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H-FABP has modest sensitivity and specificity for MI at presentation but estimates are subject to substantial uncertainty and primary data are subject to substantial heterogeneity. H-FABP may have a role alongside troponin in improving early sensitivity but comparison with high sensitivity troponin assays is required.

The World Health Organization-designated Eastern Mediterranean region (EMRO) consists of 22 countries in North Africa and Western Asia with a collective population of over 679 million. The area comprises some of the wealthiest countries per capita income and some of the poorest. The population structure is also unique and contrasts with western countries, with a much younger population. The region sits in the heart of the thalassemia belt. Many countries have a significant prevalence of sickle cell disease, and cancer is on the rise in the region. Therefore, the strategic priorities for the growth and development of hematopoietic stem cell transplantation (HSCT) differ from country to country based on resources, healthcare challenges, and prevalent infrastructure. Thirty-one reporting teams to the Eastern Mediterranean Blood and Marrow Transplantation Group have active HSCT programs in 12 countries; allogeneic transplants outnumber autologous transplants, and the proportion of allotransplants for non-malignant conditions is higher in the EMRO region than in Western Europe and North America. The vast majority (99%) of allotransplants are from matched related donors. Matched unrelated donors and other alternate donor transplants are underutilized. The chance of finding a matched related donor for allografts is higher, with a significant chance of finding matched donors among non-sibling related donors. Reasons for relatively lower rates of transplants compared with other countries are multifactorial. Capacity building, development of newer centers, innovative funding, and better utilization of information technology are required to make transplantation as an accessible modality to more patients. Cost-effectiveness and cost-containment, regulation, and ensuring quality will all be priorities in planning HSCT development in the region.

Background: Fecal calprotectin (FC) is a protein that is produced by neutrophils and monocytes. It can be detected in tissues, body fluids and stool which makes it valuable marker for neutrophil activity. FC concentrations increase in intestinal inflammation which makes it a valuable tool to distinguish inflammatory from non-inflammatory gastrointestinal conditions. We conducted a retrospective quality assurance audit on the use and cost-effectiveness of fecal Calprotectin assay at the Outpatient Gastroenterology Clinic at the Queen Elizabeth II Health Sciences Center in Halifax, NS. Aims: To assess our use of Feacal Caloprotectin and the cost-effectiveness of it in our practice Methods: Patients being followed through the gastroenterology clinic at the QE II Health Sciences Center who underwent FC testing were identified through lab services at the NSHA central zone. Inclusion criteria included any adult patient being followed through the GI ambulatory clinic at the QE II Health Sciences Center (HSC). A retrospective chart review was conducted for any FC testing performed between September 28, 2017 and March 29, 2017. Clinical visits before and after FC testing were reviewed for indication and to determine the clinical impact of FC testing. We considered FC testing to have had a "positive clinical impact" if it lead to dose escalation or change of medication (IBD management) or aided in endoscopic decision making. FC testing was considered to be cost-effective if supplanted endoscopic investigation for purposes of monitoring or screening patients. Results: One hundred and five FC tests were ordered over a period of 6 months (28th September 2017 to 29 March 2017). Eighty-one FC tests had clinical information which allowed for evaluation of test indications and outcomes. Seventy percent of the patients were female. FC testing was ordered as a screening test for bowel inflammation (21%) or as an IBD disease monitoring tool (77%). The most common clinical symptoms prompting FC testing in IBD patients were diarrhea and abdominal pain (53% and 32%, respectively). The test aided in clinical decision making in 50 patients (61.7%). In some cases, FC results didn't change the clinical decision making process (23%), were not followed-up after the test (13%), or the indication wasn't clear (1%). In 28 patients, the decision to perform endoscopic investigation was prompted by the FC results. Colonoscopy was averted in almost 40 percent of the patients as a result of normal FC concentrations. Conclusions: FC was demonstrated to have significant clinical impact when used to diagnose or monitor patients with IBD. The results of this study suggest that FC-enhanced diagnosis and monitoring may be more cost-effective than non-FC enhanced clinical decision making. Larger, long-term studies that consider the impact on health economics are needed.

burden for clinical budgets. The regional data analysis indicates that patient access to EGFR-mutation testing is significantly related to the density of clinics and of specialized physicians in respective federal states. CONCLUSIONS: Decentralized organization and funding of health care and diagnostics have led to significant regional disparities. Therefore, a detailed analysis of regional health care structures in oncology is necessary.OBJECTIVES: Current practice for suspected acute coronary syndrome (ACS) involves troponin testing 10-12 hours after symptom onset to diagnose myocardial infarction (MI). We aimed to estimate the diagnostic accuracy of early biomarkers for MI to determine if an earlier, accurate decision was possible. METHODS: A systematic review of all diagnostic cohort studies of patients presenting with suspected ACS comparing the following biomarkers at presentation with a reference standard based on the Universal definition of MI (troponin at 10-12 hours): early troponin I and T; Heart-type Fatty Acid Binding Protein (HFABP); ischaemia modified albumen (IMA) and myoglobin. A systematic search was undertaken of 10 electronic databases, citation lists and expert contacts, to identify relevant studies. The study selection, data extraction and quality assessment decisions were all verified by more than one reviewer. citations retrieved were divided between two reviewers (CC, SG) and screened for relevance to the review. Any discrepancies were resolved by discussion and reference to the full paper. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Meta-analysis was conducted using Bayesian Markov chain Monte Carlo simulation. RESULTS: Compared with the Universal definition of MI, sensitivity and specificity (95% predictive interval) were 77% (29-96%) and 93% (46-100%) for troponin I; 80% (33-97%) and 91% (53-99%) for troponin T (99th percentile threshold); 81% (50-95%) and 80% (26-98%) for quantitative HFABP, 68% (11-97%) and 92% (20-100%) for qualitative HFABP; 77% (19-98%) and 39% (2-95%) for IMA and 62% (35-83%) and 83% (35-98%) for myoglobin. CONCLUSIONS: Early troponin I and T and H-FABP have modest sensitivity and specificity for MI at presentation, when compared with the gold standard, but estimates are subject to substantial uncertainty and primary data are subject to substantial heterogeneity. More research on high sensitivity troponin assays at presentation is required.