SARS-CoV2 infection in symptomatic patients: interest of serological tests and predictors of mortality: experience of DR Congo

Background In symptomatic patients, the diagnostic approach of COVID-19 should be holistic. We aimed to evaluate the concordance between RT-PCR and serological tests (IgM/IgG), and identify the factors that best predict mortality (clinical stages or viral load). Methods The study included 242 patients referred to the University hospital of Kinshasa for suspected COVID-19, dyspnea or ARDS between June 1st, 2020 and August 02, 2020. Both antibody-SARS-CoV2 IgM/IgG and RT-PCR method were performed on the day of admission to hospital. The clinical stages were established according to the COVID-19 WHO classification. The viral load was expressed by the CtN2 (cycle threshold value of the nucleoproteins) and the CtE (envelope) genes of SARS- CoV-2 detected using GeneXpert. Kappa test and Cox regression were used as appropriate. Results The GeneXpert was positive in 74 patients (30.6%). Seventy two patients (29.8%) had positive IgM and 34 patients (14.0%) had positive IgG. The combination of RT-PCR and serological tests made it possible to treat 104 patients as having COVID-19, which represented an increase in cases of around 41% compared to the result based on GeneXpert alone. The comparison between the two tests has shown that 57 patients (23.5%) had discordant results. The Kappa coefficient was 0.451 (p < 0.001). We recorded 23 deaths (22.1%) among the COVID-19 patients vs 8 deaths (5.8%) among other patients. The severe-critical clinical stage increased the risk of mortality vs. mild-moderate stage (aHR: 26.8, p < 0.001). The values of CtE and CtN2 did not influence mortality significantly. Conclusion In symptomatic patients, serological tests are a support which makes it possible to refer patients to the dedicated COVID-19 units and treat a greater number of COVID-19 patients. WHO Clinical classification seems to predict mortality better than SARS-Cov2 viral load.

Relationship of Selected Anthropometric and Linear Kinematical Variables with the Performance of Toe-Touch Skill in Kabaddi

The purpose of this study was to find out the relationship of selected anthropometric and linear kinematical variables with the performance of toe-touch skill among male kabaddi players (raiders). Materials and Methods. One hundred male raiders were selected for this study. The age of the subjects ranged between 18 to 25 years. Selected anthropometric variables: foot length, upper leg length, lower leg length, thigh girth and calf girth were measured by standardized equipment. Selected linear kinematical variables were measured by digital software ‘Kinovea version-0.9.3’. The toe-touch skill performed by raiders was assessed by three experts rating. The inter-rater reliability of the scores awarded by the experts to the subjects was tested by Cohen’s Kappa test and Kappa coefficient was found significant. Results. Spearman’s rank correlation revealed that there was significant correlation in case of thigh girth (rs = 0.230, p = 0.022), distance (rs = 0.245, p = 0.014) and center of gravity (rs = -0.270, p = 0.007) variables, and there was not significant correlation in case of upper leg length (rs = 0.048, p = 0.634), lower leg length (rs = -0.90, p = 0.373), calf girth (rs = 0.093, p = 0.355), foot length (rs = -0.17, p = 0.863) and time (rs = -0.006, p = 0.952) variables with the performance of toe-touch skill in kabaddi. Conclusion. The study concludes that thigh girth and distance positively and center of gravity negatively contributes to the performance of toe-touch skill in male kabaddi players.

The Role of TOP2A Protein Expression and Aneuploidy in NSCLC

Purpose DNA topoisomerase II alpha (TOP2A) is a cell-cycle dependent protein associated with cell proliferation and division. Abnormal regulation of TOP2A and aneuploidy induces tumorigenesis and poor prognosis. Data related to TOP2A protein in non-small cell lung cancer (NSCLC) is limited to few studies on gene status. The present study aimed to investigate the consistency between aneuploidy and expression of TOP2A gene and protein, respectively, and the role of aneuploidy in the prognosis of NSCLC patients. Methods Clinical data and lung cancer tissues were collected from 244 patients with NSCLC. TOP2A protein and gene expression were detected using immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH), respectively. Nonparametric Spearman’s rank sum test was used to analyze clinicopathological data. Kaplan–Meier and multivariate Cox regression methods were used for survival analysis. Results Enhanced expression and amplification rate of TOP2A protein and gene were 29.9% (73/244) and 0.4% (1/244), respectively. The aneuploidy rate was 31.6% (77/244). In NSCLC, patients with enhanced expression of TOP2A protein and aneuploidy correlated with clinical stages (p < 0.001) Enhanced expression of TOP2A protein was consistent with aneuploidy as detected by Kappa test (K = 0.307) and this correlation was confirmed by chi-square test (p < 0.001). The overall survival of patients with aneuploidy was shorter than diploidy (p < 0.001). Clinically advanced patients with aneuploidy together with TOP2A overexpression had poor prognosis (p < 0.001). Conclusion Aneuploidy and overexpression of TOP2A is a predictor of poor prognosis in patients with advanced NSCLC.

531 Neuroimaging assessment of unilateral asymptomatic carotid artery stenosis: preliminary results of the carotid artery multi-modality imaging prognostic (camp) study

Aims Doppler ultrasound (DUS), CT angiography (CTA), and contrast-enhanced MR angiography (CEMRA) are all recommended techniques to evaluate the significance of carotid artery stenosis, although they may give discordant results. Plaque ulcerations may be present, but their role is still controversial. We aimed at assessing the concordance and level of agreement, as well as the prevalence of characteristics related to plaque ulceration and association to patients’ characteristics among different imaging diagnostic techniques. Methods and results Sixty-one patients with unilateral asymptomatic carotid artery stenosis (40–60% detected by DUS), enrolled in the ongoing CAMP study were prospectively evaluated with CEMRA and CTA. The level of agreement was calculated by the weighed kappa test. Plaque ulceration was defined as an intimal defect larger than 1 mm in width or 2 mm in depth, detected by CTA and/or CEMRA. Concordance rate was 71% for DUS–CTA, 51% for DUS–CEMRA, and 66% for CTA–CEMRA. Concordance among all noninvasive techniques was only 45%. Compared with DUS, the stenosis was downgraded by CTA in 17% and by CEMRA in 32% of cases. There was a moderate agreement between DUS–CTA {weighed kappa 0.49 [95% confidence interval (CI): 0.31–0.67]}, while agreement between DUS–CEMRA and CTA–CEMRA was fair [weighed kappa 0.15 (95% CI: −0.01–0.31) and 0.38 (95% CI: 0.14–0.62), respectively]. An ulcerated plaque was present in 39% of patients at CTA and/or CEMRA; compared with patients with non-ulcerated plaques, those with an ulcerated plaque had higher levels of C-reactive protein (CRP), and a trend to higher levels of high sensitivity cardiac troponin (cTn) T (Table), whereas the degree of stenosis was similar. Conclusions CTA and CEMRA tend to report a lower degree of stenosis compared with DUS. Concordance and level of agreement was higher for DUS and CTA. Plaque ulceration is common and is associated with a significant higher level of systemic inflammation, as detected by CRP and, possibly, cTn.

Research on Associations of MiR-149 with Nutritional Risk Assessment and Postoperative Complications of Patients with Colorectal Cancer

Background: MiRNAs play an important role in the development of colorectal cancer, however, there’s few evidence of miRNAs in the screening of nutritional risks of patients with colorectal cancer. Objectives: To explore the role of preoperative miR-149 in nutritional screening of patients with CRC, and its associations with clinicopathological characteristics and postoperative complications of patients with CRC. Methods: The associations of serum miR-149 with clinicopathological characteristics and postoperative complications of patients were analyzed. The ROC curves were plotted with miR-149 as the test variable, and the grouping results of patients with nutritional risks [total NRS2002 score ≥3 points] and no nutritional risks (total NRS2002 score <3 points) based on the preoperative NRS2002 score as the state variables. The consistency of miR-149 and NRS2002 in nutritional screening of CRC was analyzed using Kappa test. Results: MiR-149 was low in patients with CRC. There was a statistically significant difference in the miR-149 expression among patients with different tumor diameters and TNM stages in the two groups. The preoperative total NRS2002 score of CRC patients was <3 points (without nutritional risks) in 271 cases, and ≥3 points (with nutritional risks) in 129 cases. The sensitivity and specificity of miR-149 in the diagnosis of nutritional risks were 76.74% and 84.50%. The Kappa value was 0.622 with miR-149 =3.095 as the critical value. Conclusions: MiR-149 can reflect the perioperative nutritional status of patients with CRC, and miR-149 =3.095 can be used as the cut-off point for nutritional risk screening of patients with CRC, which is an important index for assessing the nutritional risk in the perioperative period. The expression of miR-149 has a certain association with postoperative complications.

Aplikasi Smartphone Efektif digunakan untuk Pengawasan Keseimbangan Cairan pada Anak dengan Penyakit Infeksi

Latar belakang: Keseimbangan cairan sangat penting untuk kelangsungan hidup sehingga pengawasan cairan perlu diperhatikan. Pencatatan keseimbangan cairan diperlukan untuk menjadi dasar penilaian yang akurat dari status keseimbangan cairan pasien anak dan menjadi dasar pertimbangan pemberian terapi selanjutnya. Untuk memudahkan perawat melakukan pencatatan keseimbangan cairan yang akurat diperlukan inovasi menggunakan teknologi berbasis smartphone. Penelitian ini bertujuan untuk mengetahui perbedaan efektifitas pengawasan cairan menggunakan lembar observasi dengan aplikasi smartphone. Metode: Penelitian ini diawali dengan pengembangan aplikasi smartphone bernama SIMBaCaAn berdasarkan tinjauan pustaka yang dilakukan menggunakan pendekatan PICO (Population, Intervention, Comparison,Outcome). Uji efektifitas aplikasi SIMBaCaAn dilakukan pada 48 pasien anak yang dirawat di salah satu rumah sakit rujukan di DKI Jakarta. Analisis data dilakukan menggunakan uji statistik Kappa Test. Hasil: Pengawasan keseimbangan cairan yang menggunakan lembar observasi menghasilkan pencatatan data tidak lengkap sebesar 14,6%, data lengkap tidak tepat 20,8% dan data lengkap tepat sebanyak 64,4 %. Sedangkan pengawasan keseimbangan cairan menggunakan aplikasi SIMBaCaAn didapatkan hasil data tidak lengkap 18,7% dan hasil data lengkap tepat 81,3%. Dari hasil uji statistik, ditemukan perbedaan yang signifikan antara pengawasan keseimbangan cairan menggunakan aplikasi dan lembar observasi. Kesimpulan: Aplikasi smartphone lebih efektif terhadap pencatatan keseimbangan cairan secara lengkap tepat dibandingkan dengan lembar observasi manual.

Thoracic Outlet Syndrome: Fingertip Cannot Replace Forearm Photoplethysmography in the Evaluation of Positional Venous Outflow Impairments

Objective: Fingertip photoplethysmography (PPG) resulting from high-pass filtered raw PPG signal is often used to record arterial pulse changes in patients with suspected thoracic outlet syndrome (TOS). Results from venous (low-pass filtered raw signal) forearm PPG (V-PPG) during the Candlestick-Prayer (Ca + Pra) maneuver were recently classified into four different patterns in patients with suspected TOS, two of which are suggestive of the presence of outflow impairment. We aimed to test the effect of probe position (fingertip vs. forearm) and of red (R) vs. infrared (IR) light wavelength on V-PPG classification and compared pattern classifications with the results of ultrasound (US).Methods: In patients with suspected TOS, we routinely performed US imaging (US + being the presence of a positional compression) and Ca + Pra tests with forearm V-PPGIR. We recruited patients for a Ca + Pra maneuver with the simultaneous fingertip and forearm V-PPGR. The correlation of each V-PPG recording to each of the published pattern profiles was calculated. Each record was classified according to the patterns for which the coefficient of correlation was the highest. Cohen’s kappa test was used to determine the reliability of classification among forearm V-PPGIR, fingertip V-PPGR, and forearm V-PPGR.Results: We obtained 40 measurements from 20 patients (40.2 ± 11.3 years old, 11 males). We found 13 limbs with US + results, while V-PPG suggested the presence of venous outflow impairment in 27 and 20 limbs with forearm V-PPGIR and forearm V-PPGR, respectively. Fingertip V-PPGR provided no patterns suggesting outflow impairment.Conclusion: We found more V-PPG patterns suggesting venous outflow impairment than US + results. Probe position is essential if aiming to perform upper-limb V-PPG during the Ca + Pra maneuver in patients with suspected TOS. V-PPG during the Ca + Pra maneuver is of low cost and easy and provides reliable, recordable, and objective evidence of forearm swelling. It should be performed on the forearm (close to the elbow) with either PPGR or PPGIR but not at the fingertip level.

Prosodic boundary incongruences in oral reading

Background: Characteristics of oral readings are well studied in school-aged children and teenagers, but not in educated adults. Objectives: Assess the prevalence of prosodic boundary incongruences in oral readings of adult, native, educated, Brazilian Portuguese speakers and analyze their correlations with specific linguist features. Design, settings, and participants: We studied an online video corpus of political speeches delivered by house members of the Brazilian parliament between 2017 and 2018, and their respective written texts. Measurements: We assessed a) prosodic boundary incongruences between oral readings and written texts, b) actor prototypicality of the subjects, c) thematic continuity of the sentences, and d) a variable called 'sufficiency', related to the concept of argumenthood, assorting each word according to its need for complementary words. The inter-rater reliability of the author's perceptions of incongruences underwent Cohen's Kappa test. Results: In 5 hours of oral readings, we found a median of 1.4 prosodic boundary incongruences per minute (interquartile range: 0.766 - 2.212). 80% of the incongruences were insertions of non-terminal or terminal boundaries. Prosodic boundary incongruency correlated positively with a) thematic continuity of the incongruent sentences (p-value = 0.0006345), b) the concept of 'sufficiency' (p-value < 2.2e-16); and correlated negatively with c) first-person subjects (p-value = 0.0002584). Limitations: The assessment of the variables was subjective, and we did not control sentences for their lengths when analyzing variables 'b' and 'c'. Conclusions: Prosodic boundary incongruences were relatively common in our corpus. We introduced some hypotheses to explain the results.

Interobserver Variability with the Diagnosis of Acute Myeloid Leukemia (AML) and Myelodysplastic Syndrome (MDS) ¿Is the Threshold of 20% Bone Marrow Blasts Reproducible?

Introduction. The boundaries between MDS and AML are still a matter of debate. In the 2001 WHO Classification, the myeloblast count distinguishing AML and MDS was lowered from 30% to 20% of the bone marrow (BM) cells or peripheral blood (PB) leukocytes. It was justified on the basis that treating patients with 20-29% BM blasts with intensive chemotherapy showed a similar outcome to those with &gt; 30% BM blasts. However, the better knowledge of the biology of both diseases is showing that in several cases AML and high risk MDS share identical genetic profiles, as it is well known in AML with myelodysplasia- related changes (AML-MRC). Currently there are new therapeutic options, less toxic, and suitable for elderly people.The threshold of 20% BM blast is artificial, but it is still the main criterion used in clinical trials and also in real life to discriminate patients that probably belong to the spectrum of the same biological entity. Treatment of patients with MDS or AML is widely based in this relatively arbitrary condition. Objective: To study if the threshold of 20% bone marrow blasts, distinguishing MDS with excess of blasts type 2 (MDS EB 2) and AML, is reproducible among different observers. Methods. 120 bone marrow samples from patients previously diagnosed with MDS-EB-2, AML or therapy-related myeloid neoplasms (t-MN) according to 2016 WHO classification were included. The diagnosis of MDS required cytogenetics and/or FISH, and the cases with AML should have been classified following the 2017 ELN recommendations, regarding immunophenotyping, cytogenetics and molecular biology. The design of the study was established to include cases with &lt;40% BM blasts, WBC &lt;25x109/L and less than 20% myeloblasts in peripheral blood. The proportion of samples from each category was not predefined. Specimens were collected from 12 hospitals and were evaluated by 12 morphologists. Each observer evaluated 20 samples, and each sample was analyzed independently by two morphologists. The second observer was blinded to the clinical and laboratory data, except for the peripheral blood (PB) counts. The interobserver concordance was evaluated using the Cohen kappa test. Results. Finally 116/120 samples were considered suitable for the study. Regarding 2016 WHO categories, 55 cases showed MDS EB-2, 44 AML-MRC, 8 t-MN, 4 AML- NOS, 2 NPM1-mutated AML, 2 RUNX1-RUNX1T1 AML, 1 BCR-ABL1+ AML. Next generation sequencing was performed in 79 cases. Discordance was observed in 34/116 cases (29.3%). 14 cases with MDS-EB2 (1 NPM1+) were classified as AML-MRC by the second observer, 16 AML cases as MDS EB-2, 3 MDS EB-2 as MDS- EB1 and 1 AML as MDS- EB1. The genetic and /or molecular profile of the discordant cases was heterogeneous. Regarding the threshold of 20% BM blasts, discrepancies were 31/116 (26.7%, I Kappa test = 0.46, moderate agreement). The agreement between MDS-EB-2 and AML-MRC, with discordance in 28/98 cases (28.6%), was moderate-fair (Kappa test= 0.42). Conclusion. The threshold of 20% BM blasts did not accurately separate AML from MDS EB-2. Particularly less concordance was seen for AML-MRC. Incorporation of genetic and molecular characteristics to the morphologic diagnosis is needed to optimize the definition of both entities. Acknowledgment: Angel Cedillo, Secretaría Técnica AMHH. Disclosures Font Lopez: GILEAD: Membership on an entity's Board of Directors or advisory committees; CELGENE-BMS: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees. Loscertales: Janssen, Abbvie, Astra-Zeneca, Beigene, Roche, Gilead: Consultancy; Janssen, Abbvie, Roche, Gilead: Speakers Bureau. Cedena: Janssen, Celgene and Abbvie: Honoraria.

P.148 Children and teenagers with hydrocephalus: Are narrowed dural sinuses better predictors of shunt-failure than ventriculomegaly?

Background: Intracranial hypertension secondary to shunt-failure is a feared complication requiring cross-sectional imaging for diagnosis. We compared dural sinus narrowing and ventriculomegaly as predictors of shunt-failure. Methods: 60 head MRIs and 60 MR venographies of hydrocephalus patients age 0-18 years (n=25) were analyzed. MRI studies were included when f/u clinical data combined with intra-operative findings proved shunt-failure (positive Gold standard) or when MRI was available when the child was well (negative Gold standard). The absence or presence of concerning hydrocephalus was diagnosed. On MRV, the major dural sinuses were independently analyzed with respect to >50% narrowing, suggesting compression by increased CSF pressure. Ventriculomegaly and significant dural sinus narrowing was correlated to the presence/absence of shunt failure as per Gold standard. Results: Sinus narrowing substantially correlated with proven shunt-failure (Cohen’s kappa test 0.635/p<=0.00001 as per Fisher exact test) while ventriculomegaly correlated poorly (0.258/p=0.0751). Sensitivity/specificity was 0.69/0.92 for sinus narrowing and 0.43/0.81 for ventriculomegaly. Conclusions: In this patient cohort, dural sinus narrowing more reliably predicted shunt-failure compared to ventriculomegaly.