 2-6] ARVC vs. n=9 [IQR 4-15] non-ARVC, p<0.001). As such, the LV-LGE criterion yielded specificity 28%, FPR 72% and accuracy 29% for left-sided disease. LV-LGE is observed in one-third of ARVC patients, most often in the inferolateral region. RV-LGE is observed in half of ARVC patients, typically in the RV inlet region. Notably, LGE is often present in ARVC differentials. While LGE may be helpful to determine focal fibrosis, it may result in a large number of false positive diagnoses when included as a diagnostic criterion. Knowledge of LGE patterns can be useful for diagnostic classification.

PREDICTING RESPONSE TO NEOADJUVANT CHEMOTHERAPY IN OPERABLE BREAST CANCER: ROLE OF ER, PR, HER2 AND KI-67 INDEX

Background: Neoadjuvant (anterior or pre-operative) chemotherapy for operable breast cancer helps in down-staging of the tumor and increases the rate of breast conservation surgery. Factors that identify individuals who benet from chemotherapy have not been clearly established. This study was conducted to assess the role of estrogen receptor, progesterone receptor, HER2 and Ki-67 index in predicting response to a standard anthracycline and taxane-based chemotherapy. Methods: The study included 62 women with clinical tumor stage 1-3 and nodal stage 0 or 1. All women received preoperative anthracycline and taxane-based chemotherapy followed by surgery. Clinical and pathological response was assessed using World Health Organization (UICC) and Chevallier's criteria respectively. Results: Clinical and pathological complete response rates were 40.3% and 17.7% respectively. The pathological complete response was highest in HER2-enriched patients (45.45%) while basal-like and luminal B subtypes accounted for 27.27% each. Among those that achieved pathological complete response, 90% had Ki-67 &gt;20, 81.8% had grade 3, 72.7% had ER negative status, 81.8% had PR negative status, 63.6% had HER2 positive status. However, there was no statistically signicant association between preoperative clinical tumor size(p=0.98), ER(p=0.053), PR(p=0.17), HER2(p=0.17), Ki-67 index(p=0.26) and pathological complete response. Conclusion: Ahigh pathological complete response was observed in tumors with high grade, high proliferative activity (high Ki-67), ER/PR negative status, HER2 over-expressing tumors and aggressive molecular subtypes such as basal-like and HER2-enriched breast cancer. However, none of these pre-chemotherapy factors showed statistically signicant association with pathological complete response.

Hyperferritinemia in Severe Dengue Infection: Single-Center Retrospective Cohort Study.

Hyperferritinemia in the critical phase of dengue infections may correlate with severe dengue ( sd ) disease, and our primary objective was to examine the association between ferritin level on day 1 of PICU admission and 2009 World Health Organization (WHO) criteria for sd . Our secondary objective was outcome in relation to care. It is unclear whether immunomodulatory therapy during the critical phase may restore immune homeostasis and mitigate disease severity. Retrospective cohort study of children with dengue 1 month to 16 years old with admission ferritin greater than or equal to 500 ng/mL requiring PICU admission. Demographics, clinical, and laboratory parameters, presence of the 2009 WHO sd criteria and outcomes were analyzed. Immunomodulatory therapy was used when there was persistent hyperinflammation beyond the critical phase of plasma leakage. None. Fifty-five patients were admitted in the critical phase of dengue with median (interquartile range) ferritin levels of 8,105 ng/mL (2,350-15,765 ng/mL). Patients with at least one WHO sd category had higher ferritin levels compared to those without any sd criteria, with the highest levels in eight patients with all three sd categories. In our cohort of 55, 52 patients (94%) recovered with standard supportive therapy. Recovery was associated with decreased ferritin levels that occurred in parallel with improved circulation and platelet counts; this included 22 of 24 patients with admission ferritin levels greater than or equal to 10,000 ng/mL and two with ferritin greater than 1,00,000 ng/mL. Immunomodulation was used in three patients with unremitting fever, persistent hyperferritinemia, and progressive multiple organ dysfunction beyond the critical phase, of whom two died. Hyperferritinemia in the critical phase of sd is associated with the number of 2009 WHO sd criteria present. Our data also indicate that many patients with sd recover well with supportive care.

The Conceptualization of Pregnancy-Associated Maternal Morbidity in Research Studies: A Scoping Review [ID: 1376717

INTRODUCTION: This study aimed to review the clinical literature to understand how maternal morbidity has been conceptualized. METHODS: We conducted a scoping review wherein we searched four databases until May 2022 for studies on maternal morbidity. We screened abstracts in duplicate and extracted data on the study scope, terms used to describe maternal morbidity, and conditions included. Results were presented descriptively. RESULTS: We identified 8,178 titles, of which 589 studies from 1986 to 2022 were included in the final analysis. Included studies used 73 terms to describe maternal morbidity. While 217 (37%) studies described maternal morbidity in the context of the general pregnant population, others described more specific contexts, for example, hypertensive disorders of pregnancy (43 studies, 7%), obesity (38 studies, 6%), and gestational and pregestational diabetes (31 studies, 5%). In terms of component outcomes, 156 (26%) studies utilized the World Health Organization criteria for maternal near miss and potentially life-threatening conditions or the Centers for Disease Control and Prevention criteria for severe maternal morbidity, while others included between one and 45 outcomes, the most frequent of which were intensive care unit admission, preeclampsia, eclampsia, hemorrhage, uterine rupture, hysterectomy, and blood transfusion. Notably, 36 (6%) studies included fetal or neonatal outcomes when describing maternal morbidity. CONCLUSION: Although maternal morbidity is reported in a large number of pregnancy studies, there is no consistency in what outcomes are included in its definition. There is need for a standardized definition of maternal morbidity that embodies the perspectives of persons with lived experience of pregnancy.

Performing a sperm DNA fragmentation test in addition to semen examination based on the WHO criteria can be a more accurate diagnosis of IVF outcomes

BackgroundWe analyzed the sperm DNA fragmentation index (DFI) and general semen test based on the World Health Organization (WHO) criteria and compared the two tests using semen factors. In addition, we examined whether DFI is a reliable parameter associated with in vitro fertilization (IVF) outcomes.MethodsSperm chromatin dispersion (SCD) and general semen tests were conducted in accordance with the WHO 2010 guidelines, and correlations between the two tests were investigated. The WHO criteria were set as the cutoff values for each of the following factors: semen volume, concentration, total sperm count, motility, and normal morphology, and compared with the DFI results.ResultsThe subjects had a mean sperm DFI of 15.3% ± 12.6%, and the DFI increased with age. In contrast, motility and normal morphology decreased as the DFI increased. Patients who satisfied the WHO criteria in terms of concentration, total sperm count, and motility had a significantly lower DFI than those who did not satisfy the criteria. Therefore, evaluation with a general semen test based on the WHO criteria should be regarded as a qualitative evaluation of all factors other than semen volume and normal morphology.ConclusionsHigh DFI (≥ 30%) caused a low blastocyst development rate following intracytoplasmic sperm injection. Male infertility due to DFI should be suspected when IVF results are poor despite normal semen findings based on the WHO criteria. The results of this study suggest that the SCD test may more accurately evaluate the correlation between IVF clinical outcomes and male infertility. Therefore, it is important to focus on DFI measurements.

Clustering of children’s oral diseases in families and villages in a rural setting in Egypt

BackgroundThis study assessed the clustering of children’ caries experience, plaque accumulation and gingival inflammation in families and villages in Northwestern Egypt and the factors related to the severity of these conditions.MethodsThis was a secondary analysis of a 2019 household survey of children in villages around Alexandria, Egypt. Clinical examination assessed primary and permanent teeth caries experience (dmft/ DMFT using the World Health Organization criteria), plaque accumulation (Plaque Index (PlI)) and gingival inflammation (Gingival Index (GI)). A child questionnaire assessed child’s age, sex, the frequency of toothbrushing (at least twice daily versus less) and frequency of consuming eight types of sugary products (daily sugar consumption score, sum of sugary products consumed daily). Mothers’ questionnaire assessed the number of children in the family, mother’s education (at least high school versus less), at least twice daily toothbrushing and daily sugar consumption similar to the child. Multilevel regression analyses assessed clustering, calculated by the intraclass correlation coefficient (ICC) of the three conditions in families and villages. Regression estimates (B) and 95% confidence intervals (CIs) of individual and family factors were calculated.ResultsComplete data were available for 450 children (246 families, seven villages], mean = 9.9 years-old and 56% females. The mean caries experience score = 3.6, mean plaque index = 1.5 and mean gingival index = 1.2. Caries experience, plaque accumulation and gingival inflammation were not clustered in villages (ICC < 0.01) but clustered in families (ICC = 0.10, 0.44 and 0.29). Child factors significantly improved model fit for caries experience and gingivitis (p < 0.001) but not plaque accumulation (p = 0.90). Family factors did not improve any model fit (p > 0.05). Child’s age was significantly associated with caries experience (B= -0.48, p < 0.001) and gingival inflammation (B = 0.032, p < 0.001). Children who brushed their teeth twice daily had significantly more caries experience (B = 1.04, p = 0.01).ConclusionThe three oral conditions were not clustered in villages but clustered in families. Plaque accumulation showed the greatest within-family clustering. Family factors were not associated with the three conditions and individual factors indicated the need for interventions to promote preventive behaviors and identify families at risk of oral conditions.

Association between anemia and sarcopenia among Chinese elderly: A cross-sectional study based on the China health and retirement longitudinal study

BackgroundEvidence regarding the association between anemia and sarcopenia in the elderly population is limited and controversial. The purpose of this study was to investigate the association between anemia and sarcopenia in Chinese elderly. MethodsThe cross-sectional study used the third wave of data from the China Longitudinal Study of Health and Retirement (CHARLS). Participants were classified as sarcopenic versus non-sarcopenic according to the guidelines developed by the Asian Working Group for Sarcopenia (AWGS) 2019. Meanwhile, participants were defined for anemia using World Health Organization criteria. Logistic regression models were conducted to assess the association between anemia and sarcopenia. Odds ratios (OR) were reported to indicate the strength of the association. ResultsA total of 5016 participants were included in the cross-sectional analysis. The overall prevalence of sarcopenia in this population was 18.3 %. After adjusting for all potential risk factors, anemia and sarcopenia were independently associated (OR = 1.43, 95 % CI 1.15–1.77, P = 0.001). In terms of subgroups, the association of anemia with sarcopenia was also significant in people over 71 years of age (OR = 1.93, 95 % CI 1.40–2.66, P < 0.001), women (OR = 1.48, 95 % CI 1.09–2,02, P = 0.012), rural residents (OR = 1.56, 95 % CI 1.24–1.97, P < 0.001), as well as in people with low education (OR = 1.50, 95 % CI 1.20–1.89, P < 0.001). ConclusionAnemia is an independent risk factor for sarcopenia among elderly Chinese population.

Health-Promoting Schools Project for Palestine Children's Oral Health

ObjectivesThe aim of this work was to assess the oral health outcome of a 2-year comprehensive school oral health programme based on school-health education combined with supervised toothbrushing using 1450-ppm fluoride toothpaste amongst schoolchildren in Palestine. MethodsA quasi-experimental study (2016–2018) recruited 3939 schoolchildren aged 5 to 6 years from 30 intervention schools (n = 2333) and 31 comparison schools (n = 1606). At baseline and postintervention, mothers and schoolteachers completed World Health Organization (WHO) self-administered questionnaires about oral health of children, oral health behaviour, and family factors. Of the initial participants 75.8 per cent took part in the follow up studies. In addition, 25 calibrated dentists examined dental caries of children according to WHO criteria. Trained teachers provided comprehensive oral health education to children in the classrooms and held regular oral health sessions for mothers. Children brushed their teeth with fluoride-containing toothpaste (1450 ppm fluoride). Student t-test and logistic regression were used in the statistical analysis of changes in dental health and related knowledge, behaviours, and attitudes (P < .05). ResultsIn both dentitions, dental caries experience declined over the project. The reduction in Decayed, Missing and Filled permanent Teeth and Decayed, Missing and Filled Surfaces in permanent teeth was 23.3% and 23.2% (P < .001), respectively. The drop in caries experience indices in the Gaza Strip was 8 to 4 times higher than in West Bank, and it reached 47.4% reduction. Mothers and teachers showed improvement in positive knowledge and attitudes towards dental care. Involvement of schoolteachers in oral health in schools and acceptance of dental health education materials significantly enhanced oral health behaviour of children. ConclusionsThe project recommends national implementation of an intervention for the improvement of oral health of schoolchildren and their parents in conflict zones. The project shows the importance of the WHO Health Promoting Schools concept and involving classroom-based health education carried out by schoolteachers. It is suggested to explore the health care system's capacity in hosting effective oral health programme and maintain its efficacy.