Discovery of novel 1,2,4-triazole tethered β-hydroxy sulfides as bacterial tyrosinase inhibitors: synthesis and biophysical evaluation through in vitro and in silico approaches

In this study, a series of 1,2,4-triazole-tethered β-hydroxy sulfide scaffolds 11a-h was synthesized in good to remarkable yields (69-90%) through the thiolysis of oxiranes by the thiols in aqueous basic catalytic conditions. The synthesized 1,2,4-triazole-tethered β-hydroxy sulfides were screened against bacterial tyrosinase enzyme, and Gram-positive and Gram-negative bacterial cultures i.e., (S. aureus) Staphylococcus aureus & (E. coli) Escherichia coli. Among the synthesized derivatives, the molecules 11a (IC50 = 7.67 ± 1.00 μM), 11c (IC50 = 4.52 ± 0.09 μM), 11d (IC50 = 6.60 ± 1.25 μM), and 11f (IC50 = 5.93 ± 0.50 μM) displayed the better tyrosinase inhibitory activity in comparison to reference drugs ascorbic acid (IC50 = 11.5 ± 1.00 μM) and kojic acid (IC50 = 30.34 ± 0.75 μM). The molecule benzofuran-triazol-propan-2-ol 11c proved to be the most potent bacterial tyrosinase inhibitory agent with a minimum IC50 of 4.52 ± 0.09 μM, as compared to other synthesized counterparts and both standards (kojic acid and ascorbic acid). The compound diphenyl-triazol-propan-2-ol 11a and benzofuran-triazole-propan-2-ol 11c showed comparable anti-bacterial chemotherapeutic efficacy with minimum inhibitory concentrations (MIC = 2.0 ± 2.25 mg mL-1 and 2.5 ± 0.00 mg mL-1, respectively) against S. aureus bacterial strain in comparison with standard antibiotic penicillin (MIC = 2.2 ± 1.15 mg mL-1). Furthermore, among the synthesized derivatives, only compound 11c demonstrated better anti-bacterial activity (MIC = 10 ± 0.40 mg mL-1) against E. coli, which was slightly less than the standard antibiotic i.e., penicillin (MIC = 2.4 ± 1.00 mg mL-1). The compound 11c demonstrated a better binding score (-7.08 kcal mol-1) than ascorbic acid (-5.59 kcal mol-1) and kojic acid (-5.78 kcal mol-1). Molecular docking studies also validate the in vitro anti-tyrosinase assay results; therefore, the molecule 11c can be the lead bacterial tyrosinase inhibitor as well as the antibacterial agent against both types of bacterial strains after suitable structural modifications.

Exploring theophylline-1,2,4-triazole tethered N-phenylacetamide derivatives as antimicrobial agents: unraveling mechanisms via structure-activity relationship, in vitro validation, and in silico insights

Theophylline, a nitrogen-containing heterocycle, serves as a promising focal point for medicinal researchers aiming to create derivatives with diverse pharmacological applications. In this work, we present an improved synthetic method for a range of theophylline-1,2,4-triazole-S-linked N-phenyl acetamides (4a‒g) utilizing ultrasound-assisted synthetic approach. The objective was to assess the effectiveness of synthesized theophylline-1,2,4-triazoles (4a‒g) as inhibitors of HCV serine protease and as antibacterial agents against B. subtilis QB-928 and E. coli AB-274. Theophylline-1,2,4-triazoles were obtained in good to excellent yields (69%-95%) in a shorter time than conventional approach. 4-Chlorophenyl moiety containing theophylline-1,2,4-triazole 4c displayed significantly higher inhibitory activity against HCV serine protease enzyme (IC50 = 0.015 ± 0.25 mg) in comparison to ribavirin (IC50 = 0.165 ± 0.053 mg), but showed excellent binding affinity (-7.55 kcal/mol) with the active site of serine protease, better than compound 4c (-6.90 kcal/mol) as well as indole-based control compound 5 (-7.42 kcal/mol). In terms of percentage inhibition of serine protease, 2-chlorophenyl compound 4b showed the maximum percentage inhibition (86%), more than that of the 3,4-dichlorophenyl compound 4c (76%) and ribavirin (81%). 3,4-Dimethylphenyl-based theophylline-1,2,4-triazole 4g showed the lowest minimum inhibitory concentration (MIC = 0.28 ± 0.50 μg/mL) against the B. subtilis bacterial strain as compared to the standard drug penicillin (MIC = 1 ± 1.50 μg/mL). The other 4-methylphenyl theophylline-1,2,4-triazole 4e (MIC = 0.20 ± 0.08 μg/mL) displayed the most potent antibacterial potential against E. coli in comparison to the standard drug penicillin (MIC = 2.4 ± 1.00 μg/mL). Molecular docking studies further helped in an extensive understanding of all of the interactions between compounds and the enzyme active site, and DFT studies were also employed to gain insights into the molecular structure of the synthesized compounds. The results indicated that theophylline-linked triazole derivatives 4b and 4c showed promise as leading contenders in the fight against the HCV virus. Moreover, compounds 4e and 4g demonstrated potential as effective chemotherapeutic agents against E. coli and B. subtilis, respectively. To substantiate these findings, additional in vivo studies and clinical trials are imperative, laying the groundwork for their integration into future drug design and development.

Assessment of Babesia spp. prevalence in various domestic animals across Southern Punjab, Pakistan

Parasitic diseases, notably babesiosis, exert a substantial impact on the global cattle industry, posing challenges to commerce, economies, and human health. This study, conducted in Southern Punjab, Pakistan, aimed to assess the prevalence of Babesia spp. across various livestock species using microscopic and PCR methods. A total of 180 blood samples (60 from each district) were systematically collected from apparently healthy animals, with 36 samples obtained from each domestic animal species, including camel, cattle, buffalo, goat, and sheep, noting that 12 samples were collected from each district for each animal species. Overall prevalence was determined to be 32.8% (59/180), with varying rates among species: 25.0% in cattle, 41.66% in buffalo, 30.55% in goats, 33.3% in sheep, and 33.3% in camels. Microscopic examination revealed slightly varied infection rates among large and small domestic animals (22.2%), while PCR results indicated a 32.8% overall infection rate in both large and small domestic animals, with no statistical significance. District-wise analysis showed regional variations, with Muzaffargarh recording a prevalence rate of 23.33% through microscopic examination, while Lodhran and Bahawalpur recorded 21.67%. PCR results revealed higher rates (38.33%, 26.67%, and 33.33%, respectively), underlining the importance of employing PCR for accurate detection. Examining ruminant types, large ruminants exhibited a 32.4% infection rate, while small domestic animals showed 33.3%, with no significant difference (p=0.897). District-wise prevalence showcased significant variation, with Muzaffargarh demonstrating a 25% prevalence, Lodhran 22%, and Bahawalpur 22%, through microscopic examination. PCR results displayed 38.33%, 27%, and 33.3%, respectively, with no statistical significance. Detailed analysis of individual districts highlighted variations in infection rates among camels, cattle, buffalo, goats, and sheep. The binomial test indicated significant differences through microscopic analysis (P=0.011) but non-significant variations through PCR (P=0.065), emphasizing the precision of PCR. Regional variations in prevalence, notably with Punjab exhibiting the highest frequency (33.87%) and KPK the lowest (13.24%), suggest potential influences from varying veterinary practices and environmental factors. This study underscores the pivotal role of PCR alongside microscopy for accurate babesiosis diagnosis. These findings contribute to the broader understanding of babesiosis prevalence, emphasizing the necessity of advanced molecular techniques for informed control measures.

Optimizing broadband antireflection with Au micropatterns: a combined FDTD simulation and two-beam LIL approach

Broadband antireflection (AR) is highly significant in a wide range of optical applications, and using a gold (Au) micropattern presents a viable method for controlling the behavior of light propagation. This study investigates a novel, to the best of our knowledge, methodology to achieve broadband AR properties in Au micropatterns. It employed the three-dimensional finite-difference time-domain (FDTD) method to simulate and optimize the design of micropatterns. In contrast, the fabrication of Au micropatterns was carried out using two-beam laser interference lithography (LIL). The fabricated Au micropatterns were characterized by a scanning electron microscope (SEM) and spectroscope to validate their antireflection and transmission properties and evaluate their performance at various wavelengths. The optimized Au micropatterns had a high transmittance rating of 96.2%. In addition, the device exhibits a broad-spectrum antireflective property, covering wavelengths ranging from 400 to 1100 nm. The simulation data and experimentally derived results show comparable patterns. These structures can potentially be employed in many optical devices, such as solar cells and photodetectors, whereby achieving optimal device performance reduced reflection and enhanced light absorption.

Superhydrophobic Antifrosting 7075 Aluminum Alloy Surface with Stable Cassie-Baxter State Fabricated through Direct Laser Interference Lithography and Hydrothermal Treatment

Frost formation and accumulation can have catastrophic effects on a wide range of industrial activities. Hence, a dual-scale surface with a stable Cassie-Baxter state is developed to mitigate the frosting problem by utilizing direct laser interference lithography assisted with hydrothermal treatment. The high Laplace pressure tolerance under the evaporation stimulus and prolonged Cassie-Baxter state maintenance under the condensation stimulus demonstrate the stable Cassie-Baxter state. The dual-scale surface exhibits a lengthy frost-delaying time of up to 5277 s at -7 °C due to the stable Cassie-Baxter state. The self-removal of frost is achieved by promoting the mobility of frost melts driven by the released interfacial energy. In addition, the dense flocculent frost layer is observed on the single-scale micro surface, whereas the sparse pearl-shaped frost layer with many voids is obtained on the dual-scale surface. This work will aid in understanding the frosting process on various-scale superhydrophobic surfaces and in the design of antifrosting surfaces.

Mutations in the bone morphogenetic protein 15 gene causing defective protein secretion in Cholistani infertile sheep

Abstract Naturally occurring mutations in morphogenetic protein 15 (BMP15) are associated with decreased ovulation rate (OR), litter size (LS), and sterility. It is of a great interest to elucidate BMP15 gene in Cholistani sheep breed to uplift socio-economic status and the knowledge of Cholistani sheep breeding in Southern Punjab, Pakistan. In our study, a total of 50 infertile Cholistani sheep aged between 2-6 years and having no blood relation were screened for BMP15 mutations. For this purpose, a high-quality DNA was extracted from the blood of sheep followed by primer designing, Polymerase Chain Reaction (PCR) amplification, DNA sequencing, and in silico analyses. Out of total 50 samples, 9 samples including case 1 (T3), case 2 (T8), case 3 (T17), case 4 (T22), case 5 (T25), case 6 (T33), case 7 (T40), case 8 (T44), and case 9 (T47) were found positive for a variety of already reported and novel BMP15 mutations. Further in silico analyses of the observed mutations have shown the functional impact of these mutations on different characteristics (molecular weight, theoretical PI, estimated half-life, instability index, sub-cellular localization, and 3D confirmation) of the encoded proteins, possibly altering the normal functionality. In a nutshell, findings of this study have confirmed the possible essential role of the BMP15 mutations in the infertility of the Cholistani sheep.

Morpho-physiological and phytohormonal changes during the induction of adventitious root development stimulated by exogenous IBA application in Magnolia biondii Pamp

Abstract Magnolia biondii Pamp is an important ornamental tree species widely grown and used as a rootstock in the propagation of different Magnolia varieties. In the current studies, anatomical, physiological and endogenous hormones were studied to check the effect of IBA 750 mg/L on the adventitious rooting and to provide theoretical and technical support for the propagation of Magnolia biondii Pamp through stem cuttings. Two thousand stem cuttings were prepared and divided into two groups i.e., IBA treated cuttings and water control. For the evaluation of antioxidant enzyme activities, and endogenous hormones levels, samples were collected on the day of planting and each 5th day and further steps were carried out in the laboratory according to the protocols and proper precautions. For the anatomical observations, samples were collected on the 13th, 15th, and 17th day for IBA treated cuttings while 21st, 23rd, and 25th day for control. Collected samples were preserved in the FAA solution and further observations were carried out in the laboratory. Anatomical observations showed that it took 13 days for the differentiation of root primordia to the appearance of young adventitious roots in IBA treated cuttings, while it took 21 days to develop primordia in the control. Antioxidant enzyme activities involved in ROS were significantly higher in the IBA treated cuttings compared to control. POD showed a peak on the 13th day before the emergence of roots in IBA treated cuttings while it showed a peak on the 21st day in the control. PPO showed a peak on the 21st day in the IBA treated cuttings while it showed a peak on the 29th day in the control. SOD showed a peak on the 17th day in IBA treated cuttings, while it showed a peak on the 25th day in the control. Exogenous application of IBA enhanced the endogenous IAA and GA3 levels compared to CK, while it reduced the levels of ABA continuously at the time of rooting and then increased gradually. Inclusively, our study suggests that IBA 750 mg/L is efficient for the rooting of Magnolia biondii Pamp cuttings, as it enhanced the process of antioxidant enzyme activities, endogenous hormones levels and reduced the time of root formation which is evident from the anatomical observations.

Recent Trends in the Petasis Reaction: A Review of Novel Catalytic Synthetic Approaches with Applications of the Petasis Reaction

The Petasis reaction, also called the Petasis Borono-Mannich reaction, is a multicomponent reaction that couples a carbonyl derivative, an amine and boronic acids to yield substituted amines. The reaction proceeds efficiently in the presence or absence of a specific catalyst and solvent. By employing this reaction, a diverse range of chiral derivatives can easily be obtained, including α-amino acids. A broad substrate scope, high yields, distinct functional group tolerance and the availability of diverse catalytic systems constitute key features of this reaction. In this review article, attention has been drawn toward the recently reported methodologies for executing the Petasis reaction to produce structurally simple to complex aryl/allyl amino scaffolds.

Synthesis, Cytotoxic, and Computational Screening of Some Novel Indole-1,2,4-Triazole-Based S-Alkylated N-Aryl Acetamides

Molecular hybridization has emerged as the prime and most significant approach for the development of novel anticancer chemotherapeutic agents for combating cancer. In this pursuit, a novel series of indole-1,2,4-triazol-based N-phenyl acetamide structural motifs 8a-f were synthesized and screened against the in vitro hepatocellular cancer Hep-G2 cell line. The MTT assay was applied to determine the anti-proliferative potential of novel indole-triazole compounds 8a-f, which displayed cytotoxicity potential as cell viabilities at 100 µg/mL concentration, by using ellipticine and doxorubicin as standard reference drugs. The remarkable prominent bioactive structural hybrids 8a, 8c, and 8f demonstrated good-to-excellent anti-Hep-G2 cancer chemotherapeutic potential, with a cell viability of (11.72 ± 0.53), (18.92 ± 1.48), and (12.93 ± 0.55), respectively. The excellent cytotoxicity efficacy against the liver cancer cell line Hep-G2 was displayed by the 3,4-dichloro moiety containing indole-triazole scaffold 8b, which had the lowest cell viability (10.99 ± 0.59) compared with the standard drug ellipticine (cell viability = 11.5 ± 0.55) but displayed comparable potency in comparison with the standard drug doxorubicin (cell viability = 10.8 ± 0.41). The structure-activity relationship (SAR) of indole-triazoles 8a-f revealed that the 3,4-dichlorophenyl-based indole-triazole structural hybrid 8b displayed excellent anti-Hep-G2 cancer chemotherapeutic efficacy. The in silico approaches such as molecular docking scores, molecular dynamic simulation stability data, DFT, ADMET studies, and in vitro pharmacological profile clearly indicated that indole-triazole scaffold 8b could be the lead anti-Hep-G2 liver cancer therapeutic agent and a promising anti-Hep-G2 drug candidate for further clinical evaluations.

Isolation, identification, and screening of biosurfactant-producing and hydrocarbon-degrading bacteria from oil and gas industrial waste

Qatar is one of the biggest oil and gas producers in the world, coupled with it is challenging environmental conditions (high average temperature: >40 °C, low annual rainfall: 46.71 mm, and high annual evaporation rate: 2200 mm) harbors diverse microbial communities that are novel and robust, with the potential to biodegrade hydrocarbons. In this study, we collected hydrocarbon contaminated sludge, wastewater and soil samples from oil and gas industries in Qatar. Twenty-six bacterial strains were isolated in the laboratory from these samples using high saline conditions and crude oil as the sole carbon source. A total of 15 different bacterial genera were identified in our study that have not been widely reported in the literature or studied for their usage in the biodegradation of hydrocarbons. Interestingly, some of the bacteria that were identified belonged to the same genus however, demonstrated variable growth rates and biosurfactant production. This indicates the possibility of niche specialization and specific evolution to acquire competitive traits for better survival. The most potent strain EXS14, identified as Marinobacter sp., showed the highest growth rate in the oil-containing medium as well as the highest biosurfactant production. When this strain was further tested for biodegradation of hydrocarbons, the results showed that it was able to degrade 90 to 100% of low and medium molecular weight hydrocarbons and 60 to 80% of high molecular weight (C35 to C50) hydrocarbons. This study offers many promising leads for future studies of microbial species and their application for the treatment of hydrocarbon contaminated wastewater and soil in the region and in other areas with similar environmental conditions.

Unfolding the Antibacterial Activity and Acetylcholinesterase Inhibition Potential of Benzofuran-Triazole Hybrids: Synthesis, Antibacterial, Acetylcholinesterase Inhibition, and Molecular Docking Studies

In this study, a series of novel benzofuran-based 1,2,4-triazole derivatives (10a-e) were synthesized and evaluated for their inhibitory potential against acetylcholinesterase (AChE) and bacterial strains (E. coli and B. subtilis). Preliminary results revealed that almost all assayed compounds displayed promising efficacy against AChE, while compound 10d was found to be a highly potent inhibitor of AChE. Similarly, these 5-bromobenzofuran-triazoles 10a-e were screened against B. subtilis QB-928 and E. coli AB-274 to evaluate their antibacterial potential in comparison to the standard antibacterial drug penicillin. Compound 10b was found to be the most active among all screened scaffolds, with an MIC value of 1.25 ± 0.60 µg/mL against B. subtilis, having comparable therapeutic efficacy to the standard drug penicillin (1 ± 1.50 µg/mL). Compound 10a displayed excellent antibacterial therapeutic efficacy against the E. coli strain with comparable MIC of 1.80 ± 0.25 µg/mL to that of the commercial drug penicillin (2.4 ± 1.00 µg/mL). Both the benzofuran-triazole molecules 10a and 10b showed a larger zone of inhibition. Moreover, IFD simulation highlighted compound 10d as a novel lead anticholinesterase scaffold conforming to block entrance, limiting the swinging gate, and disrupting the catalytic triad of AChE, and further supported its significant AChE inhibition with an IC50 value of 0.55 ± 1.00 µM. Therefore, compound 10d might be a promising candidate for further development in Alzheimer's disease treatment, and compounds 10a and 10b may be lead antibacterial agents.

Laser Interference Lithography-A Method for the Fabrication of Controlled Periodic Structures

A microstructure determines macro functionality. A controlled periodic structure gives the surface specific functions such as controlled structural color, wettability, anti-icing/frosting, friction reduction, and hardness enhancement. Currently, there are a variety of controllable periodic structures that can be produced. Laser interference lithography (LIL) is a technique that allows for the simple, flexible, and rapid fabrication of high-resolution periodic structures over large areas without the use of masks. Different interference conditions can produce a wide range of light fields. When an LIL system is used to expose the substrate, a variety of periodic textured structures, such as periodic nanoparticles, dot arrays, hole arrays, and stripes, can be produced. The LIL technique can be used not only on flat substrates, but also on curved or partially curved substrates, taking advantage of the large depth of focus. This paper reviews the principles of LIL and discusses how the parameters, such as spatial angle, angle of incidence, wavelength, and polarization state, affect the interference light field. Applications of LIL for functional surface fabrication, such as anti-reflection, controlled structural color, surface-enhanced Raman scattering (SERS), friction reduction, superhydrophobicity, and biocellular modulation, are also presented. Finally, we present some of the challenges and problems in LIL and its applications.

OP0246 TO SCAN OR NOT TO SCAN (BOTH HIPS) – A BRISTOL EXPERIENCE

Background

The current International Society of Clinical Densitometry (ISCD) recommendation for bone densitometry practice is that single hip measurement is sufficient in clinical practice, as there is overall a good correlation between the two hip bone mineral densities (BMD) (1) (2). However, discordance in individual T- scores and BMD between the 2 hips due to increasing age and osteoarthritis (3)-(5) is well recognised.

Objectives

We aimed to identify whether discordant hip BMD values would lead to differences in the FRAX risk assessment score between the two hips, and thereby impact treatment decisions in clinical practice.

Methods

We looked at all DXA scans performed at our centre for 2 months between 23/7/21 and 23/9/21. Cases in which both hips were scanned and anti-resorptive treatment was advised were included in our study. The femoral neck with the lower BMD is used to calculate the FRAX score and this was referred to as the ‘reported’ hip. The FRAX score for ‘reported’ and ‘unreported’ hip were calculated and the T-score of the spine was also noted. Our local treatment threshold is set at 20% for a major osteoporotic fracture and 5% for hip fracture. Cases of difference in scores crossing the 20%/5% FRAX threshold were highlighted and reviewed in more detail.

Results

DXA scans were performed in 328 patients over the 2 month period, of which 201 patients had both of their hips scanned. Of these, 50 patients were advised to start anti-resorptive treatment. The majority of the treatment decisions (60%; 30/50 cases) were based on the hip/femoral neck BMD value, while 40% (20/50 cases) were based on the spine T-score.

Where the treatment decision was based on hip/femoral neck BMD, 20% (6/30 cases) were found to have a FRAX risk above the treatment threshold at one hip only, meaning that treatment may not have been offered if both hips had not been scanned. Similarly, where treatment was advised based on spinal T-scores, 20% (4/20 cases) had a FRAX risk above treatment threshold at one hip only.

Mean age across these 10 cases with a discordant FRAX risk between the two hips was 72 years (range 59 – 83); 80% (8/10) were female. Steroid use and chronic inflammatory co-morbidities were the predominant indications for these DXA Scans.

Conclusion

A significant proportion of patients in our cohort (20%; 10/50) may not have been offered treatment if only one hip was scanned. Scanning both hips does not require much additional time and can help mitigate the risk of undertreating patients. The recommendation for best practice for DXA BMD measurements should be reviewed to consider lumbar spine and dual hip BMD as standard of care.

References

[1]E. Michael Lewiecki, Nelson B. Watts, Michael R. McClung, Steven M. Petak, Laura K. Bachrach, John A. Shepherd, Robert W. Downs, Jr., Official Positions of the International Society for Clinical Densitometry, The Journal of Clinical Endocrinology & Metabolism, Volume 89, Issue 8, 1 August 2004, Pages 3651–3655, https://doi.org/10.1210/jc.2004-0124

[2]Rao AD, Reddy S, Rao DS. Is there a difference between right and left femoral bone density? J Clin Densitom. 2000 Spring;3(1):57-61. doi: 10.1385/jcd:3:1:057. PMID: 10745302.

[3]Chen W, Khan Z, Freund J, Pocock N. Dual Hip DXA. Is it Time to Change Standard Protocol? J Clin Densitom. 2021 Jul 24:S1094-6950(21)00060-3. doi: 10.1016/j.jocd.2021.07.006. Epub ahead of print. PMID: 34391641.

[4]Mounach A, Rezqi A, Ghozlani I, Achemlal L, Bezza A, El Maghraoui A. Prevalence and Risk Factors of Discordance between Left- and Right-Hip Bone Mineral Density Using DXA. ISRN Rheumatol. 2012;2012:617535. doi: 10.5402/2012/617535. Epub 2012 Jun 17. PMID: 22778990; PMCID: PMC3384949.

[5]Nishizawa K, Harato K, Morishige Y, Kobayashi S, Niki Y, Nagura T. Correlation between weight-bearing asymmetry and bone mineral density in patients with bilateral knee osteoarthritis. J Orthop Surg Res. 2021;16(1):102. Published 2021 Feb 2. doi:10.1186/s13018-021-02252-5.

Disclosure of Interests

Aishwarya Anilkumar: None declared, Sadaf Saeed: None declared, Ehsan Elsayed: None declared, Chandrin N. R. Jayatilleke: None declared, Stuart Webber: None declared, Mathew A. Roy Consultant of: Worked as a paid consultant for Kyowa Kirin.

Perceived Stress Among Students of Private and Public Sector Medical Colleges of Pakistan: A Cross Sectional Study

Introduction

Medical-education is associated with high overall stress and it is important to identify relevant factors.

Objectives

The study was aimed to discern the differences in perceived stress among the students of public and private medical colleges of Pakistan and to identify factors subservient to any hypothesized difference.

Methods

This cross-sectional study was conducted at different private and public medical colleges of Pakistan using validated tools: PSS-14 (Perceived Stress Scale) to find out the levels of stress faced by each sector and MSSQ (Medical Student Stressor Questionnaire) to determine the factors associated with increased stress.

Results

Total of 424 medical students from various public and private medical colleges of Pakistan (212 each) filled the questionnaires. The mean score +/- SD of PSS-14 was 36.17 ± 6.096 for the public sector and 36.29 ±5.732 for the private sector. Hence, there was no difference between the two comparative means of PSS score, t(422)=-0.213,p=0.831.The results for both sectors were classified as high perceived stress (27-40 score is high perceived stress). Out of 40 individual stress-causing factors in MSSQ, the students from private-sector scored higher as compared to public-sector: Quota System in examination t(422)=-3.951,p=0.000, stress caused by lack of time for friends and family t(422)=-3.225,p=0.001, stress caused by Tests/Examination t(422)=-2.131,p=0.034, stress caused by the parental wish for them to study medicine t(422)=-2.346,p=0.019 and stress caused by fear of getting poor marks t(422)=-2.183,p=0.030.

Conclusions

There exists no overall difference in the perceived-stress among the medical students of public and private medical colleges despite private-sectors having significantly more operational financial resources.

Disclosure

No significant relationships.

Drinking water quality of various sources in Peshawar, Mardan, Kohat and Swat districts of Khyber Pakhtunkhwa province, Pakistan

Abstract The present study involves the chemical and bacteriological analysis of water from different sources i.e., bore, wells, bottle, and tap, from Peshawar, Mardan, Swat and Kohat districts of Khyber Pakhtunkhwa (KP) province, Pakistan. From each district, 50 water samples (10 samples from each source), regardless of urban and rural status, were collected from these sources and analysed for sulphates, nitrates, nitrites, chlorides, total soluble solids and coliforms (E. coli). Results indicated that majority of the water sources had unacceptable E. coli count i.e.> 34 CFU/100mL. E. coli positive samples were high in Mardan District, followed by Kohat, Swat and Peshawar district. Besides this, the some water sources were also chemically contaminated by different inorganic fertilizers (nitrates/nitrites of sodium, potassium) but under safe levels whereas agricultural and industrial wastes (chloride and sulphate compounds) were in unsafe range. Among all districts, the water quality was found comparatively more deteriorated in Kohat and Mardan districts than Peshawar and Swat districts. Such chemically and bacteriologically unfit water sources for drinking and can cause human health problems.

Antibacterial activity of Ricinus communis plant extract against antibiotic resistant Helicobacter pylori and Gluconobacter oxydans isolated from fresh apple juices samples

Bacteria were isolated from samples of Fresh Apple juices from shops of three different localities of Lahore. Analysis of samples from Liberty, Anarkali and Yateem khana Markets show different levels of contamination. There were pathogenic and non-pathogenic bacteria in all samples and were identified by the morphological and biochemical tests. Most of the plasmids of pathogenic bacteria were 4kb in their molecular size. Ribotyping of 16S ribosomal RNA gene sequencing was done to confirm Helicobacter pylori strain and Gluconobacter oxydans. The highest sensitivity of 210mm was shown by Enterobacter sp. against Aztheromysine disk (15µg) while Micrococcus sp. was highly resistant against all of the Antibiotics applied. The antibiotic resistance of pathogenic bacteria was also checked against Ricinus communis plant's extracts, all isolated bacterial pathogens were resistant but only, E.coli was inhibited at 300µl of the extracts. Presence of pathogenic bacteria in Apple juice samples was due to contamination of sewage water in drinking water while some of these pathogenic bacteria came from Apple's tree and other from store houses of fruits.

Self-Assembly of DNA molecules in magnetic Fields

In this work, a rich variety of self-assembled DNA patterns were obtained in the magnetic field. Herein, atomic force microscopy (AFM) was utilized to investigate the effects of the concentration of DNA solution, intensity and direction of magnetic field and modification of mica surface by different cations on the self-assembly of DNA molecules. It was found that owning to the change of the DNA concentration, even under the same magnetic field, the DNA self-assembly results were different. Thein situtest results showed that the DNA self-assembly in an magnetic field was more likely to occur in liquid phase than in gas phase. In addition, whether in a horizontal or vertical magnetic field, a single stretched dsDNA was obtained in a certain DNA concentration and magnetic field intensity. Besides, the modification of cations on the mica surface significantly increased the force between the DNA molecules and mica surface, and further changed the self-assembly of DNA molecules under the action of magnetic field.

Synthesis of Thiol-Modified Hemicellulose, Its Biocompatibility, Studies, and Appraisal as a Sustained Release Carrier of Ticagrelor

Background: Nature has always been considered as the primary source of pharmaceutical ingredients. A variety of hemicelluloses, as well as their modified forms, have been under investigation. Herein, a study was designed to explore the biocompatibility of hemicellulose and its modified form (thiolated hemicellulose) as well as its potential as a pharmaceutical excipient. Method: For thiol modification thiourea was used as the thiol donor, HCl as the catalytic reagent, and methanol was used for washing purposes. Modified polymers were characterized for physicochemical characteristics, including surface morphology, the amorphous or crystalline nature of the particles, modification of polymer by FTIR, and biocompatibilities. For acute oral toxicity study, a single dose of 2 g/kg was administered to albino rats of 200 g average weight (n = 3). Polymers were evaluated as pharmaceutical excipients by preparing compressed tablets of antiplatelet drug (Ticagrelor), followed by various quality control tests, such as swelling index, thickness and diameter, disintegration, and in-vitro drug release. Results: From the results, it was observed that thiol modification has been successfully accomplished as characteristic peaks belonging to -SH group appeared at 2667.7691 cm-1 in FTIR scan. The modified polymer was found safe in the use concentration range, confirming their safe use for in vivo analysis. No significant effect has been observed in the behavior, biological fluid (blood), or on vital organs. Thiolated hemicellulose was found to be an excellent drug retarding polymer as 8 h of dissolution studies showed that 67.08% of the drug has been released. Conclusion: Conclusively, incorporation of thiol moiety made the polymer more mucoadhesive with, and a worthy carrier of, the drug with good biocompatibilities.

Synthesis and Evaluation of Thiol-Conjugated Poloxamer and Its Pharmaceutical Applications

The current study was designed to convert the poloxamer (PLX) into thiolated poloxamer (TPLX), followed by its physicochemical, biocompatibilities studies, and applications as a pharmaceutical excipient in the development of tacrolimus (TCM)-containing compressed tablets. Thiolation was accomplished by using thiourea as a thiol donor and hydrochloric acid (HCl) as a catalyst in the reaction. Both PLX and TPLX were evaluated for surface morphology based on SEM, the crystalline or amorphous nature of the particles, thiol contents, micromeritics, FTIR, and biocompatibility studies in albino rats. Furthermore, the polymers were used in the development of compressed tablets. Later, they were also characterized for thickness, diameter, hardness, weight variation, swelling index, disintegration time, mucoadhesion, and in vitro drug release. The outcomes of the study showed that the thiolation process was accomplished successfully, which was confirmed by FTIR, where a characteristic peak was noticed at 2695.9968 cm⁻¹ in the FTIR scan of TPLX. Furthermore, the considerable concentration of the thiol constituents (20.625 µg/g of the polymer), which was present on the polymeric backbone, also strengthened the claim of successful thiolation. A mucoadhesion test illustrated the comparatively better mucoadhesion strength of TPLX compared to PLX. The in vitro drug release study exhibited that the TPLX-based formulation showed a more rapid (p < 0.05) release of the drug in 1 h compared to the PLX-based formulation. The in vivo toxicity studies confirmed that both PLX and TPLX were safe when they were administered to the albino rats. Conclusively, the thiolation of PLX made not only the polymer more mucoadhesive but also capable of improving the dissolution profile of TCM.

P183 Osteitis condensans ilii or axial spondyloarthritis: a diagnostic challenge!

Background/Aims 

Osteitis condensans ilii (OCI) is a rare cause of chronic non-inflammatory axial lower back pain. It has become an important differential diagnosis of axial spondyloarthritis. Bone marrow oedema can be present in 48% of patients. Although 'aunt minnie' appearance on MRI is pathognomonic, specialised imaging like SPECT/PET CT can be considered in difficult cases to confirm the diagnosis. We reviewed case notes of patients with incidental diagnosis of OCI on imaging and followed their clinical progression to see if the diagnosis was modified later.

Methods 

Retrospective radiological database analysis was performed to find imaging reported as OCI or osteitis from 2015-2020. Electronic patient records were analyzed and data was compiled through Microsoft Excel.

Results 

Data from 24 patients was reviewed. Most patients were females (91.7%), with a median age of 43 years (range 19-79 years). CT and MRI were the chief modalities of imaging (46% and 38% respectively) while 20% had plain x-rays of the pelvis. The main indications for imaging were pelvic or hip girdle pain (58.3%), cancer surveillance (25%), abdominal pain (6%), and infection (6%). 20% had an underlying rheumatological diagnosis of which 8% had spondyloarthritis. 12.5% of patients had seronegative features of spondyloarthritis and 8.3% were HLA B27 positive. Approximately 40% of patients were seen by the Rheumatology team for further assessment after imaging and 12.5% of patients were diagnosed with axial spondyloarthritis and remained under follow-up.

Conclusion 

OCI can mimic sacroiliitis on imaging. Although only a minority of patients with OCI reported on initial imaging were subsequently diagnosed with axial spondyloarthritis, thorough clinical assessment and multidisciplinary discussion can reduce the chance of a missed axial spondyloarthritis diagnosis. Further large-scale studies are required to find the exact incidence of spondyloarthritis in patients with imaging features of OCI.

Disclosure 

S. Saeed: None. M. Jamal: None. D. Ostry: None. G. Robinson: None. R. Sengupta: None.

Does number of volumes affect regional deformation measurements when using volume stitched 3D speckle tracking?

Funding Acknowledgements

Type of funding sources: None.

Background

Optimal 3D speckle tracking echocardiography (STE) requires volume stitching, a technique prone to errors, such as patient movements, respiration and arrhythmias. With different resolution at different depths (Figure 1A), such errors may cause stitching artefacts that affect STE derived deformation measurements at different levels of the left ventricle.

Methods

In this cross-sectional study, 62 patients with variable degree of aortic stenosis participated. 3D images were recorded using 3 different methods (2-, 4- and 6-beat volume stitching at 22 ± 2, 29 ± 4 and 36 ± 6 volumes per second, respectively). Strain, rotation and torsion were analyzed at 3 different levels (basal, mid and apical) (Figure 1B). Results were compared using one-way analysis of variance between methods. Inter-segmental variation was estimated using the coefficient of variation (CV) of the segments involved for each level. Results were interpreted as more accurate if low values of inter-segmental variation between segments in a level was present.

Results

Neither longitudinal strain (LS) nor circumferential strain (CS) showed any difference between methods in the basal level (Table 1). LS was higher in mid and apical level for 2-beat, while CS was higher only in apical level for 2-beat.

Inter-segmental CV showed no significant difference between methods for LS and CS. Between levels, both had higher CV in basal than apical level, but CS had much higher values, indicating lower accuracy in basal level.

Rotation measurements showed negative values in basal level and positive in apical level. None of the methods differed significantly. Torsion showed higher values for 2 beat images only.

Conclusion

3D STE from both 4- and 6 beat images have insignificant differences for strain, as well as low inter-segmental variability. LS is accurate in all levels while CS has high accuracy in apical, and poor in basal level. Both rotation and torsion differ insignificantly when using 4- and 6-beat images.

Table 1 Level Mean ± SD ANOVA P CV 2-beat 4-beat 6-beat 2-beat 4-beat 6-beat Longitudinal strain (%) Basal -17.82 ± 4.83 -16.81 ± 4.48 -17.05 ± 3.56 0.402 34.5 34.9 31.5 Mid -16.34 ± 4.30 -14.91 ± 3.62 -14.46 ± 3.53 0.019 31.4 29.9 29.9 Apical -16.80 ± 4.33 -15.06 ± 3.12 -15.09 ± 3.02 0.008 30.6 28.5 24.9 Circumferential strain (%) Basal -12.93 ± 4.42 -14.16 ± 4.21 -13.05 ± 3.24 0.168 106.7 71.7 74.4 Mid -17.59 ± 3.86 -16.73 ± 3.56 -16.98 ± 3.51 0.406 43.0 36.9 30.3 Apical -22.14 ± 6.20 -19.04 ± 4.81 -20.32 ± 5.40 0.008 26.8 29.4 23.4 Abstract Figure 1

Synthesis and characterization of thiol modified beta cyclodextrin, its biocompatible analysis and application as a modified release carrier of ticagrelor

Thiol modification of beta cyclodextrin (β-CD) was carried out using thiourea, which served as a thiol donor. The chemical reaction was mediated using HCl. Polymer prepared via thiolation was further subjected to physicochemical and biocompatible analysis. Acute oral toxicity and compatibility was determined in albino rats. Furthermore, compressed tablets of ticagrelor (TCG) were prepared using modified and unmodified polymers and evaluated via various quality control tests. Thiolation was successfully achieved and confirmed by the FTIR scan, as a significant corresponding peak was observed at 2692 cm^-1 wavenumber, demonstrating the attachment of -SH group. In vivo analysis has confirmed the safe use of β-CD, as none of the vital organs showed any kind of toxic effects. Dissolution studies revealed that Tβ-CD was able to release 96.62% of the drug within 1 h of the study, hence providing an immediate release. Conclusively, a thiol moiety was successfully attached to the polymeric backbone and was found safe to be used as a pharmaceutical excipient.

Demographic characteristics, aortic valve intervention rates and all-cause mortality in 4 flow-gradient sub-types of severe aortic stenosis

Introduction

Severe aortic stenosis (AS), defined as aortic valve area (AVA) &lt;1.0 cm2, can be divided into 4 categories based on flow status and mean gradient. Stroke volume index &lt;35 ml/m2 has classically been used to define low flow, but recent data suggest that flow rate (FR) &lt;200ml/sec may be a more accurate and robust marker of low flow.

Methods

We prospectively collected demographic, echocardiographic, aortic valve intervention (AVI) and all-cause mortality data on 1562 patients with symptomatic severe AS from 2010 to 2017 with a mean follow up period of 35±22 months. Patients were divided into 4 flow-gradient sub-groups based on a FR threshold of 200ml/s and mean pressure gradient of 40mmHg. Comparative analyses were performed among the 4 groups using analysis of variance.

Results

The prevalence of normal flow high gradient (NFHG) severe AS was 30%, NF low gradient (NFLG) 21%, low flow HG (LFHG) 18% and LFLG 31% (Table). Across these 4 sub-groups, there was a graded reduction in LVEF and FR, and an increase in age and all–cause mortality.

Conclusions

Classification of aortic stenosis based on flow-gradient patterns, shows important differences in the demographic profile and clinical outcome among the 4 groups. Classical NFHG AS was associated with the highest rate of AVI and lowest all-cause mortality compared to the 3 discordant flow-gradient subtypes. The LFLG group had the lowest AVI rates and worst outcome.

Funding Acknowledgement

Type of funding source: None

The tricuspid annular peak systolic excursion to systolic pulmonary artery pressure index: association with all-cause mortality in patients with moderate or severe tricuspid regurgitation

Background

In patients with significant tricuspid regurgitation (TR) the conventional markers for the assessment of right ventricular (RV) systolic function may be less accurate. Tricuspid annular plane systolic excursion (TAPSE) indexed to systolic pulmonary artery pressure (SPAP) (TAPSE/SPAP) may be prognostically useful in pulmonary hypertension and right ventricular (RV) dysfunction.

Objective

Our aim was to explore the prognostic value of TAPSE/SPAP index in patients with moderate or severe TR.

Methods

A total of 209 patients (72±14 years, 56% women) with moderate (n=123) or severe (n=86) TR (primary in 6% and secondary in 94%) were followed up for a median of 80 months (mean 70±33 months). The clinical correlates of TAPSE/SPAP ratio and association with all-cause mortality were assessed.

Results

The TAPSE/SPAP index was inversely correlated with all-cause mortality with an optimal threshold of 0.49 mm/mmHg. A low index was found in 139 (68%) patients and was associated with reduced survival (Figure). In a multivariate Cox regression analysis adjusted for age, smoking, coronary artery disease, left ventricular ejection fraction, right atrium area and mitral valve replacement, low TAPSE/SPAP index was associated with significantly higher hazard ratio of all-cause mortality (HR: 2.0; 95% CI 1.27–3.14, p=0.003). Age, coronary artery disease, left ventricular ejection fraction and right atrium area were other independent predictors of all-cause mortality.

Conclusions

The TAPSE/SPAP index, reflecting RV systolic function in the longitudinal axis corrected for force generating by the RV is a powerful predictor of all-cause mortality in patients with moderate or severe TR.

Figure 1

Funding Acknowledgement

Type of funding source: None

AB0736 SEVERITY OF NAIL PSORIASIS SCORE (SNAPS) IS SENSITIVE TO CHANGE IN A COHORT OF PATIENTS WITH PSORIATIC ARTHRITIS TREATED WITH ETANERCEPT

Background:

The Severity of Nail Psoriasis Score (SNAPS; range 0-40: scored one point each for the presence of pitting, onycholysis, hyperkeratosis and/or severe nail disease#in each fingernail) has been utilised to collect data regarding psoriatic nail dystrophy in the Bath Psoriatic Arthritis (PsA) Longitudinal cohort for many years. SNAPS has construct validity in PsA with the modified Nail Psoriasis Severity Index (mNAPSI) as a comparator instrument and appears to be more feasible than mNAPSI with excellent reliability1.

Objectives:

We aimed to determine if SNAPS could demonstrate longitudinal sensitivity to change in a cohort of patients treated with biological disease modifying anti-rheumatic drugs (bDMARDs) and therefore be utilized prospectively in observational and clinical trial settings.

Methods:

Patients enrolled in the Bath PsA longitudinal cohort routinely undergo clinical assessments including a 66/68 Swollen and Tender Joint Count (SJC/TJC), Psoriasis Area Severity Index (PASI), Patient Global Assessment (PtGA) and Physician Global Assessment (PhGA), as well as complete patient-reported outcome measures such as the Health Assessment Questionnaire (HAQ) and Dermatology Quality of Life (Derm-QoL). All patients who commenced treatment with Etanercept and had available outcome data at baseline, 3 months and 6 months were included in this retrospective analysis. Baseline demographics were recorded and paired t-tests were utilized to assess the change in SNAPS at 3 and 6 months. The effect size and measurement error of SNAPS in this cohort were measured. Correlations between SNAPS and other outcome measures were assessed using Pearson’s r.

Results:

Fifty-seven patients (32 male and 25 female) with available data were retrospectively analysed. The mean (±SD) age of the cohort and duration of disease was 61.3 (±11.55) and 13.3 (±10.82) years respectively. The mean SNAPS at baseline was 3.7 (±6.13) and improved to 2.0 (3.74, p=0.018) at 3 months and 1.2 (2.40) at 6 months (p=0.001 for change from baseline and p=0.039 for change from month 3). The smallest detectable difference at 3 months for SNAPS in this cohort was 1.35, representing 3.37% of the range of the score (Table 2). The standardised response mean (SRM) was 0.32 at 3 months and 0.44 at 6 months. There was a modest correlation between the improvement in the SNAPS score and the improvement in PASI and Derm QOL at 3 months (r = 0.511 and 0.558 respectively, p=0.001) and 6 months (r= 0.672, p<0.001 and r=0.510, p=0.003 respectively).

Conclusion:

SNAPS demonstrates sensitivity to change in response to treatment with a bDMARD and could be a potential outcome measure for the assessment of treatment efficacy in prospective studies.

References:

[1]Antony A, Hart D, Cavill C, Korendowych E, McHugh N, Lovell C, Tillett W. The ‘Severity of Nail Psoriasis Score’ (SNAPS) Is Feasible, Reliable and Demonstrates Construct Validity Against the mNAPSI in an Observational Cohort of Patients with Psoriatic Arthritis [abstract].Arthritis Rheumatol.2019; 71 (suppl 10).

Table 1.

Outcomes at Baseline, 3 months and 6 months

Mean (SD) or Median [IQR]Baseline3 Months(p for change from baseline)6 Months(p for change from baseline)PASI (0-72)3.0 (4.80)1.6 (2.12) p=0.011.3 (1.6) p=0.002SNAPS (0-40)3.7 (6.13)2.0 (3.73) p=0.0181.2 (2.39) p=0.001Derm-QoL (0-30)5.7 (7.07)1.95 (3.23) p=0.001 (n=33)1.9(4.72) p=0.037 (n=31)Table 2.

Measurement Error for SNAPS in an Etanercept Cohort

TimeframeStandardised Response MeanStandard Error of MeanSmallest Detectable ChangeSmallest Detectable Change (% of total score)Smallest Detectable DifferenceSmallest Detectable Difference (% of total score)0-3 months0.320.691.914.771.353.370-6 months0.440.742.065.151.463.64

Disclosure of Interests:

Anna Antony: None declared, Sadaf Saeed: None declared, Darren Hart: None declared, Preeti Nair: None declared, Charlotte Cavill: None declared, Eleanor Korendowych: None declared, Neil McHugh: None declared, Christopher Lovell: None declared, William Tillett Grant/research support from: AbbVie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer Inc, UCB, Consultant of: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, MSD, Pfizer Inc, UCB, Speakers bureau: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, Pfizer Inc, UCB

AB0735 SEVERITY OF NAIL PSORIASIS SCORE (SNAPS) DEMONSTRATES LONGITUDINAL CONSTRUCT VALIDITY AGAINST THE MODIFIED NAIL PSORIASIS SEVERITY INDEX (mNAPSI) IN AN OBSERVATIONAL COHORT OF PATIENTS WITH PSORIATIC ARTHRITIS

Background:

Longitudinal observational data on psoriatic nail dystrophy is scarce, in part due to the lack of a validated outcome measure that is feasible in routine care. The Severity of Nail Psoriasis Score (SNAPS; range 0-40: scored one point each for the presence of pitting, onycholysis, hyperkeratosis and/or severe nail disease#in each fingernail) has face validity and has recently demonstrated feasibility, reliability and cross-sectional construct validity against the modified Nail Psoriasis Severity Index (mNAPSI; range 0-130)1.

Objectives:

We aimed to assess the longitudinal construct validity of SNAPS against the mNAPSI and physician nail VAS (PhNVAS), and to determine the effect size and measurement error of these tools.

Methods:

Consenting consecutive patients enrolled in the Bath Psoriatic Arthritis (PsA) longitudinal cohort underwent photography of their fingernails at baseline1and 6 months alongside routine clinical assessments. Dorsal images of individual fingernails were acquired using a tripod mounted DSLR camera. An angled mirror positioned distally aided identification of hyperkeratosis. Photograps were scored using SNAPS, mNAPSI and PhNVAS1. Paired statistical analyses were conducted to assess for change in scores from baseline to follow-up. Pairwise correlations between change in SNAPS and change in mNAPSI and PhyNVAS were assessed using Spearman’s rho. Effect sizes and measurement error were calculated.

Results:

Fifteen patients with a mean (±SD) age of 54.5 (±10.59) were assessed at 6 months. There was a significant reduction in both the mNAPSI and SNAPS scores (p<0.005), with improvements in the most frequently-observed manifestations1i.e. pitting, onycholysis, hyperkeratosis and crumbling (Table 1). No other feature specific to mNAPSI improved over time. There was no significant change using the PhyNVAS. There was a strong correlation between changes in SNAPS and the mNAPSI (Figure 1; rho = 0.838, p<0.001). The correlation between change in SNAPS and PhyNVAS was not statistically significant (rho =0.45, p=0.095) (Figure 1). The change in mNAPSI correlated moderately with the PhNVAS (rho = 0.540, p=0.038). mNAPSI was superior to SNAPS in most parameters of measurement error (Table 2). The mNAPSI and SNAPS had similar effect sizes as measured by the SRM (Table 2).

Conclusion:

SNAPS demonstrates longitudinal construct validity against the mNAPSI in a small observational cohort of PsA patients as evidenced by a strong correlation between the measures, comparable effect sizes and sensitivity to change over time. Whilst measurement error parameters favored the mNAPSI, SNAPS may be a more feasible measure for studying nail disease in cohort studies.

References:

[1]Antony A, Hart D, Cavill C, Korendowych E, McHugh N, Lovell C, Tillett W. The ‘Severity of Nail Psoriasis Score’ (SNAPS) Is Feasible, Reliable and Demonstrates Construct Validity Against the mNAPSI in an Observational Cohort of Patients with Psoriatic Arthritis [abstract].Arthritis Rheumatol.2019; 71 (suppl 10).

Table 1.

Outcomes at Baseline and at Follow-Up:

OutcomeMean (SD) or Median (IQR) N=15t-test or Wilcoxon Sign Rank test (p-value)BaselineFollow-upSNAPS13.0 [8.00-21.00]5.0 [2.00-11.00]0.002*mNAPSI22.0 [12.00-35.00]6.0 [4.00-15.00]0.001*Physician Nail VAS23.3 (22.90)15.8 (15.22)0.147Physician Global VAS18.0 [10.75-32.75]15.0 [10.00-30.00]0.455Table 2.

Measurement error of SNAPS, mNAPSI, PtNVAS and PhyNVAS

SRMSEMSDCSDC % (% of total score)SDDSDD% (% of total score)SNAPS1.151.716.7216.793.368.40mNAPSI1.153.5113.7410.576.875.29Physician Nail VAS0.404.7118.4714.219.237.10Figure 1.

Correlation between changes in SNAPS and changes in mNAPSI

Disclosure of Interests:

Anna Antony: None declared, Sadaf Saeed: None declared, Darren Hart: None declared, Preeti Nair: None declared, Charlotte Cavill: None declared, Eleanor Korendowych: None declared, Neil McHugh: None declared, Christopher Lovell: None declared, William Tillett Grant/research support from: AbbVie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer Inc, UCB, Consultant of: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, MSD, Pfizer Inc, UCB, Speakers bureau: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, Pfizer Inc, UCB

1250 Agrypnia Excitata in a Patient with Paraneoplastic Autoimmune Encephalitis

Introduction

Agrypnia Excitata (AE) is a syndrome characterized by loss of sleep with permanent motor and autonomic hyper activation. This case describes this peculiar syndrome in a patient with paraneoplastic autoimmune encephalitis.

Report of Case

DG is a 35 yr old male with a history of anti-Ma2 limbic encephalitis secondary to cystic teratoma of the left testis diagnosed 6 months prior to presenting in Sleep Clinic. His parents described significant sleep disturbances including short sleep and wake periods throughout the day and night with no apparent pattern, acting out dreams, motor activity during sleep including pulling at his clothes or using his hands to manipulate invisible objects. Additionally they described low-grade fevers, and severe hyperphagia. Polysomnogram showed absence of slow-wave sleep and what appeared to be an admixture of stage 1 non-rapid eye movement (NREM) with rapid-eye movement (REM) sleep. Multiple sleep-latency testing (MSLT) demonstrated a mean sleep latency of 5.2 minutes and four sleep-onset REM periods (SOREMPs). Magnetic resonance imaging of the brain revealed persistent inflammation of the mesial temporal lobes and hippocampal region. Cerebral spinal fluid testing showed persistent anti-Ma2 antibodies. Based on this clinical presentation we made a diagnosis of Agrypnia Excitata.

Conclusion

Agrypnia Excitata is a syndrome characterized by loss of the normal sleep-wake rhythm. Sleep consists of the disappearance of spindle-delta activities, and persistent stage 1 NREM sleep mixed with recurrent episodes of REM sleep. The second hallmark of AE is persistent motor and autonomic hyperactivity observed during wake and sleep. AE has been described in three distinct clinical syndromes: Morvan Syndrome (autoimmune encephalitis), Fatal Familial Insomnia, and Delirium tremens. The pathogenesis of AE consists of intra-limbic disconnection releasing the hypothalamus and brainstem reticular formation from cortico-limbic inhibitory control. In autoimmune encephalitis, antibodies that act on voltage-gated potassium channels within the limbic system have been implicated in the pathophysiology.

P285 Using FITBITR for fitness monitoring in patients attending the AS residential course at RNHRD: it does make a difference!

Background

Wearable technology has become a very popular tool in fitness training. It empowers people to be in charge of their own health and encourages them to exercise more. At the Royal National Hospital for Rheumatic Diseases we have been offering dedicated inpatient courses for management of spondyloarthropathy patients. Historically this course has helped patients with chronic arthritis to improve their physical well being while also focusing on different extra articular aspects of their condition like fatigue, sleep and pain issues. As part of this programme, we provided patients with Fitbit devices to evaluate whether regular recording of their activity and sleep tracking had an impact on their overall physical activity.

Methods

Patients attending the 2 weeks’ residential course from July 2018 to June 2019 were provided with Fitbit devices and were given a paper chart to log their data in. The patients gave verbal permission for their data to be included for audit purposes. The demographic data regarding the patients was collected through electronic patient record system. Bath indices were collected from electronic patient record system and results were compiled through Microsoft Excel.

Results

Data from 42 patients was collected. Data from 38 patients was analysed. Data for sleep indices was incomplete in 16 patients. 67% participants on the course were male and 33% were female. 90% patients had a diagnosis of ankylosing spondylitis, 5% had nonradiographic SpA and the rest had PsA or undifferentiated SpA. Majority of patients (97%) had improvement in their BASMI scores with a mean improvement of 37%. 51% patients improved their physical activity with an average increase in their step count by 13.3% compared to baseline. The participants on average spent 55.67 minutes being active on the course. While resting, majority of patients spent more time being awake or in light sleep (mean 14.3% and 54% respectively) although it might have been confounded by their stay in hospital. The verbal feedback from patients regarding the use of these devices has been mostly positive and it encouraged them to be more active.

Conclusion

Majority of patients attending the residential course noticed an improvement in their arthritis. The verbal feedback on using Fitbit devices to track daily activity and sleep was positive as it encouraged patients to increase their activity and improve sleep hygiene in future. Further refinement in data collection process and including other variables like pain, stiffness and fatigue scores can be valuable in a more focused discussion regarding management strategies of spondyloarthritis.

Disclosures

M. Jamal None. S. Saeed None. E. Clarke None. R. Sengupta None.

Phlebotomy resulting in controlled hypovolaemia to prevent blood loss in major hepatic resections (PRICE-1): a pilot randomized clinical trial for feasibility

BACKGROUND

Major liver resection is associated with blood loss and transfusion. Observational data suggest that hypovolaemic phlebotomy can reduce these risks. This feasibility RCT compared hypovolaemic phlebotomy with the standard of care, to inform a future multicentre trial.

METHODS

Patients undergoing major liver resections were enrolled between June 2016 and January 2018. Randomization was done during surgery and the surgeons were blinded to the group allocation. For hypovolaemic phlebotomy, 7-10 ml per kg whole blood was removed, without intravenous fluid replacement. Co-primary outcomes were feasibility and estimated blood loss (EBL).

RESULTS

A total of 62 patients were randomized to hypovolaemic phlebotomy (31) or standard care (31), at a rate of 3·1 patients per month, thus meeting the co-primary feasibility endpoint. The median EBL difference was -111 ml (P = 0·456). Among patients at high risk of transfusion, the median EBL difference was -448 ml (P = 0·069). Secondary feasibility endpoints were met: enrolment, blinding and target phlebotomy (mean(s.d.) 7·6(1·9) ml per kg). Blinded surgeons perceived that parenchymal resection was easier with hypovolaemic phlebotomy than standard care (16 of 31 versus 10 of 31 respectively), and guessed that hypovolaemic phlebotomy was being used with an accuracy of 65 per cent (20 of 31). There was no significant difference in overall complications (10 of 31 versus 15 of 31 patients), major complications or transfusion. Among those at high risk, transfusion was required in two of 15 versus three of nine patients (P = 0·326).

CONCLUSION

Endpoints were met successfully, but no difference in EBL was found in this feasibility study. A multicentre trial (PRICE-2) powered to identify a difference in perioperative blood transfusion is justified. Registration number: NCT02548910 ( http://www.clinicaltrials.gov).

P2650Antihypertensive treatment with calcium channel blockers in patients with moderate or severe aortic stenosis: relationship with all-cause mortality

Background

Hypertension is prevalent in patients with aortic stenosis (AS) and optimal blood pressure (BP) control is advised to reduce arterial load and avoid cardiovascular events. Whether calcium channel blockers (CCB) are safe is not known.

Methods

A total of 314 patients (age 65±12 y, 68% men) with moderate or severe asymptomatic AS were included.

Results

The prevalence of hypertension was 73.6%, and 65% took antihypertensive treatment. Patients who used a CCB (25%) (CCB+) were older, had higher clinic systolic BP, were more likely to have hypercholesterolemia and coronary artery disease (CAD), and to use a diuretic or alpha blocker compared to CCB- patients (all p<0.05) (Table). During the baseline ETT, patients who used a CCB achieved a lower peak heart rate, a shorter exercise time and were more likely to have a blunted BP response compared to those who did not use a CCB (all p<0.05) (Table). Event-free survival was significantly lower in CCB+ than CCB- patients (Fig) (all-cause mortality 16 [20.3%] versus 13 (5.6%); p<0.001). In a multivariable Cox regression model, CCB+ was associated with a 6.8-fold increased hazard ratio (HR) for all-cause mortality (HR 6.77 95% CI 1.66–27.54, p=0.008), independent of age, gender, systolic BP, hypertension, diabetes, CAD, hypercholesterolemia and aortic valve area.

Table 1. Baseline characteristics of patients CCB− (n=234) CCB+ (n=80) p Age, y 64±12 70±10 <0.001 CAD, % 45 66 0.006 Hypercholesterolemia, % 62 78 0.015 Clinic systolic BP, mmHg 139±19 150±17 <0.001 Left atrial diameter, cm 3.7±0.7 3.9±0.6 0.007 LV end-diastolic diameter, cm 4.5±0.7 4.8±0.6 0.002 LV mass index, g/m2.7 50±17 57±17 0.007 Aortic valve area, cm2 0.94±0.22 0.93±0.22 0.716 LV stroke work, g-m/bmp 155±46 175±69 0.046 Peak HR at baseline ETT, bmp 138±24 120±25 <0.001 Blunted BP response, % 33 49 0.013 Exercise duration, min 10.1±4.5 8.3±3.7 0.001 Double Product, mmHg·bmp 1.85±0.43 2.08±0.54 <0.001

Figure 1

Conclusion

The use of calcium channel blockers was associated with an adverse effect on treadmill exercise and reduced survival in apparently asymptomatic patients with moderate or severe AS.

Acknowledgement/Funding

None

P1497Reversible exercise-induced left ventricular dysfunction in symptomatic patients with previous Takotsubo syndrome - Insights from exercise echocardiography

Introduction

Takotsubo syndrome (TTS) is an acute heart failure syndrome usually associated with rapid and spontaneous recovery of left ventricular (LV) function. However, approximately 10% of patients have persistent symptoms and seek further medical advice.

Purpose

To determine the cardiovascular haemodynamic and LV contractile response to exercise in these TTS survivors with ongoing symptoms.

Methods

This was a case-control study of 20 symptomatic patients with previous TTS referred for treadmill exercise echocardiography (EE), and 20 age-, sex- and ethnicity-matched control subjects with normal treadmill EE. Among the TTS group, EE was performed at a median of 8 months (mean 17±21 months) following the index event. Demographic characteristics, resting and EE data were collected. LV ejection fraction (EF) was measured at rest and peak stress. Global longitudinal and circumferential strain (GLS, GCS) were measured at rest.

Results

All 20 TTS patients were Caucasian postmenopausal females (mean age 63.5±6.6 years). There were no significant differences in body mass index (BMI), resting heart rate (HR) and the prevalence of cardiovascular risk factors compared to controls. Resting systolic and diastolic blood pressure (SBP, DBP) were higher in TTS patients (144±17 mmHg versus 128±18 mmHg, and 81±10 mmHg versus 74±9 mmHg, respectively). A comparative analysis of the resting and stress echo data is given in Table 1. The stress echo data showed similar exercise time and peak HR, but higher peak SBP in TTS patients. TTS patients had blunted contractile response to exercise with lower peak LVEF, ΔLVEF (exercise minus resting EF) and peak wall motion score index (WMSI) compared to controls. Among the 20 TTS patients, 12 had exercise-induced wall motion abnormalities: 6 involved the apical segments and 6 developed global dysfunction. In these 12 patients, the mean ΔLVEF was reduced (4%). In the other 8 patients, the ΔLVEF was 16% and pooled the TTS cohort had blunted contractile response with exercise compared to controls (ΔLVEF 8% vs. 19% in the control group, p=0.001).

Table 1

Conclusions

Our study shows that symptomatic patients with previous TTS have a blunted contractile response to exercise manifest as reversible apical or global LV dysfunction. These findings might indicate the need for treatment. Further systematic investigation of the therapeutic and prognostic implications of this reversible exercise-induced myocardial dysfunction is needed.

Effect of fitness on cardiac structure and function in overweight and obesity (the FATCOR study)

BACKGROUND AND AIMS

Obesity is associated with reduced left ventricular (LV) systolic myocardial function. We aimed to explore by means of a cross-sectional study whether this effect is offset in the presence of good fitness.

METHODS AND RESULTS

We studied clinical and echocardiographic data from 469 overweight (body mass index [BMI] >27 kg/m²) and obese (BMI ≥30 kg/m²) women and men without known cardiovascular (CV) disease in the FAT associated CardiOvasculaR dysfunction (FATCOR) study. The participants were grouped according to obesity and sex- and age adjusted peak oxygen uptake, obtained by ergospirometry. LV systolic myocardial function was assessed by peak systolic global longitudinal strain (GLS) measured by speckle tracking echocardiography. The association of fitness with GLS was tested in logistic regression analyses and reported as odds ratio (OR) with 95% confidence interval (CI). In the total study population, participants were 47 years old, 60% were women, and mean BMI was 32.0 kg/m². GLS did not differ between fit and unfit subjects within the overweight and obese groups (both p > 0.05), but the overweight fit group had higher GLS (more negative value) compared to the obese unfit group (-20.1 ± 2.6 vs. -19.0 ± 3.0, p < 0.05). In obese subjects, fitness was associated with higher GLS (OR 0.88 [95% CI 0.79-0.99, p < 0.05) in multivariable logistic regression analysis, independent of significant associations with higher arterial stiffness and lower fat percentage (all p < 0.05). In the overweight group, fitness was not significantly associated with GLS.

CONCLUSION

In obesity, fitness was independently associated with higher GLS, while no association was found in overweight.

CLINICAL TRIAL REGISTRATION

URL: http://www.clinicaltrials.govNCT02805478.

P41 Endoscopy in cerebellopontine angle lesions: feasibility and technical considerations

Objectives

To define selection criteria and describe technique nuances for the use of endoscopy in surgery for cerebello-pontine angle (CPA) lesions.

Design

Prospective observational study.

Subjects

Patients undergoing CPA lesion resection were selected for endoscope-assisted and/or endoscope-guided lesion resection.

Methods

CPA interventions without mass lesions were excluded. 10 CPA lesions were identified pre-operatively for intra-operative endoscopic use across two neurosurgical centres. We describe equipment and technique selection.

Results

10 cases were selected over a one year period. Histology revealed 3 vestibular schwannomas (VS) (30%), 1 cyst (10%), 3 epidermoids (30%), 3 meningiomata (30%). Three cases were planned and carried out fully endoscopically (including two VS and the cyst) based on patient factors and favourable anatomy. Four cases were carried out with endoscopic assistance. The endoscope was used in three cases for anatomical orientation ‘around the corner’ only. Techniques and equipment vary depending on surgical aims, surgical anatomy and working area. Tips and pitfalls are identified and described.

Conclusions

Endoscopy can be applied safely in CPA pathologies, as an alternative to the operating microscope for highly selected cases, or as an adjunct for specific surgical steps, especially when microscope optics do not allow angled visualisation. It is particularly useful in identifying lesion residuum and ‘working around the corner’. High level training is required before applying endoscopy to the CPA.

Abstract P3-03-10: Pre-operative lymphoscintigraphy for sentinel lymph node localisation: Is it necessary?

Introduction

Sentinel lymph node biopsy (SLNB) has replaced lymph node clearance for staging of the axilla in patients with early invasive breast cancer and no evidence of lymph node involvement on ultrasound or needle biopsy. It is recommended that a dual technique, using isotope and blue dye, is used to locate the sentinel lymph node (SLN) intra-operatively. Often, at the time of radioisotope injection, a lymphoscintigram (nuclear medicine scan) is obtained to demonstrate the 'hot' sentinel lymph node with or without skin marking of its anatomical position.

Performing a lymphoscintigram adds time and cost to the localisation process. In our centre, this investigation costs £899-999 (˜US $1180-1300).

Aims

The aim of this study is to find out whether obtaining a pre-operative lymphoscintigram aids the surgeon in the localisation of the SLN or affects the number of sentinel lymph nodes biopsied in the axillary staging of patients with early invasive breast cancer.

Methods

We carried out a retrospective study of patients who underwent SLNB for breast cancer in our hospital Trust between March 2012 and November 2017. We identified those patients who had a lymphoscintigram performed pre-operatively for SLN localisation. We recorded the number of SLNs identified on imaging and compared this with the number of SLNs biopsied during the operation.

Results

349 patients underwent 354 SLNBs during the study period. One patient was male, the remainders were female. The mean age of patients was 57.2 years (range 25 to 98 years).

In 295 (83.3%) cases, a lymphoscintigram was obtained prior to SLNB for node localisation, and 268 (90.8%) of these scans were able to identify one or more SLNs. In 173 (58.6%) scans, a single SLN was identified. In 27 (9.1%) scans it was either unclear how many SLNs were demonstrated or no SLNs were seen (16/295 no SLN identified, 11/295 unclear how many SLNs).

In 102 (34.6%) cases, the number of SLNs biopsied matched the number of SLNs identified on imaging. Of those that did not match, 76.2% had more and 15.0% fewer SLNs excised than shown on imaging. In 8.8% it was unknown if the number of SLNs matched that seen on imaging due to lack of histopathology results.

Conclusion

Lymphoscintigraphy for SLN localisation is costly and time consuming. In a high proportion of cases, number of SLNs identified on imaging does not match the number biopsied and thus, we suggest, that it is not required prior to SLNB and should be removed from practice.

Citation Format: Clark SL, Yilmaz D, Arun K, Javadzadeh S, Saeed S, Ullah MZ. Pre-operative lymphoscintigraphy for sentinel lymph node localisation: Is it necessary? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-10.

Sex differences in subclinical cardiac disease in overweight and obesity (the FATCOR study)

BACKGROUND AND AIMS

Subclinical cardiac disease, like abnormal left ventricular (LV) geometry or left atrial (LA) dilatation, is common in obesity. Less is known about sex differences in the prevalence and type of subclinical cardiac disease in obesity.

METHODS AND RESULTS

Clinical and echocardiographic data from 581 women and men without established cardiovascular disease and body mass index (BMI) > 27.0 kg/m² participating in the FAT associated CardiOvasculaR dysfunction (FATCOR) study was analyzed. LA dilatation was recognized as LA volume indexed for height² ≥16.5 ml/m² in women and ≥18.5 ml/m² in men, and abnormal LV geometry as LV hypertrophy and/or increased relative wall thickness. On average, the participants were 48 years old, 60% women and mean BMI was 32.1 kg/m². Overall, the prevalence of subclinical cardiac disease was higher in women than men (77% vs. 62%, p < 0.001). Women had a higher prevalence of LA dilatation than men (74% vs. 56%, p < 0.001), while men had a higher prevalence of abnormal LV geometry (30% vs. 21%, p = 0.011). After adjusting for confounders in multivariable logistic regression analysis, female sex was associated with a 2-fold higher risk of subclinical cardiac disease, in particular LA dilatation (confidence interval [CI] 1.67-3.49, p < 0.001), while male sex was associated with a 2-fold higher risk of abnormal LV geometry (CI 1.30-3.01, p = 0.001).

CONCLUSION

The majority of overweight and obese participants in the FATCOR study had subclinical cardiac disease, which may contribute to the impaired prognosis observed in obesity. Women had a higher prevalence of subclinical cardiac disease than men.

CLINICAL TRIAL REGISTRATION

URL: http://www.clinicaltrials.govNCT02805478.

Temperature-dependent development of Helicoverpa armigera (Hübner) (Lepidoptera: Noctuidae) and its larval parasitoid, Habrobracon hebetor (Say) (Hymenoptera: Braconidae): implications for species interactions

Habrobracon hebetor (Say) is a parasitoid of various Lepidoptera including Helicoverpa armigera (Hübner), a key pest of different crops and vegetables. The development of both H. armigera and H. hebetor were simultaneously evaluated against a wide range of constant temperatures (10, 15, 17.5, 20, 25, 27.5, 30, 35, 37.5 and 40 °C). Helicoverpa armigera completed its development from egg to adult within a temperature range of 17.5-37.5 °C and H. hebetor completed its life cycle from egg to adult within a temperature range of 15-40 °C. Based on the Ikemoto and Takai model the developmental threshold (To) and thermal constant (K) to complete the immature stages, of H. armigera were calculated as 11.6 °C and 513.6 DD, respectively, and 13 °C and 148 DD, respectively, for H. hebetor. Analytis/Briere-2 and Analytis/Briere-1 were adjudged the best non-linear models for prediction of phenology of H. armigera and H. hebetor, respectively and enabled estimation of the optimum (Topt) and maximum temperature (Tmax) for development with values of 34.8, 38.7, 36.3, and 43 °C for host and the parasitoid, respectively. Parasitisation by H. hebetor was maximal at 25 °C but occurred even at 40 °C. This study suggests although high temperature is limiting to insects, our estimates of the upper thermal limits for both species are higher than previously estimated. Some biological control of H. armigera by H. hebetor may persist in tropical areas, even with increasing temperatures due to climate change.