Evaluation of accuracy of EuroSCORE II in prediction of in-hospital mortality in patients underwent mitral valve replacement in Egypt

Objective: To evaluate the performance of the updated version of European System for Cardiac Operative Risk Evaluation (EuroSCORE II) for prediction of in-hospital mortality after mitral valve replacement. Patients and methods: Medical records of 580 Egyptian patients underwent mitral valve replacement in Nasser institute, Suez Canal University, and Minia University hospitals were evaluated in six-year period. Data on demographics, comorbidities, risk factors, operative outcome and postoperative complications were collected with in-hospital mortality as primary end-point. Statistical analysis assessed discriminative power and calibration of EuroSCORE II. Results: The study population had younger age, more prevalence of female gender and higher body mass index (BMI) than EuroSCORE II population. The observed in-hospital mortality rate was 2.6% and average of the predicted mortality by EuroSCORE II was 1.60%. EuroSCORE II had low discriminative power (area under the curve 0.52, 95% CI: 0.38–0.66), and poor calibration as determined by Hosmer–Lemeshow (HL) test (P-value = 0.02). On multivariate analysis, other factors not involved in EuroSCORE II were significant predictors for in-hospital mortality including redo-operation, previous valvuloplasty, hypercholesterolemia and chronic liver disease. Conclusion: Differences in clinical profile and presence of other local risk factors may explain the reduced discriminative and predictive power of EuroSCORE II in Egyptian patients underwent mitral valve replacement. Other larger prospective studies in this concern are recommended

New polymorphism in the 5′ flanking region of IGF-1 gene and its association with wool traits in Egyptian Barki sheep

Insulin-like growth factor-1 gene (IGF-1) is considered as a major candidate gene for the economic traits of animal production. Polymorphism of 5′ flanking region of IGF-1 gene in Barki sheep (n = 91) and its association with wool traits were studied using the polymerase chain reaction coupled with single-strand conformation polymorphism technique (PCR-SSCP), PCR-restriction fragment length polymorphism (PCR-RFLP), sequence analysis and different measurements of wool traits (clean fleece weight and fiber diameter). PCR-SSCP analysis revealed three different banding patterns corresponding with three genotypes frequencies GG (0.25), GA (0.58), AA (0.17). PCR-RFLP and corresponding sequence analysis revealed nucleotide transversion from Guanine (G) to Cytosine (C) at nucleotide position 85 and transition from (G) to Adenine (A) at position 87. This is the first study that recorded two SNPs within the 5′ flanking region of IGF-1 gene in Egyptian Barki sheep, which were submitted to DNA Data Bank OF Japan (DDBJ) with Accession No. LC151463.1. The genotype GG showed positive significant association (P  0.05) with different IGF-1 genotypes. This study adds evidence of the association between IGF-1 gene polymorphism and CFW of wool in Egyptian Barki sheep. Therefore; it is important to consider IGF-1 gene as a candidate gene marker for wool weight traits and it should be identified before using successful breeding program

Hypertensive disorders in women with peripartum cardiomyopathy: insights from the ESC EORP PPCM Registry

Aims: Hypertensive disorders occur in women with peripartum cardiomyopathy (PPCM). How often hypertensive disorders co-exist, and to what extent they impact outcomes, is less clear. We describe differences in phenotype and outcomes in women with PPCM with and without hypertensive disorders during pregnancy. Methods: The European Society of Cardiology PPCM Registry enrolled women with PPCM from 2012-2018. Three groups were examined: 1) women without hypertension (‘PPCM-noHTN’); 2) women with hypertension but without pre-eclampsia (‘PPCM-HTN’); 3) women with pre-eclampsia (‘PPCM-PE’). Maternal (6-month) and neonatal outcomes were compared. Results: Of 735 women included, 452 (61.5%) had PPCM-noHTN, 99 (13.5%) had PPCM-HTN and 184 (25.0%) had PPCM-PE. Compared to women with PPCM-noHTN, women with PPCM-PE had more severe symptoms (NYHA IV in 44.4% and 29.9%, p<0.001), more frequent signs of heart failure (pulmonary rales in 70.7% and 55.4%, p=0.002), higher baseline LVEF (32.7% and 30.7%, p=0.005) and smaller left ventricular end diastolic diameter (57.4mm [±6.7] and 59.8mm [±8.1], p<0.001). There were no differences in the frequencies of death from any cause, re-hospitalization for any cause, stroke, or thromboembolic events. Compared to women with PPCM-noHTN, women with PPCM-PE had a greater likelihood of left ventricular recovery (LVEF≥50%) (adjusted OR 2.08 95% CI 1.21-3.57) and an adverse neonatal outcome (composite of termination, miscarriage, low birth weight or neonatal death) (adjusted OR 2.84 95% CI 1.66-4.87). Conclusion: Differences exist in phenotype, recovery of cardiac function and neonatal outcomes according to hypertensive status in women with PPCM