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Isolated short PR interval in adolescent athletes and non-athletes : should we worry?

Sun, 01 Jan 2023 00:00:00 GMT

Title: Isolated short PR interval in adolescent athletes and non-athletes : should we worry? Authors: Abela, Mark; Grech, Neil; Degiorgio, Sophie; Grech, Victor E.; Sammut, Mark Adrian Abstract: The PR interval on an electrocardiogram (ECG) mirrors atrial depolarisation and conduction down the atrioventricular node. It is initially shorter in young children than in adolescents, with gradual physiological PR interval prolongation in adolescence.1 The PR interval, however, fails to prolong in several healthy teenagers. There is limited data on isolated short PR interval in adolescent athletes and non-athletes. In the absence of symptoms and ventricular pre-excitation, referral for evaluation does not appear justified.2 An otherwise benign condition may represent a concealed accessory pathway; therefore, it should not be overlooked in cardiac screening programs. The objectives of this study were to assess the prevalence, symptoms, clinical implications and outcomes of an isolated short PR interval in athletic and non-athletic adolescents. [excerpt]

BEAT-IT : a de-novo cardiac screening programme in Maltese adolescents

Mon, 01 Jan 2024 00:00:00 GMT

Title: BEAT-IT : a de-novo cardiac screening programme in Maltese adolescents Authors: Abela, Mark; Yamagata, Kentaro; Bonello, John; Xuereb, Sara; Borg, Lisa; Xuereb, Rachel; Fleri Soler, Jeremy; Camilleri, William; Abela, Estelle; Callus, Adrian; Farrugia, Maria; Sapiano, Karl; Felice, Tiziana; Burg, Melanie; Sammut, Mark A.; Grech, Victor E.; Papadakis, Michael Abstract: AIMS Sudden cardiac death (SCD) in young individuals is often unexpected, provoking substantial emotional stress for family and friends of the deceased. Cardiac screening may identify individuals who harbour disorders linked to SCD. The feasibility and diagnostic yield of a nationwide cardiac screening programme in adolescents has never been explored.; METHODS All individuals eligible for cardiac screening (students aged 15 years) were systematically invited to enrol. Students were provided with a health questionnaire. ECGs were acquired at school. A physician led consultation was carried out on site. Participants with an abnormal screen were then referred for secondary evaluation to the nation’s tertiary centre. Feasibility criteria included a) participation rate >60%, b) adherence to secondary evaluation >80%, and c) cost per individual screened equating to <€100. The diagnostic yield was also evaluated.; RESULTS At the end of enrolment, 2708 students gave consent (mean 15 years, 50.4% male), equating to 67.9% of the eligible cohort. Overall, 109 participants (4.0%) were referred for further evaluation. An abnormal electrocardiogram (ECG) was the most common reason for referral (3.7%). Fifteen individuals (0.6%) were diagnosed with a cardiac condition. Nine (0.3%) had a condition linked to SCD (n = 1 Long-QT syndrome, n = 1 Hypertrophic Cardiomyopathy, n = 5 Wolff-Parkinson White, n = 2 coronary anomalies). The yield was similar in athletes and non-athletes (p = 0.324). The cost per cardiac individual screened equated to €51.15.; CONCLUSION A nationwide systematic cardiac screening programme for adolescent athletes and non-athletes is feasible and cost-efficient, provided that responsible centres have the appropriate infrastructure.

Immunogenicity of reduced dose priming schedules of serogroup C meningococcal conjugate vaccine followed by booster at 12 months in infants : open label randomised controlled trial

Thu, 01 Jan 2015 00:00:00 GMT

Title: Immunogenicity of reduced dose priming schedules of serogroup C meningococcal conjugate vaccine followed by booster at 12 months in infants : open label randomised controlled trial Authors: Pace, David; Khatami, Ameneh; McKenna, Jennifer; Campbell, Danielle; Attard-Montalto, Simon; Birks, Jacqueline; Voysey, Merryn; White, Catherine; Finn, Adam; Macloed, Emma; Faust, Saul N.; Kent, Alison Louise; Heath, Paul T.; Borrow, Ray; Snape, Matthew D.; Pollard, Andrew J. Abstract: Objective: To determine whether the immunogenicity of a single dose infant priming schedule of serogroup C meningococcal (MenC) conjugate vaccine is noninferior to a two dose priming schedule when followed by a booster dose at age 12 months.; Design: Phase IV open label randomised controlled trial carried out from July 2010 until August 2013; Setting: Four centres in the United Kingdom and one centre in Malta.; Participants: Healthy infants aged 6–12 weeks followed up until age 24 months.; Interventions: In the priming phase of the trial 509 infants were randomised in a 10:10:7:4 ratio into four groups to receive either a single MenC-cross reacting material 197 (CRM) dose at 3 months; two doses of MenC-CRM at 3 and 4 months; a single MenC-polysaccharidetetanus toxoid (TT) dose at 3 months; or no MenC doses, respectively. Haemophilus influenzae type b (Hib)-MenC-TT vaccine was administered to all infants at 12 months of age. All infants also received the nationally routinely recommended vaccines. Blood samples were taken at age 5, 12, 13, and 24 months.; Main outcome measure: MenC serum bactericidal antibody assay with rabbit complement (rSBA) one month after the Hib-MenC-TT vaccine. Non-inferiority was met if the lower 95% confidence limit of the difference in the mean log10 MenC rSBA between the single dose MenC-CRM and the two dose MenC-CRM groups was >−0.35.; Results: The primary objective was met: after a Hib-MenC-TT booster dose at 12 months of age the MenC rSBA geometric mean titres induced in infants primed with a single MenC-CRM dose were not inferior to those induced in participants primed with two MenC-CRM doses in infancy (660 (95% confidence interval 498 to 876) v 295 (220 to 398)) with a corresponding difference in the mean log10 MenC rSBA of 0.35 (0.17 to 0.53) that showed superiority of the single over the two dose schedule). Exploration of differences between the priming schedules showed that one month after Hib-MenC-TT vaccination, MenC rSBA ≥1:8 was observed in >96% of participants previously primed with any of the MenC vaccine schedules in infancy and in 83% of those who were not vaccinated against MenC in infancy. The MenC rSBA geometric mean titres induced by the Hib-MenC-TT boost were significantly higher in children who were primed with one rather than two MenC-CRM doses in infancy. Only priming with MenC-TT, however, induced robust MenC bactericidal antibody after the Hib-MenC-TT booster that persisted until 24 months of age.; Conclusions: MenC vaccination programmes with two MenC infant priming doses could be reduced to a single priming dose without reducing post-boost antibody titres. When followed by a Hib-MenC-TT booster dose, infant priming with a single MenC-TT vaccine dose induces a more robust antibody response than one or two infant doses of MenC-CRM. Bactericidal antibody induced by a single Hib-MenC-TT conjugate vaccine dose at 12 months of age (that is, a toddler only schedule), without infant priming, is not well sustained at 24 months. Because of rapid waning of MenC antibody, programmes using toddler only schedules will still need to rely on herd protection to protect infants and young children.

Meningococcal serogroup Y disease in Europe : continuation of high importance in some European regions in 2013

Thu, 01 Jan 2015 00:00:00 GMT

Title: Meningococcal serogroup Y disease in Europe : continuation of high importance in some European regions in 2013 Authors: Bröker, Michael; Emonet, Stéphane; Fazio, Cecilia; Jacobsson, Susanne; Koliou, Maria; Kuusi, Markku; Pace, David; Paragi, Metka; Pysik, Alexander; Simões, Maria João; Skoczynska, Anna; Stefanelli, Paola; Toropainen, Maija; Taha, Muhamed-Kheir; Tzanakak, Georgina Abstract: Neisseria meningitidis or meningococcus is divided into 12 distinct serogroups of which A, B, C, W, X, and Y are medically most important and cause health problems in different parts of the world. The epidemiology of N. meningitidis is unpredictable over time and across geographic regions. Globally, serogoup A has been prevalent in the African “meningitis belt” whereas serogroup B and C have predominated in Europe. In a paper published earlier in this journalCitation1, an increase in serogroup Y invasive meningococcal disease (IMD) in some European countries was reported based on the epidemiological data for 2010, 2011 and 2012. Here, we report additional data from 30 European countries indicating that high or increased serogroup Y disease levels have continued in 2013 in certain regions of Europe. In the Western and Central Europe, there were no major changes in the proportion of serogroup Y IMD cases in 2013 compared to 2012. In the Scandinavian countries, proportion of serogroup Y disease remained high, ranging from 26% to 51% in 2013. This was in contrast to Baltic, Eastern and most Southern European countries, where the proportion of serogroup Y IMD was low similarly to previous years. For the last 2 decades, the mean age of patients affected by serogroup Y was 41 y for 7 countries from which data was available and 50% of cases were in patients aged 45 to 88 y. The age distribution of serogroup Y was bimodal and did not change significantly despite the increase of the total number and the proportion of serogroup Y IMD in some European regions.