Spliceosome malfunction causes neurodevelopmental disorders with overlapping features

Pre-mRNA splicing is a highly coordinated process. While its dysregulation has been linked to neurological deficits, our understanding of the underlying molecular and cellular mechanisms remains limited. We implicated pathogenic variants in U2AF2 and PRPF19, encoding spliceosome subunits in neurodevelopmental disorders (NDDs), by identifying 46 unrelated individuals with 23 de novo U2AF2 missense variants (including 7 recurrent variants in 30 individuals) and 6 individuals with de novo PRPF19 variants. Eight U2AF2 variants dysregulated splicing of a model substrate. Neuritogenesis was reduced in human neurons differentiated from human pluripotent stem cells carrying two U2AF2 hyper-recurrent variants. Neural loss of function (LoF) of the Drosophila orthologs U2af50 and Prp19 led to lethality, abnormal mushroom body (MB) patterning, and social deficits, which were differentially rescued by wild-type and mutant U2AF2 or PRPF19. Transcriptome profiling revealed splicing substrates or effectors (including Rbfox1, a third splicing factor), which rescued MB defects in U2af50-deficient flies. Upon reanalysis of negative clinical exomes followed by data sharing, we further identified 6 patients with NDD who carried RBFOX1 missense variants which, by in vitro testing, showed LoF. Our study implicates 3 splicing factors as NDD-causative genes and establishes a genetic network with hierarchy underlying human brain development and function.

Study of some morphometric and meristic characteristics of Alepes vari (Cuvier, 1833) collected from the Arabian coast

Abstract The present study examines the correlations between fifteen morphometric and ten meristic characters and total length (TL) of males, females, and combined sexes of Alepes vari (Cuvier, 1833) collected from Karachi fish harbor, West Wharf of Karachi Coast. Statistical analyses of linear regression relationships show mostly strong correlations (r≥0.70; p<0.05) between total length (TL) and most morphometric characters in males, females, and combined sexes, except the height of pectoral-fin (PFH), and pelvic-fin base length (PelFL); whereas, meristic characters were found to be constant and indicate weak or negative type correlations (r≤0.50; p>0.05) with total length (TL). Hence, according to our present results, there is a direct relationship between the total length of fish and all morphometric characters, which were found to be the best indicators of positive allometric pattern growth in fish. Moreover, analysis of the 2-sample t-test revealed (t-test; p>0.05) that no sexual dimorphism was reported in Alepes vari. Thus, our present study could be valuable in systematic classification, sexual dimorphism, and management of this species on the Karachi coast.

Evaluation of the feasibility, diagnostic yield, and clinical utility of rapid genome sequencing in infantile epilepsy (Gene-STEPS): an international, multicentre, pilot cohort study

BACKGROUND

Most neonatal and infantile-onset epilepsies have presumed genetic aetiologies, and early genetic diagnoses have the potential to inform clinical management and improve outcomes. We therefore aimed to determine the feasibility, diagnostic yield, and clinical utility of rapid genome sequencing in this population.

METHODS

We conducted an international, multicentre, cohort study (Gene-STEPS), which is a pilot study of the International Precision Child Health Partnership (IPCHiP). IPCHiP is a consortium of four paediatric centres with tertiary-level subspecialty services in Australia, Canada, the UK, and the USA. We recruited infants with new-onset epilepsy or complex febrile seizures from IPCHiP centres, who were younger than 12 months at seizure onset. We excluded infants with simple febrile seizures, acute provoked seizures, known acquired cause, or known genetic cause. Blood samples were collected from probands and available biological parents. Clinical data were collected from medical records, treating clinicians, and parents. Trio genome sequencing was done when both parents were available, and duo or singleton genome sequencing was done when one or neither parent was available. Site-specific protocols were used for DNA extraction and library preparation. Rapid genome sequencing and analysis was done at clinically accredited laboratories, and results were returned to families. We analysed summary statistics for cohort demographic and clinical characteristics and the timing, diagnostic yield, and clinical impact of rapid genome sequencing.

FINDINGS

Between Sept 1, 2021, and Aug 31, 2022, we enrolled 100 infants with new-onset epilepsy, of whom 41 (41%) were girls and 59 (59%) were boys. Median age of seizure onset was 128 days (IQR 46-192). For 43 (43% [binomial distribution 95% CI 33-53]) of 100 infants, we identified genetic diagnoses, with a median time from seizure onset to rapid genome sequencing result of 37 days (IQR 25-59). Genetic diagnosis was associated with neonatal seizure onset versus infantile seizure onset (14 [74%] of 19 vs 29 [36%] of 81; p=0·0027), referral setting (12 [71%] of 17 for intensive care, 19 [44%] of 43 non-intensive care inpatient, and 12 [28%] of 40 outpatient; p=0·0178), and epilepsy syndrome (13 [87%] of 15 for self-limited epilepsies, 18 [35%] of 51 for developmental and epileptic encephalopathies, 12 [35%] of 34 for other syndromes; p=0·001). Rapid genome sequencing revealed genetic heterogeneity, with 34 unique genes or genomic regions implicated. Genetic diagnoses had immediate clinical utility, informing treatment (24 [56%] of 43), additional evaluation (28 [65%]), prognosis (37 [86%]), and recurrence risk counselling (all cases).

INTERPRETATION

Our findings support the feasibility of implementation of rapid genome sequencing in the clinical care of infants with new-onset epilepsy. Longitudinal follow-up is needed to further assess the role of rapid genetic diagnosis in improving clinical, quality-of-life, and economic outcomes.

FUNDING

American Academy of Pediatrics, Boston Children's Hospital Children's Rare Disease Cohorts Initiative, Canadian Institutes of Health Research, Epilepsy Canada, Feiga Bresver Academic Foundation, Great Ormond Street Hospital Charity, Medical Research Council, Murdoch Children's Research Institute, National Institute of Child Health and Human Development, National Institute for Health and Care Research Great Ormond Street Hospital Biomedical Research Centre, One8 Foundation, Ontario Brain Institute, Robinson Family Initiative for Transformational Research, The Royal Children's Hospital Foundation, University of Toronto McLaughlin Centre.

Trio RNA sequencing in a cohort of medically complex children

Genome sequencing (GS) is a powerful test for the diagnosis of rare genetic disorders. Although GS can enumerate most non-coding variation, determining which non-coding variants are disease-causing is challenging. RNA sequencing (RNA-seq) has emerged as an important tool to help address this issue, but its diagnostic utility remains understudied, and the added value of a trio design is unknown. We performed GS plus RNA-seq from blood using an automated clinical-grade high-throughput platform on 97 individuals from 39 families where the proband was a child with unexplained medical complexity. RNA-seq was an effective adjunct test when paired with GS. It enabled clarification of putative splice variants in three families, but it did not reveal variants not already identified by GS analysis. Trio RNA-seq decreased the number of candidates requiring manual review when filtering for de novo dominant disease-causing variants, allowing for the exclusion of 16% of gene-expression outliers and 27% of allele-specific-expression outliers. However, clear diagnostic benefit from the trio design was not observed. Blood-based RNA-seq can facilitate genome analysis in children with suspected undiagnosed genetic disease. In contrast to DNA sequencing, the clinical advantages of a trio RNA-seq design may be more limited.

Pharmacogenetic profiling via genome sequencing in children with medical complexity

BACKGROUND

Children with medical complexity (CMC) are a priority pediatric population, with high resource use and associated costs. Genome-wide sequencing is increasingly organized for CMC early in life as a diagnostic test. Polypharmacy becomes common as CMC age. Clinically relevant pharmacogenetic (PGx) information can be extracted from existing genome sequencing (GS) data via GS-PGx profiling. The role of GS-PGx profiling in the CMC population is unclear.

METHODS

Prescribed medications were extracted from care plans of 802 eligible CMC enrolled in a structured Complex Care Program over a 10-year period. Drug-gene associations were annotated using curated Clinical Pharmacogenetics Implementation Consortium data. GS-PGx profiling was then performed for a subset of 50 CMC.

RESULTS

Overall, 546 CMC (68%) were prescribed at least one medication with an established PGx association. In the GS-PGx subgroup, 24 (48%) carried variants in pharmacogenes with drug-gene guidelines for one or more of their current medications. All had findings of potential relevance to some medications, including 32 (64%) with variants in CYP2C19 that could affect their metabolism of proton-pump inhibitors.

CONCLUSION

GS-PGx profiling at the time of diagnostics-focused genetic testing could be an efficient way to incorporate precision prescribing practices into the lifelong care of CMC.

IMPACT

Polypharmacy and genetic test utilization are both common in children with medical complexity. The role of repurposing genome sequencing data for pharmacogenetic profiling in children with medical complexity was previously unclear. We identified a high rate of medication use with clinically relevant drug-gene associations in this priority pediatric population and demonstrated that relevant pharmacogenetic information can be extracted from their existing genome sequencing data. Pharmacogenetic profiling at the time of diagnostics-focused genetic testing could be an efficient way to incorporate precision prescribing practices into the lifelong care of children with medical complexity.

1251 FRAILTY PREVALENCE AND RISK OF SARCOPENIA IN OLDER HEART FAILURE (HF) INPATIENTS

Introduction

Both frailty and HF are common in the elderly population. Elderly HF patients have an increased risk of frailty and elderly frail patients are at a higher risk of developing HF. Frailty is an independent predictor of mortality in cardiovascular disease. Sarcopenia (defined as decreased muscle mass and muscle strength and/or performance) is also prevalent in HF patients and may progress to cardiac cachexia. HF may induce sarcopenia and sarcopenia may contribute to the poor prognosis of HF.

Aims

Methods

A cross-sectional, retrospective analysis of consecutive patients, 60 years and over, admitted with HF to a UK hospital. Data was manually extracted from anonymized electronic records. The Rockwood Clinical Frailty Scale (CFS) was used for assessment for frailty and the SARC-F tool was used for screening for sarcopenia. Patients with medical history of HF but did not present with decompensated HF were excluded. Also, patients with incomplete data were excluded. The IBM SPSS 28 statistical package was used for statistical analysis. Descriptive statistics and risk estimates were calculated.

Results

163 patients were analysed; 82 males and 81 females. The mean age was 81.4 years (SD 9.69). 71.5 % of patients were frail while 28.5 % were non-frail. The risk of sarcopenia was 10.9 times greater in the frail than in the non-frail patients (OR = 10.9; 95% C.I 4.85 – 24.67). There was a lower risk of sarcopenia in male patients than in the female patients (OR =0.45; 95% C.I 0.22 – 0.94).

Conclusions

Frailty is prevalent in older heart failure inpatients. It significantly increases the risk of sarcopenia in these patients. Women are at higher risk of sarcopenia than men. More research is needed into frailty and sarcopenia in.

1242 CO-MORBIDITY, FRAILTY AND EJECTION FRACTION IN OLDER HEART FAILURE INPATIENTS

Introduction

Co-morbidities and frailty are common in older heart failure patients. The aim of this study is to explore the relationship between co-morbidity, frailty and ejection fraction (EF) in older heart failure inpatients

Methods

A cross-sectional, observational, retrospective analysis of consecutive patients aged 60 years and over who were admitted with heart failure in a UK hospital. Patients with incomplete data were excluded. The Carlson’s comorbidity index (CCI) was used to compute comorbidity and the Rockwood Clinical Frailty Scale (CFS) was used to measure frailty. The EF was calculated as the midpoint of the ranges measured by echocardiography. IBM SPSS 28 software was used for statistical analysis. Descriptive statistics were used to measure baseline characteristics and Pearson’s correlation coefficient and linear regression were used to calculate correlation.

Results and discussion

101 patients were analysed; 48 males and 53 females. Mean age was 81.2 years(SD 9.98). Mean CCI was 6.97(SD 1.63) and mean CFS was 5.09(SD 1.14). There was statistically significant positive correlation between CCI and CFS (r= 0.232; p= .01). There was statistically significant inverse correlation between CCI and EF (r= -.277; p=. 005). When taking into account the level of frailty the correlation between CCI and EF was much stronger in non-frail than in frail patients (r= -.612; p=. 035 and r= -.216; p= .047 respectively). There was no correlation between CFS and EF (r= .095; p=.26). This was not surprising as HFpEF is the most common type of HF in the elderly. HFpEF patients are more likely to have more comorbidities and to be more frail compared to HFrEF patients.

Conclusion

There was a positive correlation between multi-morbidity and frailty in older inpatients admitted with heart failure. There was statistically significant inverse correlation between CCI and ejection fraction but there was no correlation between frailty and ejection.

A Case Report of Acute Severe Necrotizing Pancreatitis following the Johnson & Johnson Vaccine against the Novel SARS-CoV-2

Acute pancreatitis is an inflammatory condition, which is a leading gastrointestinal cause of hospitalization in the United States. Several conditions are associated with acute pancreatitis. More recently, there have been a few cases reported of acute pancreatitis following the Pfizer-BioNTech COVID-19 mRNA vaccine. To our knowledge, no cases of acute pancreatitis have been yet reported following the Johnson & Johnson's Janssen COVID-19 vaccine (J& J vaccine). Herein we report a 34-year-old male with no significant past medical history admitted with acute necrotizing pancreatitis, the day following the receipt of the J&J vaccine. Based on the Naranjo and the modified Naranjo scale, the patient met the requirements for probable drug induced pancreatitis. This case report has the objective to raise awareness of a potentially severe side effect of the J&J vaccine. We hope to use this case to support screening all patients for previous history of acute pancreatitis before administration of the J& J vaccine.

Haemodialysis Alters the Index of Cardiac-Electrophysiological Balance

Objective: To study electrocardiographic changes during haemodialysis and determine the relationship between electrolyte alterations and acid-base balance.Study Design: Cross-sectional analytical study. Place and Duration of Study: Haemodialysis Unit, Combined Military Hospital, Peshawar Pakistan, from Jun to Jul 2022. Methodology: Adult patients with end-stage renal disease on maintenance hemodialysis were selected by convenience sampling. Exclusion criteria included current hospitalization, chest pain during haemodialysis, intra-dialytic hypotension,atrial fibrillation, pericardial effusion, shortening of haemodialysis sessions and unwillingness to participate in the study.Twelve lead electrocardiograms were recorded immediately before the start and end of haemodialysis sessions. At the same time, serum urea, creatinine, potassium, calcium and phosphate were measured. Bicarbonate levels were assessed by venous blood gas analysis. In addition, measurements for heart rate and durations of the PR interval, QRS complex, QT interval andcorrected QT interval reported by ECG machine software were recorded. Results: There were 35 patients with a mean age of 48.69±11.39 years. Duration of QRS complex increased from 92.83±9.98 to 100.00± 17.94 seconds after haemodialysis (p=0.017). Changes in other parameters were insignificant. QT/QRS and QTc/QRS ratios reduced by 0.27±0.62 and 0.31±0.62 after haemodialysis (p=0.014 and 0.005, respectively). Changes in none of the biochemical parameters during haemodialysis could predict the reduction in QT/QRS or QTc/QRS ratios. Conclusion: The reduction in the index of cardiac electrophysiological balance during hemodialysis was not related to intradialytic changes in different electrolytes or base content.

A novel scoring system to predict cardiac device implantation in patients presenting with syncope

Background

Cardiac syncope occurs when the heart fails to maintain cardiac output to match cerebral need and can occur due to either mechanical/structural defect of the heart or secondary to an arrhythmia. It has a raised 1-year mortality with some figures estimating this as high as 30%. Implantable loop recorders (ILR) are a useful diagnostic tool in patients presenting with syncope or pre-syncope to ascertain a cardiac cause. A higher number of patients are presenting with advancing age and undergoing ILR implantation. Subsequently, they end up requiring a cardiac implantable electronic device (CIED) implantation, adding to additional costs, exposure to procedural complications and frequent hospitalisations.

Purpose

To investigate the number of patients undergoing CIED implantation following implantation of ILRs for syncope and identify predictors of CIED implantation in patients presenting with syncope.

Methods

A retrospective analysis of 736 patients who underwent ILR implantation at our teaching hospital trust between November 2012 to October 2020. Data on demographics, clinical characteristics, pathology results, ECGs, holter findings and CIED implanted was collected using the local electronic patient record system. The data was analysed using SPSS software. Univariable and multivariable regression analysis and ROC curve analysis was carried out to determine prediction model for CIED implantation.

Results

The mean age of patients who underwent an ILR implantation was 65±19 years. 22% of patients required CIED implantation, 68% of patients did not require a cardiac device and were safely discharged and 10% of patients died during follow up. Age (p&lt;0.001), male sex (p=0.006), impaired left ventricular function (p=0.04) and presence of hypertension (p=0.04) were found to be independent predictors of CIED implantation on univariable and multivariable regression analysis (see Table 1).

Conclusions

Old age, presence of coronary artery disease, impaired left ventricular function and presence of hypertension are inter-linked and in our study were found to be key predictors of poor prognosis and thus requiring CIED implantation. We propose a scoring system based on age &gt;75, male sex, presence of ischaemic heart disease, heart failure and hypertension as key markers of conduction abnormalities requiring CIED implantation (see fi−ure 1).

Funding Acknowledgement

Type of funding sources: None.

Assessment of skeletal relationships in cleft palate with or without cleft lip: A cone-beam computed tomography study in a pakistani population

BACKGROUND

Understanding the different skeletal relationships in orofacial clefts by using cone-beam computed tomography (CBCT) may eventually lead to developing better diagnosis and treatment protocols for facial deformities.

AIMS

The objective of this study was to investigate the different skeletal relationships in the cleft palate with or without cleft lip (CP ± L), using CBCT scans. This is a retrospective study conducted at the Orthodontics and Oral Radiology department, CMH-Lahore medical college and Institute of dentistry. In the current study, 4,152 CBCT scans (dcm format) were collected from a radiology center in Lahore, Pakistan between February 2015 and February 2018. All CBCT scans were imported to the Romexis Viewer, version 4.4.0 (Planmeca, Finland). Data sorting was performed to identify age, sex, cleft phenotype, unilateral cleft quadrant, sagittal skeletal relationship, and facial soft tissue involvement.

MATERIALS AND METHODS

Statistics were generated, using the Chi-square test. A P value <0.05 was considered statistically significant.

RESULTS

We identified 73 cases of CP ± L in the sample. The male-to-female ratio was 1.21:1. Bilateral cleft lip and palate (BCLP) mostly affected males (60%), whereas unilateral cleft lip and palate (UCLP) mainly affected females (57.6%), with a left-side female predominance. The different cleft phenotypes do not show any statistically significant difference regarding skeletal relationships and sex (P > 0.05).

CONCLUSIONS

Skeletal class III relationships were found to be predominant in both sexes, followed by class II, and class I skeletal relationships. Henceforth, such CP ± L patients should be pre-emptively screened in early life to avoid such skeletal complications.

Synthetic and Natural Fiber-Reinforced Polymer Matrix Composites for Advanced Applications

"Synthetic and Natural Fiber Reinforced Polymer Matrix Composites for Advanced Applications" is a recently opened Special Issue (SI) of Materials that focuses on the fundamentals, characterization, and applications of fiber-reinforced polymer composites [...].

67 Does a National Lockdown Affect the Characteristics of Deep Vein Thromboses in Patients in the Community?

Aim

Has lockdown and COVID-19 led to a change into the characteristics of DVT's and patients who have them alongside a review of the DVT service.

Method

Data was collected retrospectively from electronic patient records system for the following periods: 1st April until 30th June 2019 and 1st April until 30th June 2020. These were the key months during the first United Kingdom national lockdown. Data was analysed for patient demographics, risk factors, characteristics of the DVT, management and DVT reoccurrence. Statistical analyses were preformed using GraphPad Prism 8.

Results

227 patients sustained community DVT's in 2019 and 211 patients in 2020 during the study period. 13 of these patients in 2020 were COVID-19 positive. There was a difference in gender distribution (p= 0.0128) with 128 males and 99 females in 2019, 93 males and 118 females in 2020. No significant difference was noted for the incidence of thrombophilia with 9 in 2019 and 3 in 2020 (p=0.1437). Fewer long-haul journeys were made (p=0.012) with 16 in 2019 and only 2 in 2020. Fewer patients had immobility as a risk factor with 79 in 2019 and 55 in 2020 (p=0.0494). However, there were more patients using the contraceptive pill (p=0.0086) with 1 in 2019 and 9 in 2020.

Conclusion

There is no significant difference in the characteristics, extent, and management of DVT's prior to and during Lockdown during COVID-19. National Lockdowns do not affect community DVT's however it is important to highlight the surrounding inpatient numbers.

Variant-specific changes in RAC3 function disrupt corticogenesis in neurodevelopmental phenotypes

Variants in RAC3, encoding a small GTPase RAC3 which is critical for the regulation of actin cytoskeleton and intracellular signal transduction, are associated with a rare neurodevelopmental disorder with structural brain anomalies and facial dysmorphism. We investigated a cohort of 10 unrelated participants presenting with global psychomotor delay, hypotonia, behavioural disturbances, stereotyped movements, dysmorphic features, seizures and musculoskeletal abnormalities. MRI of brain revealed a complex pattern of variable brain malformations, including callosal abnormalities, white matter thinning, grey matter heterotopia, polymicrogyria/dysgyria, brainstem anomalies and cerebellar dysplasia. These patients harboured eight distinct de novo RAC3 variants, including six novel variants (NM_005052.3): c.34G > C p.G12R, c.179G > A p.G60D, c.186_188delGGA p.E62del, c.187G > A p.D63N, c.191A > G p.Y64C and c.348G > C p.K116N. We then examined the pathophysiological significance of these novel and previously reported pathogenic variants p.P29L, p.P34R, p.A59G, p.Q61L and p.E62K. In vitro analyses revealed that all tested RAC3 variants were biochemically and biologically active to variable extent, and exhibited a spectrum of different affinities to downstream effectors including p21-activated kinase 1. We then focused on the four variants p.Q61L, p.E62del, p.D63N and p.Y64C in the Switch II region, which is essential for the biochemical activity of small GTPases and also a variation hot spot common to other Rho family genes, RAC1 and CDC42. Acute expression of the four variants in embryonic mouse brain using in utero electroporation caused defects in cortical neuron morphology and migration ending up with cluster formation during corticogenesis. Notably, defective migration by p.E62del, p.D63N and p.Y64C were rescued by a dominant negative version of p21-activated kinase 1. Our results indicate that RAC3 variants result in morphological and functional defects in cortical neurons during brain development through variant-specific mechanisms, eventually leading to heterogeneous neurodevelopmental phenotypes.

Prevalence of gastrointestinal parasitic infection in cows and buffaloes in Lower Dir, Khyber Pakhtunkhwa, Pakistan

Gastrointestinal (GI) Parasitic infection is a hot issue for cattle management. There is variation of GI parasites effects in sex, age of cattle, drinking water condition, nutrition, and severity of infection. Studies on prevalence of GI parasites among cattle population in Dir Lower are lacking. A total of 40 farms were selected randomly in six tehsil namely Tehsil Adenzai, Tehsil Timergara, Tehsil Balambat, Tehsil Munda ,Tehsil Lalqala, Tehsil Khall. Freshly cattle fecal samples were collected randomly from the selected farms during March 2018 till December 2018. Out of 314 buffaloes and cattle examined 58.59% (184/314) were positive for eggs, cyst/oocyst of one or more species of GI Parasites. The prevalence of parasitic infection was higher in Buffaloes 63.55% (75/118) as compared to Cow 55.61% (109/196) but the difference was not significant (p>0.05) Entamoeba,spp, Moniezia spp, Haemonchus spp and Coccidian spp were found in this study. The non-treated animals indicated the highest percentage of infection in cow 57.71% (101/175) and buffalo 68.13% (62/91).GI parasite prevalence in female animal were higher female cow 62.58% (87/139) and female buffalo 77.33% (58/75) as compared to male. But the difference is non-significant (p> 0.05) Yearling calves had the lower rate of GI parasitic infection than adults. Future investigations are necessary to evaluate the economic loss due to GI parasites in cattle's.

Seven Day Safety Net Service

A seven day safety net telephone service was developed in an acute medical unit at a university hospital in London. The service attempts to provide all patients discharged from acute medicine with patient activated access to a member of the acute medical team. This allows patients to flag deterioration triggering further review in the ambulatory clinic or to ask for advice on symptoms or medication. Here we evaluate the first sixteen months of the service and report on its benefits and limitations.

Phytochemical and biological attributes of Bauhinia variegata L. (Caesalpiniaceae)

Abstract Bauhinia variegata plant is a very popular and traditionally potent ethnomedicine. Therefore, it is need of hour to study ameliorative characteristics of B. variegata for novel secondary metabolites. The current study was designed to explore antiproliferative potential of B. variegata due to scant reports on this aspect. Extracts of various parts (flowers, leaves, bark, stem, and roots) were prepared by successive maceration using organic solvents in increasing order of polarity (n-hexane, ethyl acetate, methanol, and water). The determination of polyphenolic contents was done by using colorimetric methods while antioxidant potential was measured using reducing power assay. Brine shrimp lethality assay was performed for determining preliminary cytotoxicity and antiproliferative activity against breast cancer MCF-7 cell line using MTT protocols. Moreover, antimicrobial activities were detected by using disc diffusion assay. The alpha-amylase assay was performed to monitor the antidiabetic potential of the plant. In case of phytochemical analysis methanolic extract of leaves and bark showed highest phenolic and flavonoids contents. n-Hexane and ethyl acetate extracts of stem and roots exhibited more than 90% mortality with LD50 ranges between 1-25 µg/mL when studied by brine shrimp lethality assay. n-Hexane and ethyl acetate extracts of roots and stem also showed antiproliferative activity against human breast cancer MCF-7 cell line with IC50 values ranges between 12.10-14.20 µg/mL. Most of the extracts displayed moderately high antibacterial and antifungal activities. The n-hexane extract of roots showed antidiabetic activity with 60.80 ± 0.20% inhibition of alpha-amylase. In sum, these preliminary results will be useful for further compound isolation from selected plant parts for the discovery of antibacterial, antidiabetic, and anticancer lead candidates.

Evaluation of indigenous plants' extracts for mosquitocidal activity against different stages of Culex quinquefasciatus say (Diptera: Culicidae)

Being vector of West Nile Virus and falariasis the control of Culex quinquefasciatus is likely to be essential. Synthetic insecticide treatment is looking most effective for vectors mosquito control. However, these products are toxic to the environment and non-target organisms. Consequently, ecofriendly control of vectors mosquito is needed. In this regard botanical insecticide is looking more fruitful. Therefore, the present research aimed to investigate the effectiveness of methanolic extract and various fractions, including, n-hexane, ethyl-acetate, chloroform, and aqueous fraction, obtained from methanolic extract of Ailanthus altissima, Artemisia scoparia, and Justicia adhatoda using separating funnel against larval, pupal, and adult stages of Culex quinquefasciatus. The larvae and pupae of Culex quinquefasciatus were exposed to various concentrations (31.25-1000 ppm) of methanolic extract and its fractions for 24 hours of exposure period. For knock-down bioassay (filter paper impregnation bioassay) different concentration of the methanolic extract and its various fractions (i.e. 0.0625, 0.125, 0.25, 0.5 and 1mg/mL) were applied for 1 hour exposure period. The results were statistically analysed using standard deviation, probit analysis, and linear regression. The R2 values of larvae, pupae, and adult range from 0.4 to 0.99. The values of LC50 (concentration causing 50% mortality) for late 3rd instar larvae after 24 hours exposure period range from 93-1856.7 ppm, while LC90 values range from 424 -7635.5ppm. The values of LC50for pupae range form 1326.7-6818.4ppm and and values of LC90 range from 3667.3-17427.9ppm, respectively. The KDT50 range from 0.30 to 2.8% and KDT90 values range from1.2 to 110.8%, respectively. In conclusion, Justicia adhatoda may be effective for controlling populations of vector mosquito.

Prevalence of gastrointestinal parasite in small ruminants of District Dir Upper Khyber Pakhtunkhwa Province of Pakistan

The present research was planned to assess the occurrence of intestinal parasites in small ruminants of Upper Dir of Khyber Pakhtunkhwa Province of Pakistan. For this purpose, the faecal material was collected randomly with gloved fingers directly from the rectum region of sheep and goats and the faecal materials were then put in hygienic plastic bottles with 10% formalin. The overall 315 (n=184 sheep and n= 131 goats) faecal samples were collected out of 315 samples, 281 were found positive for different parasites. Patterns-wise prevalence of GI parasites of the study area was found. Overall Single parasitism 89.20% (281/315) with 94.0% (173/184) in sheep and 82.43% (108/131) in goats. Double parasitic infection in small ruminant recorded in which Fasciola+ Haemonchus. contortus in sheep were found their prevalence was 25.54% (47/184). While in goats, the double parasitic infection in which Haemonchus contortus+Trichuris spp were found and their prevalence were 23.43% (30/131). The species found in the sample of sheep were includes, i.e., Strongyloides papillosus (41.30%), Heamonchus controtus (21.73%), Trichuris ovis (17.39%), and Fasciola hepatica (13.58%), the corresponding value for goat were Strongyloides spp 33.33% (36/108), Haemonchus spp 28.70%, (27/108), Trichuris spp 25.20% (27/184) and Fasciola spp 10.68% (14/184). The sheep of the study area are more infected as compared to goats. This study suggested that gastrointestinal parasites are major health problems of small ruminants in the study area. Therefore, a comprehensive study on species of gastrointestinal parasites circulating in the area, control options, cost-effective strategies and awareness about gastrointestinal parasites among the farmers in the study area should be instituted.

Revision of some mensural measurements, food preference, and haematological parameters in breeding pairs of blue rock pigeon, Columba livia sampled from punjab Pakistan

The present study describes the haematological profile, feeding preference, and comparison of morphometric characters of blue rock pigeon (Columba livia) breeding pairs. For this purpose, 25 pairs (25 samples per sex) were sampled through Mist nets from district Okara and Bahawalnagar, Punjab, Pakistan. Birds were then anaesthetized with a combination of ketamine HCL (10 mg/kg) and diazepam (0.2 mg/kg) and subjected to morphometric measurements. 5µL blood also was taken from the jugular vein of each anaesthetized bird for haematological analysis. Few pairs were also dissected to remove gastrointestinal tracts (GITs) for food preferences. Results revealed that there are no significant differences in the haematological parameters and feeding preference of breeding pairs of Columba livia. The gut analysis further revealed, the major portion of gut contents consisted of pea and corn in most of the pairs. Regarding the mensural measurements, significant differences were recorded in the body weight, length of the longest primary feather, and chest circumference, whereas the rest of the studied parameters remain nonsignificant between sexes. So, it is concluded that apart from 3 morphometric parameters (body weight, length of longest primary feather and chest circumference), both sexes are alike in term of morphometry, haematology and food preference.

516 Does the Use of Adjuvant Chemotherapy Increase Incisional Hernia Rates in Colorectal Cancer Patients – A Retrospective Single Centre Cohort Study

Aim

Incisional hernias (IH) are a known complication of any major abdominal surgery. It is known that chemotherapy impairs healing processes via delayed inflammation, impaired collagen synthesis and reduced fibrin deposition and wound contraction. There are currently, to our knowledge, no trials examining the effect of adjuvant chemotherapy on incidence of IH in patients with colorectal cancer. This study aims to assess the same by comparing IH rates between chemotherapy and non-chemotherapy patient groups.

Method

All the patients who had major surgery for colorectal cancer between January 2009 and January 2014 were divided into two groups of chemotherapy (A) and non-chemotherapy (B). Records of first 160 patients from each group were retrospectively analysed.

Results

There were non-significant differences between groups for sex, tumour location, primary operation, and type of procedure (emergency or elective). Significant differences were observed for age (more elder patients in group B, p = 0.000011), method of access (more open procedures in group B and more laparoscopic procedures in group A, p = 0.0007) and Charlson co-morbidity scores (more advanced score in group B, p = 0.029). We found that 21/120 (21.21%) patients in the chemotherapy group and 12/99 (13.79%) patients in non-chemotherapy group developed Incisional hernias. Although there was a higher rate of IH in the chemotherapy group, this was not statistically significant (p = 0.27).

Conclusions

Although this study fails to demonstrate any statistically significant difference in IH incidence between two groups, but this study can act as a pilot in order to fuel further high-quality research to draw more valid conclusions.

Accuracy of Magnetic Resonance Cholangiopancreatography in Case of Biliary Obstruction Comparing Post-operative Findings: A Study of 50 Cases

Complete assessment of obstructive jaundice requires the use of various imaging modalities that are required to detect the cause and level of obstruction thus helping in treatment planning. Magnetic Resonance Cholangio Pancreatography (MRCP) is a current available technology which is a non-invasive technique that visualizes the gallbladder, biliary tree and pancreatic duct and also provides information about surrounding structures. This study was done to correlate the MRCP findings with post-operative result and thereby demonstrate the specificity, sensitivity and efficacy of MRCP as an accurate investigatory tool for biliary obstruction. Total of fifty (50) patients of clinically diagnosed obstructive jaundice were studied from March 2017 to August 2017 in the Department of Radiology and Imaging, Combined Military Hospital, Dhaka, Bangladesh. In all these cases, USG was the initial screening investigation followed by MRCP. Cause and level of obstruction were evaluated using MRCP findings. MRCP results were correlated with surgical findings and few cases also with direct ERCP findings. Statistical analysis was done to see the sensitivity, specificity, accuracy, positive and negative predictive values of MRCP in diagnosis of biliary obstruction. In this study, USG detected level of obstruction in 56% (28 out of 50) cases. USG could detect causes of obstruction in 100% (02 out of 02) cases of choledocal cyst and 66.67% (02 out of 03) benign stricture, 60% (03 out of 05) cases of periampullary carcinoma, 57.70% (06 out of 14) cases of choledocholithiasis, and 42.86% (15 out of 26) cases of cholangiocarcinoma. On the other hand, MRCP detected level of obstruction in 98% (49 out of 50) cases. MRCP could detect causes of obstruction in 100% cases of cholangiocarcinoma, choledocholithiasis, benign stricture and choledocal cyst and 80% (04 out of 05) cases of periampullary carcinoma. In this study, ERCP could detect causes of obstruction in 32 cases of choledocholithiasis and benign stricture, but in case of cholangiocarcinoma ERCP was failed in 3 cases. In this study, for detection of cause of obstruction, ERCP had the highest sensitivity (97.79%); followed by MRCP (96.65%) and USG (60.25%). The overall diagnostic accuracy for detection of cause of obstruction was the highest for ERCP (95.50%); followed by MRCP (94.50%) and USG (64.50%). MRCP can be done in a short duration and is a noninvasive diagnostic modality compared to ERCP. MRCP needs to be advocated as a viable and non-invasive alternative with compararable sensitivity and specificity to ERCP.

Identification of terrestrial gastropods families found in district Swat, Pakistan

Very little is known about the malacofauna in district Swat of Khyber Pakhtunkhwa province, situated in the Northern part of Pakistan. The Swat valley possesses a variety of suitable environmental conditions, providing different types of habitats for both flora and fauna. Taken into consideration these points, the present study was conducted to explore the terrestrial snails diversity in agricultural and non-agricultural fields in the lower Swat valley. A total of 417 shells were collected from three sites: Kokarai, Kanju Township, and Deolai. Based on conchological features, three families: Bradybaenidae, Hygromiidae, and Zonitidae were identified using different terrestrial snail keys. In Kokarai and Deolai, shells of members of all the above-mentioned families were found from agricultural fields. In Kanju Township, shells of members of the family Bradybaenidae and Zonitidae were found. From these findings, it was concluded that district Swat possesses a significant malacofauna which was unexplored before and aided more to the existing literature on malacofauna. It also supports the idea that the agroecosystem is rich in species diversity. Further in-depth and extensive study is recommended to be carried out for a detailed taxonomy of the described terrestrial gastropod families.

Genome sequencing for detection of pathogenic deep intronic variation: A clinical case report illustrating opportunities and challenges

Variants in JAM3 have been reported in four families manifesting a severe autosomal recessive disorder characterized by hemorrhagic destruction of the brain, subependymal calcification, and cataracts. We describe a 7-year-old male with a similar presentation found by research-based quad genome sequencing to have two novel splicing variants in trans in JAM3, including one deep intronic variant (NM_032801.4: c.256+1260G>C) not detectable by standard exome sequencing. Targeted sequencing of RNA isolated from transformed lymphoblastoid cell lines confirmed that each of the two variants has a deleterious effect on JAM3 mRNA splicing. The role for genome sequencing as a clinical diagnostic test extends to those patients with phenotypes strongly suggestive of a specific Mendelian disorder, especially when the causal genetic variant(s) are not found by a more targeted approach. Barriers to diagnosis via identification of pathogenic deep intronic variation include lack of laboratory consensus regarding in silico splicing prediction tools and limited access to clinically validated confirmatory RNA experiments.

Euphlyctis Cyanophlyctis Schneider, 1799 (Amphibia: Dicroglossidae) in district Lower Dir, Pakistan

Euphlyctis cyanophlyctis (the skittering frog) is one of the most widespread species in Pakistan. Present study was aimed to know the presence of Euphlyctis cyanophlyctis in urban and rural areas of Lower Dir, the North-western Pakistan. A total of 33 frogs were collected, including 15 from rural and 18 from urban areas. The frogs were caught by hands covered with gloves instead of using nets. The collection was managed from August to October 2016 and from April to May 2018. Morphometric analysis, coloration as well as photographs of the frogs have been provided in detail. Skittering frogs were seen frequent in swampy areas near the water bodies. These frogs were mostly seen after sunset.

Consensus statement from the international consensus meeting on post-traumatic cranioplasty

Background

Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach.

Methods

The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP.

Results

The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations.

Conclusions

This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.

Seroprevalence of low avidity anti-Toxoplasma IgG in pregnant women and its relationship with their age and contact with cats

Toxoplasma gondii is a protozoan parasite that can infect all mammals, serving as intermediate hosts. The cause of congenital toxoplasmosis is transplacental transmission of the parasite to the foetus, resulting in wide range of manifestations from mild chorioretinitis to miscarriage. Its frequency can be reduced by early screening of pregnant women which is based mainly on tests for anti-Toxoplasma antibodies. We collected serum samples of 594 pregnant women (subjects) after taking their consent over a period of two years (2016-2018) and analyzed them for anti-Toxoplasma IgG by ELISA. The positive samples were then analyzed for IgG avidity test which could differentiate between recent and past infections. The seroprevalence was also correlated with the age of the subjects and their contact with cats. 162 subjects were found positive out of which only three showed a recent infection. After following up until delivery, one of them delivered a baby who had jaundice and was diagnosed with anti-Toxoplasma IgM at birth. The foetus of the second subject died in-utero, while the third woman delivered a normal baby after being given spiramycin when diagnosed with toxoplasmosis in the first trimester. It was found that most of the positive subjects had frequent contact with cats. Invasion of the parasite during third trimester resulted in death in-utero and jaundice. Most common cause of pregnancy wastage during our study was spontaneous abortions while pregnancy loss due to congenital anomalies was rare.

The effect of maize-alfalfa intercropping on the physiological characteristics, nitrogen uptake and yield of maize

In Northeastern China, the intensive cropping system and increased use of chemical fertilizer has caused severe problems in terms of sustainable agricultural development. Therefore, to improve agricultural sustainability and crop productivity the farming system needs to be modified in the region. A pot experiment was conducted to evaluate the effect of maize-alfalfa intercropping on the physiological characteristics, nitrogen (N) uptake and yield of the maize crops in northeast China in 2017-2018. The study findings showed that intercropping under N fertilization progressively improved the physio-agronomic indices of the maize crop as compared to mono-cropping. The grain yield, 100 seed weight and biomass dry matter of maize crop improved in intercropping when it was practiced with N fertilizer. Furthermore, intercropping with N fertilization increased the chlorophyll content of the maize crop at bell-mouthed, silking, filing and mature stages by 19%, 44%, 12%, and 9% in 2017 and by 23%, 43%, 15%, and 11% in 2018, respectively, as compared with the monocropping system. Unlike monocropping, intercropping with N fertilization increased the photosynthesis rate (14% and 15%), stomatal conductance (74% and 98%) and transpiration rate (74% and 75%) in 2017 and 2018, respectively. However, intercropping reduced intercellular CO₂ (C_i ). Moreover, intercropping with N fertilization increased the maize N content of grain and leaves as well as total N uptake by 49%, 31% and 93% in 2017 and 53%, 34% and 132%, respectively, in 2018 as compared to monocropping. In conclusion, our results suggest that maize-alfalfa intercropping with optimal N fertilization provides a practical method for improving growth, yield and N accumulation in the maize crop.

THU0594 A CASE OF TAKAYASU’S ARTERITIS IN A PATIENT WITH TUBERCULOUS LYMPHADENITIS

Background:

Takayasu’s arteritis (TA) is a large vessel vasculitis that principally affects the aorta and its main branches. The incidence has been reported at between 1.2 – 2.3 cases per million per year, more commonly in the Asian population. The age of onset is typically between tenth and fourth decade; between 80 and 90 percent of the cases are female.

The relationship between Mycobacterium Tuberculosis (mTB) and TA has long been considered; both demonstrate chronic inflammatory changes on histological examination and some granuloma formation in arterial walls. There is increasing evidence implicating mTB in the pathogenesis of TA through molecular mimicry between the mycobacterium heat shock protein -65 (mHSP-65) and the human homologue HSP -60 (hHSP-60). However, no definitive link between the two diseases has been explained.

Objectives:

Case presentation.

Results:

A 23-year-old lady was referred to our outpatient rheumatology clinic with a twelve-month history of persistently enlarged cervical lymph nodes on the left side for which she had received six months of anti-Tuberculosis medication. She had been referred to the respiratory physicians who had diagnosed presumed Tuberculous Lymphadenitis, with caseating granulomas demonstrated on biopsy, positive acid-fast bacilli smear but a negative culture. The patient had been initiated six months of anti-Tuberculosis medication; however, her lymphadenopathy showed no improvement. More recently she described a five-month history of weakness, paraesthesia and claudication symptoms in her left upper limb with episodes of dizziness and blurred vision, episodes occurring 2-3 times per day and lasting between a few minutes to a few hours.

Her examination at this presentation revealed an unrecordable blood pressure in the left upper limb and 104/67mmHg in the right. There was significant tender lymphadenopathy of the left cervical lymph nodes and diminished pulses in the left upper limb. Right sided pulses were normal. The rest of her examination was normal.

Investigations at presentation revealed elevated inflammatory markers with C- reactive protein (CRP) of 116mg/dL and erythrocyte sedimentation rate (ESR) of 128mm/h. Complete blood count (CBC) found her to be anaemic with a haemoglobin of 100g/L, with a mean cell volume of 71.3fl, and have elevated platelet count of 649x 109/L. Recent computerized tomography scan with contrast of the thorax demonstrated features consistent with Takayasu Arteritis. Marked left subclavian stenosis was found on magnetic resonance imaging. High dose prednisolone at 60mg once daily along with Azathioprine 2mg/kg/day was started with a follow up appointment in two weeks.

Conclusion:

There is increasing evidence implicating mTB in the development of TA and a few cases recognising this link have been reported. We report a case of TA in a patient recently diagnosed and treated for Tuberculous lymphadenitis who then developed symptoms of TA. There should be a low threshold for suspecting a diagnosis of Takayasu’s arteritis in patients previously or actively infected with Mycobacterium Tuberculosis. Further research exploring the relationship between mTB and TA is required.

References:

[1]Espinoza JL, Ai S, Matsumura I. New Insights on the Pathogenesis of Takayasu Arteritis: Revisiting the Microbial Theory. Pathogens. 2018;7(3):73.

[2]Aggarwal A, Chag M, Sinha N, et al. Takayasu’s arteritis: role of Mycobacterium tuberculosis and its 65 kDa heat shock protein. International Journal of Cardiology. 1996; 55: 49–55.

[3]Reshkova V, Kalinova D, Rashkov R. Takayasu’s Arteritis associated with Tuberculosis Infections. Journal of Neurology and Neuroscience. 2016; 3:114.

[4]Moritz K, Jansson Hilte F, Antje Kangowski, Christian Kneitz, Emil C. Reisinger. Tuberculosis and Takayasu arteritis: case-based review Rheumatology International 2019 39:345–351

[5]D Misra, A Wakhlu, V Agarwal, D Danda. Recent advances in the management of Takayasu arteritis International Journal of Rheumatic Diseases 2019; 22: 60–68

Disclosure of Interests:

None declared

Complete Measurement of the Λ Electromagnetic Form Factors

The exclusive process e^{+}e^{-}→ΛΛ[over ¯], with Λ→pπ^{-} and Λ[over ¯]→p[over ¯]π^{+}, has been studied at sqrt[s]=2.396  GeV for measurement of the timelike Λ electric and magnetic form factors, G_{E} and G_{M}. A data sample, corresponding to an integrated luminosity of 66.9  pb^{-1}, was collected with the BESIII detector for this purpose. A multidimensional analysis with a complete decomposition of the spin structure of the reaction enables a determination of the modulus of the ratio R=|G_{E}/G_{M}| and, for the first time for any baryon, the relative phase ΔΦ=Φ_{E}-Φ_{M}. The resulting values are R=0.96±0.14(stat)±0.02(syst) and ΔΦ=37°±12°(stat)±6°(syst), respectively. These are obtained using the recently established and most precise value of the asymmetry parameter α_{Λ}=0.750±0.010 measured by BESIII. In addition, the cross section is measured with unprecedented precision to be σ=118.7±5.3(stat)±5.1(syst)  pb, which corresponds to an effective form factor of |G|=0.123±0.003(stat)±0.003(syst). The contribution from two-photon exchange is found to be negligible. Our result enables the first complete determination of baryon timelike electromagnetic form factors.

Amplitude Analysis of D_{s}^{+}→π^{+}π^{0}η and First Observation of the W-Annihilation Dominant Decays D_{s}^{+}→a_{0}(980)^{+}π^{0} and D_{s}^{+}→a_{0}(980)^{0}π^{+}

We present the first amplitude analysis of the decay D_{s}^{+}→π^{+}π^{0}η. We use an e^{+}e^{-} collision data sample corresponding to an integrated luminosity of 3.19  fb^{-1} collected with the BESIII detector at a center-of-mass energy of 4.178 GeV. We observe for the first time the W-annihilation dominant decays D_{s}^{+}→a_{0}(980)^{+}π^{0} and D_{s}^{+}→a_{0}(980)^{0}π^{+}. We measure the absolute branching fraction B(D_{s}^{+}→a_{0}(980)^{+(0)}π^{0^{(}+)},a_{0}(980)^{+(0)}→π^{+(0)}η)=(1.46±0.15_{stat}±0.23_{sys})%, which is larger than the branching fractions of other measured pure W-annihilation decays by at least one order of magnitude. In addition, we measure the branching fraction of D_{s}^{+}→π^{+}π^{0}η with significantly improved precision.