Homozygosity predominantly affects hypertrophic cardiomyopathy minor genes in an Egyptian clinical cohort

Background

Consanguinity is prevalent in Egypt (35%) resulting in a high incidence of homozygosity. The influence of homozygosity on the genetics of Hypertrophic Cardiomyopathy (HCM) has not been adequately studied.

Purpose

The purpose of this study is to define the genetic architecture of HCM in Egypt using ethnically-matched case and control cohorts.

Methods

Prospective Egyptian patients (n=514) and controls (n=400) were recruited to Aswan Heart Centre for clinical phenotyping and genetic testing for 174 genes implicated in inherited cardiac conditions (Illumina). Rare variation (gnomAD filtering allele frequency ≤4x10–5) in 13 validated HCM genes were classified according to the American College of Medical Genetics (ACMG) guidelines and compared with a prospective HCM cohort of predominantly European ancestry (n=684).

Results

Significantly fewer rare variants detected in Egyptian patients could be classified as (likely) pathogenic compared to Europeans (40.8% vs. 61.6%, p-value=1.6x10–5). Incorporating analysis from these Egyptian case-control cohorts into the ACMG guidelines increased this yield to 53.8%. Homozygous variants were more frequently observed in Egyptian patients (4.1% vs 0.1%, p-value=2x10–7), with variants in the minor HCM genes MYL2, MYL3 and CSRP3 more likely to present in homozygosity than the major genes (MYH7, MYBPC3 and troponins), suggesting such variants are less penetrant in the heterozygous state.

Conclusions

The integration of Egyptian-specific genetic and phenotypic data significantly improves variant interpretation in HCM and consequently the precision of genetic testing. The observed prevalence of homozygosity and rare variation in minor HCM genes in Egyptian patients provides important insights into its disease-mechanisms and genetics.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Science and Technology Development FundAl Alfi Foundation

Impact of surgical myectomy on electrocardiographic changes in patients of hypertrophic obstructive cardiomyopathy

Funding Acknowledgements

Type of funding sources: None.

Background

Hypertrophic cardiomyopathy (HCM) is the commonest genetically inherited cardiac condition affecting 1 in 500 of the population. [1] The amelioration of patient symptomatology and decreased morbidity after surgical myectomy is previously documented. [2]. However, no data is available regarding the associated electrocardiographic changes that may occur after surgical myectomy, especially in patients showed improvement of functional status.

Aim of study:  The study was conducted to investigate the electrocardiographic changes following surgical myectomy in hypertrophic obstructive cardiomyopathy (HOCM) patients, and its relation to cardiac mechanics

Methods

The study included 25 patients (mean age: 35.44 ± 12.3 years, 52% male) with HOCM who were subjected to successful surgical myectomy. 12-lead surface ECG and echocardiographic examination including 2D strain imaging were performed pre and post myectomy.

Results

Postoperatively, 84% of patients developed new complete left bundle branch block (LBBB), 4% developed right BBB (RBBB) and 4% developed complete AV block necessitating permanent pacing. These Changes were associated with increased QRS width and QT interval prolongation in almost all patients (p < 0.001).  Following surgery, there was significant reduction in left atrium size, left ventricle mass, LV outflow tract gradient, mitral and annular systolic & diastolic velocities (S’, E’, A’) and EF%(p < 0.001 for all) compared with its preoperative values. At segmental level only LV septal εsys% showed significant inverse correlation to QRS duration (r = 0.47, P < 0.02). No significant correlation was detected between QRS & QTc duration and any other LV wall εsys%. In contrast: QTc intervals showed inverse correlation to the magnitude of reduction in RV εsys %, r=-0.59,P < 0.001 and the magnitude of reduction in RV TTP-SD (r=-.42, P < 0.03).

Conclusion

Left bundle branch block is a common conduction abnormality after septal myectomy but it did not influence the clinical improvement or structural remodeling. Post myectomy, prolongation of QRS duration was a powerful aspect of mechanical dysfunction especially of septal mechanics than QT interval prolongation. Electrical and mechanical dysfunction is commonly associated while mechanical heterogeneity is not always coexisting.

On boundary corrections of Lüscher-Weisz string

The potential and the density profile of the QCD flux-tube are investigated within the framework of the Luscher-Weisz (LW) string action with two boundary terms. The Numerical simulations involve 4D SU(3) Yang-Mills LGT at finite temperature. In general, we detect signatures of the two boundary terms considered in the LWstring action. Near the end of QCD Plateau, the LW string is yielding a static potential which is in a good agreement with the lattice data for source separations R ≥ 0.3 fm. However, at T/Tc = 0.9, the fit to the potential data improves with a good fit attained at R ≥ 0.7 fm. The mean-square width of the energy profile at T/Tc = 0.9 matches well the width of the LW string over distance scales R ≥ 0.5 fm.

Physical and mechanical properties of eggshell as affected by chicken breed and flock age

1. A study was conducted to evaluate the relationship among physical and mechanical properties of the eggshell, as affected by breed and hen's age. 2. Data on eggshell quality (external characteristics and derived measurements) were obtained from 322 laying hens, from three breeds (Fayoumi, Dandarawi and Hy-Line Brown) during the laying cycle, starting from 38 wks of age for four experimental periods (38, 46, 54 and 62 wks). 3. Eggs obtained from the Fayoumi breed exhibited the highest shell thickness and breaking force. There was a linear improvement in eggshell quality attributes associated with hen's age up to 54 wks, thereafter a deterioration was found for all breeds. 4. Generally, eggs laid by native breeds (Fayoumi and Dandarawi) had better mechanical properties compared to those produced by the commercial strain (Hy-Line Brown). In addition, the interaction between breed and hen's age was not significant for any physical property or mechanical attribute. There was a highly significant (P ≤ 0.01) positive correlation between the breaking force and either eggshell toughness or shell thickness, and regression analyses suggested that eggshell toughness was the best predictor for breaking force, followed by shell thickness.

Stiff self-interacting strings at high temperature QCD

We investigate the implications of Nambu-Goto (NG), Lüscher Weisz (LW) and Polyakov-Kleinert (PK) effective string actions for the Casimir energy and the width of the quantum delocalization of the string in 4-dim pure SU(3) Yang-Mills lattice gauge theory. At a temperature closer to the critical point T/Tc=0.9, we found that the next to leading-order (NLO) contributions from the expansion of the NG string in addition to the boundary terms in LW action to decrease the deviations from the lattice data in the intermediate distance scales for both the quark-antiquark QQ̅ potential and broadening of the color tube compared to the free string approximation. We conjecture possible stiffness of the QCD string through studying the effects of extrinsic curvature term in PK action and find a good fitting behavior for the lattice Monte-Carlo data at both long and intermediate quark separations regions.

Prediction of Eggshell Ultrastructure via Some Non-destructive and Destructive Measurements in Fayoumi Breed

Possibilities of predicting eggshell ultrastructure from direct non-destructive and destructive measurements were examined using 120 Fayoumi eggs collected from the flock at 45 weeks of age. The non-destructive measurements included weight, length and width of the egg. The destructive measurements were breaking strength and shell thickness. The eggshell ultrastructure traits involved the total thickness of eggshell layer, thickness of palisade layer, cone layer and total score. Prediction of total thickness of eggshell layer based on non-destructive measurements individually or simultaneously was not possible (R² = 0.01 to 0.16). The destructive measurements were far more accurate than the non-destructive in predicting total thickness of eggshell layer. Prediction based on breaking strength alone was more accurate (R² = 0.85) than that based on shell thickness alone (R² = 0.72). Adding shell thickness to breaking strength (the best predictor) increased the accuracy of prediction by 5%. The results obtained indicated that both non-destructive and destructive measurements were not useful in predicting the cone layer (R² not exceeded 18%). The maximum accuracy of prediction of total score (R² = 0.48) was obtained from prediction based on breaking strength alone. Combining shell thicknesses and breaking strength into one equation was no help in improving the accuracy of prediction.

Normalization of nano-sized TiO2-induced clastogenicity, genotoxicity and mutagenicity by chlorophyllin administration in mice brain, liver, and bone marrow cells

The intensive uses of titanium dioxide (TiO2) nanoparticles in sunscreens, toothpaste, sweats, medications, etc. making humans exposed to it daily by not little amounts and also increased its risks including genotoxicity. Thus, the present study was designed as one way to reduce nano-titanium-induced clastogenicity, genotoxicity, and mutagenicity in mice by co-administration of the free radical scavenger chlorophyllin (CHL). In addition, markers of oxidative stress were detected to shed more light on mechanism(s) underlying nano-sized TiO2 genotoxicity. Male mice were exposed to multiple injection into the abdominal cavity for five consecutive days with either CHL (40 mg/kg bw/day), or each of three dose levels of nano-sized TiO2 (500, 1000, or 2000 mg/kg bw/day) alone, or both simultaneously and sacrificed by cervical dislocation 24 h after the last treatment. After CHL co-administration, the observed dose-dependent genotoxicity of TiO2 nanoparticles indicated by the significant elevations in frequencies of both micronuclei and DNA damage induction was significantly decreased and returned to the negative control level. The observed induced mutations in p53 exons 5, 7, & 8 and 5 & 8 in the liver and brain, respectively, were declined in most cases. Moreover, CHL significantly decreased hepatic malondialdehyde level and significantly increased glutathione level and superoxide dismutase, catalase, and glutathione peroxidase activities that were significantly disrupted in animal groups treated with nano-TiO2 alone. In conclusion, the evidenced in vivo genotoxicity of nano-TiO2 in the present study was normalized after CHL co-administration which supports the previously suggested oxidative stress as the possible mechanism for titanium toxicity.

Estimating tuberculosis case detection rate in resource-limited countries: a capture-recapture study in Egypt

SETTING

Most countries endemic and highly endemic for tuberculosis (TB) still do not have reliable TB surveillance systems. Indirect estimation of TB incidence is needed to monitor the performance of the National Tuberculosis Programme (NTP) in the context of the World Health Organization implementation and impact targets for TB control.

OBJECTIVE

To estimate the case detection rate (CDR) of all TB cases and sputum smear-positive TB cases in Egypt in 2007.

METHODS

Record linkage and three-source capture-recapture analysis of data collected through active prospective longitudinal surveillance within the public and private non-NTP sector in four Egyptian governorates selected by stratified cluster random sampling.

RESULTS

For all TB cases, the estimated CDR of NTP surveillance and completeness of case ascertainment after record linkage was respectively 55% (95%CI 46-68) and 62% (95%CI 52-77). For sputum smear-positive TB cases, these proportions were respectively 66% (95%CI 55-75) and 72% (95%CI 60-82).

CONCLUSION

This pilot study shows that representative sampling, prospective surveillance in the non-NTP sector, record linkage and capture-recapture analysis can improve CDR estimation. For global, standardised and reliable use, this methodology should be further developed. Until then, all resource-limited countries should strengthen their national surveillance systems in the context of the Stop TB strategy.

Early lymphocyte recovery following autologous peripheral stem cell transplantation is associated with better survival in younger patients with lymphoproliferative disorders

Early absolute lymphocyte count (ALC) has become an important end point for engraftment in patients undergoing autologous peripheral stem cell transplantation (APSCT). In this retrospective study, we evaluate the prognostic significance of early recovery of ALC ( > or = 0.5 cells x 10(9)/l on or before day 15) following APSCT in predicting transplant outcome in 72 patients with lymphoproliferative disorders, including non-Hodgkin's lymphoma (n = 30), Hodgkin's lymphoma (n = 8) and multiple myeloma (n = 34). The median quantities of CD34+ stem cells and lymphocytes infused were 4.97 x 10(6)/kg (range 0.64-11.7) and 11.3 x 10(7)/kg (range 1.11-110) respectively. After a median follow-up of 18 months (range 2-68), 28 patients had experienced a relapse and 16 had died. Of the 72 patients, 27 (37%) demonstrated early recovery of ALC. Early recovery of ALC was strongly associated with long-term overall and disease-free survival in patients aged less than 50 years (P < 0.001). In both univariate and multivariate survival analyses, a shorter time from diagnosis to APSCT was associated with early recovery of ALC (P = 0.03). These findings indicate that early recovery of ALC may contribute to longer survival in younger patients with lymphoproliferative disorders. A shorter time from diagnosis to APSCT may favor recovery of ALC independent of the infused stem cell or lymphocyte doses.

[Optic neuritis after meningococcal vaccination]

CASE REPORT

We report the case of a 13 year-old male with bilateral optic neuritis after meningococcal C vaccination. He was treated with intravenous corticosteroids, but only showed visual recovery in one eye. A significant limitation of his sharp vision remained in his other eye.

DISCUSSION

There have been no previously reported cases of optic neuritis after meningococcal C vaccination and for this reason we have reported this case. It is not possible, however, to exclude some other factor in the etiology of the optic neuritis, but the temporal relationship between the neuritis and the vaccination suggests this was the cause.

Brain atrophy after immunoablation and stem cell transplantation in multiple sclerosis

The authors measured brain atrophy in nine patients undergoing immunoablation and autologous hematopoietic stem cell transplantation for multiple sclerosis. From baseline to 1 month after treatment, atrophy was 10 times faster than before treatment. A patient with non-CNS lymphoma showed comparable acute brain atrophy after analogous therapy. These observations suggest that brain atrophy after immunoablation may not be due entirely to the resolution of edema but may be related to chemotoxicity.

Ruptured intracranial dermoid cysts

Rupture of intracranial dermoid cysts (RICDC) is a rare phenomenon. The mechanism of rupture, pathophysiology of fat in the ventricles and subarachnoid spaces, possible complications, and proper management of such conditions are proposed on the basis of a review of the literature and experience with two cases of ruptured intracranial dermoid cysts (One was in the pineal region, while another was in the fourth ventricle). It is concluded that rupture of intracranial dermoid cysts is usually spontaneous and non-fatal. Persistence of fat in the subarachnoid spaces postoperatively may last asymptomatically for years. Surgery is the only way to deal with these benign lesions. If the capsule is adherent to vital areas, incomplete removal is advised as recurrence and malignant transformation are unlikely to occur.

Myeloablative allografting for chronic lymphocytic leukemia: evidence for a potent graft-versus-leukemia effect associated with graft-versus-host disease

In all, 30 patients with CLL proceeded to myeloablative allogeneic BMT using related (n=20, 67%) or unrelated (n=10) donors, at the Princess Margaret Hospital (Toronto) (n=20) or the Leukemia/BMT Program of BC (Vancouver) (n=10), from 1989 to 2001. Median (range) interval from diagnosis to BMT was 4.8 (0.3-13) years, median number of prior therapies was three and median age 48 years. The preparative regimen included total body irradiation in 15 (50%). In all, 14 of 30 patients (47%) are alive, with median (range) follow up of 4.3 (2.4-10.5) years. All are in complete remission, two following therapy for post-BMT progression. Actuarial overall (OS) and event-free survival (EFS) at 5 years is 39% (OS 48% for related donor and 20% for unrelated donor BMT); cumulative incidence of nonrelapse mortality (NRM) and relapse is 47 and 19%, respectively. Both acute (RR=0.008, P=0.01) and chronic (RR=0.006, P=0.02) Graft-versus-host disease (GVHD) were associated with markedly decreased risk of relapse. Patients receiving grafts from unrelated donors had increased NRM (RR=3.6, P=0.02) and decreased OS (RR of death=3.4, P=0.002). Allogeneic BMT has resulted in long-term EFS in approximately 40% of patients with CLL. There is evidence for a strong graft-versus-leukemia effect associated with acute and chronic GVHD, resulting in near complete protection from relapse.

Long-term follow-up of secondary malignancies in adults after allogeneic bone marrow transplantation

The purpose of this study was to evaluate the estimated incidence of secondary malignancies post-allogeneic bone marrow transplantation (BMT) in a cohort of adult patients previously reported now with an additional 8.5 years of follow-up. A cohort of 557 patients older than age 16 years underwent allogeneic BMT between June 1970 and November 1993. Histologic reports confirmed the diagnosis of a secondary malignancy. Multivariate Cox proportional hazards method was utilized to investigate predictors for the development of secondary malignancies. In all, 31 patients in this cohort developed a secondary malignancy a median of 6.79 years after their transplant. The estimated cumulative incidence rate of secondary malignancy was 4.2% at 10 years post transplant. When compared to the general population, the estimated observed/expected ratio of new cancer diagnoses was 5.13. On multivariate analysis, older age at the time of transplant was the only significant predictor for development of secondary cancer (P=0.01). The most common malignancies observed were nonmelanomatous skin cancers and squamous cell cancers of the buccal cavity. The risk of developing a secondary malignancy after allogeneic BMT is significant, particularly in older patients. Long-term survivors of transplant require regular monitoring for early signs of cancer, particularly of the skin and oral cavity.

Automated superficial lamellar keratectomy augmented by excimer laser masked PTK in the management of severe superficial corneal opacities

AIM

To assess superficial lamellar keratectomy augmented by excimer laser smoothening with sodium hyaluronate 0.25%, for the management of superficial corneal opacities.

METHODS

Consecutive procedure performed in 14 eyes (13 patients) with an automated microkeratome and excimer laser phototherapeutic keratectomy (PTK) smoothening using sodium hyaluronate 0.25%.

MAIN OUTCOME MEASURES

UCVA, BCVA, pachymetry, degree of haze, ray tracing analysis, and complications. Mean follow up was 12 (SD 1.6) months.

RESULTS

Mean preoperative haze from previous corneal refractive surgeries was 3.5 (SD 0.5) (11/14 cases). In one case, opacity was caused by ocular trauma and in two by infectious keratitis. The mean preoperative UCVA was 0.7 logMAR (0.2 (SD 0.13) decimal value). BCVA was 0.4 logMAR (0.4 (SD 0.17) decimal value). Mean preoperative corneal pachymetry was 508 (SD 62.5) micro m and mean opacity depth measured by corneal confocal microscopy was 115.2 (SD 49.4) micro m. At 6 months, 71.4% of the eyes with previous corneal refractive surgery showed grade I haze or less. Mean postoperative corneal pachymetry at 6 months was 352.36 (SD 49.05) micro m.

CONCLUSIONS

Automated superficial lamellar keratectomy combined with excimer laser PTK smoothening assisted by sodium hyaluronate 0.25% induces a significant improvement of corneal transparency and visual acuity in cases of corneal opacity caused by previous refractive surgery, ocular trauma, and keratitis.

HLA class II associations with rheumatic heart disease are more evident and consistent among clinically homogeneous patients

BACKGROUND

Discrepancies in reported HLA class II associations with rheumatic heart disease (RHD) may have been due to inaccuracies of serological typing reagents and/or lack of defined clinical classification of patients analyzed. The molecular association between HLA and RHD was investigated in patients with defined clinical outcome.

METHODS AND RESULTS

Class II allele/haplotype distribution was determined in 2 groups of RHD patients (n=88) and a control group (n=59). Patients were divided into the mitral valve disease (MVD) category (ie, those with mitral regurgitation with or without mitral stenosis) and the multivalvular lesions (MVL) category, with impairment of aortic and/or tricuspid valves in addition to mitral valve damage. The MVD category (n=65) accounted for 74% of patients and included significantly fewer recurrent RF episodes compared with MVL patients (P=0.002).

CONCLUSIONS

Significant increases in DRB1*0701 and DQA1*0201 alleles and DRB1*0701-DQA1*0201 haplotypes were found in patients. Removal of the MVL patients from analysis increased the strength of HLA associations among the MVD sample. The frequency of DQA1*0103 allele was decreased and the DQB1*0603 allele was absent from the patient group, suggesting that these alleles may confer protective effects against RHD. DQ alleles in linkage disequilibrium with DR alleles appear to influence risk/protection effect: whereas the DRB1*13-DQA1*0501-3-DQB1*0301 haplotype showed a trend toward risk, the DRB1*13-DQA1*0103-DQB1*0603 haplotype was absent in the RHD sample. Our data indicate that certain class II alleles/haplotypes are associated with risk or protection from RHD and that these associations appear to be stronger and more consistent when analyzed in patients with relatively more homogeneous clinical manifestations.

Poly(binaphthyl-20-crown-6) as receptor based molecular selective potentiometric electrodes for catecholamines and other 1,2-dihydroxybenzene derivatives

A novel type of poly(crown ether) electrode that is capable of selectively determining some 1,2-dihydroxybenzenes has been developed. A lipophilic macrocyclic crown ether, binaphthyl-20-crown-6, is electrochemically deposited on a platinum disc electrode. The film obtained is used as a sensory element for a potentiometric electrode for the determination of some neurotransmitters, namely, catecholamines. The new electrode is also capable of discriminating the steric shapes of 1,2-dihydroxybenzene moieties. The response of the new electrode is based on the principle of 'host-guest' chemistry. The potentiometric response is dependent on the pH of the solution and the nature of the buffer medium. The new sensor electrode has a useful analytical range of 1.5 x 10(-8) M-2 x 10(-5) M with a linear dynamic range between about 1 x 10(-7) M-5 x 10(-4) M with a 'super-Nernstian' slope of 110-130 mV/decade. The detection limit in phosphate buffer (0.1 M, pH 9.4) is ca. 3 x 10(-8) M for catecholamine. The sensor electrode is virtually insensitive towards interference from most inorganic ions and circumvents the interference from ascorbic acid, which is often found using amperometric methods in biological samples. A partial response mechanism of the present electrode is discussed, supported by results of electron dispersive analysis by x-rays (EDAX).

Electrochemistry and detection of some organic and biological molecules at conducting poly(3-methylthiophene) electrodes

Electrodes modified by the electrodeposition of poly(3-methylthiophene) were used as chemical sensors for some organic and biological molecules of industrial and medicinal interest. The electrochemical behaviors of ferri/ferrocyanide, catechol, ascorbic acid, hydroquinone, dopamine epinephrine, acetaminophen, p-aminophenol and NADH were examined by cyclic voltammetry. The results showed that the proposed modified surface catalyzes the oxidation of these compounds. Differential pulse and square wave techniques were used for the analysis of binary mixture of ascorbic acid with catechol, NADH, dopamine and p-aminophenol. Voltammetric peak resolution was also demonstrated for a ternary mixture of ascorbic acid, catechol and p-aminophenol. Polymer coated electrode was also used in an amperometric detector for flow injection analysis of most of the aforementioned compounds. The responses of the polymer electrode were 4-10 times larger as compared to those of platinum. The modified electrode displayed excellent response stability for successive injections and detection limits were 10 ppb for catechol, dopamine, epinephrine, NADH and p-aminophenol, 1 ppb for acetaminophen and 100 ppb for ascorbic acid. Voltammetric peak positions were affected by the nature of the electrolyte and its pH. Also, film thicknesses were shown to be a factor affecting both the current magnitudes and oxidation peak potential of NADH.

Therapeutic evaluation for intralesional injection of bleomycin sulfate in 143 resistant warts

A 1 U/ml solution of bleomycin sulfate in physiologic saline solution was injected intralesionally in 38 patients, and was compared with physiologic saline solution injection into paired warts in the same patient. No patient received more than 2 ml of bleomycin. Ninety-seven of 143 warts (67.8%) showed complete resolution after one or two bleomycin injections, while 25 warts (17.5%) showed incomplete resolution. Bleomycin local injection failed to elicit any therapeutic response in 21 warts (14.7%). The cure rate was 77% for warts on the extremities, 71.4% for periungual warts, and 47.6% for the plantar warts. The responsive warts showed hemorrhagic eschars that healed without scarring. It is concluded that this form of treatment for resistant warts, up to the dose used, is safe, reliable, and accepted by the patient.