Cardiology across continents: takeaways from a rare case presentation.

Purpose: This study aimed to evaluate pre-operative and post-operative sagittal parameters using pelvic incidence (PI), lumbar lordosis (LL), and segmental lordosis (SL) between Asian and African population who underwent minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF) and open-TLIF surgeries. Study compares blood loss, operative time, and hospital stay; and evaluates disability and pain by Oswestry disability index (ODI) and visual analog scale (VAS) score, respectively, in both groups. Methods: This retrospective study included 104 patients with an average age of 52.1 ± 12.9 years. All were operated for open-TLIF and MIS-TLIF for one- or two-level lumbar canal stenosis or spondylolisthesis. Patients were divided into two groups according to race: Asian and African. Clinical improvements were evaluated using VAS and ODI scores. Modified MacNab’s criteria were used to evaluate outcome. Estimated blood loss, hospital stay, operative time, perioperative morbidity, and complications were reviewed. On radiological parameters, patients’ LL, PI, and SL were compared between two groups. Results: Average follow-up was 40.6 ± 13.9 months. Both groups showed significant post-operative improvement in their VAS and ODI scores in both open- and MIS-TLIF (P < 0.0001); however, comparing clinical improvement between Asian and African groups, it did not show significant difference in VAS (P = 0.103) and ODI (P = 0.077). Both groups showed significant improvement in LL and SL in both open- and MIS-TLIF (P < 0.0001); however, there was no change in PI. It did not show any significant difference in improvement in LL (P = 0.156), PI (P = 0.798), and SL (P = 0.179) between Asian and African groups. Regarding post-operative complications, there were 4 (6.9%) and 3 (6.5%) complications occurred in Asian and African population, respectively. There were no difference in complication rates in both groups (P = 0.939). Discussion: TLIF (MIS and open) gives similar clinical outcome between Asian and African population. Sagittal parameters were higher in African population than the Asian population. Attention should be paid to predetermine the value of LL to achieve during surgery. Keywords: Transforaminal lumbar interbody fusion, Asian versus African, Sagittal parameters, Clinical outcome.

Geographic patterns of genetic diversity and fertility restoration ability of Asian and African origin pearl millet populations

BackgroundThe major risk factors for atherosclerotic cardiovascular disease differ by race or ethnicity but have largely been defined using populations of European ancestry. Despite the rising prevalence of cardiovascular disease in Africa there are few related data from African populations. Therefore, we compared the association of established cardiovascular risk factors with carotid‐intima media thickness (CIMT), a subclinical marker of atherosclerosis, between African, African American, Asian, European, and Hispanic populations.Methods and ResultsCross‐sectional analyses of 34 025 men and women drawn from 15 cohorts in Africa, Asia, Europe, and North America were undertaken. Classical cardiovascular risk factors were assessed and CIMT measured using B‐mode ultrasound. Ethnic differences in the association of established cardiovascular risk factors with CIMT were determined using a 1‐stage individual participant data meta‐analysis with beta coefficients expressed as a percentage using the White population as the reference group. CIMT adjusted for risk factors was the greatest among African American populations followed by Asian, European, and Hispanic populations with African populations having the lowest mean CIMT. In all racial or ethnic groups, men had higher CIMT levels compared with women. Age, sex, body mass index, and systolic blood pressure had a significant positive association with CIMT in all races and ethnicities at varying magnitudes. When compared with European populations, the association of age, sex, and systolic blood pressure with CIMT was weaker in all races and ethnicities. Smoking (beta coefficient, 0.39; 95% CI, 0.09–0.70), body mass index (beta coefficient, 0.05; 95% CI, 0.01–0.08) and glucose (beta coefficient, 0.13; 95% CI, 0.06–0.19) had the strongest positive association with CIMT in the Asian population when compared with all other racial and ethnic groups. High‐density lipoprotein‐cholesterol had significant protective effects in African American (beta coefficient, −0.31; 95% CI, −0.42 to −0.21) and African (beta coefficient, −0.26; 95% CI, −0.31 to −0.19) populations only.ConclusionsThe strength of association between established cardiovascular risk factors and CIMT differed across the racial or ethnic groups and may be due to lifestyle risk factors and genetics. These differences have implications for race‐ ethnicity‐specific primary prevention strategies and also give insights into the differential contribution of risk factors to the pathogenesis of cardiovascular disease. The greatest burden of subclinical atherosclerosis in African American individuals warrants further investigations.

Background Carotid artery intima-media thickness (cIMT) is an intermediate surrogate marker for cardiovascular disease (CVD). It has been reported that although the distribution of cIMT values is very heterogeneous and values vary widely between different ethnicity, geographic location, and ultrasound protocol, the prediction of vascular events with study-specific cIMT values is consistent across all ethnicities and regions (1). Hence, Consensus Statement from the American Society of Echocardiography suggests that cIMT greater than or equal to 75th percentile for the patient’s age, sex, and ethnicity is indicative of increased CVD risk (2). Aims We aimed to establish age, sex, and ethnic-specific reference intervals in the multi-ethnic Asian population comprising Chinese, Malays, and Indians. Methods We analysed data from 8762 healthy individuals who had a 3D carotid ultrasonography done as part of the Health for Life in Singapore study. Carotid ultrasonography measurements were taken from the distal common carotid artery (CCA) at both the lateral and posterior angles bilaterally during the end-diastolic phase. The mean of all 4 measurements were taken as average cIMT (avgcIMT). For this analysis, we excluded individuals on treatment for diabetes, hypertension, hyperlipidemia, and ischemic heart disease to derive a healthy population subset comprising of 6522 individuals (Chinese: 69%, Malays: 14%, Indians: 17%). We then assessed the 75th percentile as a marker of cardiovascular risk in all individuals, by testing associations with Framingham risk scores (locally adapted) and with cardiometabolic risk factors (3). Results Ethnic- and sex-specific 75th percentiles (95% CI) of CIMT for our Asian populations are summarised in Table 1. Compared to reference intervals reported in European and African American populations, the 75th centiles are lower in all Asian ethnic subgroups (p<0.05). Framingham risk score, BMI, LDL-C, HbA1c and systolic blood pressure were higher in Asians with cIMT more than 75th percentile (p<0.001), compared to Asians with normal cIMT. Conclusions We estimated race- and sex-specific 75th percentiles of avgcIMT across age in the multi-ethnic Asian population. The thresholds for Asian populations are substantially lower than reported in European and African populations. The 75th centiles identify people with raised cardiovascular risk factors, supporting the validity of cIMT as marker of vascular risk in the population. The 75th centiles will be useful in interpretation of cIMT measures obtained both in research and clinical settings in different ethnic populations in Asia. Longitudinal evaluation is needed to determine the prediction of our Asian specific thresholds for predicting hard cardiovascular outcomes.

ACC/AHA/AAP RECOMMENDATIONS FOR TRAINING IN PEDIATRIC CARDIOLOGY

Several reports of CYP2C genetic polymorphism demonstrate its potential clinical role in determining both inter-individual and inter-ethnic differences in drug efficacy. We estimated the distribution of CYP2C9 and CYP2C19 common variants in the Bolivian population (a South American population), and compared these data with those from Asian, African, Caucasian and Oceanian populations. Genomic DNA was obtained from 778 unrelated healthy volunteers from Bolivia. The genotypic status of CYP2C9 and CYP2C19 was determined by means of polymerase chain reaction-restriction fragment length polymorphism. Allelic and genotypic frequencies of CYP2C9 and CYP2C19 were determined for the Bolivian population, and comparison of the data with other ethnic groups revealed a lower CYP2C9*2 frequency (4.8%) than in Caucasians, but a higher frequency than in Asians; frequencies of CYP2C9*3 (3.0%) and CYP2C9 (0.4%) poor metabolizers (PMs) were similar to those seen in Asian populations. Frequencies of CYP2C19*2 (7.8%), CYP2C19*3 (0.1%), and CYP2C19 PMs (1.0%) in the Bolivian population were for the most part lower than in Caucasian, Asian, Oceanian and African populations. This is the first study to investigate a South American population for genetic polymorphism in the CYP2C subfamily. The Bolivian population differs from most other ethnic groups in the incidence of CYP2C9 and CYP2C19 common variants that might be influenced by its admixture characteristics.

Objective: Hypertension is the global leading risk factor for the development of cardiovascular diseases, with the highest prevalence in Asian and African populations. Post-exercise hypotension (PEH) defined as a sustained reduction in blood pressure (BP) after a single bout of exercise is an important physiological phenomenon in BP management. However, little is known about PEH in non-Caucasian populations. Therefore, we aim to systematically summarize the effects of a single bout of aerobic exercise on BP in non-Caucasian populations. Design and method: We searched the MEDLINE database identifying randomized controlled trials investigating the effect of a single bout of aerobic exercise on BP in African or Asian populations published in a peer reviewed journal up to August 2021. A meta-analysis was performed to estimate random effect sizes within 95% of confidence intervals. Results: We identified 10 aerobic exercise trials in individuals of Asian origin (n = 156; mean age: 27.05 years: 72% male) and 11 aerobic exercise trials involving individuals of African origin (n = 112; mean age: 41.37 years; 62% male). Non-significant reductions in office BP at 30 minutes (-1.18 [-9.98, 7.62]/-1.29 [-7.32, 4.74] mmHg) and 60 minutes postexercise (-1.80 [-9.98, 7.62]/ -1.28 [-6.03, 3.46] mmHg) were observed in the African group. Similar to the African group, non-significant reductions in office BP at 30 minutes (-2.17 [-6.78, 2.43] / -0.82 [-2.41, 0.77] mmHg) postexercise were observed in the Asian group. No effect was found on 24h-systolic BP postexercise, but 24h-diastolic BP reduced significantly (-1.89 [-3.47, -0.31] mmHg) in the African group. Conclusions: Except for a small, though statistically significant effect on 24h-DBP in the African group, a single bout of aerobic exercise does not seem to cause clinically relevant PEH in the African and Asian populations. It should be acknowledged that the available studies on PEH applying aerobic exercise are limited and there is a lack of data on PEH following isometric and resistance exercise in these populations. This systematic review and meta-analysis is a call for more research on exercise therapy in non-Caucasians.

In 2009, President Obama signed an Executive Order calling for strategies to improve the health of Asian Americans and to seek data on the health disparities in Asian American subgroups.1 Data on Asian American subgroups are scarce and many health disparities remain unknown. The purpose of this Advisory is to highlight the gaps in existing research on cardiovascular disease (CVD) among Asian Americans, and to serve as a call to action on behalf of the American Heart Association to address these areas of need. Asian Americans are the fastest growing racial/ethnic group in the United States, representing 25% of all foreign-born people in the United States.2 They are projected to reach nearly 34 million by 2050.3 Several major Federal surveys (eg, the American Community Survey, the National Health Interview Survey, and the Behavioral Risk Factor Surveillance Survey) only recently started to classify Asian Americans into 7 subgroups: Asian Indian, Chinese, Filipino, Korean, Japanese, Vietnamese, and Other Asian. The first six of these subgroups together constitute >90% of Asian Americans in the United States.4 Although some data are available on Asian subgroups from these major federal surveys, in general, these data are not available for public use because of the privacy concerns resulting from the small sample sizes within subgroups. This situation limits their utility for health-related research. Because health surveys and questionnaires almost universally combine persons of Asian ancestry into a single group, the heterogeneity within this classification is masked. Socioeconomic and cultural factors have been found to be associated with CVD and its risk factors, which is why it is important to understand these differences among Asian subgroups. The Table shows the number of persons in each group based on the most recent US Census data available (American Community Survey, 2008), with the recognition that …

Dose-limiting toxicity from azathioprine treatment affects up to 37% of patients. Screening for thiopurine methyltransferase (TPMT) polymorphisms will prospectively identify approximately 10% of patients. Recently, a polymorphism in the inosine triphosphate pyrophosphatase gene (ITPA) has been associated with severe azathioprine toxicity. We demonstrate here that this proline to threonine substitution at codon 32 in the ITPA gene is found at low frequency in Central/South American populations (1-2%), at a constant frequency across Caucasian and African populations (6-7%), and is highest in Asian populations (14-19%). This data is consistent with previously described allele frequencies in other Caucasian (7%), African (5%), and Asian (11-15%) populations. This data provides a foundation on which prospective screening studies can be planned to identify patients at risk for severe toxicity from azathioprine therapy.

Introduction: Prostate cancer is one of most frequent neoplasia in males, affecting the majority of men in the eighth decade of life. It is not yet known what specifically causes prostate cancer, but there are several risk factors for the disease, including age or diet, and it is known that different populations have different risk of developing this cancer. For instance, men in developed countries have higher risk to get this neoplasia and mortality rate is higher in black men, according International Agency for Research on Cancer 2012 data. Prostate cancer can often be detected before symptoms start by testing the amount of prostate-specific antigen (PSA) and is variant forms in a man’s blood. However, high levels of this protein do not mean malignancy. So, new biomarkers of this cancer are need. In order to learn more about prostate cancer, we aim to analyze the frequency of ARE-I polymorphism at -158 position of the KLK3 gene in prostatic tissue and the results were compared with other populations frequencies it was done the analysis of the ARE-I polymorphism at -158 position of the KLK3 gene in prostatic tissue and the results were compared with other populations frequencies [1]. Materials and methods: In this study it was analysed the rs266882 polymorphism at - 158 position of the KLK3 gene in prostatic tissue from 96 Portuguese individuals diagnosed with prostate cancer and individuals with benign prostatic hyperplasia, from Anatomy Pathology Department of CHBM.The study protocol was previously approved by the hospital ethics committee. PCR-RFLP analysis was performed in DNA extracted from paraffin embedded tissue sections. The allelic and genotype frequencies were analysed and calculated by Hardy-Weinberg R package based on χ2–test, with a 95% CI and the results were compared with other ethnic populations from Ensembl Project using a χ2 test. Results: Samples from the same individual showed the same genotype in cancer and normal tissue, and the genotype found were 48 cases of AA (50%), 35 of AG (36.5%) and 13 GG (13.5%). All frequencies were in Hardy-Weinberg equilibrium (p = 0.119), with allelic frequency of 68,2% for A and 31.8% for G, being significantly different from African (p < 0.016), European (p < 0.0003), American, South and East Asian (p < 0.0001) population. Obtained genotype frequencies were more comparable to African population (p < 0.0004) than the others ethnic groups. No statistically significant association was showed between genotype and diagnosis. As reported previously [2], the result of the association between genotype and the T of tumour stage was nearly statistically significant (p-value = 0.08), and the presence of the A allele showed a statistically significant association with T (p-value = 0.046) but not the G allele. Discussion and conclusions: The allelic and genotype frequencies are closer to the African than European or Asian population, but it wasńt confirm by statistical tests. The African population does not present significant differences from our population to the level of 0.01 for the allelic frequency. The presence of the A allele showed a statistically significant association with T of stage tumor. PSA levels were associated with the tumor volume.

Breast cancer (BC) is one of the most common types of cancer in women worldwide. Several factors including genetic and environmental have been linked with susceptibility to development of BC. Her2 is a transmembrane protein with tyrosine kinase activity, overexpressed in several cancers including BC. Various studies in different populations have shown association of Her2 variants with susceptibility to BC, however these results were inconsistent, inconclusive and controversial. To obtain a common conclusive finding, we performed meta-analysis of 35 case-control studies reported earlier including 19, 220 cases and 22, 306 controls. We observed significant association of Her2Ile655Val polymorphism with susceptibility to development of breast cancer (Overall allele Val vs Ile: OR = 1.130, 95% CI = 1.051–1.216, p = 0.001; Ile-Val vs Ile-Ile: OR = 1.100, 95% CI = 1.016–1.192, p = 0.019; Val-Val+Ile-Val vs Ile-Ile: OR = 1.127, 95% CI = 1.038–1.223, p = 0.004). Subgroup analysis indicated a significant association with susceptibility to breast cancer in African and Asian populations. However, such association was not observed in other ethnic groups. Our findings suggested that Her2Ile655Val polymorphism is associated with breast cancer risk in overall, Asian and African populations, and can be used as diagnostic marker for BC.

BackgroundSinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly, either acquired or congenital. This anomaly most often arises from the right coronary sinus, while less frequently arises from the...

In 2018, an algorithm-based allocation system for heart transplantation (HT) was implemented in France. Its effect on access to HT of patients with rare causes of heart failure (HF) has not been assessed. In this national study, including adults listed for HT between 2018 and 2020, we analyzed waitlist and posttransplant outcomes of candidates with rare causes of HF (restrictive cardiomyopathy [RCM], hypertrophic cardiomyopathy, and congenital heart disease). The primary end point was death on the waitlist or delisting for clinical deterioration. Secondary end points included access to HT and posttransplant mortality. The cumulative incidence of waitlist mortality estimated with competing risk analysis and incidence of transplantation were compared between diagnosis groups. The association of HF cause with outcomes was determined by Fine-Gray or Cox models. Overall, 1604 candidates were listed for HT. At 1 year postlisting, 175 patients met the primary end point and 1040 underwent HT. Candidates listed for rare causes of HF significantly differed in baseline characteristics and had more frequent score exceptions compared with other cardiomyopathies (31.3%, 32.0%, 36.4%, and 16.7% for patients with hypertrophic cardiomyopathy, RCM, congenital heart disease, and other cardiomyopathies). The cumulative incidence of death on the waitlist and probability of HT were similar between diagnosis groups (P=0.17 and 0.40, respectively). The adjusted risk of death or delisting for clinical deterioration did not significantly differ between candidates with rare and common causes of HF (subdistribution hazard ratio (HR): hypertrophic cardiomyopathy, 0.51 [95% CI, 0.19-1.38]; P=0.18; RCM, 1.04 [95% CI, 0.42-2.58]; P=0.94; congenital heart disease, 1.82 [95% CI, 0.78-4.26]; P=0.17). Similarly, the access to HT did not significantly differ between causes of HF (hypertrophic cardiomyopathy: HR, 1.18 [95% CI, 0.92-1.51]; P=0.19; RCM: HR, 1.19 [95% CI, 0.90-1.58]; P=0.23; congenital heart disease: HR, 0.76 [95% CI, 0.53-1.09]; P=0.14). RCM was an independent risk factor for 1-year posttransplant mortality (HR, 2.12 [95% CI, 1.06-4.24]; P=0.03). Our study shows equitable waitlist outcomes among HT candidates whatever the indication for transplantation with the new French allocation scheme.

Correlation of Q223R and K109R polymorphisms in leptin receptor gene with susceptibility of breast cancer: A systematic review and meta-analysis.

Funding Acknowledgements Type of funding sources: None. Background Worldwide, raised blood pressure (BP) or hypertension (HT) is the global leading risk factor for the development of cardiovascular diseases and all-cause mortality, with the highest prevalence found in Asian and African-origin populations. Post-exercise hypotension (PEH) defined as a sustained reduction in BP after a single bout of exercise is an important physiological phenomenon in BP management which can last up to 24 hours. However, little is known about the hypotensive effect of a single bout of exercise in non-Caucasian populations. Objectives To systematically summarize the acute effects of a single bout of aerobic exercise on blood pressure in a population of African or Asian origin. Methods We searched the MEDLINE database identifying randomized controlled trials investigating the effect of a single bout of aerobic exercise on BP in African or Asian populations with optimal BP, high normal BP or HT published in a peer reviewed journal up to August 2021. A subsequent meta-analysis was performed using random effect models fitted to estimate effect sizes. Results We identified 10 aerobic exercise trials of individuals of Asian origin (n= 156; mean age: 27.05 years: 72% male; baseline SBP/DBP: 114.93 [99,142] / 67.34 [61,74] mmHg) and 11 aerobic exercise trials involving individuals of African origin (n=112; mean age: 41.37 years; 62% male; baseline SBP/DBP: 125.77 [106.6,140.2] / 79.72 [69.9, 84.3] mmHg). Non-significant moderate reductions in office SBP and DBP at 30 minutes postexercise (-2.25 [-6.38, 1.88] mmHg, p = 0.28 / -1.02 [-2.51, 0.47] mmHg, p = 0.18) and 60 minutes postexercise (-2.80 [-7.90, 2.28], p = 0.27 / -1.95, [-5.66, 1.75], p = 0.3) were observed compared to control group. No statistically significant differences were found between ethnic groups (p &amp;gt; 0.05). Ambulatory BP was reported only in the African groups. No effect was found on 24h-SBP post-exercise, but 24h-DBP was statistically signficantly reduced (-1.89 [-3.47, -0.31] mmHg, p &amp;lt; 0.01) after a bout of aerobic exercise. Conclusions A single bout of aerobic exercise did not significantly reduce BP immediately in the African and Asian group. In the African group a small though statistically significant lower 24h-DBP was observed. Unfortunately, no data was found on the 24h-BP response in Asians. The low number of studies in both ethnic groups and lack of data on isometric and resistance exercise in African and Asian populations warrant more research to improve quality of evidence.