38. Diastolic function is an independent predictor of cardiorespiratory fitness in patients with preserved ejection fraction

The aim of this analysis is to determine whether diastolic dysfunction is an independent predictor of CRF among patients with normal left ventricular function. Cardiorespiratory fitness (CRF), expressed in metabolic equivalent (METs), has been shown to be a significant predictor of outcomes. A retrospective analysis including patients who underwent clinically indicated treadmill stress testing using Bruce protocol and transthoracic echocardiography within one-year period between 2008 and 2014. Cardiorespiratory fitness was estimated using the maximum speed and grade achieved during treadmill time. Multivariable Linear regression was used to determine the independent predictors of CRF. Results: A total of 2816 patients (Mean age 46 ± 12 years, 61% were males) were included. The prevalence of risk factors were: hypertension 23.6%, diabetes mellitus 18.2% and dyslipidaemia 57.6%. The distribution of the diastolic dysfunction across the different CRF groups are shown. Using multivariate logistic regression, the independent predictors of poor CRF (achieving less than 6 METS) included diastolic dysfunction OR 1.87 (95% CI, 1.326–2.518), p < 0.001 and BMI (OR 0.907, (95% CI, 0.895–0.918), p < 0.001 per 1 kg/m2) after adjusting for potential confounders.Among patients with normal left ventricular function, diastolic function assessment is an independent predictor of cardiorespiratory fitness

75. King Abdulla Medical City – Makkah (KAMC) echocardiography service experience & challenges during hajj season (pilgrimage)

2–4 million Muslims attend Hajj each year over last 4–5 years. Umra visitors are seen all along most the year. This creates high demand on all services provided specially the medical. The majority of Hajjes are elderly with co morbidities. They are subject to intense emotional, spiritual & physical endurance during the short period of Hajj season. For the last 4 years King Abdulla Medical City (KAMC) is the centre of care for almost all cardiac services provided in Makkah. Echocardiography is a pivotal & integral part of any cardiology service, providing important information about morphology, function & possible etiology in many cases. There is an increasing demand on echo service in KAMC especially during Hajj season. Our service model is unique to meet this increasing demand during Hajj season. To report: we report the service set up. The volume of cases done our experience & challenges met during last four years. The service is provided between first & 15th of Dhul Haja each year. The service is 24 h divided into 12 h shifts. The two shifts are adequately covered by well trained echocardiographers & experienced non-invasive consultant cardiologists. This staff is distributed within the various cardiology clinical areas, to insure rapid response. The studies are done Philips (i30, Epic7) machines. Data acquired is transmitted by special ports/WiFi to our echo lab (Xcelera system) where the data is stored & available for viewing & reporting. Reports are created by the responsible consultants using a number of dedicated stations. Viewing stations are well distributed over the whole hospital. The results of this abstract are analyzed using simple Microsoft office tools. Between years 2011 and 2015 there is exponential increase of echo studies done in KAMC, with similar increase in the number of studies done among Hajjes. There was an increase in the number of echo machines, echocardiographers & consultants (See Tables and Graphs attached). Between the years 2011–2012 and 2012–2013 there was a significant jump in the number of echo studies done in KAMC & during Hajj season. Between the years 2013–2014 and 2014–2015 the incremental rate slowed down. (See Table 2). Some of challenges noted during Hajj season: locum staff needed to cover the Hajj period High volume of echo studies needed done & reported within short time. Language barrier causing lack of important medical information & causing delay/failure to consent when special studies are needed eg TEE. The infrequent lack of clinical data in the request forms to guide the study & reporting. There is occasional complex cases. Hajj season is unique & challenging experience to most Hajjes & service providers. Our service set up is demanding but quite adequate to meet the expectations. The data gathered over last 4 years showed clear & exponential increase in the number of echo studies. Service providers need to plan & accommodate this expected increase

Threshold effects of landscape structure on biological control in agroecosystems. Ecological Applications

Abstract. Habitat fragmentation may adversely affect the ability of natural enemies to control pest outbreaks in agricultural landscapes by interfering with their search behavior and ability to aggregate in response to prey. We determined how landscape structure affected the ability of two ladybird beetles (Coleoptera: Coccinellidae) to track aphid populations in experimental landscapes that differed in the abundance and degree of fragmentation of red clover (Trifoliutn pratense). One coccinellid was a native species (Coleomegilla maculntn Pallas) and the other (Hartnonia a~r i d i s Timberlake) was introduced specifically for the biological control of crop pests such as pea aphids (Acyrrlzosiphon pisurn Harris; Homoptera: Aphididae). Landscape structure exhibited a threshold in lacunarity (a measure of interpatch distances) below 20% habitat. at which point clover patches became significantly more isolated. This threshold in landscape structure was mirrored by a similar threshold in the distribution of pea aphid populations. The distribution of the biocontrol agent, H. nxyridis, tracked this threshold in aphid distribution, but the native coccinellid. C. maculata, was unable to do so in fragmented clover landscapes. Although C. maculata was a more active forager within clover cells, overall it was less mobile and moved significantly less among clover cells and between landscapes than H. axyridis, which may have contributed to its inability to track aphid populations in fragmented landscapes. The two coccinellids did not differ in their search success within fragmented landscapes. however. and it was only in clumped landscapes that H. axyridis maximized search success and foraged within clover cells that had 2.5-3 times more aphids than those in which C. rnnculntn occurred. Thus, the potential of predators to control pest populations in fragmented landscapes may ultimately reflect the extent to which thresholds in landscape structure interfere with the aggregative response of predators. In this system, the aggregative response of coccinellids was more closely tied to thresholds in the distribution of clover than aphids. With its greater mobility, H. nxyridis was more effective than the indigenous C. maculata at tracking aphids when they occurred at low patch occupancy (below the threshold in landscape structure), which is a requisite for successful biocontrol. If native insect predators are generally more sensitive to habitat fragmentation, greater reliance may be placed on the introduction of exotic species for biocontrol, which is not without economic cost and potential ecological impacts to native insect communities. Our study demonstrates that. in addition to economic thresholds. there are also ecological thresholds that must be surmounted if biocontrol measures are to be successful. In addition to enhancing vegetational diversity within agroecosystems, conservation biological control should also strive to mitigate fragmentation effects on natural enemies, especially if thresholds in landscape structure disrupt predator-prey interactions and compromise the efficacy of biocontrol programs

Predicting streptococcal pharyngitis in adults in primary care: a systematic review of the diagnostic accuracy of symptoms and signs and validation of the Centor score

Background: Stratifying patients with a sore throat into the probability of having an underlying bacterial or viral cause may be helpful in targeting antibiotic treatment. We sought to assess the diagnostic accuracy of signs and symptoms and validate a clinical prediction rule (CPR), the Centor score, for predicting group A ?-haemolytic streptococcal (GABHS) pharyngitis in adults (&gt; 14 years of age) presenting with sore throat symptoms. Methods: A systematic literature search was performed up to July 2010. Studies that assessed the diagnostic accuracy of signs and symptoms and/or validated the Centor score were included. For the analysis of the diagnostic accuracy of signs and symptoms and the Centor score, studies were combined using a bivariate random effects model, while for the calibration analysis of the Centor score, a random effects model was used. Results: A total of 21 studies incorporating 4,839 patients were included in the meta-analysis on diagnostic accuracy of signs and symptoms. The results were heterogeneous and suggest that individual signs and symptoms generate only small shifts in post-test probability (range positive likelihood ratio (+LR) 1.45-2.33, -LR 0.54-0.72). As a decision rule for considering antibiotic prescribing (score ? 3), the Centor score has reasonable specificity (0.82, 95% CI 0.72 to 0.88) and a post-test probability of 12% to 40% based on a prior prevalence of 5% to 20%. Pooled calibration shows no significant difference between the numbers of patients predicted and observed to have GABHS pharyngitis across strata of Centor score (0-1 risk ratio (RR) 0.72, 95% CI 0.49 to 1.06; 2-3 RR 0.93, 95% CI 0.73 to 1.17; 4 RR 1.14, 95% CI 0.95 to 1.37). Conclusions: Individual signs and symptoms are not powerful enough to discriminate GABHS pharyngitis from other types of sore throat. The Centor score is a well calibrated CPR for estimating the probability of GABHS pharyngitis. The Centor score can enhance appropriate prescribing of antibiotics, but should be used with caution in low prevalence settings of GABHS pharyngitis such as primary care

Impact of Moderate Aortic Stenosis in Patients With Heart&nbsp;Failure With Reduced&nbsp;Ejection Fraction

BackgroundAfterload from moderate aortic stenosis (AS) may contribute to adverse outcomes in patients with heart failure with reduced ejection fraction (HFrEF).ObjectivesThe authors evaluated clinical outcomes in patients with HFrEF and moderate AS relative to those without AS and with severe AS.MethodsPatients with HFrEF, defined by left ventricular ejection fraction (LVEF)&nbsp;&lt;50% and no, moderate, or severe AS were retrospectively identified. The primary endpoint, defined as a composite of all-cause mortality and heart failure (HF) hospitalization, was compared across groups and within a propensity score-matched cohort.ResultsWe included 9,133 patients with HFrEF, of whom 374 and 362 had moderate and severe AS, respectively. Over a median follow-up time of 3.1 years, the primary outcome occurred in 62.7% of patients with moderate AS vs 45.9% with no AS (P&nbsp;&lt; 0.0001); rates were similar with severe and moderate AS (62.0% vs 62.7%; P&nbsp;=&nbsp;0.68). Patients with severe AS had a lower incidence of HF hospitalization (36.2% vs 43.6%; P&nbsp;&lt; 0.05) and were more likely to undergo AVR within the follow-up period. Within a propensity score-matched cohort, moderate AS was associated with an increased risk of HF hospitalization and mortality (HR: 1.24; 95%&nbsp;CI: 1.04-1.49; P&nbsp;=&nbsp;0.01) and fewer days alive outside of the hospital (P&nbsp;&lt; 0.0001). Aortic valve replacement (AVR) was associated with improved survival (HR: 0.60; CI: 0.36-0.99; P&nbsp;&lt; 0.05).ConclusionsIn patients with HFrEF, moderate AS is associated with increased rates of HF hospitalization and mortality. Further investigation is warranted to determine whether AVR in this population improves clinical outcomes