Patterned immobilization of polyoxometalate-loaded mesoporous silica particles via amine-ene Michael additions on alkene functionalized surfaces

Polyoxometalates (POM) are anionic oxoclusters of early transition metals that are of great interest for a variety of applications, including the development of sensors and catalysts. A crucial step in the use of POM in functional materials is the production of composites that can be further processed into complex materials, e.g. by printing on different substrates. In this work, we present an immobilization approach for POMs that involves two key processes: first, the stable encapsulation of POMs in the pores of mesoporous silica nanoparticles (MSPs) and, second, the formation of microstructured arrays with these POM-loaded nanoparticles. Specifically, we have developed a strategy that leads to water-stable, POM-loaded mesoporous silica that can be covalently linked to alkene-bearing surfaces by amine-Michael addition and patterned into microarrays by scanning probe lithography (SPL). The immobilization strategy presented facilitates the printing of hybrid POM-loaded nanomaterials onto different surfaces and provides a versatile method for the fabrication of POM-based composites. Importantly, POM-loaded MSPs are useful in applications such as microfluidic systems and sensors that require frequent washing. Overall, this method is a promising way to produce surface-printed POM arrays that can be used for a wide range of applications.

EFFECT OF RELIGIOUS FASTING ON THE SERUM LEVEL OF PRE-HAPTOGLOBIN-2 AND SOME OTHER BIOCHEMICALS

During the month of Ramadan, which falls on the ninth month of the Hijri Calendar, Muslims are obligated to observe religious fasting. The goal of the study was to examine the impact of fasting on various blood parameters, specifically zinc, magnesium, pre-haptoglobin-2, serum copper, total cholesterol, and HDL-cholesterol levels. In a study, a group of volunteers consisting of 20 men and 10 women agreed to partake in the fast, abstaining from food and drink for approximately 14-15 hours each day. The researchers collected two blood samples from each participant, one before the start of Ramadan fasting and another after 29 days of fasting, serum was separated and analysed for specified parameters. Serum zinc levels showed a significant (p<0.05) decrease after fasting. On the other hand, serum magnesium levels exhibited a significant (p<0.05) increase, Regarding pre-haptoglobin-2, there was a small, insignificant increase observed after 29 days of fasting. However, the study did not identify any significant changes in serum copper, total cholesterol, or HDL-cholesterol levels. Based on these findings, the study concludes that Ramadan fasting may necessitate zinc supplementation or an increase in the consumption of zinc-rich foods. Furthermore, it suggests a decrease in the intake of high-fat foods. These recommendations aim to counteract the observed decrease in serum zinc levels during fasting.

An Automated Brain Metastasis Detection and Segmentation System from MRI with a Large Multi-Institutional Dataset

PURPOSE/OBJECTIVE(S)

Developments of automated systems for brain metastasis (BM) detection and segmentation from MRI for assisting early detection and stereotactic radiosurgery (SRS) have been reported but most based upon relatively small datasets from single institutes. This work aims to develop and evaluate a system using a large multi-institutional dataset, and to improve both identification of small/subtle BMs and segmentation accuracy of large BMs.

MATERIALS/METHODS

A 3D U-Net system was trained and evaluated to detect and segment intraparenchymal BMs with a size > 2mm using 1856 MRI volumes from 1791 patients treated with SRS from seven institutions (1539 volumes for training, 183 for validation, and 134 for testing). All patients had 3D post-Gd T1w MRI scans pre-SRS. Gross tumor volumes (GTVs) of BMs for SRS were curated by each institute first. Then, additional efforts were spent to create GTVs for the untreated and/or uncontoured BMs, including central reviews by two radiologists, to improve accuracy of ground truth. The training dataset was augmented with synthetic BMs of 3773 MRIs using a 3D generative pipeline. Our system consists of two U-Nets with one using small 3D patches dedicated for detecting small BMs and another using large 3D patches for segmenting large BMs, and a random-forest based fusion module for combining the two network outputs. The first U-Net was trained with 3D patches containing at least one BM < 0.1 cm3. For detection performance, we measured BM-level sensitivity and case-level false-positive (FP) rate. For segmentation performance, we measured BM-level Dice similarity coefficient (DSC) and 95-percentile Hausdorff distance (HD95). We also stratified performances based upon BM sizes.

RESULTS

For 739 BMs in the 134 testing cases, the overall lesion-level sensitivity was 0.870 with an average case-level FP of 1.34±1.92 (95% CI: 1.02-1.67). The sensitivity was >0.969 for the BMs >0.1 cm3, but dropped to 0.755 for the BMs < 0.1 cm3 (Table 1). The average DSC and HD95 for all detected BMs were 0.786 and 1.35mm. The worse performance for BMs > 20 cm3 was caused by a case with 83 cm3 GTV and artifacts in the MRI volume.

CONCLUSION

We achieved excellent detection sensitivity and segmentation accuracy for BMs > 0.1 cm3, and promising performance for small BMs (<0.1cm3) with a controlled FP rate using a large multi-institutional dataset. Clinical utility for assisting early detection and SRS planning will be investigated. Table 1: Per-lesion detection and segmentation performance stratified by individual BM size. N is the number of BMs in each category.

Equity, Diversity and Inclusion (EDI) in Organ Transplantation: An ESOT Survey About EDI Within ESOT as an Organization and its Educational Activities, and Transplantation Research and Science

The European Society of Organ Transplantation (ESOT) strives to promote equity, diversity, and inclusion (EDI) across all its activities. We surveyed the transplant community's experiences and perspectives regarding EDI within ESOT as an organization and its educational activities, and research in general. A total of 299 respondents completed the questionnaire. About half agreed that ESOT's Executive Committee, Council, and Sections/Committees are diverse and inclusive (51%) and that ESOT promotes EDI in its live and digital educational activities (54%). Forty percent of respondents agreed that scientific and clinical trials in the field of transplantation are diverse and inclusive. Despite the wide distribution of the survey, most of the respondents self-identified as White and were either physician or surgeon. However, the results contribute a unique insight into the experiences and perspectives of the transplantation community regarding EDI. Whilst ESOT is committed to the principles of EDI, perceptions and the high number of proposals show the apparent need to prioritize efforts to embed EDI across ESOT and transplantation science. These data should constitute a starting point for change and provide guidance for future efforts to promote EDI within the transplantation community.

Morphometric analysis and roosting ecology of bat species Pteropus Medius in Mansehra, Khyber Pakhtunkhwa, Pakistan

Morphometric measurement and roosting ecology of Pteropus medius were aimed to find out in Mansehra district of KP, Pakistan. Total 3149 numbers of bats were found in eight biological spots visited; Baffa Doraha, Darband, Dadar, Jallu, Hazara University, Garhi Habibullah Chattar Plain and Jabori, in total 299 numbers of different species of trees including; Morus alba, Pinus raxburghi, Eucalyptus camaldulensis, Morus nigra, Grevillea robusta, Brousonetia papyrifera, Platanus orientalis, Ailanthus altissima, Hevea brasiliensis and Populus nigra. Morphometric features were measured and found vary according to sex of the bats. The average wing span, wing`s length from tip of wing to neck, from thumb to tip of wing and the body`s length from head and claws were recorded to be 102.98 cm, 49.07cm, 28.7 cm and 22.78 cm respectively in males while 93.67 cm, 44.83cm, 24.78cm and 22.78 cm respectively in female bats. Mean circumference of the body including wings and without wing were measured as 22.78 cm and 17.29 cm in males and that of female were 20.07 cm and 16.9 cm. Average length of thumb 3.64 cm, ear`s length 3.1 cm, snout 5.62cm, eye length were 1.07 cm for both sexes and length between the feet in extended position were16.3 cm. Generally different measurement of males bodies were found to be greater than female such as mean body surface area, mass, volume and pressure were found to be 2691.79 cm2, 855.7gm,1236.4 ml and 295.77 dyne/ c m 3 for male and 2576.46 cm2, 852.71gm,1207 ml and 290.2 dyne/ c m 3 respectively for female. While weight and density for both males and females bats were same with mean of 8.59 newton and 0.701 g/m3. Findings of current reports can add valued information in literature about bats, which can be used for species identification and conservation.

Candida pneumonia in young and immunocompetent lady: A case report and literature review

Background

Candida is a frequent respiratory tract colonizer. True candida pneumonia is rare and seen with predominance in immunosuppressed patients. Our aim is to document a previously unreported case of Candida pneumonia in a young and immunocompetent patient, highlighting, an unusual pathological manifestation of this infection in immunocompetent individuals.

Case summary

We report a previously healthy young lady who remained symptomatic with fever, cough and shortness of breath for three weeks duration despite treatment with extensive antibiotics regimen for community acquired pneumonia. She was eventually treated as a probable, rare case of candida pneumonia. The patient demonstrated a dramatic response to single antifungal treatment both clinically and biochemically within the first 24hrs of treatment. Candida albican was isolated on repetitive cultures form the sputum and bronchoalevolar lavage samples. The patient had negative blood cultures. Her HRCT scan revealed bilateral basal air space opacities with peri bronchovascular distribution and centrilobular nodules with branching pattern suggestive of tree in bud predominantly in lower lobes. Her endobronchial biopsies was mostly unremarkable apart from rare non-necrotizing granuloma.

Conclusion

Candida can rarely cause clinically significant pneumonia in immunocompetent patients and should be considered in the differential diagnosis of granulomatous lung disease.

Physical, Psychological and Social Impact of COVID-19 Pandemic on Healthcare Workers at a COVID Designated Bangladeshi Public Hospital

The world has been devastated facing the outbreak of a novel infectious disease known as Corona virus disease (COVID-19). This has been declared as a pandemic by the World Health Organization. The frontline health care workers, who are directly involved in the diagnosis, treatment and care of patients with COVID-19, are taking significant personal risks on their own health and those of their family members. Objectives of the study include establishing the physical, psychological and social impact experience by the healthcare workers serving in public hospitals of Bangladesh. This prospective cross-sectional observational study was carried out at Kuwait Bangladesh Friendship Government Hospital, the first Covid-19 designated hospital of Bangladesh between the 1st June and the 31st August, 2020. A total of 294 doctors, nurses, ward boys and ailed healthcare workers were included in this study via purposive sampling. The study found statistically significant (p value 0.024) difference of medical co-morbidities between Covid-19 positive and Covid-19 negative groups of health care professionals. Significant association was found between duration of work and presence during aerosol generating procedure with COVID infectivity of the study subjects. 72.8% respondents experienced public fear of contracting the virus from them and 69.0% noticed negative attitude of the society towards them. Eighty five percent (85.0%) did not get any community support during this pandemic crisis. The health care professionals engaged in COVID-19 treatment have been taking significant personal risk on their life in terms of physical, psychological and social perspective. Providing safeguard to the health care workers are integral components of public health measures for addressing the COVID-19 pandemic. Special interventions to promote their physical wellbeing and arrangement of adequate psychological training need to be immediately implemented to cope up this critical situation.

DECIDE-AI: a new reporting guideline and its relevance to artificial intelligence studies in radiology

DECIDE-AI is a new, stage-specific reporting guideline for the early and live clinical evaluation of decision-support systems based on artificial intelligence (AI). It answers a need for more attention to the human factors influencing clinical AI performance and more transparent reporting of clinical studies investigating AI systems. Given the rapid expansion of AI systems and the concentration of related studies in radiology, these new standards are likely to find a place in radiological literature in the near future. This review highlights some of the specificities of AI as complex intervention, why a new reporting guideline was needed for early stage, live evaluation of this technology, and how DECIDE-AI and other AI reporting guidelines can be useful to radiologists and researchers.

SARS-CoV-2 Infection after Vaccination: A Comparative Profile between Dose 1 and Dose 2

Since the initial shipment of vaccination campaign against SARS-CoV-2 infection, it was a major concern all over the world regarding appropriate gapping between the first and second dose and also the necessity of booster dose after being vaccinated with the second dose. This cross-sectional type of comparative study was conducted at Kuwait Bangladesh Friendship Government Hospital, from the period of March 01 2021 to August 31 2021, on 148 hospitalized patients who were vaccinated with Astra Zeneca. They were divided into two groups on the background of 1st dose and 2nd dose. Collected data were entered into SPSS-26 version and after data cleaning, descriptive analysis was done with frequency distribution. To find out the significant difference between the two groups considering clinico-demographic information, disease severity, and duration of the last dose of vaccine; the Pearson Chi-square test was done with a significance level ≤0.05. The patients from both groups were mostly male and above 60 years. There were no significant age or sex variations between the two groups. SARS-CoV-2 infection was common after 38 days of dose 1 and after 63 days of dose 2. Fever, cough, running nose, shortness of breath, fatigue, nausea, vomiting, lower oxygen saturation, radiological involvement were comparatively more in patients who got only a single dose. Mild pneumonia (70.7%) was the commonest presentation in both doses of vaccinated patients and single dose vaccinated patients mostly (45.5%) presented with severe pneumonia. Elderly clinically risks group patients were mostly hospitalized with infection after 1 month of the 1st dose and on the other hand after 2 months of completing the 2nd dose. Symptomatic infection and disease severity were more in 1st dose vaccine recipients in comparison to 2nd dose.

162 A REVIEW OF THE GENERAL PRACTITIONER REFERRALS TO A RAPID ACCESS FRAILTY ASSESSMENT UNIT IN A MODEL-3 HOSPITAL

Background

The Rapid Access Frailty assessment unit (RAFAU) was set up in February 2021 and is run by a Raft (Rapid access frailty team). This is a dedicated multidisciplinary team in a model three hospital to review frail older patients to improve outcomes and admission avoidance. They review patients in the Emergency department as well as the assessment unit and on the ward for inpatient frailty reviews. The team is expanding as new roles are incorporated into the team and our service has evolved into a five day a week rapid access service.

Methods

We examined the number of GP referrals to our RAFU since May 2021 to March 2022 and the outcome of the review. Data was collected on all patients attending the RAFAU over an 11-month period. We selected all GP referrals which produced a cohort of 259 referrals to the unit.

Results

A total of 259 referrals were reviewed in RAFAU clinics. Mean age was 70-75 years old 60% were female, 40 % male. Reason for referral included: 38 % medical reasons, 32% cognitive issues, 18 % mobility ,7 % falls. Overall, 41% of referred patients had Clinical frailty scale score of 1-3, 16 % had a clinical frailty scale of 4, 8% clinical frailty scale of 5, 9% clinical frailty scale of 6, 5% clinical frailty scale of 7.The outcome of this cohort were as follows: 86 % needed further follow up, 9% were discharged and 1% admitted.

Conclusion

The RAFAU gives an alternative referral destination to GP’s for rapid review of frail older patients and thus potentially avoiding ED referral and admission. The vast majority of these referrals were for review of medical issues and cognitive assessment. The majority of patients required ongoing specialist frailty services and we hope to expand our service in the future.

Atrial fibrillation virtual ward: reshaping the future of AF care

Background

Atrial fibrillation (AF) hospital admissions represent significant AF related treatment costs nationally. In the year 2019–2020 our hospital reported 1,333 admissions with a primary diagnosis of AF, with a 10% annual increase. A virtual ambulatory AF ward providing multidisciplinary care with remote hospital-level monitoring could reshape the future model of AF management.

Methods

An AF virtual ward was implemented at our UK tertiary centre, as a proof-of-concept model of care. Patients admitted with a primary diagnosis of AF satisfying the AF virtual ward (AFVW) entry criteria (i.e., haemodynamically stable, HR &lt;140 bpm with other acute conditions excluded) were given access to a single lead ECG recording device, a Bluetooth integrated blood pressure machine and pulse oximeter with instruction to record daily ECGs, blood pressure readings, oxygen saturations and fill an online AF symptom questionnaire via a smart phone or electronic tablet. Data were uploaded to an integrated digital platform for review by the clinical team who undertook twice daily virtual ward rounds. Medication adjustment was arranged through the hospital pharmacy. Data was collected prospectively for patients admitted to the AF virtual ward between 31 January and 11 March 2022. Outcomes included length of hospital stay, admission avoidance and re-admissions. Re-admission avoidance was assessed using the index admission criteria as a parameter for re-admission likelihood. Patients' satisfaction was assessed using the NHS family and friends' test (FFT).

Results

Over the 6-week period a total of 14 patients were enrolled. One patient was unable to be onboarded because of technology related anxiety with 13 patients onboarded to the virtual ward, 30.7% (n=4) did not have smart phones and were provided with electronic tablets. The age on admission was 64±10 years (mean±SD) with the oldest at 78 years of age. All patients were in AF with a mean heart rate of 122±24 bpm, and 38.5% (n=5) were discharged from the virtual ward in sinus rhythm. One patient was onboarded directly from pacemaker clinic and hence hospital admission was completely avoided, and 5 re-admissions were avoided for 3 patients. One patient required brief readmission due to persistent tachycardia requiring acute cardioversion. The FFT yielded 100% positive responses among patients.

Conclusion

This proof-of-concept is a first real world experience of a virtual ward for hospital patients with fast AF. It demonstrates a promising new telemedicine-based care model and with clear appetite among both patients and health professionals. This model of care has the potential to reduce the financial and backlog pressures caused by AF admissions without compromising patients' care or safety. Work is ongoing to further confirm the safety and cost-effectiveness upon further progress in a larger patient cohort.

Funding Acknowledgement

Type of funding sources: None.

NMR Relaxivities of Paramagnetic, Ultra-High Spin Heterometallic Clusters within Polyoxometalate Matrix as a Function of Solvent and Metal Ion

Selectivity and image contrast are always challenging in magnetic resonance imaging (MRI), which are - inter alia - addressed by contrast agents. These compounds still need to be improved, and their relaxation properties, i. e., their paramagnetic relaxation enhancement (PRE), needs to be understood. The main goal is to improve specificity and relaxivities, especially at the high magnetic fields currently exploited not only in material science but also in the medical environment. Longitudinal and transverse relaxivities, r₁ and r₂ , which correspond to the longitudinal and transverse relaxation rates R₁ and R_2, normalized to the concentration of the paramagnetic moieties, need to be considered because both contribute to the image contrast. ¹ H-relaxivities r₁ and r₂ of high-spin heterometallic clusters were studied containing lanthanide and transition-metal ions within a polyoxometalate matrix. A wide range of magnetic fields from 0.5 T/20 MHz to 33 T/1.4 GHz was applied. The questions addressed here concern the rotational and diffusion correlation times which determine the relaxivities and are affected by the solvent's viscosity. Moreover, the variation of the lanthanide and transition-metal ions of the clusters provided insights into the sensitivity of PRE with respect to the electron spin properties of the paramagnetic centers as well as cooperative effects between lanthanides and transition metal ions.

Image-Quality Assessment of 3D Intracranial Vessel Wall MRI Using DANTE or DANTE-CAIPI for Blood Suppression and Imaging Acceleration

BACKGROUND AND PURPOSE

3D intracranial vessel wall MRI techniques are time consuming and prone to artifacts, especially flow artifacts. Our aim was to compare the image quality of accelerated and flow-suppressed 3D intracranial vessel wall MR imaging techniques relative to conventional acquisitions.

MATERIALS AND METHODS

Consecutive patients undergoing MR imaging had conventional postcontrast 3D T1-sampling perfection with application-optimized contrasts by using different flip angle evolution (SPACE) and either postcontrast delay alternating with nutation for tailored excitation (DANTE) flow-suppressed or DANTE-controlled aliasing in parallel imaging results in higher acceleration (CAIPI) flow-suppressed and accelerated T1-SPACE sequences performed. The sequences were evaluated using 4- or 5-point Likert scales for overall image quality, SNR, extent/severity of artifacts, motion, blood suppression, sharpness, and lesion assessment. Quantitative assessment of lumen and wall-to-lumen contrast ratios was performed.

RESULTS

Eighty-nine patients were included. T1-DANTE-SPACE had significantly better qualitative ratings relative to T1-SPACE for image quality, SNR, artifact impact, arterial and venous suppression, and lesion assessment (P < .001 for each, respectively), with the exception of motion (P = .16). T1-DANTE-CAIPI-SPACE had significantly better image quality, lesion assessment, arterial and venous blood suppression, less artifact impact, and less motion compared with T1-SPACE (P < .001 for each, respectively). The SNR was higher with T1-SPACE compared with T1-DANTE-CAIPI-SPACE (P < .001). T1-DANTE-CAIPI-SPACE showed significantly worse lumen (P = .005) and wall-to-lumen contrast ratios (P = .001) compared with T1-SPACE, without a significant difference between T1-SPACE and T1-DANTE-SPACE. T1-DANTE-CAIPI-SPACE scan time was 5:11 minutes compared with 8:08 and 8:41 minutes for conventional T1-SPACE and T1-DANTE-SPACE, respectively.

CONCLUSIONS

Accelerated postcontrast T1-DANTE-CAIPI-SPACE had fewer image artifacts, less motion, improved blood suppression, and a shorter scan time, but lower qualitative and quantitative SNR ratings relative to conventional T1-SPACE intracranial vessel wall MR imaging. Postcontrast T1-DANTE-SPACE had superior SNR, blood suppression, higher image quality, and fewer image artifacts, but slightly longer scan times relative to T1-SPACE.

Short term outcomes of distal (ventricular) His bundle pacing: A single centre retrospective study

Funding Acknowledgements

Type of funding sources: None.

Introduction

Chronic right ventricular apical pacing can lead to pacing induced cardiomyopathy in a significant proportion of patients. Conduction system pacing may restore more physiological activation of the heart, and has recently been shown to have favourable outcomes in clinical trials. However there remains concern regarding the long-term outcomes due to lead displacement and high pacing thresholds. The most widely used technique in current practice is to pace the His bundle proximal to the tricuspid valve. Distal His bundle pacing has a number of advantages over proximal His pacing, including, lower capture thresholds, a more stable lead position, less far field atrial sensing and better spacing from the AV node in case ablation of this is required for AF rate control. Despite these, outcomes of distal His bundle pacing from the ventricular aspect are less well defined.

Methods

We performed a retrospective review of patients who underwent conduction system pacing between January 2020 and October 2021 at our centre. During this period all procedures were performed employing a distal His bundle pacing approach with the lead placed on the ventricular aspect of the tricuspid annulus. Data was collected at implant, follow-up at 1 month and then every 6 months.

Results

Out of 35 patients, 33 underwent successful His bundle pacing (acute success rate of 94%), 1 patient had left bundle branch pacing and another patient had an unsuccessful procedure. Mean age was 74 years, median LVEF 45% and median pre-implant QRS was 108ms. 80% of the cohort had a history of AF. The indications for pacing were as follows: AF - for pace & ablate (60%); high grade AV block with narrow QRS and mild LVSD (17%); failed LV lead (14%); and other 9%. Mean procedure duration and fluoroscopy time were 78 minutes and 12.05 minutes, respectively. Median threshold at implant was 1.00V (IQR 0.719V). Selective His bundle pacing was achieved in 60% and non-selective in 34%. Mean follow-up duration was 150 days with median threshold at last f/up of 0.75V (IQR 0.750V). There were no acute procedural complications. 1 patient had a significant rise in threshold at follow-up and therefore required upgrade to CRT-P.

Discussion

Our data shows that distal His bundle pacing is a safe and effective technique for conduction system pacing. Thresholds appear stable at follow-up and failure rate was found to be comparable to biventricular pacing. We noted an initial learning curve for both implanter and physiologists with relatively poorer outcomes for the earlier cases. Longer term follow-up is ongoing, including functional assessment and follow-up to assess for remodelling with echocardiography. Prospective randomised trials are needed to compare conduction system pacing vs RV pacing in AF patients with HFpEF or mild LVSD undergoing AVN ablation, and vs biventricular pacing in the severe LVSD population.

Short term outcome of distal (ventricular) His bundle pacing and atrioventricular node ablation in patients with symptomatic atrial fibrillation - Refining the concept

Funding Acknowledgements

Type of funding sources: None.

Introduction

Many patients with atrial fibrillation (AF) do not benefit from rhythm control due to failed catheter ablation, advanced left atrial disease and comorbidities. "Pace and AV node (AVN) ablation" strategy is often adopted for rate control but with a substantial risk of pacing-induced cardiomyopathy. His bundle pacing (HBP) enables physiological biventricular activation through the His Purkinje conduction system. However, the proximity of the HBP lead to the site of AV node ablation may potentially compromise lead integrity in patients who undergo conventional HBP and AVN ablation. Therefore, we have modified HBP by placing the HBP lead distally at the ventricular side of the His bundle (D-HBP) before AVN ablation in patients with symptomatic AF. All patients had a backup RV lead.

Method

Patients who had D-HBP as part of a "Pace and AVN ablation" strategy were retrospectively analysed. Implant and device clinic follow-up data were collected and analysed.

Result

Twenty-one patients who had "pace and AVN ablation strategy" with D-HBP between 26th February 2020 and 3rd November 2021 were included. They had a mean age of 75 ± 1.4 years (mean ± SEM), NYHA class of 2.1 ± 0.2, QRS duration of 106 ± 5.3ms and 50% had at least moderately impaired LV systolic function. Seventeen patients (81%) had narrow QRS duration. D-HBP was successful in twenty of twenty-one patients (95%). At D-HBP implant, the mean acute threshold of the HBP lead was 0.96 ± 0.12V at 0.5 ± 0.05ms and the mean HBP lead impedance was 548.1 ± 29.5Ω. Selective HBP pacing was observed in thirteen of twenty patients. The mean QRS duration of HBP paced beats was 104.5 ± 4.7ms. Failure to capture the His bundle was observed in one patient. AVN ablation was performed on the same day after D-HBP in eleven patients and as a subsequent procedure in nine patients. The mean duration of procedure and fluoroscopy for D-HBP were 77.4 ± 4.6 minutes and 11.9 ± 1.4 minutes respectively. There were no acute procedural complications with no lead damage, displacement or lead perforation observed. The median follow-up period was 207 days. The mean D-HBP lead threshold following AVN ablation was 1.1 ± 0.2 V at 0.6 ± 0.07 ms and the mean lead impedance was 433.8 ± 20.7Ω, which were similar to before AVN ablation. One patient was reprogrammed with RV pacing only for elevated HBP lead threshold after AVN ablation to 4.2 V at 1ms. The mean D-HBP percentage was 92.3 ± 6.6% and the mean estimated battery longevity of the pacemaker was 7.9 ± 0.6 years at the last follow up. There was improvement in heart failure symptoms in eight patients from previously symptomatic to NYHA class I following D-HBP and AVN ablation.

Conclusion

D-HBP appear to be safe with potentially more favourable lead parameters than conventional proximal HBP in patients with symptomatic AF offered "Pace and AVN ablation" strategy.

Insights into Early Pregnancy Demise following Intracytoplasmic Sperm Injection in Women with Unexplained Infertility

OBJECTIVE

To investigate the effects of some potential risk factors on early pregnancy loss -EPL - in a cohort of pregnant women treated by assisted reproductive technology - ART.

METHODS

This is a retrospective cohort of 195 pregnancies, defined as serum human chorionic gonadotrophins ≥ 10 IU/l on day 14 - 17 after embryo transfer, recruited from an assisted reproductive technology unit, Ain Shams & Al-Azhar Maternity hospital, Cairo, Egypt, during the period from January 1st, 2016 to December 31, 2020. Risk factors investigated were maternal age, body mass index, status, baseline hormonal profiles, treatment protocol, quality and number of embryos.

RESULTS

Overall early pregnancy loss among the studied 195 pregnant women was 29 cases (15%). The risk of early pregnancy loss was associated with older age and fewer number of embryos transferred. Women > 35 years were found to have two and half times of early pregnancy loss compared with younger age group < 25 years, this was not significant after adjusting for other factors. The risk in both lean (BMI < 25 kg/m2) and very obese (BMI > 35 kg/m2) women was also not significantly higher in unadjusted analysis. Transfer of two or more embryos was associated with a non-significant reduced risk of early pregnancy loss, and after adjusting for other factors, the reduction was about 70%.

CONCLUSIONS

Early pregnancy loss represents a considerable drawback of intracytoplasmic sperm injection treated women with old age to increase the risk of early pregnancy loss and transferring more than one embryo to reduce the risk by about 70%. Obesity and other factors appeared to play a minor role.

Prevalence and Predictors of Metabolic Syndrome among Adults in North-Central, Nigeria

BACKGROUND

Metabolic syndrome contributes to the burden of non-communicable diseases and is a growing public health problem in both developed and developing countries. We determined the prevalence and predictors of metabolic syndrome among adults in Benue State, North-Central, Nigeria to guide targeted interventions.

METHODS

We conducted a community-based cross-sectional study in Benue State, North-Central, Nigeria. Multistage sampling technique was used to recruit 823 respondents. We defined metabolic syndrome using the National Cholesterol Education Programme Adult Treatment Panel III guideline and adapted a component of the WHO Stepwise questionnaire for data collection. Prevalence of metabolic syndrome and the associated risk factors were estimated using Chi square test and logistic regression at 5% level of significance. Statistical analysis was done using SPSS version 23.0.

RESULTS

The mean age of the respondents was 40.1± 15.7 years. Most of the respondents were literate (86.8%) and married (67.0%). The prevalence of metabolic syndrome was 19.4%. One in every four of the respondents had pre-metabolic syndrome (25.6%) and this was more in females (28.2%) compared to males (22.9%). Thirty-four percent of the respondents had only one whereas 20.7% did not have any of the risk factors for metabolic syndrome. Age [aOR:10.3; 95%CI: 4.8-22.2], sex [aOR:2.4; 95% CI: 1.7-3.5] and education [aOR:2.9; 95%CI: 1.4-6.1] were significantly associated with metabolic syndrome among the respondents.

CONCLUSION

The prevalence of metabolic syndrome was high. The associated risk factors were age, gender and educational status. Therefore, interventions should be targeted at young adults to reduce the long-term impact of the disease.

Mental health crisis in Somalia: a review and a way forward

Background

Somalia has been without an effective government since the collapse of the military regime in 1991. Years of conflict, disasters, and insecurity have all contributed to very low scores for most health indicators due to poor governance, protracted conflict, underdevelopment, economic decline, poverty, social and gender inequality, and environmental degradation. The three-decade long protracted conflict has led to widespread psychosocial trauma, social deprivation and substance abuse with devastating consequences on mental health. A WHO study showed Somalia has one of the highest rates of mental illness in the world. The main aim of this study is to assist policy makers in setting priorities for the design and delivery of interventions to promote mental health and psychosocial wellbeing in Somalia.

Methods

The study uses a systematic mapping technique (from January 1991 to May 2020) and data collected from public domain, to collect, collate, and present mental health data mainly from WHO’s Global Health Observatory. Since there is no primary database for Somalia’s public health research, the bibliographic databases used for mental health in this study included Medline, PubMed, CINAHL, PsycINFO, and Google Scholar. Data were extracted using techniques for web data mining for public health.

Results

Systematic mapping of mental health-related issues in Somalia showed that policy-related determinants and mental health services dominated (74.4%), followed by the disaster-related determinants and women’s health consequences (39.3%). The ratio of the number of beds for mental health in general hospitals (per 100,000 population) in Somalia in 2017 is 0.5 compared to the Eastern Mediterranean region (EMR) at 6.4 and globally at 24. One of the biggest casualties of the civil war was loss of essential human resources in healthcare as most either fled the country or were part of the victims of the war.

Conclusions

The vast scale of the mental health problems in Somalia and the priority setting guidelines for interventions to address the issues outlined in this paper, prompt a dire need that the Somali government and its national/international partners should prioritize and emphasize the need to invest in the prevention and the treatment of mental illness across the country.

Failure to rescue following emergency surgery: A FRAM analysis of the management of the deteriorating patient

BACKGROUND

Failure to rescue (FTR) denotes mortality from post-operative complications after surgery with curative intent. High-volume, low-mortality units have similar complication rates to others, but have lower FTR rates. Effective response to the deteriorating post-operative patient is therefore critical to reducing surgical mortality. Resilience Engineering might afford a useful perspective for studying how the management of deterioration usually succeeds and how resilience can be strengthened.

METHODS

We studied the response to the deteriorating patient following emergency abdominal surgery in a large surgical emergency unit, using the Functional Resonance Analysis Method (FRAM). FRAM focuses on the conflicts and trade-offs inherent in the process of response, and how staff adapt to them, rather than on identifying and eliminating error. 31 semi-structured interviews and two workshops were used to construct a model of the response system from which conclusions could be drawn about possible ways to strengthen system resilience.

RESULTS

The model identified 23 functions, grouped into five clusters, and their respective variability. The FRAM analysis highlighted trade-offs and conflicts which affected decisions over timing, as well as strategies used by staff to cope with these underlying tensions. Suggestions for improving system resilience centred on improving team communication, organisational learning and relationships, rather than identifying and fixing specific system faults.

CONCLUSION

FRAM can be used for analysing surgical work systems in order to identify recommendations focused on strengthening organisational resilience. Its potential value should be explored by empirical evaluation of its use in systems improvement.

Prevalence of cutaneous leishmaniasis in the largest populated city Karachi, Pakistan

The study was undertaken from September 2018 to April 2019 to determine the prevalence of cutaneous leishmaniasis in human beings living in six districts of Karachi. Suspected persons were screened for the disease and positive cases were identified on the basis of skin lesions and blood samples. Samples were observed by mounting their smear. A total of 207 subjects of different ages and sex groups were investigated, however, only 192 (92%) of the suspected cases were found to have the disease 64% of cases were male which were significantly high (p 0.05), than female 36%. The lesion was more frequently detected among the youth ages of 21-30 years (31%) as compared to other groups. In both sexes, legs were found to be more infected (25% male + 20% female) followed by arms (20% male + 0% female) and face (15% male +11% female). The mixed body parts had shown the lowest infections such as (4% in males + 5%) in females. In conclusion, the highest and lowest leishmaniasis infections were observed in District West (23% male + 9% female) followed by District East (15% male + 7% female), District Malir (11% male+ 4% female), District Central (7% male + 5% female), District Korangi (4% male + 7% female) and District South (4% male + 4% female) respectively.

NMR Relaxivities of Paramagnetic Lanthanide-Containing Polyoxometalates

The current trend for ultra-high-field magnetic resonance imaging (MRI) technologies opens up new routes in clinical diagnostic imaging as well as in material imaging applications. MRI selectivity is further improved by using contrast agents (CAs), which enhance the image contrast and improve specificity by the paramagnetic relaxation enhancement (PRE) mechanism. Generally, the efficacy of a CA at a given magnetic field is measured by its longitudinal and transverse relaxivities r1 and r2, i.e., the longitudinal and transverse relaxation rates T1-1 and T2-1 normalized to CA concentration. However, even though basic NMR sensitivity and resolution become better in stronger fields, r1 of classic CA generally decreases, which often causes a reduction of the image contrast. In this regard, there is a growing interest in the development of new contrast agents that would be suitable to work at higher magnetic fields. One of the strategies to increase imaging contrast at high magnetic field is to inspect other paramagnetic ions than the commonly used Gd(III)-based CAs. For lanthanides, the magnetic moment can be higher than that of the isotropic Gd(III) ion. In addition, the symmetry of electronic ground state influences the PRE properties of a compound apart from diverse correlation times. In this work, PRE of water 1H has been investigated over a wide range of magnetic fields for aqueous solutions of the lanthanide containing polyoxometalates [DyIII(H2O)4GeW11O39]5- (Dy-W11), [ErIII(H2O)3GeW11O39]5- (Er-W11) and [{ErIII(H2O)(CH3COO)(P2W17O61)}2]16- (Er2-W34) over a wide range of frequencies from 20 MHz to 1.4 GHz. Their relaxivities r1 and r2 increase with increasing applied fields. These results indicate that the three chosen POM systems are potential candidates for contrast agents, especially at high magnetic fields.

C80. Pulmonary Embolism in Congenital Heart Disease with Pulmonary Arterial Hypertension: a Case Series

Background

Pulmonary arterial hypertension (PAH) is a frequent complication of congenital heart disease (CHD), notably in patients with left-to-right shunts. Patients with severe PAH due to CHD, Eisenmenger syndrome (ES), represent a high-risk group of pulmonary artery (PA) thrombosis patients. We present serial adult cases of CHD with PAH complicated by pulmonary embolism (PE).

Case Description

We found 3 cases of pulmonary embolism on adult congenital heart disease in our center. All of the patients were female, with an age range of 36 to 61 years old. The presenting symptoms were shortness of breath, WHO classification class II-III. All patients were hemodynamically stable. CHD and estimated RV systolic pressure were evaluated with echocardiography. CT-PA was performed in all patients, which findings were supporting PE. All patients were treated with anticoagulation. After three months, right heart catheterization was conducted in two patients, and one patient was refused.

Discussion

The prevalence of PE among adult patient with CHD and PAH range from 17 to 21%. PE was frequently found in older patients, women, and patients with lower oxygen saturation. To date, no uniformity regarding routine prophylaxis anticoagulation therapy in ES due to the high bleeding risk in this population despite being at risk of PA thrombosis. We conclude that risk stratification for PA thrombosis in adult CHD-PAH patients is essential, and further research is needed to prevent PE in this population.

C80. Pulmonary Embolism in Congenital Heart Disease with Pulmonary Arterial Hypertension: a Case Series

Background

Pulmonary arterial hypertension (PAH) is a frequent complication of congenital heart disease (CHD), notably in patients with left-to-right shunts. Patients with severe PAH due to CHD, Eisenmenger syndrome (ES), represent a high-risk group of pulmonary artery (PA) thrombosis patients. We present serial adult cases of CHD with PAH complicated by pulmonary embolism (PE).

Case Description

We found 3 cases of pulmonary embolism on adult congenital heart disease in our center. All of the patients were female, with an age range of 36 to 61 years old. The presenting symptoms were shortness of breath, WHO classification class II-III. All patients were hemodynamically stable. CHD and estimated RV systolic pressure were evaluated with echocardiography. CT-PA was performed in all patients, which findings were supporting PE. All patients were treated with anticoagulation. After three months, right heart catheterization was conducted in two patients, and one patient was refused.

Discussion

The prevalence of PE among adult patient with CHD and PAH range from 17 to 21%. PE was frequently found in older patients, women, and patients with lower oxygen saturation. To date, no uniformity regarding routine prophylaxis anticoagulation therapy in ES due to the high bleeding risk in this population despite being at risk of PA thrombosis. We conclude that risk stratification for PA thrombosis in adult CHD-PAH patients is essential, and further research is needed to prevent PE in this population.

Antibacterial and antifungal activity of methanolic extracts of Salix alba L. against various disease causing pathogens

The present study was aimed to manifest the antibacterial and antifungal activity of methanolic extracts of Salix alba L. against seven Gram-positive and Gram-negative bacterial pathogens e.g. Streptococcus pyogenes, Staphylococcus aureus (1), S. aureus (2), Shigella sonnei, Escherichia coli (1), E. coli (2) and Neisseria gonorrhoeae and three fungal isolates from the air such as Aspergillus terreus, A. ornatus, and Rhizopus stolonifer. Two different serotypes of S. aureus and E. coli were used. The agar well-diffusion method results showed the dose-dependent response of plant extracts against bacterial and fungal strains while some organisms were found resistant e.g. E. coli (1), S. sonnei, A. terreus and R. stolonifer. The highest antibacterial activity was recorded at 17.000±1.732 mm from 100 mg/mL of leaves methanolic extracts against S. pyogenes while the activity of most of the pathogens decreased after 24 h of incubation. The highest antifungal activity was reported at 11.833±1.0 mm against A. ornatus at 50 mg/mL after 48 h of the incubation period. These experimental findings endorse the use of S. alba in ethnopharmacological formulations and suggest the use of methanolic extracts of the said plant to develop drugs to control the proliferation of resistant disease causing pathogenic microbes.

Forklift-related lower limb injuries: a retrospective case series study with patient-reported outcome measures (PROMs)

AIM

Forklift trucks can cause serious lower limb trauma with long-lasting sequelae to patients. The aim of this study was to analyse a case series of patients with forklift-related injuries over 7 years at a level 1 major trauma centre in the UK and present their patient-reported outcome measures (PROMs) with long-term follow-up. To the best of the authors' knowledge, this is the largest case series study in the UK describing forklift injuries.

METHODS

Retrospective case note analysis of 19 patients over 7 years. Data including demographics, injury mechanism, pattern of injury, management, length of hospital stay, number of operations and complications were extracted from the notes. We used 'Enneking score' as a validated tool for PROMs.

RESULTS

Seventeen men and two women with mean age of 47 years; 20% had bilateral injuries and 34% had multi-level fractures. The mean number of theatre sessions was 5.21, while the mean length of hospital stay was 30.10 days. There was one mortality. Twelve patients (63%) required reconstruction with free tissue transfer, with one flap failure. The mean long-term Enneking percentage score was 57.33%. The mean Enneking score for patients in this study is lower than our institute's score for Gustilo 3B, highlighting the gravity of these injuries.

CONCLUSION

Forklifts can cause grave injuries with massive energy transfer. This study highlights the seriousness of those injuries, thus guiding patient counselling and optimising planning of management.

NiII 36 -Containing 54-Tungsto-6-Silicate: Synthesis, Structure, Magnetic and Electrochemical Studies

The 36-NiII -containing 54-tungsto-6-silicate, [Ni36 (OH)18 (H2 O)36 (SiW9 O34 )6 ]6- (Ni36 ) was synthesized by a simple one-pot reaction of the Ni2 -pivalate complex [Ni2 (μ-OH2 )(O2 CCMe3 )4 (HO2 CCMe3 )4 ] with the trilacunary [SiW9 O34 ]10- polyanion precursor in water and structurally characterized by a multitude of physicochemical techniques including single-crystal XRD, FTIR, TGA, elemental analysis, magnetic and electrochemical studies. Polyanion Ni36 comprises six equivalent {NiII 6 SiW9 } units which are linked by Ni-O-W bridges forming a macrocyclic assembly. Magnetic studies demonstrate that the {Ni6 } building blocks in Ni36 remain magnetically intact while forming a hexagonal ring with antiferromagnetic exchange interactions between adjacent {Ni6 } units. Electrochemical studies indicate that the first reduction is reversible and associated with the WVI/V couple, whereas the second reduction is irreversible attributed to the NiII/0 couple.

Methylene blue versus vasopressin analog for refractory septic shock in the preterm neonate: A randomized controlled trial

BACKGROUND

Refractory septic shock in neonates is still associated with high mortality, necessitating an alternative therapy, despite all currently available treatments. This study aims to assess the vasopressor effect of methylene blue (MB) in comparison to terlipressin (TP) as adjuvant therapy for refractory septic shock in the preterm neonate.

METHODS

A double-blinded randomized controlled trial was conducted in the Neonatal Intensive Care Units at Ain Shams University, Egypt. Thirty preterm neonates with refractory septic shock were randomized to receive either MB or TP as an adjuvant to conventional therapy. Both MB and TP were administered as an intravenous loading dose followed by continuous intravenous infusion. The hemodynamic variables, functional echocardiographic variables, and oxidant stress marker were assessed over a 24 h period together with the side effects of MB.

RESULTS

MB causes significant improvement in mean arterial blood pressure with a significant decrease of the norepinephrine requirements (1.15±0.21μm/kg/min at baseline vs. 0.55±0.15μm/kg/min at 24 h). MB infusion causes an increase of the pulmonary pressure (44.73±8.53 mmHg at baseline vs. 47.27±7.91 mmHg after 24 h) without affecting the cardiac output. Serum malonaldehyde decreased from 5.45±1.30 nmol/mL at baseline to 4.40±0.90 nmol/mL at 24 h in the MB group.

CONCLUSION

Administration of MB to preterm infants with refractory septic shock showed rapid increases in systemic vascular resistance and arterial blood pressure with minimal side effects.

90 Penetrating Abdominal Trauma: Comperative Study Between Operative and Conservative Management

Aim

to Assess the feasibility and safety of selective non-operative management in penetrating abdominal injuries and to identify a protocol for selection of patient’s candidates for non-operative management.

Method

In this comparative study 40 abdominal stab victims (admitted to Emergency Department of Alexandria Main University Hospital) were selected during 6 months period where 20 patients were suitable for non-operative management according to strict selection criteria whereas the other 20 patients were operated according to clinical and/or radiological indications or on basis of department protocol, the results were compared in view of final outcome.

Results

In our study, 15 patients were assigned for operative management according to selected clinical and/or radiological indications only 3 of them (20%) had non-therapeutic laparotomies, On the other hand, five patients were explored on basis of department protocol in violation of our indications for exploration; four of them (80%) were non-therapeutic. So, the rate of non-therapeutic laparotomies was significantly higher when done mandatory without selected clinical and radiological indications.

Conclusions

Assessment of vital signs together with abdominal examination are the most important and dependable tools in decision making in penetrating abdominal trauma patients. Patients with shock on admission (but responding to resuscitation), proved low grade solid organ injury (by CT), and proved intraperitoneal collection (by US or CT) could be managed conservatively regarding that they remain vitally and clinically stable. If failure of conservation occurs, it is usually during the 1st 24 hours after admission.

Early Detection of Acute Kidney Injury by Neutrophil Gelatinase Associated Lipocalin in Patients Undergoing Coronary Artery Bypass Grafting with Cardiopulmonary Bypass

Neutrophil Gelatinase-Associated Lipocalin (NGAL) is rapidly released by renal tubules after injury, potentially allowing early identification of acute kidney injury (AKI) after cardiac surgery. However, the diagnostic performance of NGAL has varied widely in clinical studies and it remains unknown what factors modify the relationship between NGAL and AKI. The main objective of the study was to determine the efficacy of NGAL in early detection of AKI among the CABG patients undergoing cardiopulmonary bypass (CPB). This prospective observational study was conducted in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh in collaboration with the Department of Biochemistry, BSMMU among 42 patients admitted into the Department of Cardiac Surgery, Ibrahim Cardiac Hospital and Research Institute, Dhaka Bangladesh from July 2014 to June 2015. For the measurement of NGAL, urine samples were obtained before surgery and 6 hours after commencement of CPB. Serum creatinine was measured preoperatively and 6, 24 and 48 hours postoperatively. Increase in the serum creatinine level at 6, 24 and 48 hours after surgery was used to analyze the diagnostic value of urinary NGAL. In this study 42 CABG patients with no known renal insufficiency planned to have CPB were included. Receiver-operator characteristic (ROC) was constructed by using NGAL, which gave a cut off value of ≥185.90ng/ml. Eight patients were AKI positive among them 6(75.0%) patients were NGAL positive and 2(25.0%) were NGAL negative. Diagnosis of AKI was delayed by 24-48 hours by serum creatinine measurement. This study has demonstrated that level of urinary NGAL concentration at 6 hours post CPB increased before the increase of serum creatinine level and NGAL is an early predictor of AKI in adult cardiac surgical patients. The early detection of renal injury by NGAL may allow earlier intervention in patients with high risk for AKI.

Day-case unicompartmental knee arthroplasty: a literature review and development of a novel hospital pathway

INTRODUCTION

We have seen unparalleled changes in our healthcare systems globally as a result of the COVID-19 pandemic. As we strive to regenerate our full capacity elective services in order to contest the increasing demand for lower limb arthroplasty, this pandemic has allowed us a rare opportunity to revise and develop novel elective arthroplasty pathways intended to improve patient care and advance healthcare efficiency. We present an extensive evidence-based review of the approaches used to achieve day-case unicompartmental arthroplasty (UKA) as well as the development of a day-case UKA care pathway in a UK NHS institution based on the evidence provided in the literature.

METHODS

An extensive search of the literature was performed for articles that reported on readmission or complication rates ≥30 days postoperatively following day-case UKA.

FINDINGS

Fifteen manuscripts reporting the results of day-case UKA, defined as discharged on the same calendar day of surgery, were included in our review. Mean reported complication rates for day-case and inpatient UKA within the follow-up periods were 4.05% and 6.52%, respectively. Mean readmission rates were 2.71% and 4.36% for day-case and inpatient UKA, respectively. The mean rate of successful same-day discharge was 92.45%.

CONCLUSION

We introduce our institutional Elective Day Surgery Arthroplasty Pathway (EDSAP) founded upon the evidence presented in the literature. Stringent patient selection complimented by a well-defined day-case arthroplasty pathway is fundamental for successful commencement of day-case UKA in the NHS.

Changing susceptibility pattern of Neisseria Gonorrhoeae: A threat to management of sexually transmitted infections - Case series

Gonorrhoea is a sexually transmitted infection (STI) that increases the risk of infection with human immunodeficiency virus (HIV) and causes infertility and urethral stricture. We describe three cases of sexually active men, otherwise stable, who presented with a history of painful micturition and creamy white, urethral discharge. A clinical diagnosis of gonococcal urethritis was made and confirmed by microscopy, culture and 16SrRNA. Antimicrobial susceptibility revealed resistance to all the antimicrobial agents tested including ceftriaxone. A dual therapy was initiated using ceftriaxone and azithromycin, but at a higher dose for the patient with multi-drug resistant (MDR) Neisseria gonorrhoeae. Patients did well and were followed up for 5 months. Contact tracing was done for their sexual partners. While it is also important for healthcare workers to familiarize themselves with current treatment guidelines for gonococcal urethritis, the place of clinical laboratory in the management of STIs, with molecular techniques and the need for surveillance for MDR Neisseria gonorrhoeae cannot be overemphasized.

Evaluation of mare endometrial cytology using the novel cytotape technique

The cytobrush is considered the method of choice to obtain endometrial samples. Rigid brush fibers, however, may induce endometrial irritation and bleeding, or cell fragmentation, decreasing quality and diagnostic value of the samples. It was hypothesized that samples collected using a novel cytotape would provide sample smears of greater quality and less blood contamination than the cytobrush. Endometrial samples were collected with a cytotape and a cytobrush from ten mares without endometritis. Endometritis was then induced with artificial insemination, and samples were again collected 6 h after insemination. A cytology smear and bacterial culture were prepared from each sample. The collection methods and times were compared in terms of number and integrity of endometrial cells; number, integrity, and percentage of neutrophils; number of red blood cells, and number of colony-forming units. Frequency of positive cytology and culture was compared when there was use of each technique. The sensitivity, specificity, positive predictive value, and negative predictive value of cytology and culture for each technique was calculated using endometrial biopsy as the gold standard. While all samples had adequate and comparable cellularity and cell integrity, cytotape samples had less red blood cell contamination compared to cytobrush samples (P < 0.05). The number and percentage of PMNs, frequency of positive cytology diagnosis, number of colony-forming units and frequency of positive cultures did not differ between collection methods. In conclusion, the cytotape is a rapid, easy, and practical technique that can provide endometrial samples with similar diagnostic value to the cytobrush, but with less blood contamination.

Recovery from COVID-19 Pneumonia in a Heart Transplant Recipient

Introduction

Solid-organ transplant patients have a high risk of severe infection related to Severe Acute Respiratory Syndrome Coronavirus-2. There are limited data on COVID-19 presentation and clinical outcome in a cardiac transplant recipient.

Case Report

A 54-year old woman a heart transplant recipient presented with symptoms of fatigue, excessive sleepiness and cough with phlegm for one week. She did not report any fever or shortness of breath. She had a heart transplant six months prior complicated by antibody-mediated rejection. She was treated with plasmapheresis, intravenous immune globulin, and high dose methylprednisolone. She could not have further scheduled RV biopsies due to the lockdown. She remained on a high dose of immune suppressive medication till her current presentation. Her medication included Prednisolone 20mg daily, Mycophenolate Mofetil (MMF) 1g bid, Tacrolimus 7 mg bid for a target FK level 10-15. On her current presentation to the hospital, she was found to be hypoxic, tachypnic, tachycardic with a BP 130/70. Her chest x-ray showed bilateral infiltrates. She had leukopenia 3.5 and lymphopenia 0.2, CRP 25, ferritin 1106, LDH 632, and IL6 87. She was started empirically on oseltamivir, vancomycin and piperacillin/tazobactam. Her COVID-19 PCR result was positive. Subsequently, she was started on Favipiravir loading of 1600 mg for two doses and a maintenance dose of 600 mg twice daily for 7 days. The MMF and tacrolimus were discontinued. The prednisone was switched to hydrocortisone 50mg IV q6h. Despite treatment, she had reduced level of consciousness and progressive bilateral lung infiltrates requiering mechanical ventilation. The multidisciplinary team discussed enrolling patients in the convalescent plasma study. The patient's family was informed and they agreed and consented to proceed with plasma therapy. Two units of compatible ABO plasma therapy was given for two consecutive days. Intravenous dexamethasone was started. She was extubated successfully after ten days. Given her marked clinical improvement, she was started on MMF 1g bid, and tacrolimus adjusted to the target FK level of 5. The patient was discharged home after three weeks of admission.

Summary

This case represents a recent heart transplant recipient who presented with COVID-19 pneumonia. Her treatment involved convalescent plasma transfusion, Favipiravir, dexamethasone, and reduction of immune suppression.

Assessment of pentraxin 3 in a systemic inflammatory response occurring with neonatal bacterial infection

INTRODUCTION

In the developing countries, neonatal sepsis is the most common complication in neonatal period. It is as a systemic inflammatory response because of infection. Laboratory indicators, do not have satisfactory sensitivity. Thus, early identification of sepsis is still needed. Because PTX3 may be a faster acute-phase protein that is not liver-dependent, it is probable that it is superior to traditional biomarkers for mirroring rapid inflammatory courses.

METHODS

A prospective case control study design was used to determine the sensitivity of pentraxin 3 in the diagnosis of neonatal sepsis to allow early diagnostic tool. This study was carried out on neonatal ICU unit in Suez Canal University Hospital and the studied population were divided into two groups, including patients diagnosed with neonatal sepsis, based on clinical, laboratory and positive blood culture results, and control groupRESULTS:The study found that there was statistically significant differences between both groups in serum CRP values in diseased and control group (Mean = 49.3±37.4 mg/L, 26.8±17.2 mg/L, p < 0.05), and pentraxin values in diseased and control group (Mean = 5.2±3.7 mg/L, 2.3±0.78 mg/L, p < 0.0001). In addition, there were statistically significant correlations between pentraxin and serum CRP concentrations (p < 0.05) in diseased group. ROC curve showed that serum CRP demonstrated good diagnostic accuracy in predicting neonatal sepsis AUC = 0.875 with sensitivity of 100% and specificity of 92.3%.

CONCLUSION

Serum PTX3 may be a promising acute-phase protein for interpretation of affected newborns with symptoms and signs of sepsis.