World Health Organization Criteria Research Articles

Acute decompensated heart failure in patients with prediabetes: relationship with risk factors and comorbidities

Aim. To determine the incidence, risk factors and course of acute decompensated heart failure (ADHF) in patients with prediabetes.Material and methods. Within 24 months, 426 patients hospitalized to cardiology department of a multidisciplinary hospital with ADHF were consecutively included in the study. In addition, 136 patients who met the inclusion criteria and did not have exclusion criteria were divided into 2 groups depending on prediabetes presence. The first group consisted of 51 (37,5%) patients with prediabetes, the second — 85 (62,5%) patients without this pathology. ADHF was verified based on a rapid increase in symptoms and signs of hypoperfusion. Prediabetes was defined according to World Health Organization criteria. The risk level for type 2 diabetes was determined using the FINDRISC online calculator. In the first 48 hours of hospitalization, echocardiography was performed. The serum concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP) and cystatin C was determined using enzyme immunoassay.Results. The incidence of prediabetes among patients with ADHF was 37,5%. In 9,8%, prediabetes was verified prior to hospitalization. Patients with prediabetes and ADHF were younger and were more likely to have obesity with a body mass index (BMI) of more than 30 kg/m2, non-alcoholic fatty liver disease, and higher waist circumference. In patients with ADHF and prediabetes, congestion symptoms were more pronounced, their higher frequency was recorded, as well as the frequency of wet-warm phenotype. Spironolactone dose was higher during hospitalization in the group of patients with ADHF and prediabetes. In the same group, the duration of hospitalization was longer. Prevalence of ADHF with preserved and mildly reduced ejection fraction (EF), severity of LV diastolic dysfunction (DD), LV mass index in patients with BMI >30 g/m2, left atrial volume index, pulmonary artery systolic pressure were significantly higher in the group of patients with ADHF and prediabetes. At a high risk of type 2 diabetes, the concentrations of NT-proBNP, triglyceride/glucose index, cystatin C, LV diastolic dysfunction severity were significantly higher, and the glomerular filtration rate was lower.Conclusion. The development of ADHF in patients with prediabetes is interrelated with multiple risk factors and comorbidities, characterized by more pronounced congestion, longer hospitalization, predominantly preserved and mildly reduced EF in combination with severe LVDD, LV hypertrophy, and activation of nonspecific inflammation.

Critical Evaluation of Drug Promotional Literature Using WHO Ethical Criteria and Perception of Clinicians at a Tertiary Care Hospital

Objective To evaluate the rationality of drug promotional literature (DPL) using World Health Organization (WHO) ethical criteria and to evaluate the perception of clinicians regarding DPLs using prevalidated criteria. Methods The promotional material was collected at a tertiary care teaching hospital over a period of 3 months. The perception of different prescribers has been changed. The data were analyzed using descriptive analysis. Results 191 DPLs were collected from various outpatient departments at a tertiary care hospital. The information regarding brand name, generic name, and active ingredients was mentioned in 100% of the collected material. Therapeutic uses of the promotional agents were mentioned in only 60.20%; references were cited in only 15.18%. The adverse effects were listed in only 17.80% of the DPLs. The perception regarding DPLs was gathered from 27 physicians at the same institute. The percentage of clinicians who were aware of the WHO criteria used for analyzing DPL was only 37.03%. All healthcare workers have agreed on the necessity of including critical appraisal of the DPLs in the undergraduate curriculum.

Mortality, Cardiovascular, and Medication Outcomes in Patients With Myocardial Infarction and Underweight in a Meta-Analysis of 6.3 Million Patients

Although most of the current evidence on myocardial infarction focuses on obesity, there is growing evidence that patients who are underweight have unfavorable prognosis. This study aimed to explore the prevalence, clinical characteristics, and prognosis of this population at risk. Embase and Medline were searched for studies reporting outcomes in populations who were underweight with myocardial infarction. Underweight and normal weight were defined according to the World Health Organization criteria. A single-arm meta-analysis of proportions was used to estimate the prevalence of underweight in patients with myocardial infarction, whereas a meta-analysis of proportions was used to estimate the odds ratio of all-cause mortality, medications prescribed, and cardiovascular outcomes. Twenty-one studies involving 6,368,225 patients were included, of whom 47,866 were underweight. The prevalence of underweight in patients with myocardial infarction was 2.96% (95% confidence interval 1.96% to 4.47%). Despite having fewer classical cardiovascular risk factors, patients who were underweight had 66% greater hazard for mortality (hazard ratio 1.66, 95% confidence interval 1.44 to 1.92, p <0.0001). The mortality of patients who were underweight increased from 14.1% at 30 days to 52.6% at 5 years. Nevertheless, they were less likely to receive guideline-directed medical therapy. Relative to subjects with normal weight, Asian populations who were underweight had greater mortality risks than those of their Caucasian counterparts (p=0.0062). In conclusion, in patients with myocardial infarction, those who were underweight tend to have poorer prognostic outcomes. A lower body mass index is an independent predictor of mortality, which calls for global efforts in addressing this modifiable risk factor in clinical practice guidelines.

Oral Health Status in a Group of Roma Children in Seville, Spain.

Identify the oral health status through an epidemiological survey of the population of gipsy children in the city of Seville. The WHO (World Health Organization) criteria for oral health surveys were used in the study with children aged 6 to 13 years carried out in two Seville schools located in neighborhoods with a high percentage of gypsy population (Polígono Norte and Sur of the city of Seville). The final sample consisted of 108 children in whom the DMF (decay-missing-filled index) for primary dentition was 5.0 + -3.1 for the 6-9 year-old age group and the DMFT (Decayed, Missing, and Filled Teeth) for the 10-13 year-old group was 4.5 + -3.3. The frequency of brushing was low, with a significant percentage of children not brushing their teeth (42.3%). The striking feature is that 26.9% of children had never visited the dentist despite their basic dental care being covered by the regional government. The children studied present high levels of caries compared to the rest of the Spanish population, as well as very low levels of oral hygiene. Given the lack of success of existing oral health programmes among this population, a different intervention is needed, taking into account the idiosyncrasies of the gipsy community.

Patient Characteristics and Predictors of Pulmonary Embolism in Patients Infected with COVID - 19 in Upper Egypt.

A little is known about the risk factors and predictors of pulmonary embolism (PE) in Coronavirus disease 2019 (Covid-19) infected patients. Therefore, we directed this study to investigate the predictors of PE in patients infected with Covid - 19 in Upper Egypt. We conducted a retrospective cohort study on 297 patients infected with COVID-19, aged ≥ 18years old. Suspicion of COVID-19 infection was based on the World Health Organization (WHO) criteria and confirmed by nasal and pharyngeal swab for real-time reverse transcriptase-polymerase chain reaction (RT-PCR) analysis. The patient was also determined to have COVID-19 when CT results that were thought to be typical for COVID-19 and clinical data that were compatible were present. PE was diagnosed in 18.2% of patients. We found that the incidence of PE was significantly higher in older patients, females, those with higher BMI, hypertensive patients, diabetics, and patients with co-morbidities. Also, PE was significantly higher in patients presented with dyspnea, chest pain, longer duration of symptoms at hospital admission, and lower oxygen concentration. The mean serum Hb level, platelet count, TLC and absolute lymphocytic count were markedly reduced in those who had PE. All the patients who developed PE had a CO-RADS scale five on their CT chest scan. Age > 65, BMI > 25, DM, and associated co-morbidities were the independent patients' characteristics associated with the development of PE after the multivariate regression analysis. PE is a common complication of Covid 19 infection. PE is associated with a variety of clinical and laboratory parameters in univariate analysis, but age > 65, BMI > 25, DM, and associated co-morbidities were the independent patients' characteristics associated with the development of PE in those infected with Covid-19.

Outpatient treatment of COVID-19: an experience with 552 cases in Mexico.

The impact of the coronavirus disease 2019 (COVID-19) pandemic has globally challenged health services, especially because when the pandemic first reached Mexico, in February 2020, there was no known effective and safe treatment. A treatment scheme was offered by the Institute for the Integral Development of Health (IDISA) in Mexico City from March 2020 to August 2021 when there were many patients with COVID-19. This report summarizes the experience managing COVID-19 with this scheme. This is a descriptive, retrolective study. The data was obtained from the case files of the patients who attended the IDISA from March 2020 to August 2021 with COVID-19. All the cases were treated with the scheme consisting of nitazoxanide, azithromycin, and prednisone. Various laboratory blood tests and chest computerized tomography scan were done. When indicated, supplementary oxygen, and another specific treatment were used. A standardized clinical recording was conducted for 20 days based on symptoms and systemic symptoms. Based on the World Health Organization criteria, the patients were classified according to the disease severity: 170 mild, 70 moderate, and 312 severe cases. The outcome was the discharge of 533 patients after their recovery, 16 were excluded from the study, and 6 died. The use of nitazoxanide, azithromycin, and prednisone proved to be effective as it resulted in improvement of symptoms and in successful outcomes for the management of COVID-19 outpatients.

The Impact of Cholecaciferol Supplementation on Bone Mineral Density in Long-Term Kidney Transplant Recipients

Although reduced bone mineral density (BMD) is associated with a higher risk of fractures, morbidity, and mortality in kidney transplant patients (KTRs), there is no consensus on optimal treatment for the alterations of BMD in this population. This study aims at assessing the effect of cholecalciferol supplementation on BMD over a follow-up period of 2 years in a cohort of long-term KTRs. Patients with age ≥ 18 years were included and divided into two subgroups based on treatment with bisphosphonate and/or calcimimetics and/or active vitamin D sterols (KTRs-treated) or never treated with the above medications (KTRs-free). BMD was evaluated at lumbar vertebral bodies (LV) and right femoral neck (FN) with standard DEXA at the beginning and end of the study. According to World Health Organization (WHO) criteria, results were expressed as T-score and Z-score. Osteoporosis and osteopenia were defined as T score ≤ -2.5 SD and T score < -1 and >-2.5 SD, respectively. Cholecalciferol was supplemented at a dose of 25,000 IU/week over 12 weeks followed by 1500 IU/day. KTRs-free (n. 69) and KTRs-treated (n. 49) consecutive outpatients entered the study. KTRs-free were younger (p < 0.05), with a lower prevalence of diabetes (p < 0.05) and of osteopenia at FN (46.3 % vs. 61.2 %) compared to KTRs-treated. At the entry none of the study subjects had a sufficient level of cholecalciferol; Z-score and T-score at LV and FN were not different between groups. At the end of the study period, serum cholecalciferol concentration was significantly increased in both groups (p < 0.001); the KTRs-free group presented an improvement in both T-score and Z-score at LV (p < 0.05) as well as a lower prevalence of osteoporotic cases (21.7% vs. 15.9%); in contrast, no changes were recorded in KTR-treated individuals. In conclusion, supplementation with cholecalciferol ameliorated Z-score and T-score at LV in long-term KTRs who had been never treated with active or inactive vitamin D sterols, bisphosphonates, and calcimimetics. Future endeavours are needed to confirm these preliminary findings.

Comparative evaluation of dental caries experience using CAST index and WHO criteria among 5 and 15-year-old schoolchildren.

CAST (Caries Assessment Spectrum and Treatment) index is a relatively new caries assessment tool that hierarchically describes the entire caries spectrum. Its comparability with WHO (World Health Organization) criteria in different populations and age groups needs to be investigated. The objective of this study was to assess caries among 5 and 15-year-old schoolchildren using the CAST index and WHO criteria and to compare both indices on the basis of caries experience and examination time. A cross-sectional study was conducted among 553 schoolchildren aged 5 and 15 years in the North zone of Bengaluru city, India. Examiners underwent training and calibration for performing the CAST index. The first examination was performed using the CAST index followed by a second examination using the WHO criteria 2013, after some days. Time taken for examination was also recorded. The study sample consisted of 279 five-year-old and 274 fifteen-year-old schoolchildren. The difference in caries experience among 5 and 15-year-old children assessed using the CAST index (52%, 45.6%) and WHO criteria (42.3%, 24.5%) were found to be statistically significant (p < 0.05). The average examination time was longer for the CAST index (93.77±24.77 seconds and 105.04±9.49 seconds) when compared to WHO criteria (61.05±15.91 seconds and 58.72±9.42 seconds) for primary and permanent dentition (p < 0.05). Though the CAST index took a longer examination time, the information obtained was more precise and facilitated researchers in treatment planning encompassing prevention of initial lesions, restoration, and rehabilitation.

Prognostic role of neutrophil gelatinase-associated lipocalin in patients with coronary artery disease and abdominal obesity

Aim. To study the prognostic role of neutrophil gelatinase-associated lipocalin (NGAL) as a marker of adverse cardiovascular events (CVEs) in patients with coro­nary artery disease (CAD) associated with abdominal obesity (AO).Material and methods. This 12-month prospective study included 68 patients diagnosed with CAD who were hospitalized for elective percutaneous coronary intervention (PCI). The median age was 61 [55;65] years. Depending on the presence of obesity according to the World Health Organization (1999) criteria, patients were divided into 2 groups. The 1st group included 30 patients with AO, while the 2nd group — 38 patients without obesity. Patients were measured for waist circumference and hip circumference, and waist-to-hip ratio was calculated. Lipid profile and NGAL concentration were determined. During the study, body mass index (BMI), visceral adiposity index (VAI), triglycerides (TG)/glucose index, lipid accumulation product (LAP), metabolic index (MI), TG to high-density lipoprotein cholesterol ratio (HDL-C). During this period, data was collected on the disease course and intervention outcome. After 12 months an extended examination was performed to assess the endpoints.Results. During the follow-up period, unfavorable cardiovascular events in the 1st group of patients were registered in 33,3% of patients, and in the 2nd group — in 26,3%. In the group of patients with obesity, higher values of anthropometric indices and NGAL were established. The concentration of NGAL has the highest correlation with BMI, MI, LAP and slightly less with total cholesterol and VAI levels. The analysis showed that NGAL &gt;47,1 ng/ml is a predictor of adverse CVEs in patients with CAD and obesity after PCI.Conclusion. Thus, NGAL has the highest correlation with the following indices: BMI, MI, LAP, total cholesterol, and VAI. NGAL &gt;47,1 ng/ml is a predictor of adverse CVEs in patients with CAD and obesity after PCI. NGAL may serve as a promising marker for predicting adverse CVEs. This biomarker already at the stage of hos­pitalization can assess the risk adverse outcomes in patients with CAD and AO, including those who underwent PCI.

Genetic variants in HFE are associated with non-alcoholic fatty liver disease in lean individuals

Background & AimsAround 20% of patients with non-alcoholic fatty liver disease (NAFLD) are lean. Increasing evidence suggests that lean NAFLD is a unique subtype of the disease. We aimed to explore the metabolic profile, genetic basis, causal risk factors, and clinical sequelae underlying lean NAFLD. MethodsNAFLD was diagnosed by whole liver proton density fat fraction ≥5%. Whole liver proton density fat fraction and hepatic iron were quantified using magnetic resonance imaging in the UK Biobank. Individuals in this study were stratified according to the World Health Organization criteria of obesity, into lean, overweight, and obese. Mediation analysis, Mendelian randomisation analysis, and Bayesian networks were used to identify a risk factor or a clinical sequela of lean/obese NAFLD. ResultsLean NAFLD manifested a distinct metabolic profile, featured by elevated hepatic iron and fasting glucose. Four loci, namely, HFE rs1800562, SLC17A3-SLC17A2-TRIM38 rs9348697, PNPLA3 rs738409, and TM6SF2 rs58542926, were associated with lean NAFLD (p <5 × 10-8). HFE rs1800562 was specifically associated with lean NAFLD and demonstrated a significant mediation effect through elevating hepatic iron. Type 2 diabetes was the most pronounced clinical sequela of lean NAFLD, followed by liver cirrhosis. ConclusionsOur study suggested that HFE plays a potential steatogenic role rather than regulating iron homoeostasis in patients with lean NAFLD. The increased liver iron deposition is associated with lean NAFLD, whereas obese NAFLD is not related to hepatic iron. The clinical management of patients with lean NAFLD shall be concerned with the prevention and treatment of type 2 diabetes and liver cirrhosis. Impact and implicationsLean NAFLD has a distinct natural history from obese NAFLD. This study underscored liver iron content and the genetic variant of the iron homoeostasis gene HFE as major risks of lean NAFLD, in addition to the unique metabolic profile. The development of type 2 diabetes or liver cirrhosis shall be closely monitored and prevented in patients with lean NAFLD.

Durability of long-lasting insecticidal nets (LLINs) in Ethiopia

BackgroundThe functional survival time of long-lasting insecticidal nets (LLINs), which varies across different field contexts, is critical for the successful prevention of malaria transmission. However, there is limited data on LLIN durability in field settings in Ethiopia.MethodsA three-year longitudinal study was conducted to monitor attrition, physical integrity, and bio-efficacy and residual chemical concentration of LLINs in four regions in Ethiopia. World Health Organization (WHO) guidelines were used to determine sample size, measure physical integrity, and calculate attrition rates, and functional survival time. Yearly bio-efficacy testing was done on randomly selected LLINs. An excel tool developed by vector works project was used to calculate the median functional survival time of the LLINs. Predictors of functional survival were identified by fitting binary and multivariate cox proportional hazards model.ResultsA total of 3,396 LLINs were included in the analysis. A total of 3,396 LLINs were included in the analysis. By the end of 36 months, the proportion of LLINs functionally surviving was 12.9% [95% confidence interval (CI) 10.5, 15.6], the rates of attrition due to physical damage and repurposing were 48.8% [95% confidence interval (CI) 45.0, 52.6] and 13.8% [95% confidence interval (CI) 11.6, 14.6], respectively. The estimated median functional survival time was 19 months (95%CI 17, 21). Factors associated with shorter functional survival time include being in a low malaria transmission setting [Adjusted Hazards Ratio (AHR) (95%CI) 1.77 (1.22, 2.55)], rural locations [AHR (95%CI) 1.83 (1.17, 2.84)], and in a room where cooking occurs [AHR (95%CI) 1.28 (1.05, 1.55)]. Bioassay tests revealed that 95.3% (95%CI 86.4, 98.5) of the LLINs met the WHO criteria of bio-efficacy after 24 months of distribution.ConclusionThe LLIN survival time was shorter than the expected three years due to high attrition rates and rapid loss of physical integrity. National malaria programmes may consider, procuring more durable LLINs, educating communities on how to prevent damage of LLINs, and revising the current three-year LLIN distribution schedule to ensure sufficient protection is provided by LLINs against malaria transmission. While this paper contributes to the understanding of determinants impacting functional survival, further research is needed to understand factors for the rapid attrition rates and loss of physical integrity of LLINs in field settings.

Lower cognitive function as a risk factor for anemia among older Japanese women from the longitudinal observation in theSONICstudy

The aging-related increase in the incidence of anemia potentially affects the mortality risk. Lower cognitive function is common among older adults, and anemia is one of the causes of cognitive decline. However, to the best of our knowledge, no study has investigated whether cognitive decline is a risk factor for anemia in older people. Therefore, in this study, we used a 3-year longitudinal evaluation to examine the association of cognitive function with anemia in community-dwelling older adults. This longitudinal study enrolled participants without anemia (diagnosed based on the World Health Organization's criteria) at baseline. Cognitive function was assessed using the Japanese version of the Montreal Cognitive Assessment. Multiple logistic regression models were used to examine the association between cognitive function at baseline and the presence of anemia 3 years later. Participants were in the 69-71 and 79-81 years age groups, and 974 older people (48.6% men) were enrolled, of whom 126 (12.9%) had anemia after 3 years. After adjusting, cognitive function at baseline was associated with anemia in women, but not in men. Older Japanese women with lower cognitive function have an increased risk for anemia 3 years later. The adoption of a lifestyle that utilizes or improves cognitive function might be important to prevent anemia in older women. Geriatr Gerontol Int 2023; 23: 334-340.

Towards Precision Medicine in Gestational Diabetes: Pathophysiology and Glycemic Patterns in Pregnant Women With Obesity.

Precision medicine has revolutionized our understanding of type 1 diabetes and neonatal diabetes but has yet to improve insight into gestational diabetes mellitus (GDM), the most common obstetric complication and strongly linked to obesity. Here we explored if patterns of glycaemia (fasting, 1 hour, 2 hours) during the antenatal oral glucose tolerance test (OGTT), reflect distinct pathophysiological subtypes of GDM as defined by insulin secretion/sensitivity or lipid profiles. 867 pregnant women with obesity (body mass index ≥ 30 kg/m2) from the UPBEAT trial (ISRCTN 89971375) were assessed for GDM at 28 weeks' gestation (75 g oral glucose tolerance test OGTT; World Health Organization criteria). Lipid profiling of the fasting plasma OGTT sample was undertaken using direct infusion mass spectrometry and analyzed by logistic/linear regression, with and without adjustment for confounders. Insulin secretion and sensitivity were characterized by homeostatic model assessment 2b and 2s, respectively. In women who developed GDM (n = 241), patterns of glycaemia were associated with distinct clinical and biochemical characteristics and changes to lipid abundance in the circulation. Severity of glucose derangement, rather than pattern of postload glycaemia, was most strongly related to insulin action and lipid abundance/profile. Unexpectedly, women with isolated postload hyperglycemia had comparable insulin secretion and sensitivity to euglycemic women, potentially indicative of a novel mechanistic pathway. Patterns of glycemia during the OGTT may contribute to a precision approach to GDM as assessed by differences in insulin resistance/secretion. Further research is indicated to determine if isolated postload hyperglycemia reflects a different mechanistic pathway for targeted management.

The Association between Unhealthy Food Consumption and Impaired Glucose Metabolism among Adults with Overweight or Obesity: A Cross-Sectional Analysis of the Indonesian Population.

It has been shown that dietary patterns are associated with glucose control. However, the association between the types of food consumed and blood glucose in overweight or obese individuals is still unclear. The present study aimed to determine the association between unhealthy food consumption and impaired glucose metabolism in adults with overweight or obesity. The analysis presented in this study was based on the data from a population-based, cross-sectional, nationally representative survey (Indonesian Basic Health Research 2018/RISKESDAS 2018). The body mass index (BMI) was calculated as weight (kg)/height squared (m2) and was determined based on the World Health Organization (WHO) criteria for the Asian population. A validated questionnaire and food card were used to assess the diet. Fasting plasma glucose and 2-hpost-prandial glucose were employed to determine blood glucose markers. In total, 8752 adults with overweight or obesity were included in this analysis. We found that consumption of sweet, grilled, and processed foods was associated with impaired fasting plasma glucose (IFG) before and after adjustment (p < 0.05). Consumption of high-fat foods was also associated with impaired glucose tolerance (IGT) for all models tested (p < 0.05). Furthermore, all models showed a link between processed food consumption and combined glucose intolerance (CGI) (p ≤ 0.001). Differential food group consumption was associated with IFG, IGT, and CGI in Indonesian adults who were overweight or obese.

The sulfur microbial diet and increased risk of obesity: Findings from a population-based prospective cohort study

Gut-produced hydrogen sulfide (H2S) has been associated with increased gut permeability and inflammation, which may be related to higher obesity risk. We investigated the association of sulfur microbial diet, a dietary index associated with 43 sulfur-metabolizing bacteria, with the incident obesity and whether the relationship was modified by the genetic predisposition to obesity. We included 27,429 participants with available body mass index (BMI) data from the UK Biobank. The sulfur microbial diet score was assessed using the 24-h dietary assessment method. Obesity and abdominal obesity were defined according to the World Health Organization criteria. Body fat percentage was assessed using a body composition analyzer. The genetic risk score (GRS) was calculated by 940 BMI-related variants. We documented 1472 and 2893 cases of obesity and abdominal obesity during a mean follow-up of 8.1 years. After multivariable adjustment, the sulfur microbial diet score was positively associated with obesity (HRQ4vsQ1= 1.63; 95% CI= 1.40-1.89, P-trend= 0.001) and abdominal obesity risk (HRQ4vsQ1= 1.17; 95% CI= 1.05-1.30, P-trend= 0.002). We also observed that increased sulfur microbial diet score was positively related to several adiposity indicators, including a 5% increase in BMI, WC, and body fat percentage. Moreover, the sulfur microbial diet had no significant interactions with genetic risk on obesity incidence. Our results emphasized the significance of avoiding the sulfur microbial diet for obesity prevention across all levels of genetic risk.

KCNH2 regulates the growth and metastasis of pancreatic cancer

Objective: Due to the characteristics of insidious onset and early metastasis of pancreatic cancer (PC), patients are often diagnosed at an advanced stage and often delayed in completing surgical resection timely, resulting in poor prognosis. Therefore, this study aims to explore the expression of potassium voltage-gated channel subfamily H member 2 (KCNH2) in PC and its relationship with clinicopathological parameters and the related mechanisms. Methods: GEPIA database and immunohistochemical staining were used to analyze the difference in KCNH2 expression between PC and adjacent tissue in RNA and protein levels. Chi-squared test was used to evaluate the relationship between KCNH2 expression and clinicopathological features. The Cox regression model was used for multivariate analysis and univariate analysis. Histological diagnosis was performed according to World Health Organization (WHO) criteria to evaluate the relationship between KCNH2 expression and clinicopathological features. Results: KCNH2 expression was upregulated in PC compared with normal pancreatic tissue. In addition, the knockdown of KCNH2 inhibits PC cell proliferation, migration, invasion, and epithelial-mesenchymal transformation and promotes their apoptosis. In addition, clinical data showed that the abnormal expression of KCNH2 in PC was related to the tumor stage. Patients with high expression of KCNH2 had a poor prognosis. Conclusions: KCNH2 is expected to be a novel targeted molecule in treating PC.

A Novel and Simplified Score for Determining Treatment Eligibility for Patients with Chronic Hepatitis B

Background: International guidelines for hepatitis B infection (HBV) recommend initiating antiviral treatment based on viral replication with inflammation or fibrosis. HBV viral loads and liver fibrosis measurements are not widely available in resource-limited countries. Aim: To develop a novel scoring system for the initiation of antiviral treatment in HBV-infected patients. Methods: We examined 602 and 420 treatment-naïve, HBV mono-infected patients for derivation and validation cohorts. We performed regression analysis to identify parameters associated with the initiation of antiviral treatment based on the European Association for the Study of the Liver (EASL) guidelines. The novel score was developed based on these parameters. Results: The novel score (HePAA) was based on HBeAg (hepatitis B e-antigen), the platelet count, alanine transaminase, and albumin. The HePAA score showed excellent performance, with AUROC values of 0.926 (95% CI, 0.901-0.950) for the derivation cohort and 0.872 (95% CI, 0.833-0.910) for the validation cohort. The optimal cutoff was ≥3 points (sensitivity, 84.9%; specificity, 92.6%). The HePAA score performed better than the World Health Organization (WHO) criteria and the Risk Estimation for HCC in Chronic Hepatitis B (REACH-B) score, and it performed similarly to the Treatment Eligibility in Africa for HBV (TREAT-B) score. Conclusions: The HePAA scoring system is simple and accurate for chronic hepatitis B treatment eligibility in resource-limited countries.

A138 SERRATED POLYPOSIS SYNDROME IN INFLAMMATORY BOWEL DISEASE: A SEQUELAE OF CHRONIC DISEASE ACTIVITY OR NEW WHO PHENOTYPE?

Abstract Background Serrated polyposis syndrome (SPS) is a growing health concern with up to 1 in 125 universal screening program participants meeting diagnostic criteria. Conversely, SPS in inflammatory bowel disease (IBD) is rarely described in the literature, despite the predisposition for serrated epithelial change and serrated polyps in this population. Purpose To describe a case of World Health Organization (WHO) criterion I SPS in a patient with IBD, and discuss the existing literature on this rare occurrence. Method Case report and review of the literature. Result(s) Case Report A 53-year-old female with ulcerative colitis (UC; Phenotype: Left-sided; Duration of disease: 40 years; Medical therapy: sulfasalazine) undergoing regular endoscopic surveillance was recently found to have multiple serrated-class lesions including 6 in the sigmoid colon ranging between 8-30mm in size; this included 3 sessile serrated lesions (SSLs) between 20-30mm removed by piecemeal cold snare resection without complication and 2 residual large SSLs for staged endoscopic resection. No endoscopic disease activity was appreciated (Mayo 0), with histopathology of the sigmoid colon and rectum demonstrating chronic inactive colitis. Literature Review From 2008 to 2021, there are eleven reported cases of SPS in IBD. Six patients had UC and most were in remission for several decades at the time of SPS diagnosis. Most SPS cases met WHO criteria and fit within described phenotypes. While the case above meets WHO criterion I for SPS, the presence of large distal lesions is atypical, raising the question of whether chronic disease activity contributed to the development of these serrated lesions, given the known predisposition for serrated epithelial change and serrated lesions in patients with colonic IBD. Image Conclusion(s) SPS in patients with IBD is rare. Questions remain about the role of chronic disease activity contributing to the formation of serrated lesions, its clinical relevance, and optimal management strategy. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Maternal death in Iceland 1976-2015

Maternal deaths are rare and an indirect measure of the societal framework surrounding pregnancy and childbirth. We surveyed and classified maternal mortality in Iceland using international guidelines, calculating changes over a 40-year period. Information from Statistics Iceland on women aged 15-49 years who died in 1985-2015 were cross-checked against birth registration and hospital admission data to identify women who died in pregnancy or ≤42 and within 43-365 days from birth or termination of a pregnancy. Data for 1976-1984 were searched manually. Case records and autopsy reports were scrutinized. Deaths were classified as direct, indirect or coincidental and as early or late. Among 1600 women 48 died in pregnancy or within a year after pregnancy. Births totaled 172369 and overall maternal mortality was 27.8/100.000 births. Maternal mortality by World Health Organization criteria (direct/indirect ≤42 days) occurred in 14 instances giving a maternal mortality ratio (MMR) of 8.1/100.000. Rates lowered between the first and last 10-year periods, particularly initially followed by a lesser downward trend. Direct deaths were 6, indirect 20, coincidental 22 (accidents, diseases). Causes of direct deaths were severe preeclampsia, pulmonary embolism and choriocarcinoma. Underlying causes of indirect deaths included cancer, diabetes, brain/heart conditions and suicide. No deaths occurred from ectopic pregnancy, hemorrhage or anesthesia. Maternal mortality in Iceland is among the lowest reported. Women died because of the pregnancy, from worsening of underlying conditions or coincidentally. Risk groups require better support. Continued attention to adverse health connected to maternity is essential.

Clinical impact of plasma concentrations of first-line antituberculosis drugs.

The clinical significance of low antituberculosis (anti-TB) drug concentrations has not been fully elucidated. To investigate the clinical consequences of first-line drug concentrations in adult patients with drug-susceptible pulmonary TBin South Africa (SA). We conducted a pharmacokinetic study nested within the control arm of the Improving Treatment Success (IMPRESS) trial(NCT02114684) in Durban, SA. During the first 2 months of treatment, participants received weight-based dosing of first-line anti-TBdrugs (rifampicin, isoniazid, pyrazinamide and ethambutol), and had plasma drug concentrations measured at 2 and 6 hours after drugadministration during the 8th week of treatment. Intermediate (8 weeks), end-of-treatment (6 months) and follow-up TB outcomes wereassessed using World Health Organization criteria. We measured plasma drug concentrations on available samples in 43 participants. Peak drug concentrations were below thetherapeutic range in 39/43 (90.7%) for rifampicin, 32/43 (74.4%) for isoniazid, 27/42 (64.3%) for pyrazinamide and 5/41 (12.2%) forethambutol. At the end of the intensive phase of treatment (week 8), 20.9% (n=9/43) of participants remained culture positive. We did notfind a relationship between the concentrations of first-line drugs and treatment outcomes at week 8. All participants were cured at the endof treatment, and there were no relapses during the 12-month follow-up period. Treatment outcomes were favourable despite low drug concentrations as defined by current reference thresholds.