The high prevalence of RHD is a major public health problem in Yemen. Urgent screening surveys and an RHD prophylactic programme of appropriate management of group A β-haemolytic streptococcal pharyngotonsilitis are required.

Abstractobjectives To estimate the prevalence of Group A beta-haemolytic streptococcus (GAS) and non-GAS infections among children with acute pharyngotonsillitis in Aden, Yemen, to evaluate the value of a rapid diagnostic test and the McIsaac score for patient management in this setting and to determine the occurrence of emm genotypes among a subset of GAS isolated from children with acute pharyngotonsillitis and a history of acute rheumatic fever (ARF) or rheumatic heart disease (RHD).methods Group A beta-haemolytic streptococcus infections in school-aged children with acute pharyngotonsillitis in Aden, Yemen, were diagnosed by a rapid GAS antigen detection test (RADT) and/or GAS culture from a throat swab. The RADT value and the McIsaac screening score for patient management were evaluated. The emm genotype of a subset of GAS isolates was determined.results Group A beta-haemolytic streptococcus pharyngotonsillitis was diagnosed in 287/691 (41.5%; 95% CI 37.8-45.3) children. Group B, Group C and Group G beta-haemolytic streptococci were isolated from 4.3% children. The RADT had a sensitivity of 238/258 (92.2%) and specificity of 404/423 (95.5%) against GAS culture. A McIsaac score of ≥4 had a sensitivity of 93% and a specificity of 82% for confirmed GAS infection. The emm genotypes in 21 GAS isolates from children with pharyngitis and a history of ARF and confirmed RHD were emm87 (11), emm12 (6), emm28 (3) and emm5 (1).conclusion This study demonstrates a very high prevalence of GAS infections in Yemeni children and the value of the RADT and the McIsaac score in this setting. More extensive emm genotyping is necessary to understand the local epidemiology of circulating strains.

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Introductions & Aims: Acute Coronary Syndrome (ACS) and its magnitudes is one of the most common cardiac diseases world-wide. Yet in Yemen; GULF RACE I data are the first nation- wide information that highlight the magnitude of this problem. Cardiogenic shock is a miserable complication of ACS. Pointing out this problem among Yemeni with ACS, its prognostic importance and impact in patients outcomes is a major aim of this study. Methods and Patients: Yemen data arm was a part from the GULF RACE I, which is a prospective, multinational, multicentres survey of consecutive patients hospitalized with the final diagnosis of ACS in six Arabian Peninsula/Gulf countries over a period of six month. Yemeni patients were 1054 patients included from 20 major hospitals all over the country with ACS including cases of ST Elevation Acute Myocardial Infarction (STEMI), non ST Elevation Acute Myocardial Infarction (NSTEMI), newly developed Left Bundle Branch Block (LBBB) and unstable angina pectoris (UA). Patients with Acute Heart Failure (AHF) and presented with cardiogenic shock were pointed out. The end point of this study was all causes of in-hospital mortality. Results: Out of 1054 hospitalized with ACS, 181 patients (17.3%) had AHF on presenting to the hospital or during hospitalization itself. Out of those patients with AHF there were 74 patients who developed Cardiogenic Shock. They were relatively older 64.7±9.7 (SD) years (P