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Background: Acute lymphoblastic leukemia (ALL) is a malignant disease that arises from several genetic mutations in a single B- or T-lymphoid precursor, resulting in altered blast cell survival, proliferation, and maturation. Objectives: This current study was aimed to determine the significance of aberrant CD133 and 45 expressions in Sudanese Patients with Acute lymphoblastic Leukemia, and their clinical significance in Khartoum state. Materials and Methods: One hundred Sudanese participants were enrolled in this study as follows: 88 Patients diagnosed with ALL as a case and 12 healthy controls donors were randomly selected. 2.5-5 mL of EDTA blood/bone marrow for flowcytometry from each patient and controls subject. Results: Eighty-eight newly diagnosed Sudanese patients with acute lymphocytic leukemia (ALL) were involved in this study, their age average is (15.7) and their stander deviation (SD) is 17.4. The frequency of aberrant markers concerning control groups was significantly associated with all patients in CD 45 with a P value (0.0001), while there was no difference between cases and control in the frequency of CD 133 antigen, there was no significant difference between age groups in the expression of different aberrant antigens. The study was significantly more expressed CD133 in males than females. Also no significant difference in hematological parameters between patients with or without expression of Aberrant CD 45 and 133 markers, while we found significantly high TWBCs in T. cell leukemia. Conclusion: Aberrant myeloid antigens CD45 was significantly associated with childhood and adult ALL and may be considered as important prognostic factors, while CD 133 were not associated with ALL.

Background There is limited data on the clinical presentation and predictors of mortality in the African‐American(AA) patients hospitalized with COVID‐19 despite the disproportionately higher burden and mortality. The aim of this study is to report on the clinical characteristics and the predictors of mortality in hospitalized AA patients with COVID‐19 infection. Methods In this retrospective cohort review, we included all AA patients with confirmed COVID‐19 infection admitted to an inner‐city teaching community hospital in New York City. Demographics, clinical presentation, baseline co‐morbidities, and laboratory data were compared between survivors and non‐survivors. The predictors of mortality were assessed using multivariate logistic regression analysis. Results Of the 408 (median age, 67years) patients included, 276(66.65%, median age 63years) survived while 132(33.35%, median age 71years) died. The most common presenting symptoms were cough, myalgia, fever/chills, shortness of breath, and gastrointestinal symptoms (nausea, vomiting, diarrhea, and abdominal pain), with a prevalence of 62.50%, 43.87%, 53.68%, and 27.21%, respectively. Age (OR 1.06, CI 1.04‐1.08, P‐

Background Recognizing the etiology of sudden cardiac arrest (SCA) has an enormous impact on the management of victims and their immediate families. A significant proportion of SCA survivors with a structurally normal heart are not offered a diagnosis and there is no clear consensus on the type and duration of follow‐up. We aimed to assess the utility of a multidisciplinary approach in optimizing diagnosis of cardiac arrest etiology during follow‐up. Methods and Results We retrospectively assessed 327 consecutive SCA survivors (mean age 61.9±16.2 years, 80% men) who underwent secondary prevention implantable cardioverter defibrillators between May 2015 and November 2018. The initial diagnosis was recorded at the time of admission and follow‐up diagnosis was deduced from subsequent clinic records, investigations, and outcomes of multidisciplinary team meetings. Structural heart disease accounted for 282 (86%) of SCAs. Forty‐five (14%) patients had a structurally normal heart and underwent comprehensive testing and follow‐up (mean duration 93±52 weeks). On initial evaluation, 14/45 (31%) of these received a diagnosis, rising to 29/45 (64%) with serial reviews during follow‐up. Discussion in multidisciplinary team meetings and imaging reassessment accounted for 47% of new diagnoses. No additional diagnoses were made beyond 96 weeks. Nineteen (5.8%) fatalities occurred in the entire cohort, exclusively in patients with structural heart disease. Conclusions Systematic comprehensive testing combined with multidisciplinary expert team review of SCA survivors without structural heart disease improves the yield and time to diagnosis compared with previously published studies. This approach has positive implications in the management of SCA survivors and their families.

Background Diabetic foot complications result in substantial morbidity and mortality, fortunately they can be prevented. Our study measured the frequency of patient-reported diabetes-related foot problems and foot self-care practices among diabetic patients attending Abdallah Khalil Diabetes Center, Khartoum state, Sudan. Methodology This was a descriptive cross-sectional health facility-based study conducted at Abdallah Khalil Diabetes Center in Omdurman, Khartoum in the period from January to March, 2021. A convenience sample of 194 (n=250) Sudanese diabetic patients, aged 20 and above were in enrolled in this study. A pretested interviewer-administered questionnaire was used to obtain data on socio-demographic and clinical characteristics, patient-reported foot problems and foot self-care practices, data was analyzed using SPSS 23, chi-square and multi-variate logistic regression tests were used to measure associations and predictive factors among different variables. Results 194 patients were included in this study (response rate: 77.6%), mean diabetes duration 10.20±8.07 years, 60.3% were female, 47.4% were unemployed and 10.8% were retired, illiterate participants represented (28.9%). 80.4% reported having at least one or more sensory peripheral neuropathy symptoms, 36.6% reported one or more peripheral vascular disease symptoms in the previous month, and 29.4% had a history of foot ulceration. Reported foot self-care practices were overall suboptimal; 55.2 average scores (25-36), only 4.1% attained good scores (37-48). 24.7$ and 27.8% never or rarely examine the bottom of their feet each day. On multivariate logistic regression HbA1c was found to be predictive of foot ulceration (p value 0.038), while duration and peripheral vascular disease were found to be predictive of amputations. (p value 0.001 and 0.021, respectively). Conclusion Diabetes related foot complications were frequently reported by our study participants, yet adoption of preventive foot self-care practices was of average levels, making it something very vital and urgent to carry out routine foot care educational programs and sessions. Future research for assessing the effectiveness of the preventive programs is going to be needed. Key words: Diabetes Mellitus, Diabetic Foot, Self-Care, Ulcer, Amputation

Background: Although the forced expiratory flow parameters are increasingly used in the diagnosis of small airway disease (SAD), the reversibility of these indicators is rarely described. The aim of this study is to evaluate the association of small airways reversibility with the presence of SAD and bronchodilator reversibility (BDR) of the proximal airways. Methods: The forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and the indicators of SAD (FEF25%, FEF50%, FEF75%, FEF25-75%, and FEF75-85%) were measured before and 20 minutes after salbutamol administration (200 mcg by using inhaler/Spacer). Positive BDR was accepted when FEV1 or FVC was increased ? 12% and > 200 ml, indicating responsive proximal airways. Positive small airway reversibility was diagnosed when any of the small airway indicators is increased ? 30% above the baseline results. All measurements were performed with the All-flow spirometer (Clement Clarke International, Harlow, UK). Results: Evidence of SAD was found in 62.1% of all participants and in 75.2% of those who showed responsive proximal airways. The positive predictive value of the SAD in diagnosing responsive proximal airways was 67.8%. The reversibility of the small airway indicators showed insignificant association with the FEV1 or FVC BDR. The reversibility of FEF50%, FEF75% and FEF25-75% showed significant association with the diagnosis of SAD, with specificities ranging from 75.5%-81.1%. Conclusion: SAD has a significant association with positive reversibility of both the proximal and the peripheral airways. Further studies are needed to evaluate the clinical significance of positive small airway reversibility in the diagnosis and management of obstructive lung diseases. Keywords: Asthma; Small airway disease; Bronchodilator Reversibility, FEV1, FVC; FEF25-75%

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): I have received a research fellowship grant from the UK based charity Cardiac Risk in the Young Objectives We investigated the effect of long-term exercise and sex on left ventricular (LV) geometry in a large group of female and male masters athletes. Background Studies assessing LV geometry in masters athletes are scarce. Methods Different types of LV geometry were identified according to echocardiography-derived relative wall thickness (RWT) and left ventricular mass (LVM) values as per international guidelines. 4 groups were formed: normal (normal LVM/normal RWT), concentric hypertrophy (increased LVM/increased RWT), eccentric hypertrophy (increased LVM/normal RWT), and concentric remodeling (normal LVM/increased RWT). Results A total of 277 healthy, elite, caucasian endurance masters athletes (65% female; mean age54.8 ± 7.7 years) were assessed. The athletes were exercising for a mean 32 ± 11.7 years and have completed a median 70 competitions including a median 13 marathon-type competitions. Females exhibited lower absolute LVM (127.7 ± 30.31g vs 196.57 ± 45.0g, p < 0.001), indexed LVM (76.8 ± 18.0 g/m2 vs. 103.6 ± 22.7 g/m2; p < 0.001), RWT (0.36 ± 0.07 vs. 0.42 ± 0.08; p < 0.001) and absolute LV end-diastolic dimension (LVEDD) (46.3 ± 4.1 mm vs 50.1 ± 5.11 mm, p < 0.001) but greater indexed LVEDD (27.7 ± 2.7mm/m2 vs 26.5 ± 2.7 mm/m2, p < 0.001) compared with male athletes. Most female athletes showed normal LV geometry (72% vs 38% in male athletes, P Conclusions A sex-specific response to chronic exercise is observed. Male masters athletes exhibit significantly more frequently abnormal LV geometry with concentric LV remodeling and/or concentric hypertrophy. Cohort characteristics Male masters athletes N = 97 Female masters athletes N = 180 P value Age (years) 55.0 ± 9.0 54.7 ± 6.9 0.68 Years of exercise 32.0 ± 12.8 33.3 ± 11.1 0.14 LV Mass (g) 127.7 ± 30.31 196.57 ± 45.0

Background Parkinson’s disease (PD), the second most common progressive neurodegenerative disorder, is characterized by the abnormal accumulation of intraneuronal inclusions enriched in aggregated α-synuclein (α-syn), known as Lewy bodies (LBs) and Lewy neurites (LNs), and significant loss of dopaminergic (DA) neurons in the substantia nigra pars compacta (SNpc) of the brain. Recent evidence suggests that the intrastriatal inoculation of α-syn preformed fibrils (PFF) in mice brain triggers endogenous α-syn in interconnected brain regions. 1-methyl, 4-phenyl, 1,2,3,6 tetrahydropyridine (MPTP), a mitochondrial neurotoxin, has been used previously to generate a PD mouse model. However, the common methods of MPTP exposure do not induce LB or α-syn aggregation in mice. In the present study, we evaluated the effect of different doses of MPTP (10 mg/kg.b.wt and/or 25 mg/kg.b.wt) on the spread, accumulation, and toxicity of endogenous α-syn in mice administered an intrastriatal injection of human α-syn PFF. Methods We inoculated human WT α-syn PFF in mouse striatum. At 6 weeks post PFF injection, we challenged the animal with two different doses of MPTP (10 mg/kg.b.wt and 25 mg/kg.b.wt) once daily for five consecutive days. At 2 weeks from the start of the MPTP regimen, we collected the mice brain and performed immunohistochemical analysis, and Rotarod test to assess motor coordination and muscle strength before and after MPTP injection. Results A single injection of human WT α-syn PFF in the mice striatum induced the propagation of α-syn, occurring as phosphorylated α-synuclein (pS129), towards the SNpc, within a very short time. Injection of a low dose of MPTP (10 mg/kg.b.wt) at 6 weeks post α-syn PFF inoculation further enhanced the spread, whereas a high dose of MPTP (25 mg/kg.b.wt.) reduced the spread. Majority of the accumulated α-syn were proteinase K resistant, as recognized using a conformation-specific α-syn antibody. Injection of α-syn PFF alone caused 12 % reduction in the number of tyrosine hydroxylase positive neurons while α-syn PFF + a low dose of MPTP caused 33 % reduction (loss), compared to the control mice injected with saline. This combination also reduced the motor coordination. Interestingly, a low dose of MPTP alone did not cause any significant reduction in the number of tyrosine hydroxylase positive neurons compared to saline treatment. Animals that received α-syn PFF and a high dose of MPTP showed massive activation of glial cells and decreased spread of α-syn, majority of which were detected in the nucleus. Conclusion Our results suggest that a combination of human WT α-syn PFF and a low dose of MPTP increases the pathological conversion and propagation of endogenous α-syn, and neurodegeneration, within a very short time. Our model can be used to study the mechanisms of α-syn propagation and screen for potential drugs against PD.

The Authors’ reply We are grateful to Dr Stuart1 for his interest in our paper.2 We agree entirely that our dilated cardiomyopathy (DCM) cohort were indeed highly selected. Most individuals with DCM do not have the capacity to exercise intensively and would not fit in the differential diagnosis of an athlete’s heart with borderline or mildly reduced left ventricular (LV) ejection fraction. For the purposes of this study, we sought to identify individuals with a mild form of DCM who were motivated to and could exercise intensively for a prolonged …

Coronavirus disease 2019 (COVID‐19) caused by severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) is spreading at a rapid pace, and the World Health Organization declared it as pandemic on 11 March 2020. Mycoplasma pneumoniae is an "atypical" bacterial pathogen commonly known to cause respiratory illness in humans. The coinfection from SARS‐CoV‐2 and mycoplasma pneumonia is rarely reported in the literature to the best of our knowledge. We present a study in which 6 of 350 patients confirmed with COVID‐19 were also diagnosed with M. pneumoniae infection. In this study, we described the clinical characteristics of patients with coinfection. Common symptoms at the onset of illness included fever (six [100%] patients); five (83.3%) patients had a cough, shortness of breath, and fatigue. The other symptoms were myalgia (66.6%), gastrointestinal symptoms (33.3%‐50%), and altered mental status (16.7%). The laboratory parameters include lymphopenia, elevated erythrocyte sedimentation rate, C‐reactive protein, lactate dehydrogenase, interleukin‐6, serum ferritin, and D‐dimer in all six (100%) patients. The chest X‐ray at presentation showed bilateral infiltrates in all the patients (100%). We also described electrocardiogram findings, complications, and treatment during hospitalization in detail. One patient died during the hospital course., Highlights The COVID‐19 pneumonia is a serious condition and can be associated with the common respiratory pathogens. Co‐infections with COVID‐19 can result in protracted respiratory symptoms, prolonged ICU stay, morbidity, and mortality if not detected and treated appropriately. The treatment of Co‐infection if y available might facilitate early recovery.

Background: Chronic lymphocytic leukemia is the most common form of leukemia in adults. The prognostic impact of ZAP-70 in CLL has been reported in several studies. The aim of conducting this study was to investigate the prevalence of ZAP-70 in Sudanese patients with chronic lymphocytic leukemia attending Khartoum Oncology Hospital. Materials and Methods: A total of 93 newly diagnosed patients with chronic lymphocytic leukemia were enrolled in this study. Lymphadenopathy and organomegaly were assessed in all participants using clinical examination, chest radiography, and abdominal ultrasound. Full blood count was carried out by an automated hematology analyzer. ZAP-70 was evaluated using flowcytometry on peripheral blood samples. ZAP-70 was defined as positive expression at a cutoff level of 20%. Results: There were 63 (67.7%) males and 30 (32.3%) females and the median age of the group was 63 years; 68 patients (73.1%) were presented with anemia and 66 (70.9%) had lymphadenopath;y. Majority of our patients 35 (37.6%) were in Rai stage IV. ZAP-70 positivity was detected in 21 patients (22.6%). There was no statistically significant association of ZAP-70 with age, sex, lymphadenopathy, organomegaly, hemoglobin concentration, total white blood cell count, platelet count and Rai staging system ( p -value > 0.05). Conclusion: Only 21 patients (22.6%) were ZAP-70 positive. There was no association between ZAP-70 and the study variables. Further studies to evaluate prognostic role of ZAP-70 in Sudanese patients with chronic lymphocytic leukemia are recommended. Keywords: ZAP-70, chronic lymphocytic leukemia, flowcytometry

Aim Autism is a heterogeneous neurological disorder that is characterized by impairments in communication and social interactions, repetitive behaviors, and sensory abnormalities. The etiology of autism remains unclear. Animal, genetic, and post-mortem studies suggest that an imbalance exists in the neuronal excitation and inhibition system in autism. The aim of this study was to determine whether alterations of the measured parameters in children with autism are significantly associated with the risk of a sensory dysfunction. Methods The glutamine synthetase (GS), kidney-type glutaminase (GLS1), and glutamic acid decarboxylase autoantibody levels were analyzed in 38 autistic children and 33 age- and sex-matched controls using enzyme-linked immunosorbent assays. Results The obtained data demonstrated significant alterations in glutamate and glutamine cycle enzymes, as represented by GS and GLS1, respectively. While the glutamic acid decarboxylase autoantibodies levels were remarkably increased, no significant difference was observed compared to the healthy control participants. Conclusion The obtained data indicate that GS and GLS1 are promising indicators of a neuronal excitation and inhibition system imbalance and that combined measured parameters are good predictive biomarkers of autism.

Background: Chronic myeloid leukemia (CML) is a malignancy of white blood cells, distinguished by the Philadelphia chromosome's presence. The biological profile of sufferers with CML at diagnosis is nevertheless missing in Africa, especially in Sudan. Therefore, the study pursued to measure the fibrinogen level among Sudanese patients diagnosed with CML attending the Radiation and Isotopes Centre of Khartoum. Methods: This descriptive perspective and the analytical casecontrol study were performed at the Radiation and Isotopes Centre of Khartoum from August to September 2021. In this study, fifty patients with CML were utilized as a case, and 50 healthy people were used as a control group. The blood samples from groups were collected in sodium citrate anticoagulant containers. Fibrinogen levels in the blood were determined by the Clauss technique using a coagulometer device. Results: There was a significant increase in fibrinogen levels between case and control groups. Further, age, gender, family history, and presence of chronic disease were non-significantly variations in CML patients. Moreover, smoking was considered a risk factor in CML. Conclusions: Fibrinogen level was significantly elevated in CML patients; additionally, there were significant differences associated with smoking, and there were non-significant differences related to age, gender, family history, presence of chronic disorder, and treatment.

Background: There is limited data on the clinical presentation and predictors of mortality in the African-American (AA) patients hospitalized with COVID-19 despite the disproportionately higher burden and mortality. The aim of this study is to report on the clinical characteristics and the predictors of mortality in hospitalized AA patients with COVID-19 infection. Methods: In this retrospective cohort review, we included all AA patients with confirmed COVID-19 infection admitted to an inner-city teaching community hospital in New York City. Demographics, clinical presentation, baseline co-morbidities, and laboratory data were compared between survivors and non-survivors. The predictors of mortality were assessed using multivariate logistic regression analysis. Results: Of the 408 (median age, 67years) patients included, 276(66.65%, median age 63years) survived while 132(33.35%, median age 71years) died. The most common presenting symptoms were cough, myalgia, fever/chills, shortness of breath, and gastrointestinal symptoms (nausea, vomiting, diarrhea, and abdominal pain), with a prevalence of 62.50%, 43.87%, 53.68%, and 27.21%, respectively. Age (OR 1.06, CI 1.04-1.08, P

BackgroundNeuroinflammation plays a major role in the pathogenesis of autism because the cytokine levels are typically disturbed in the brain in autistic patients. Prebiotics-rich diet maintains the healthy gut microbiota and hence can regulate the neuroinflammation indirectly. The study aimed to investigate the role of bee pollen and propolis in ameliorating neuroinflammation, including cytokine levels, in an animal model of autism.MethodsHamsters were classified as four groups: Group I, control; Group II, autistic model/animals treated with 250 mg propionic acid (PPA)/kg body weight (BW)/day for 3 days; Group III, animals treated with bee pollen at a dose of 250 mg/kg BW/day for 4 weeks; and Group IV, animals treated with propolis at a dose of 250 mg/kg BW/day for 4 weeks. Neuroinflammatory responses were evaluated using the levels of interferon γ (IFN-γ), interleukin 1 alpha (IL-1α), IL-6, IL-10, IL-12 (p70), vascular endothelial growth factor (VEGF), and tumor necrosis factor α (TNFα).ResultsSignificant decrease of IL-10 (PPPPPPPPConclusionsOur findings indicate that both bee pollen and propolis protect against neuroinflammation in the rodent model of autism. However, further studies are needed to investigate the clinical benefits of prebiotics-rich diet in neurodevelopmental disorders, such as autism.

ObjectiveDistinguishing early dilated cardiomyopathy (DCM) from physiological left ventricular (LV) dilatation with LV ejection fraction MethodsThirty-five asymptomatic active males with DCM, 25 male athletes in the ‘grey zone’ and 24 male athletes with normal LV ejection fraction underwent N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement, ECG and exercise echocardiography. Grey-zone athletes and patients with DCM underwent cardiovascular magnetic resonance (CMR) and Holter monitoring.ResultsLarger LV cavity dimensions and lower LV ejection fraction were the only differences between grey-zone and control athletes. None of the grey-zone athletes had abnormal NT-proBNP, increased ectopic burden/complex arrhythmias or pathological late gadolinium enhancement on CMR. These features were also absent in 71%, 71% and 50% of patients with DCM, respectively. 95% of grey-zone athletes and 60% of patients with DCM had normal ECG. During exercise echocardiography, 96% grey-zone athletes increased LV ejection fraction by >11% from baseline to peak exercise compared with 23% of patients with DCM (p63% in 92% grey-zone athletes compared with 17% patients with DCM (p11% from baseline to peak exercise or achieve a peak LV ejection fraction >63% had sensitivity of 77% and 83%, respectively, and specificity of 96% and 92%, respectively, for predicting DCM.ConclusionComprehensive assessment using a cascade of routine investigations revealed that exercise stress echocardiography has the greatest discriminatory value in differentiating between grey-zone athletes and asymptomatic patients with DCM. Our findings require validation in larger studies.

Background The diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) is often challenging and some structural abnormalities typical of the disease may overlap with changes reflective of cardiac adaptation to exercise. Purpose The aim of the study was to assess the performance of the cardiac magnetic resonance (CMR) 2010 Task Force Criteria (TFC) in a cohort of patients with definite diagnosis of ARVC and define the overlap with a cohort of highly trained athletes of similar age and sex. Methods We compared the CMR features of 43 patients (mean age 49±17 years, 49% males, 32 (74%) genotyped) with a definite diagnosis of ARVC according to the revised TFC to 97 (mean age 45±16 years, 61% males) highly-trained athletes of similar age and sex, in whom cardiac disease was excluded after comprehensive work-up. Results The CMR was abnormal in 37 (86%) patients. The right ventricle (RV) was affected in isolation in 17 (39%) patients, with 18 (42%) patients exhibiting biventricular involvement and 2 (5%) patients showing isolated left ventricular (LV) involvement. The most common RV abnormalities were regional wall motion abnormalities (RWMA) (n=34; 79%), RV dilatation fulfilling a major or minor volume TFC (n=18; 42%), impaired systolic function (RV ejection fraction (EF) ≤45%: n=17; 40%) and myocardial fibrosis (n=13; 30%). The predominant LV abnormality was myocardial fibrosis (n=20; 47%), with a small proportion of patients exhibiting RWMA (n=6; 14%) and impaired systolic function (LVEF Conclusions The great majority (86%) of patients with ARVC demonstrates structural abnormalities suggestive of cardiomyopathy on CMR but only 53% fulfills any of the CMR TFC. Only a small proportion (16%) of older athletes demonstrate significant RV dilatation that overlaps with the volume criteria for ARVC, in juxtaposition to younger athletes who exhibit a greater degree of overlap. The emergence of ARVC as a biventricular disease provides an opportunity to re-evaluate the diagnostic criteria and include LV involvement in conjunction with RV involvement to improve diagnostic accuracy. Acknowledgement/Funding CRY (Cardiac Risk in the Young) charity

Background The diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) is often challenging and structural abnormalities typical of the disease may overlap with changes reflective of cardiac adaptation to exercise. The aim of the study was to assess the performance of the cardiac magnetic resonance (CMR) 2010 Task Force Criteria (TFC) in a cohort of patients with definite diagnosis of ARVC and define the overlap with a cohort of highly trained athletes of similar age and sex. Methods We compared the CMR features of 43 patients (mean age 49±17 years, 49% males, 32 (74%) genotyped) with a definite diagnosis of ARVC according to the revised TFC to 97 (mean age 45±16 years, 61% males) highly-trained athletes of similar age and sex, where cardiac disease was excluded after comprehensive work-up. Results The CMR was abnormal in 37 (86%) patients. The RV was affected in isolation in 17 (39%) patients, with 18 (42%) patients exhibiting biventricular involvement and 2 (5%) patients showing isolated left ventricular involvement. The most common RV abnormalities were regional wall motion abnormalities (RWMA) (n=34; 79%), RV dilatation fulfilling a major or minor volume TFC (n=18; 42%), impaired systolic function (RVEF ≤45%: n=17; 40%) and myocardial fibrosis (n=13; 30%). The predominant LV abnormality was myocardial fibrosis (n=20; 47%), with a small proportion of patients exhibiting RWMA (n=6; 14%) and impaired systolic function (LVEF Twenty-three (53%) patients fulfilled a major (n=14; 32%) or a minor (n=9; 21%) CMR TFC. Sixteen (16%) athletes exceeded the cut-off values for RV volumes used as a major (n=10; 10%) or a minor (n=6; 6%) TFC with an inverse relationship between age and RV volumes (r=-0.41, p=0.001). None of the athletes fulfilled the TFC for RV ejection fraction. Applying the CMR TFC to the ARVC patient population, showed a sensitivity of 33% for the major and 28% for the minor criteria. Applying the RV volume and systolic function TFC values in the entire study population, showed a sensitivity of 53%, a specificity between 83% and an accuracy of 0.68. Please see (Figure 1). Conclusion The great majority (86%) of patients with ARVC demonstrate structural abnormalities suggestive of cardiomyopathy on CMR but only 53% fulfil any of the CMR TFC. A small proportion (16%) of older athletes demonstrate significant RV dilatation that overlaps with the volume criteria for ARVC. The emergence of ARVC as a biventricular disease provides an opportunity to re-evaluate the diagnostic criteria and include LV involvement in conjunction with RV involvement to improve diagnostic accuracy. Conflict of Interest no

Objective: This study was conducted to assess the hazardous effects of high fructose administration on kidney, heart and aorta in rats. Materials and methods: Twenty adult healthy male albino rats weighing about 200-220 gm each were used in this study. The rats were divided into 2 duplicate groups; control group and fructose group. Fructose was administered to rats in fresh drinking water daily for 8 weeks (the whole experimental period). Serum urea, creatinine and sodium concentration were determined by using ready-made kits. Spectrophotometric and colorimetric methods were also used for the detection of other serum components. Histopathological examination of the tissues was done by staining with H&E, PAS and Masson trichrome stains. Results : Nephropathy was achieved in fructose group after one month as indicated by biochemical assay. Pathological observation showed that high fructose administration decreased size of cardio-myocytes, increased cardiac interstitial fibrosis score and aortic wall thickness. In kidneys, high fructose administration decreased glomerular tuft area and corpuscular area, increased percentage in the rats affected with interstitial renal fibrosis score 1 and percentage of rats had glomerular sclerosis score 2. Conclusion : High fructose in diet should be avoided because it can damage kidney, heart and aorta in rats. http://doi.org/10.5455/javar.2017.d193

Background: Anterior T-wave inversion (ATWI) on electrocardiography (ECG) in young white adults raises the possibility of cardiomyopathy, specifically arrhythmogenic right ventricular cardi...

Introduction: Athletes can exhibit abnormal electrocardiogram (ECG) phenotypes that require further evaluation prior to competition. These are apparently more prevalent in high-intensity endurance sports. The purpose of this study was to assess the association between ECG findings in athletes and intensity of sport and level of competition. Methods: A cohort of 3423 competitive athletes had their ECGs assessed according to the Seattle criteria (SC). The presence of abnormal ECGs was correlated with: (1) intensity of sport (low/moderate vs. at least one high static or dynamic component); (2) competitive level (regional vs. national/international); (3) training volume (≤20 vs. >20 hours/week); (4) type of sport (high dynamic vs. high static component). The same endpoints were studied according to the ‘Refined Criteria’ (RC). Results: Abnormal ECGs according to the SC were present in 225 (6.6%) athletes, more frequently in those involved in high-intensity sports (8.0% vs. 5.4%; p=0.002), particularly in dynamic sports, and competing at national/international level (7.1% vs. 4.9%; p=0.028). Training volume was not significantly associated with abnormal ECGs. By multivariate analysis, high-intensity sport (OR 1.55, 1.18-2.03; p=0.002) and national/international level (OR 1.50, 95% CI 1.04-2.14; p=0.027) were independent predictors of abnormal ECGs, and these variables, when combined, doubled the prevalence of this finding. According to the RC, abnormal ECGs decreased to 103 (3.0%), but were also more frequent in high-intensity sports (4.2% vs. 2.0%; p20 horas/semana); 4) tipo de desporto (elevados componentes dinâmico versus estático). Os mesmos endpoints foram estudados pelos Refined Criteria (RC). Resultados: De acordo com os SC, 225 (6,6%) atletas tinham alterações patológicas, mais frequentes nos envolvidos em desportos de elevada intensidade (8,0 versus 5,4%; p=0,002), sobretudo dinâmica, e em nível nacional/internacional (7,1 versus 4,9%; p=0,028). O volume de treino não esteve significativamente associado a estas alterações. Em análise multivariada, desporto de elevada intensidade (OR 1,55, IC 95% 1,18-2,03; p=0,002) e o nível nacional/internacional (OR 1,50, IC 95% 1,04-2,14; p=0,027) foram preditores independentes de ECG anormais, variáveis que combinadas duplicaram a prevalência. Com os RC o número de ECG patológicos decresceu para 103 (3,0%), também mais frequentes nos desportos de elevada intensidade (4,2 versus 2,0%; p

Objectives The purpose of this study was to determine the potential value of a novel marker for the severity of structural heart disease and the risk of arrhythmia. Background The ventricular ectopic QRS interval (VEQSI) has been shown to identify structural heart disease and predict mortality in an unselected population. In ischemic heart disease (IHD), risk stratification for sudden death is imperfect. We hypothesized that VEQSI would identify patients with prior myocardial infarction (MI) compared with healthy subjects and distinguish IHD patients who have suffered life-threatening events from those without prior significant ventricular arrhythmia. Methods The 12-lead Holter recordings from 189 patients with previous MI were analyzed: 38 with prior ventricular tachycardia/ventricular fibrillation (MI-VT/VF) (66 ± 9 years; 92% male); 151 without prior significant ventricular arrhythmia (MI-no VT/VF) (64 ± 11 years; 74% male). These were compared with 60 healthy controls (62 ± 7 years; 70% male). All ventricular ectopic beats were reviewed and maximal VEQSI duration (VESQI max) was recorded as the duration of the longest ventricular ectopic beat. Results VEQSI max was longer in post-MI patients compared with normal controls (185 ± 26 ms vs. 164 ± 16 ms; p 198 ms had 86% sensitivity, 85% specificity, 62% positive predictive value, and 96% negative predictive value for identifying patients with prior life-threatening events (odds ratio: 37.4; 95% confidence interval: 13.0 to 107.5). Conclusions VEQSI max >198 ms distinguishes post-MI patients with prior life-threatening events from those without prior significant ventricular arrhythmia. This may be a useful additional index for risk stratification in IHD.

Background Accurate knowledge of causes of sudden cardiac death (SCD) in athletes and its precipitating factors is necessary to establish preventative strategies. Objectives This study investigated causes of SCD and their association with intensive physical activity in a large cohort of athletes. Methods Between 1994 and 2014, 357 consecutive cases of athletes who died suddenly (mean 29 ± 11 years of age, 92% males, 76% Caucasian, 69% competitive) were referred to our cardiac pathology center. All subjects underwent detailed post-mortem evaluation, including histological analysis by an expert cardiac pathologist. Clinical information was obtained from referring coroners. Results Sudden arrhythmic death syndrome (SADS) was the most prevalent cause of death (n = 149 [42%]). Myocardial disease was detected in 40% of cases, including idiopathic left ventricular hypertrophy (LVH) and/or fibrosis (n = 59, 16%); arrhythmogenic right ventricular cardiomyopathy (ARVC) (13%); and hypertrophic cardiomyopathy (HCM) (6%). Coronary artery anomalies occurred in 5% of cases. SADS and coronary artery anomalies affected predominantly young athletes (≤ 35 years of age), whereas myocardial disease was more common in older individuals. SCD during intense exertion occurred in 61% of cases; ARVC and left ventricular fibrosis most strongly predicted SCD during exertion. Conclusions Conditions predisposing to SCD in sports demonstrate a significant age predilection. The strong association of ARVC and left ventricular fibrosis with exercise-induced SCD reinforces the need for early detection and abstinence from intense exercise. However, almost 40% of athletes die at rest, highlighting the need for complementary preventive strategies.

Background: It was considered that the resistance of drugs such as carbapenems and cephalosporins against severe or high risk gram-negative bacteria became a tremendous confront. This might be attributed to the little amount of these drugs to be used against the multi-resistant bacteria (MRB). Therefore, Colistin, Fosfomycin, Temocillin, and Rifampicin are antibiotics that have been used as multidrug-resistant bacterial infections in the treatment of some species of bacteria such as Acinetobacter, Pseudomonas species, and Enterobacteriaceae. Aim: the present study is aimed to assess the integrity and efficiency of colistin for treating of the multidrug-resistant bacteria (MDR) especially gram-negative one among critical and non-critical patients in tertiary hospital in Jazan city. Ninety four patients who met the selection criteria and received colistimethate sodium (colistin) in the period between Februarys 2017 and March 2018 were recruited and their charts were reviewed retrospectively. Patients' information, medical conditions, and laboratory data were extracted. All patients received IV colistin, and the majority of the patients showed in their culture reports multidrug-resistant bacteria such as Pseudomonas aeruginosa and Acinetobacter baumannii. Patients who had normal renal function received from 2.5 to 5.0 mg of colistin/kg, which was divided in two or three doses intravenously, for duration ranging between 10 and 14 days. Results and conclusion: Approximately half of patients (48.93%) were fully recovered, while 19% of them were partially responded to colistin treatment. In the current study it was showed that IV colistin treatment against the multidrug-resistant bacteria (gram-negative bacteria) was strongly related to mild nephrotoxicity in addition to with a proper response as shown only in three of our patients

Objective The objective of this study was to evaluate the cluster of differentiation-38 (CD38) expression in Sudanese patients with chronic lymphocytic leukemia (CLL) and to determine its association with clinical and laboratory characteristics of the disease. Results We conducted a cross-sectional study on 99 patients diagnosed with CLL in Khartoum Oncology Hospital in Khartoum, Sudan. Immunophenotyping and CD38 expression levels were measured with four-color flowcytometry. The results of physical examination and blood analyses were used for assigning a modified Rai clinical staging system. The collected data were analyzed using the Statistical Package for the Social Science, version 22 (SPSS Inc., Chicago, IL, USA). According to our findings, the frequencies of 7%, 20%, and 30% cutoff levels of CD38 expressions were 68.7%, 41.4%, and 36.4% respectively. CD38 cutoff level of 7% showed a significant association with hemoglobin concentration (P = 0.04), whereas other cutoff levels showed insignificant results. All the three cutoff levels showed insignificant associations with the other clinical and laboratory variables. In conclusion, the CD38 expression at a cutoff level of 7% seems to be more valuable clinically than higher cutoff levels in Sudanese CLL patients.

Background Hypophosphatemia is a recognised complication of iron infusion. Patients receiving Home Parenteral Nutrition (HPN) due to intestinal failure are at additional risk of hypophosphatemia due to their underlying disease state. This study aimed to identify the extent of hypophosphatemia following iron infusion in this group of patients. Methods The medical records of all HPN patients treated with parenteral iron infusion in the Department of Gastroenterology, Freeman Hospital, between April 2012 and February 2017 were retrospectively reviewed. Patients were identified from the regional HPN electronic database. Patient’s demographics, type and dose of iron infusion were noted. Blood test parameters including haemoglobin, ferritin, transferrin saturations and phosphate levels were analysed before and after iron infusion. Management of abnormal phosphate level was documented. Degree of hypophosphataemia was categorised as severe ( Results Thirty five patients (19 females, 16 males), mean age 54, received iron infusions. All patients received Ferrinject iron infusion (Vifor Pharma UK Limited) at a dose appropriate to manufacturer recommendations, based on bodyweight. Results demonstrated that phosphate levels fell in 7 out of 35 patients (20%) following iron infusion; 2 with severe hypophosphataemia (5.7%) and 5 with mild hypophosphataemia (14.3%). Table 1 summarises the effect on phosphate level of iron infusion. Twenty seven out of 35 patients (71%) had phosphate levels checked within 2 months post iron infusion. One patient who developed severe hypophosphataemia had mild hypophosphataemia prior to iron infusion. All other patients had normal phosphate levels beforehand. Both patients with severe hypophosphataemia required intravenous phosphate replacement via manipulation of their HPN prescription. Of the 5 patients who developed mild hypophosphataemia, 4 resolved spontaneously, 1 required HPN prescription change. Time to normalisation of phosphate ranged from 4 weeks to 5 months. Conclusions Severe Hypophosphatemia is a rare but potentially significant occurrence following iron infusion and can be prolonged in patients receiving Home Parenteral Nutrition. Numbers in this study are small and more studies are needed to investigate this further, including assessing the incidence using other preparations of intravenous iron in this group of patients. Routinely checking phosphate levels after iron infusions in this group of patients is probably warranted.

We are grateful for interest shown in our article. Harrell and colleagues propose that myocardial bridging may be a potential explanation for the increased prevalence of coronary atherosclerosis in male masters athletes. We agree that this is an interesting concept. As expected, we observed an element of myocardial bridging in a small proportion of our athletes and control subjects but did not report this in our article. Although it is conceivable that myocardial bridging may cause atherosclerotic plaque proximal to the bridge, our observations do not substantiate this particular theory as a possible mechanism of atherosclerosis in masters athletes. Male masters athletes had a higher prevalence of atherosclerosis affecting ≥2 vessels compared with controls (23 [21.7%] versus 2 [3.7%]; P =0.0024) and a higher proportion of multiple plaques (25 [23.6%] versus 2 [3.7%]; P =0.0014).1 The diffuse pattern of atherosclerosis noted in some of the athletes is difficult to reconcile with a single …

BACKGROUND: Methotrexate (MTX) is the most commonly used disease-modifying drug in the treatment of rheumatoid arthritis (RA); however, it causes many side effects, including pulmonary lesions. In this review, we characterised the histopathological features of MTX-induced pulmonary lesions in RA patients.AIM: We carried out an electronic search of the relevant literature published during the period from 1990 to 2016. We included only the cases with definitive histo-pathological findings caused by MTX therapy.MATERIAL AND METHODS: The total number of cases is 27. Male: female ratio was 1:3, and ages ranged from 48 to 87 years old, with a mean (SD) = 65.7 (1.0). The cases were originally from Asia (55%), Europe (41%), and America (4%). The major complications of methotrexate therapy were lymphoproliferative disorders (42%) followed by interstitial fibrosis (33), and infections (25%). The incidence of these complications significantly increases with the duration of MTX treatment (p = 0.044). Among the infections, the most common causative organism was pneumocystis jiroveci. The majority of patients who developed infections following methotrexate therapy were from Europe whereas the majority of those who developed lymphoproliferative disorders were from Asia (p = 0.003).CONCLUSION: In conclusion, methotrexate therapy in rheumatoid arthritis patients causes different types pulmonary complications.

Article History Received: 10 / 4 / 2014 Accepted: 21 / 5 / 2014 Objectives: The aim of this study was to determine the association between HR-HPV and p53 gene mutation among Sudanese oral cancer patients. Methodology: In this retrospective study 200 patients with oral lesions were screened by molecular methods (PCR) for the presence of HR- HPV subtypes and Immunohistochemistery for presence of p53 gene mutation. Of the 200 patients, 100/200 were patients with oral cancer (ascertained as case group) and 100/200 were patients with non- neoplastic oral lesions (ascertained as control group). Results: Out of the 200 patients, 12/200 (6%) were found with HR-HPV infection. Of the 12 positive patients, 10/12 (83.3%) were among cases and the remaining 2/12 (16.7%) were among control group, HPV16 was the most prevalent type. None of the sample of patients with benign tumor with positive HPV showed p53 gene mutation. From three samples obtained from patients with oral cancer who were positive HPV showed (30%) had mutations in the p53 gene. The chi- square test was shown to have significant differences between the oral cancer with HPV infection and the presence of p53 mutation Conclusion: HPV is a risk factor for oral cancer, and not always that the incidence of cancer is caused by mutations in gene.

Sudden cardiac death (SCD) is defined as a non-traumatic, non-violent and unexpected fatality resulting from sudden cardiac arrest within 6 h of previously witnessed normal health.[1][1] The majority of victims are elderly patients with a history of coronary artery disease or heart failure. However

Background: Studies in middle-age and older (masters) athletes with atherosclerotic risk factors for coronary artery disease report higher coronary artery calcium (CAC) scores compared with sedentary individuals. Few studies have assessed the prevalence of coronary artery disease in masters athletes with a low atherosclerotic risk profile. Methods: We assessed 152 masters athletes 54.4±8.5 years of age (70% male) and 92 controls of similar age, sex, and low Framingham 10-year coronary artery disease risk scores with an echocardiogram, exercise stress test, computerized tomographic coronary angiogram, and cardiovascular magnetic resonance imaging with late gadolinium enhancement and a 24-hour Holter. Athletes had participated in endurance exercise for an average of 31±12.6 years. The majority (77%) were runners, with a median of 13 marathon runs per athlete. Results: Most athletes (60%) and controls (63%) had a normal CAC score. Male athletes had a higher prevalence of atherosclerotic plaques of any luminal irregularity (44.3% versus 22.2%; P =0.009) compared with sedentary males, and only male athletes showed a CAC ≥300 Agatston units (11.3%) and a luminal stenosis ≥50% (7.5%). Male athletes demonstrated predominantly calcific plaques (72.7%), whereas sedentary males showed predominantly mixed morphology plaques (61.5%). The number of years of training was the only independent variable associated with increased risk of CAC >70th percentile for age or luminal stenosis ≥50% in male athletes (odds ratio, 1.08; 95% confidence interval, 1.01–1.15; P =0.016); 15 (14%) male athletes but none of the controls revealed late gadolinium enhancement on cardiovascular magnetic resonance imaging. Of these athletes, 7 had a pattern consistent with previous myocardial infarction, including 3(42%) with a luminal stenosis ≥50% in the corresponding artery. Conclusions: Most lifelong masters endurance athletes with a low atherosclerotic risk profile have normal CAC scores. Male athletes are more likely to have a CAC score >300 Agatston units or coronary plaques compared with sedentary males with a similar risk profile. The significance of these observations is uncertain, but the predominantly calcific morphology of the plaques in athletes indicates potentially different pathophysiological mechanisms for plaque formation in athletic versus sedentary men. Coronary plaques are more abundant in athletes, whereas their stable nature could mitigate the risk of plaque rupture and acute myocardial infarction.

Methods 77 healthy volunteers with no known cardiovascular condition underwent CMR at 1.5T (Siemens, Avanto). Mid ventricular short axis native T1 maps by MOLLI (with T1* reconstruction in addition) and ShMOLLI were acquired. Hematocrit (Hct), iron profile and lipid profile were acquired immediately prior to the scan. CVI42 (Calgary, Canada) was used for analysis of the maps. A ROI was drawn in the blood pool on the MOLLI T1 map, avoiding papillary muscles and was copied on to the MOLLI T1* and ShMOLLI T1.

Introduction/Objective: Around 90% of patients with HCM have an abnormal ECG; however there is paucity of data on the ECG in DCM. Approximately 14% athletes show an LV cavity >60mm and 1-2% reveal a borderline low LVEF which overlaps with DCM. The role of ECG in facilitating the differentiation between physiologic LV enlargement and DCM has not been investigated. We sought to ascertain the utility of the various ECG screening criteria in differentiating physiology from pathology in a cohort of individuals with LV dilatation. Methods: 89 individuals with a dilated LVEDD (43 asymptomatic athletes from cardiac screening (male=37, female=6) and 46 non-ischaemic DCM NYHA class I from a cardiomyopathy clinic (males=33, female=13) were included. Fourty (87%) of the DCM patients were on a beta-blocker. The 2010 ESC, ‘Seattle’ and the novel ‘Refined’ screening criteria were applied to the most recent ECG in both cohorts to assess whether ECG screening would have accurately raised suspicion of pathology. Results: Using the ESC criteria 11 DCM patients had a normal ECG and 6 had group 1 changes; therefore 40.0% of DCM patients would have been considered to have an ECG compatible with athletic training. Excluding sinus bradycardia, the most common group 1 change was early repolarisation. The sensitivity and specificity of the ESC criteria for detecting pathology in our cohort was 63.0% and 69.0% respectively. The sensitivity and specificity of the ‘Seattle’ criteria is 50% and 76.7%. The ‘Refined’ criteria was less sensitive at 41.3% but had a higher specificity of 79.2%. Conclusions: It is often assumed the ECG is abnormal in patients with a dilated cardiomyopathy. In our cohort 40% of the ECGs in our DCM patients would have not prompted further investigation if seen at pre-participation screening. This study demonstrates the ECG is not a particularly useful investigation in distinguishing physiological from pathological LV dilatation.

The short QT syndrome is a cardiac channelopathy characterised by accelerated repolarisation which manifests as a short QT interval on the ECG. The definition of a short QT interval is debated, ranging from390 to ≤320 ms, and its clinical significance in healthy young individuals is unknown. We assessed the prevalence and medium-term significance of an isolated short QT interval in a diverse young British population.Between 2005 and 2013, 18 825 apparently healthy people aged 14-35 years underwent cardiovascular evaluation with history, physical examination and ECG. QT intervals were measured by cardiologists using 4 recommended guidelines (Seattle 2013, Heart Rhythm Society 2013, European Society of Cardiology 2010 and American Heart Association 2009).The prevalence of a short QT interval was 0.1% (26 patients, ≤320 ms), 0.2% (44 patients, ≤330 ms), 7.9% (1478 patients,380 ms), 15.8% (2973 patients,390 ms). Male gender and Afro-Caribbean ethnicity had the strongest association with short QT intervals. Athletes had shorter QT intervals than non-athletes but athletic status did not predict short QT intervals. Individuals with short QT intervals ≤320 ms did not report syncope or a sinister family history, and during a follow-up period of 5.3±1.2 years, there were no deaths in this group.The prevalence of a short QT interval depends on the recommended cut-off value. Even at values ≤320 ms, there was an excellent medium-term prognosis among 14 people followed. We conclude that a definition of ≤320 ms is realistic to prevent overdiagnosis and excessive investigations.

Deaths of young athletes from cardiac disease are uncommon but receive considerable media attention and intermittently galvanize debates about cardiac screening prior to participation in sports. Both the American Heart Association (AHA) and European Society of Cardiology (ESC) endorse preparticipation screening in athletes; however, there is disagreement about the best approach. The AHA recommends history and physical examination; this approach is pragmatic and relatively inexpensive but has poor sensitivity because most athletes are asymptomatic and physical examination identifies only a minority of those at risk of sudden cardiac death. The inclusion of the electrocardiogram in accordance with the recommendations of the ESC improves sensitivity for detection of serious cardiac disease but is associated with an unacceptably high false-positive rate, in part because of the overlap between the electrical manifestations of athletic training and the cardiomyopathies. For young athletes with normal electrocardiogram results, echocardiography contributes minimally to the diagnosis of serious cardiac diseases. Given all the complexities, cardiac screening of young athletes should be voluntary not mandatory and conducted by highly experienced physicians who fully understand the cardiovascular adaptation to intensive exercise.

Purpose Anterior T wave inversion (V1-V4) is the hallmark of arrhythmogenic right ventricular cardiomyopathy (ARVC). However, it is widely perceived that anterior T wave inversion is also common in female individuals. Previous studies in small cohorts of female athletes have demonstrated a highly variable prevalence of anterior T wave inversion of up to 14%. This study investigated the prevalence and significance of anterior T wave inversion in a large, unselected cohort of female athletic and non-athletic individuals who underwent cardiac screening. Methods Between May 2007 and September 2013, 17,708 individuals (n = 5,234; 29.6% females) aged 14–35 underwent cardiac screening with health questionnaire, 12-lead ECG and consultation with a cardiologist. Further evaluation was dictated by initial results. The ECGs of female subjects were analysed placing emphasis on the presence of anterior T wave inversion, defined as T wave inversion in ≥2 contiguous anterior leads. Results T wave inversion was present in 322 (6.2%) females, the majority confined to the anterior leads; 73% anterior, 14% lateral, 13% inferior. Anterior T wave inversion was more prevalent in competitive athletes compared to non-athletes (7.02 vs 3.78%, p 16 years of age. The majority of anterior T wave inversion (n = 171; 73%) was confined to leads V1-V2, with only 1.2% of females exhibiting T wave inversion beyond V2, raising the suspicion of ARVC. Multivariate analysis identified black ethnicity as the sole, independent predictor for the presence of anterior T wave inversion (OR 3.1, 95% CI 1.2–8.4, p = 0.03). Conclusion In the largest unselected cohort of females to date, the overall prevalence of anterior T wave inversion was higher (4.5%) than those in previously reported studies. This was also the case for females of Caucasian ethnicity. Anterior T wave inversion persisted in a considerable proportion of females >16 years, excluding the ‘juvenile’ pattern. Although we did not identify ARVC in any females with anterior T wave inversion, given the low prevalence of T wave inversion beyond V2, particularly in Caucasian individuals (1.06%), such patterns not be considered a normal finding and should trigger further clinical evaluation.

Purpose Recommendations for interpretation of the athlete’s electrocardiogram (ECG) has evolved in recent years, namely with the European Society of Cardiology (ESC, 2010), Seattle (2013) and more recently, the Refined (2014) criteria. A principle aim of these developments has been to improve the sensitivity and specificity for identification of young athletes at risk of sudden cardiac death and reduce false-positive rates. Whether these criteria are effective in adolescents is yet to be validated. Our study aimed to compare these criteria in a large cohort of adolescent (aged 14–17 years) athletes. Methods Between July 1998–August 2012, 7993 adolescent, professional male footballers aged between 14 and 17, were assessed through pre-participation screening. This included a history, examination, 12-lead ECG and echocardiogram. A retrospective analysis of the ECG data was undertaken with the application of the ESC, Seattle and Refined criteria. Results Athletes were aged 16.1 ± 1.5 years and were all male. 87.8% were Caucasian, 10.3% were Afro-Caribbean and the remainder being Oriental and South-East Asians. 1017 (12.7%) subjects were deemed to have an abnormal ECG when the ESC criteria were applied. This compared with 312 (3.9%) athletes against the Seattle criteria (p Conclusions/implications Recent developments of recommendations for interpretation of the athlete’s ECG, most significantly through the Refined criteria, shows a reduction in the number of adolescent athletes deemed to have cardiac abnormalities. Our results suggest that current screening criteria are applicable in adolescent athletes as well as older counterparts. The Refined criteria will further improve the specificity of screening and therefore reduce the burden posed by high false-positive rates.

Purpose Hypertrophic cardiomyopathy (HCM) is the commonest cause of SCD in young athletes. The differentiation between physiological left ventricular hypertrophy (LVH) and morphologically mild hypertrophic cardiomyopathy (HCM) is crucial and an erroneous diagnosis has potentially serious consequences. Day to day clinical practice most commonly utilises transthoracic echocardiography (ECHO) for this purpose. The British Society of Echocardiography (BSE) recently produced a diagnostic algorithm to facilitate the differentiation between these two morphologically similar, yet clinically distinct entities. This study aimed to validate the recommended echocardiographic parameters. Methods A cohort of 56 competitive athletes with LVH (maximal wall thickness >12 mm) was evaluated. Of these, 19 were athletes with physiological LVH while 37 were diagnosed with HCM based on the results of comprehensive evaluation including cardiac MRI, familial evaluation and gene testing. The ECHO data were analysed for 4 parameters: 1) S’, average of septal and lateral walls (cm/s): >9 LVH vs 1 LVH vs 9 LVH vs 12 HCM. Results Athletes with physiological LVH were younger (24.7 vs 29.1 years, p = 0.03) and exhibited a lower maximum left ventricular wall thickness (13.2 vs 16.4 mm, p = 0.05) compared to the athletes with HCM. All 37 athletes with HCM were male whereas the cohort of physiological LVH comprised of 17 males and 2 females. A summary of the sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of individual parameters to identify athletes with HCM is presented in Table 1. Table 1 showing the sensitivity, specificity, PPV and NPV of the respective echo parameters. Conclusion The current BSE guidelines are informative in helping differentiate physiological LVH from HCM in athletes to some extent. However, their sensitivity in identifying athletes with HCM is poor. Prior knowledge of patient demographics, clinical history and additional investigations should be taken into consideration to aid the interpretation of the echo data.

Background Pre-participation cardiovascular evaluation is being recommended by a growing number of sporting bodies and scientific organisations in an attempt to identify athletes harbouring quiescent cardiac conditions which put them at risk of exercise-related sudden cardiac death (SCD). However cardiac adaptation to exercise may itself result in ECG patterns that overlap with those observed in several cardiac conditions, including hypertrophic cardiomyopathy (HCM), the leading cause of SCD in athletes worldwide. This raises significant challenges for physician’s involved in ECG-based pre-participation cardiovascular evaluation of athletes with respect to distinguishing physiological from pathological ECG changes. Data demonstrates that cardiac conditions such as hypertension may modulate the HCM phenotype. However the effect of exercise on the HCM phenotype remains unknown. We compared the ECGs and echocardiographic parameters of athletes with HCM to sedentary HCM patients and healthy athletes to establish whether physical activity modifies the phenotype in HCM. Methods The presenting ECGs of 103 young (14–35) consecutive asymptomatic athletes with HCM identified through pre-participation or familial evaluation were compared to the presenting ECGs of 106 sedentary HCM patients (14–40) and 110 consecutive healthy young athletes. Echocardiographic characteristics indicating disease severity and patterns of left ventricular hypertrophy (LVH) were also compared. Results Sedentary HCM patients were older than the athlete groups (Table 1). All 3 groups contained a similar number Afro-Caribbean individuals (30.2% sedentary HCM vs. 33.0% athletes with HCM vs. 30.9% healthy athletes, p > 0.05), the remainder being Caucasian. Athletes with HCM exhibited significantly more repolarisation changes (specifically T-wave inversions [TWIs] and deep TWIs) in addition to voltage criteria for LVH compared to sedentary HCM patients and healthy athletes (p Conclusions Athletes with HCM exhibit more ECG repolarisation changes compared to sedentary HCM patients and healthy athletes, suggesting that exercise modifies the ECG phenotype in HCM. Virtually all athletes with HCM revealed TWIs, rendering softer ECG changes such as axis deviation and atrial enlargement less relevant to the detection of HCM in athletes. These results should be taken into consideration when devising criteria for interpretation of an athlete’s ECG.