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Mutations in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genome continue to threaten the global landscape of the coronavirus disease 2019 (COVID-19) pandemic. The Omicron variant (B.1.1.529) rapidly displaced previous ‘variants of concern’ (VoC) in 2021 due to its high rate of transmissibility and multitude of mutations. This global influx of infections saturated healthcare systems, overwhelmed testing capacity and case reporting, and increased the COVID-19 death toll. Global health leaders are now being faced with the most transmissible COVID-19 variants yet, the Omicron sublineages BA.4 and BA.5, which contain additional spike protein (S) mutations from previous Omicron and VoC serotypes. With universally observed antibody waning, increasing vaccine-variant mismatch, and resuming international travel, the stage is set for unprecedented levels of breakthrough infections and superspreading events. In this paper, we raise awareness to these novel variants and provide context for the high likelihood of an upcoming wave of infection capable of inflicting significant disease burden on a global scale.

The rapid development of multiple SARS-CoV-2 vaccines within one year of the virus’s emergence is unprecedented and redefines the timeline for vaccine approval and rollout. Consequently, over 13 billion COVID-19 vaccine doses have been administered worldwide, accounting for ∼70% of the global population. Despite this steadfast scientific achievement, many inequalities exist in vaccine distribution and procurement, particularly in low- and middle-income countries such as those in Africa. This stems from the cost of COVID-19 vaccines, storage and cold-chain challenges, distribution to remote areas, proper personnel training, and so on. In addition to logistical challenges, many developed nations rapidly procured available vaccines, administering second and third doses and leaving many developing nations without the first dose. In this paper, we explore the level of reception to COVID-19 vaccines prior to their availability in Rwanda using a survey-based approach. While several countries reported spikes in vaccine hesitancy generally coinciding with new information, new policies, or newly reported vaccine risks, Rwanda functions as an exemplar for controlling disease burden and educating locals regarding the benefits of vaccination. We show that, even before COVID-19 vaccines were available, many Rwandans (97%) recognized the importance of COVID-19 vaccination and (93%) were willing to receive a COVID-19 vaccine following vaccine availability. Our results underscore the level of preparedness in Rwanda, which rivals and outcompetes many developed nations in terms of vaccination rate (nearing 80% in Rwanda), vaccine acceptance, and local knowledge relating to vaccination. Furthermore, in addition to the whole-of-government coordination as well as tailored delivery approach, previously developed practices relating to vaccination and communication surrounding the Ebola Virus Disease may have compounded the COVID-19 vaccine program in Rwanda, prior to its implementation.

Purpose Various methods have been described for the treatment of anterior shoulder instability with glenoid bone loss. The incidence of recurrent dislocations following surgical intervention is high and, therefore, necessitates a reliable and replicable revision procedure. The purpose of this Technical Note is to describe a method of arthroscopic anatomic glenoid reconstruction using a distal tibial allograft and screw fixation in the setting of a failed Latarjet procedure with significant glenoid bone loss. Methods We describe in detail patient positioning, portal placement, steps of the diagnostic arthroscopy, and graft preparation using imaging and a detailed intraoperative arthroscopic technique. Level of Evidence Level 1, Shoulder; Level 2, Instability., Technique Video Video 1 Technical video illustrating the arthroscopic anatomic glenoid reconstruction using screw fixation in the setting of a failed Latarjet procedure with hardware removal. The patient is placed in the lateral decubitus position, and the right arm is prepped and draped in the usual fashion. The posterior portal is used as the viewing portal for diagnostic arthroscopy, and the anterosuperior portal is used as the viewing portal for the rest of the surgical steps.

The overall goal of this survey was to understand the Ebola Virus Disease (EVD) - related knowledge, attitudes, and practices (KAP) at individual, inter-personal, institutional, and societal levels in Rwanda. This cross-sectional mixed-methods survey was conducted in five selected districts: Rusizi, Karongi, Rubavu, Burera and Gasabo. Quantitative data was collected from 1,010 participants using a structured questionnaire and Kobo Collect. Qualitative data was collected from 98 participants through Key Informant Interviews and Focus Group Discussions using a semi structured interview guide. Among the 1,010 surveyed respondents, 56% were male, 70.3% were married, and 50% had primary education. An important finding was the high level of Ebola awareness and knowledge in all the five districts, with 99.6% reporting having previously heard of Ebola, which indicates previous awareness-raising efforts were successful. More than 54% of respondents indicated that Ebola is caused by a virus which originates from wild animal animals (42.1%). Furthermore, fever (85%), bleeding (87.7), and vomiting (40.2%) were cited as the primary signs and symptoms for Ebola. Most of the respondents were knowledgeable regarding prevention measures for Ebola. Despite this, 80% of the survey respondents had not received formal training or health education on Ebola. The majority of respondents (78.2%) reported having a positive attitude towards EVD survivors. Many respondents (90%) believe that the country is at risk of an EVD outbreak and about 87.8% think that they are personally at risk of contracting Ebola. Most respondents reported adopting habits that included avoiding physical contact with the patients and reducing unnecessary movements/travel throughout the Ebola-affected regions. At the community level, participants state that they participate in the sharing of Ebola-related information and reporting suspected cases to relevant authorities. Additionally, many participants know the necessary emergency contact number (114) for assistance and reporting of EVD-related information. Most respondents (97.2%) believed that it is important to be vaccinated to prevent Ebola, and around 93.3% are ready/willing to be vaccinated once the EVD vaccine is available. While the radio is the preferred source for Ebola-related information, the most trusted sources are the ministry of health and governmental institutions, such as the Rwanda Biomedical Centre. Our results show that there was high EVD-related knowledge and awareness among the general population in Rwanda. However, for strong public health awareness, preparedness, and protection, there is a need to implement public sensitization programmes that address EVD-related misconceptions and discriminatory attitudes toward EVD patients.

Background Microvascular dysfunction in HCM has been associated with adverse clinical outcomes. Advances in quantitative cardiovascular magnetic resonance (CMR) perfusion imaging now allow myocardial blood flow to be quantified at the pixel level. We applied these techniques to investigate the spectrum of microvascular dysfunction in hypertrophic cardiomyopathy (HCM) and to explore its relationship with fibrosis and wall thickness. Methods CMR perfusion imaging was undertaken during adenosine-induced hyperemia and again at rest in 35 patients together with late gadolinium enhancement (LGE) imaging. Myocardial blood flow (MBF) was quantified on a pixel-by-pixel basis from CMR perfusion images using a Fermi-constrained deconvolution algorithm. Regions-of-interest (ROI) in hypoperfused and hyperemic myocardium were identified from the MBF pixel maps. The myocardium was also divided into 16 AHA segments. Results Resting MBF was significantly higher in the endocardium than in the epicardium (mean ± SD: 1.25 ± 0.35 ml/g/min versus 1.20 ± 0.35 ml/g/min, P

Methods Twenty one body-builders were studied 14 anabolic steroid users and 7 controls matched for age and training history. First pass CMR perfusion imaging was performed on a 1.5T Avanto (Siemens, Erlangen, Germany) after adenosine-induced hyperemia (140 mcg/kg/min) and at rest using a hybrid echo-planar imaging sequence. Images of the base, mid-ventricle and apex were acquired and the myocardium was divided into 16 segments as well as endocardial and epicardial layers. After image registration, a modified Fermi-constrained deconvolution algorithm was applied pixel-wise to quantify absolute MBF. Late gadolinium enhancement (LGE) imaging was performed as well as standard assessment of ventricular volumes, function and LV mass. Data were analysed using a linear mixed effects model.

Non-invasive assessment of interstitial myocardial fibrosis in pressure-overload left ventricular hypertrophy Andrew Jabbour, Tevfik F Ismail, Sofia V De Noronha, Carl Shakespeare, Sameer Zaman, Oluwatosin Sotubo, Saman S Zaman, Callum Ettles, Benjamin Hewins, Rick Wage, Ankur Gulati, Pedro F Ferreira, Pierre Croisille, Yanqiu Feng, Katsuya Norita, Raad H Mohiaddin, Taigang He, John Pepper, David N Firmin, Mary Sheppard, Dudley J Pennell, Mario Petrou, Sanjay K Prasad

Background Hypertrophic cardiomyopathy (HCM) is associated with increased myocardial fibrosis and collagen deposition. Collagen reduces cardiovascular magnetic resonance (CMR) derived T2 times, however, the inflammatory milieu required for its deposition is often associated with localised oedema. Focal areas of high T2 signal intensity have been reported in association with areas of late gadolinium enhancement (LGE) in patients with HCM. However, this previous work has relied upon the subjective visual assessment of local changes in signal intensity. We hypothesised that quantitative CMR T2mapping would reveal marked differences in myocardial T2 characteristics in patients with HCM relative to controls. Methods Twenty-two consecutive patients with HCM (15 male, age 55.8±8.7 years) but no co-morbidity and 22 healthy controls (9 male, age 49.3±13.1 years) were studied. For each subject, a short axis mid-ventricular slice was acquired using a 1.5T Avanto (Siemens Healthcare, Erlangen, Germany). A breath-hold T2-prepared singleshot steady-state free precession (SSFP) sequence was used to produce three T2-weighted images with different T2 preparation times (0 ms, 24 ms, 55 ms). Parallel imaging was used to reduce the imaging time and motioncorrection was applied to improve the accuracy of T2 measurement. T2 maps were produced by fitting the signal intensity-time exponential decay curve using a linear 2-parameter model after logarithmic transformation (CMRtools, Cardiovascular Imaging Solutions, London, UK). An inversion recovery prepared gradient echo sequence with the inversion time optimised to null normal myocardium was used 10 minutes after intravenous gadolinium contrast (Gadovist, Bayer-Schering, Berlin, Germany, 0.1 mmol/kg) to detect late enhancement. Imaging was repeated in an orthogonal phase encoding direction to exclude artifact. Results There were no significant differences in baseline demographic characteristics between HCM and control patients. LV-wall thickness, indexed LV mass and ejection fraction were significantly higher in HCM patients (Table 1). In keeping with LV hypertrophy, the LV volumes were significantly smaller. None of the healthy controls exhibited any late enhancement whereas 18 (82%) HCM patients had areas of mid-wall enhancement, predominantly in the areas of hypertrophy. T2 times in patients with HCM were similar to controls with no evidence of any significant differences (HCM 54.1±2.5ms versus Controls 54.1±1.6ms, P=0.97). Conclusions

Background Abuse of anabolic steroids to induce skeletal muscle hypertrophy is widespread amongst recreational bodybuilders, however, the cardiac effects of such drugs have not been systematically documented. The ability of cardiovascular magnetic resonance (CMR) to image the myocardium in any plane and achieve full myocardial coverage renders it the gold standard for assessing LV volumes and mass.We sought to investigate the cardiac effects of anabolic steroid use with CMR hypothesising that significant hypertrophy and distinct LV remodelling would be seen in steroid users relative to non-users. Methods

Background Fibrosis is thought to play an important role in the pathogenesis of the adverse sequelae of hypertrophic cardiomyopathy (HCM). Late gadolinium enhancement (LGE) cardiovascular magnetic resonance detects replacement fibrosis but cannot presently detect interstitial fibrosis. The latter is thought to be a very early feature of HCM and can be triggered by inflammation, which can also expand the size of the myocardial interstitium. We sought to determine whether extracellular volume (ECV) mapping by T1-relaxometry in concert with T2mapping can identify interstitial changes in HCM and whether these were related to myocardial edema.

circumferential max strain (r=0.43, p=0.03), angle δ strain (r=0.78, p=0.001), and motion magnitude peak strain (r=0.87, p

Multimodality assessment of aortic stenosis severity in Transcatheter Aortic Valve Implantation (TAVI): comparison between cardiovascular magnetic resonance, transesophageal and transthoracic echocardiography Andrew Jabbour, Tevfik F Ismail, Ali Vazir, Isabelle Roussin, Ankur Gulati, Francisco Alpendurada, Sameer Zaman, Oluwatosin Sotubo, Saman S Zaman, Benjamin Hewins, Simon Davies, Sanjay K Prasad, Susanna Price, Michael B Rubens, Neil Moat, Raad H Mohiaddin

Abnormalities of the coronary microvasculature are thought to be a histological hallmark of hypertrophic cardiomyopathy (HCM). We sought to determine the prevalence of microvascular ischemia in HCM using stress perfusion cardiovascular magnetic resonance (CMR) and to assess its relationship to

Background Interstitial fibrosis is a pathological hallmark of hypertrophic cardiomyopathy (HCM) and is thought to contribute to the abnormal myocardial mechanics seen in this patient group. T1-mapping now allows interstitial fibrosis to be detected non-invasively. Replacement fibrosis as identified by late gadolinium enhancement imaging has been associated with abnormal cardiac mechanics in HCM. However, the relationship between interstitial fibrosis and contractile function in HCM has not been previously explored. We assessed the association between interstitial fibrosis as assessed by T1-mapping and contractile function as determined by continuous spatial modulation of magnetisation (CSPAMM) tagging, hypothesising that increased fibrosis would correlate with abnormal myocardial strain. Methods Twelve HCM patients free of significant comorbidity and 16 controls were studied. CMR was undertaken on a 1.5T Siemens Avanto (Siemens, Erlangen, Germany). Tagged images were acquired at the mid-ventricle using aC SPAMM sequence (Field of View: 300mm, slice thickness 6mm, tag separation 7mm, typical TR/TE 30/ 1.26ms, Flip Angle 20°, 20 phases). Peak circumferential (Ecc) and radial (Err) strains were determined using inTag (Creatis, Lyon, France). Mid-ventricular short-axis T1 maps were acquired using the Modified Look-Locker Inversion Recovery sequence pre-gadolinium bolus and then at 5, 7, 9, 11, 15, 20 and 25 minutes. Signal intensity-time curves for myocardial and blood pool regions of interest were used to determine T1 relaxation times through a non-linear curve-fit (CMR42, Circle Cardiovascular Imaging, Calgary, Canada). The partition coefficient at equilibrium, an index of fibrosis, was determined by plotting the reciprocal of myocardial T1 times at equilibrium against those for the blood pool and calculating the slope of the resultant linear regression line. Results HCM patients were older than the controls and there was a preponderance of men. In keeping with their diagnosis, HCM patients had significantly higher indexed LV mass and wall thickness than controls (Table 1). The partition coefficient was significantly higher in HCM patients than controls (mean ±SD: 0.439 ±0.230 for HCM vs 0.281 ±0.071 for controls, P=0.02). Whilst peak global Ecc was significantly lower in the HCM group relative to the controls (0.173 ±0.041 vs 0.226 ±0.025, P