299: Cardiac remodeling and factors determining occurrence of atrial arrhythmia after surgical closure of atrial septal defect in adults

ObjectivesThe purpose of this study is to assess cardiac remodeling and to determine factors predicting the occurrence of atrial arrhythmia after surgical closure of atrial septal defect (ASD) in adults.MethodsRetrospective study including 33 adult patients (>20 years old, mean age: 34±11 years, 26 women) who underwent surgical closure of secundum or sinus venosus ASD. Before operation, all patients had dyspnea and 15% were in NYHA III-IV. Sinus rythm was present in 85% of patients. The ratio of pulmonary to systemic blood flow was calculated, yielding a mean of 2,8±1 and pulmonary artery hypertension (PAH) was observed in 80% of patients with a mean value of 41,3±10mmHg. The ASD were closed by pericardial or Dacron patch in 97% of cases.ResultsOperative death was observed in 2 cases. In survival patient, with a follow-up of 97+/−57 months, regression of right ventricular dilatation and PAH occurred in the first post-operative month and was maintained at late follow-up. Atrial arrhythmia occurred in 4 patients and were determined by older operative age (p=0.003) and the absence of cardiac remodeling after surgery.ConclusionSurgical correction of ASD in adults is safe and efficacious. Cardiac remodeling after ASD closure in the adult is a common and an early event and prevents late morbidity which is in most cases due to arrhythmias. The mode of closure does not seem to significantly impact remodeling

Evaluation of PCR pncA-restriction fragment length polymorphism and PCR amplification of genomic regions of difference for the identification of M. bovis strains in lymph nodes cultures

Background: A rapid accurate identification of Mycobacterium bovis is essential for surveillance purposes. Objectives: A PCR pncA-Restriction Fragment Length Polymorphism (RFLP) and a multiplex PCR based on the detection of 3 regions of difference (RD-PCR): RD9, RD4 and RD1 were evaluated for the identification of M. bovis in lymph nodes cultures, in Tunisia, during 2013-2015. Methods: Eighty-two M. tuberculosis complex strains were identified using the biochemical tests, GenoType MTBC assay, PCR pncA-RFLP and RD-PCR. Results: The PCR pncA-RFLP showed that 54 M. bovis strains, identified by GenoType MTBC, had a mutation at position 169 of pncAi> gene. Twenty-eight strains did not show any mutation at this position 27 M. tuberculosis isolates and one M. caprae . The PCR pncA-RFLP had a sensitivity of 100.0% (95%CI: 93.3 -100.0) and a specificity of 100.0% (95%CI: 87.9-100.0) for identifying M. bovis. The RD-PCR showed that all M. bovis strains had the RD9 and RD4 deleted but presented RD1. RD-PCR also presented high sensitivity and specificity in detecting M. bovis strains (100.0%). Conclusions: PCR pncA-RFLP and RD-PCR represent very accurate and rapid tools to identify M. bovis. They can be easily implemented in each laboratory due to their low cost and easy use

161: Factors predicting mitral restenosis after successful percutaneous mitral commissurotomy

IntroductionPercutaneous mitral commissurotomy (PMC) is the alternative treatment of choice for mitral stenosis (MS). Its immediate and medium term results are comparable to those of surgical commissurotomy, however in the long term there is a risk of restenosis. The purpose of this study is to determine the factors predicting restenosis after PMC.Methods322 patients (66% women), average age: 35 ±13 years (9-75 years) having a tight MS and treated by PMC with Inoué balloon. The anatomic aspect of the mitral apparatus before PMC has been studied according to the criteria of the Wilkins score with a concomitant study of the state of mitral commissures. The primary success of PMC is defined as follows: mitral area (MA) post-PMC >1,5cm2 and gain in MA >25% and mitral regurgitation (MR) ≤ grade 2. Mitral restenosis is defined as a MA <1,5cm2 and/or loss >50% of initial gain in MA.ResultsThe rate of primary success of PMC was 86% and mean MA post PMC was 1,82±0,33cm2 compared to MA pre-PMC of 1±0,18cm2 (p <0.0001). Opening of two commissures has been observed in 74% of patients. After an average period of 62±32 months, only 12% of patients had a dyspnea stage IIIIV of NYHA, MA was 1,64±0.3cm2 (p<0.001) and mitral restenosis happened in 47 patients (20%) after a period of 60,48±27 months (22–124 months). The independent predictors of mitral restenosis after a successful PMC were: previous surgical commisurotomy, Wilkins score >8, MA after PMC <1,8cm2 and absence of bicommissural opening post PMC.ConclusionA favorable anatomy of mitral apparatus and the optimisation of immediate result of PMC are the guaranty for the maintain of good result in the long term

Postirradiation Osteosarcoma of the Maxilla: A Case Report and Current Review of Literature

Background. Radiation-induced sarcomas are well-known potential late sequelae of radiation therapy. They are of rare occurrence in jaw bones and are even rarer in the maxilla. Case report. We report a case of radiation-induced osteosarcoma involving the maxilla in a patient treated with radiotherapy for nasopharyngeal carcinoma 14 years ago. Despite neoadjuvant chemotherapy, surgical treatment could not be performed, and the patient received palliative chemotherapy. Conclusions. Radiation-induced osteosarcomas are aggressive and often elude early detection and timely intervention, rapidly leading to early demise of afflicted patients. Long-term patient follow-up and a high index of suspicion are crucial for timely intervention

Individual or Group-based Approach to the Assessment of Preschool Children: A Comparison using the INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA)

Introduction: It is unclear if the assessment of early child development can be carried out using a group approach, as opposed to individually.&#x0D; Objective: To compare scores obtained from children aged 22 to 26 months assessed either in small groups or individually using the INTERGROWTH-21st Neurodevelopment Assessment  (INTER-NDA), which measures cognition, language, motor skills, behavior, attention and socio-emotional reactivity.&#x0D; Methods: A small group based strategy for administering and scoring the INTER-NDA was developed. Thirty-six preschool children attending four Centros de Cuidado y Atención Infantil of the Sistema Nacional para el Desarrollo Integral de la Familia (DIF) of Mexico were assessed in small groups of three children by a teacher specifically trained in the INTER-NDA. A second teacher, unaware of the group results, assessed the children individually on a different day. The sex, age, weight, length and head circumference of the children at the time of assessment were recorded.&#x0D; Results: INTER-NDA domain scores for group and individual assessments were statistically significantly correlated (range r=0.35 to r=1.00) for all domains except receptive language (r=0.25, p=0.14). Bland-Altman analysis showed agreement between group and individual scores for the language, behavior, attention and socio-emotional reactivity domains, and consistency (but not agreement) between group and individual scores for the cognitive and motor domains. None of the differences between group and individual scores examined were statistically significant, even after adjusting for the children’s age, sex, nutritional status and location of the preschool.&#x0D;  &#x0D; Conclusion: INTER-NDA domain specific scores obtained following group and individual assessment of children aged 22 to 26 months are consistent. It is feasible for trained preschool teachers to administer INTER-NDA at both group and individual level.</jats:p

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Genotypic variability for salt stress tolerance among wild and cultivated wheat germplasms at an early development stage

This study was conducted to evaluate the variability of salt tolerance potentials among nine wheat genotypes representing wild and cultivated species namely Triticum turgidum subsp. durum, Triticum aestivum and Aegilops geniculata. Ionomic and photosynthetic traits were used for the screening of the studied samples when faced with four salinity levels of NaCl (0, 50, 100 and 150 mM) under green house conditions at the seedling stage. The investigated genotypes exhibited different levels of salt stress tolerance. Ionomic and photosynthetic traits underline the distinctiveness of the common wheat varieties which highlighted particular performances under salt stress conditions and showed higher tolerance potentials among the studied genotypes. Interestingly, the Vaga variety showed more ability to maintain higher K+/Na+ ratios and Pq coefficients compared with the control conditions and stable Fv/F0 and Fv/Fm ratios. Stable behaviour was exhibited by wild Aegilops accessions while durum wheat varieties have been shown to be more sensitive to salt stress. Further investigations were required for the common wheat variety Vaga, which could be useful for successful breeding and biotechnological improvement strategies concerning wheat species

The Impact of Innovation on Store Managers’ Job Satisfaction: Evidence from Tunisian Retailing

International audienc

323: Pulmonary embolism: the value of transthoracic echocardiography

IntroductionAcute pulmonary embolism (PE) remains a life-threatening disease and one of three major disease entities with chest discomfort seen in the emergency room. Despite progress in imaging techniques and knowledge of this disease, its medical diagnosis is one of the most difficult to achieve. The clinical assessment of PE probability remains central to the diagnosis and evaluation. Presently, accepted diagnostic modalities for the confirmation of PE include V/Q scanning, chest CT, and standard angiography. All approaches have limitations. Because echocardiography is noninvasive, provides rapid bedside results. It is an attractive imaging modality to diagnose PE.PurposeThe purpose of this study is to assess the contribution of transthoracic echocardiography (TTE) in the clinical setting of PE.ResultsEighteen patients were included. There were 7 men and 11 women. The mean age was 57 years [28; 80]. TTE was performed in all patients within the first 24 to 72 hours of admission. The diagnosis of PE was confirmed by standard angiography in all cases. Tricuspid regurgitation was the most common TTE finding (16 of 18), followed by dilated right ventricle (15 of 18), pulmonary hypertension (11 of 18), paradoxical interventricular septal motion (7 of 18) and right ventricular hypokinesis (2 of 18). TTE revealed thrombi inside the right-sided heart cavities in 3 patients. The thrombus was detected at the apex of the right ventricle in the first case, at the right atria in the second case and many thrombi were objectified even at the right atria and ventricle, at the inferior vena cava and at the left pulmonary artery in the third case.ConclusionTransthoracic echocardiography may reveal findings that strongly support hemodynamically significant PE. In the majority of cases TTE provides only indirect signs of PE. It could, though, far less frequently visualise thromboembolic material inside the right-sided heart cavities. Direct visualisation of the thrombus, although confirming PE, remains an exceptional finding. This may be useful for prompt decision making in patients with haemodynamic compromise considered for thrombolysis or embolectomy