Significant Higher Risk Research Articles

Metabolic syndrome and risk of colorectal adenoma and colorectal cancer: a meta-analysis

Background: Growing evidence suggests that metabolic syndrome (MetS) could be linked with the incidence of colorectal adenoma and cancer (CRA and CRC). Aims: Conducting a meta-analysis to assess the association of MetS with both CRA and CRC. Methods and Material: Relevant studies were identified by systematically searching PubMed database for articles published in the last ten years. A random effect analysis model and Mantel-Haenszel statistical method were used to obtain pooled risk ratios (RRs) and their 95% confidence intervals (CIs) for dichotomous data. The analyses were assessed for heterogeneity and publication bias. Results: 35 studies were included in the meta-analysis involving approximately 1300000 participants. A significant high risk for CRA was observed among patients with MetS compared to those without (RR = 1.43; 95% CI = 1.31, 1.57). The pooled RRs of CRC were 1.46 (95% CI = 1.36, 1.56). The risk estimates varied according to the type of the study (cohorts and non-cohorts), gender (men and women), MetS definition (NCEP-ATPIII, IDF, harmonized and others), populations (Asia, Europe, and the USA), and cancer location (colon and rectum). Conclusions: MetS is associated with an increased risk of CRA and CRC. The risk was higher for advanced adenomas. Taking into consideration MetS patients in the secondary prevention programs and the management of this condition in the aim of the primary prevention is highly recommended. Keywords: Metabolic syndrome, colorectal cancer, colorectal adenoma, incidence, meta-analysis.

Interaction between ALOX15 polymorphisms and coronary artery disease in North Indian population

ABSTRACTBackground: Coronary artery disease (CAD) is major cause of death and morbidity worldwide. Arachidonate 12/15-lipoxygenase (ALOX) is a member of the lipid peroxidizing enzyme family and implicated in the pathogenesis of atherosclerosis, but with contradicting results. Aim: The present study aimed to investigate the association of two polymorphisms in ALOX15 (rs2619112 and rs7217186) and the risk of CAD in North Indian population. Methods: A total of 500 angiographically confirmed CAD patients and 500 control subjects of North Indian population were recruited in the case-control study and genotyped by PCR-RFLP. Results: The data showed a significant association between the two polymorphisms and CAD. Multiple logistic regression revealed heterozygous genotype of both the polymorphisms viz. GA of rs2619112 and CT of rs7217186 to be associated with significant high risk of CAD after adjustment for confounders (p = 0.034, OR = 2.274, 95% CI (1.062–4.870) and p = 0.000, OR = 3.407, 95% CI (2.092–5.548) respectively). Stratified analysis based on gender showed GA and AA of rs2619112 each significantly increased the risk of CAD in females (p = 0.001, OR = 13.120, CI = 2.780–61.928; p = 0.028, OR = 5.393, CI = 1.196–24.316 respectively) whereas only GA increased CAD risk in males (p = 0.005, OR = 2.277, CI = 1.290–4.020). In case of rs7217186, CT and TT showed a significant high risk of CAD in males (p = 0.000, OR = 4.048, CI = 2.678–6.119; p = 0.000, OR = 2.861, CI = 1.928–4.245). Conclusion: The present study shows that rs7217186:C > T and rs2619112:G > A of ALOX15 are associated with increased risk of CAD in the North Indian population.

Rupture of the aortic root : Arare but life-threatening complication of transcatheter aortic valve replacement.

Transcatheter aortic valve replacement (TAVR) has been shown to be avalid treatment option for patients with significant symptomatic aortic valve stenosis and high surgical risk. Rupture of the aortic root is arare but life-threatening complication that occurs in approximately 1% of procedures and usually manifests as an acute complication at the time of valve implantation; however, physicians should be aware of apotentially subacute onset, since early recognition and immediate management are crucial. While many potential causes have been described, it is currently unknown which combinations will lead to its occurrence. Accurate preprocedural assessment of the aortic annulus and its adjacent structures as well as adequate sizing of the prosthetic valve are important steps to prevent rupture of the device landing zone.

Systemic vasculitis is associated with a higher risk of lower extremity amputation in patients with severe peripheral arterial occlusive disease: a secondary analysis of a nationwide, population-based health claims database.

Previous research has shown that diabetes mellitus increases the risk of lower extremity amputation in patients with peripheral arterial occlusive disease. However, to our knowledge, no studies have investigated whether systemic autoimmune disease, in particular systemic vasculitis is associated with a higher risk of lower extremity amputation in these patients. To investigate the association between systemic autoimmune disease and lower extremity amputation in patients with severe peripheral arterial occlusive disease based on a secondary analysis of a nationwide, population-based health claims database. Using the inpatient datafile of the Taiwan's National Health Insurance Research Database (NHIRD), we identified 432 patients with severe peripheral arterial occlusive disease that required hospitalization between 2000 and 2012. We also identified patients who had undergone lower extremity amputation and their comorbidities using the same datafile. The risk of lower extremity amputation was assessed using multiple logistic regression analysis, adjusting for age, sex, insured amount, the urbanization level of residence, and the presence of comorbidities. Among patients with severe peripheral arterial occlusive disease, those with systemic vasculitis exhibited a significant higher risk of lower extremity amputation (adjusted odds ratio [aOR]=6.82, p<0.001). Diabetes mellitus (aOR=4.90, p<0.001) and chronic obstructive pulmonary disease (aOR=2.87, p=0.007) were also significantly associated with a higher risk of lower extremity amputation. Among patients with severe peripheral arterial occlusive disease, a significantly higher risk of lower extremity amputation was observed in those with systemic vasculitis.

Prevalence and pathological investigations of avian colibacillosis in commercial broiler at Chittagong district in Bangladesh

This study was carried out to identify and observe prevalence and pathological lesions of avian colibacillosis in commercial broiler in variation of litter type, age, farm size, source of water and season of year in Chittagong region. Colibacillosis in commercial broiler farms causes huge economic loss through a relatively high mortality and loss of production. In the present study, a total of 275 broilers of 104 farms were examined through post-mortem and among them 150 (54.55%) broiler was diagnosed as affected with any lesion of colibacillosis. The most frequent gross lesions of colibacillosis were air sacculitis (20.67%), omphalitis (12.00%), pericarditis (13.33%), perihepatitis (13.33%), peritonitis (1.33%), colisepticemia (8.00%), enteritis (8.00%) and a large number 35 (23.33%) of broiler combination of different form of colibacillosis. The microscopic lesions of these conditions were chronic passive congestion, fibrosis of liver capsule, telangiectasis, thick fibrous layer in the pericardium of heart, blunting and sloughing off villus and infiltration of lamina propria of intestine. The results obtained during the study period revealed that winter season of the year was significant (p&gt;0.05) high risk factors of colibacillosis in broiler but litter, age, farm size, source of water were not significantly risk factor. Considering the factor it could be concluded based on pathology that colibacillosis causes high mortality and winter season was the main risk factor in broiler at Chittagong District.&#x0D; Asian Australas. J. Biosci. Biotechnol. 2017, 2 (2), 173-180

Neonatal alloimmune thrombocytopenia caused by anti-HPA antibodies in pregnant Chinese women: a study protocol for a multicentre, prospective cohort trial

BackgroundNeonatal alloimmune thrombocytopenia (NAIT), caused by maternal antibodies raised against alloantigens carried on foetal platelets, is a very common haematological abnormality in newborns worldwide. However, baseline data on NAIT in China are lacking. Therefore, this study seeks to explore the incidence of alloantibody against the human platelet antigen (HPA) in pregnant women and its associations with NAIT in China.MethodsA multicentre, prospective cohort study design will be used, and 55,497 pregnant women will be recruited for the first screening of the anti-HPA antibody at 12 to 28 weeks of gestational age. Subjects who are positive in the first screening for the anti-HPA antibody will be included in the exposure group. Re-tests of the antibody titre, antigen-specificity and genotyping of HPA and HLA will be conducted during admission. A ratio of 1:1 paired individuals with the same ethnicity and parity but testing negative for the anti-HPA antibody will be randomly selected to be included in the non-exposure group. NAIT will be diagnosed in the newborns on day one of the birth. The HPA of the neonates in the exposure group will also be genotyped by sequencing. Associations of maternal HLA with the occurrence of the anti-HPA antibody and correlation of the severity of NAIT with the titre of the anti-HPA antibody will be further analysed.DiscussionThe study is expected to provide baseline data on NAIT in China. Besides, we hope to find out a population who expresses particular HLA molecules has significant higher risk of HPA alloimmunization in Chinese individuals. We also hope to find a Chinese-specific cut-off antibody titre for the prediction of the severity of NAIT and to provide a means to evaluate the necessity of antenatal treatment.Trial registrationClinicalTrials.gov: NCT02934906 (date registered: 13.10.2016).

ОСОБЛИВОСТІ ЗМІН МІНЕРАЛЬНОЇ ЩІЛЬНОСТІ КІСТКОВОЇ ТКАНИНИ У ХВОРИХ НА РЕВМАТОЇДННИЙ АРТРИТ В ПОЄДНАННІ З НЕАЛКОГОЛЬНИМ СТЕАТОГЕПАТИТОМ

РЕЗЮМЕ. РА займає особливе місце серед захворювань, які призводять до розвитку остеопорозу. Остеопороз при РА є наслідком як існуючого хронічного системного захворювання, так і терапії глюкокортикоїдами. Не проводилось вивчення взаємозв’язку між морфофункціональними порушеннями печінки і МЩКТ у хворих на РА.Мета дослідження – дослідити порушення структурно-функціонального стану кісткової тканини та виявити залежність змін мінеральної щільності кісткової тканини від наявності НАГС чи його відсутності, застосовуючи рентгенівську денситометрію в пацієнтів із РА.Матеріали та методи. Обстеження пацієнтів проводилося за традиційною методикою і включало: 1) загальноклінічні: огляд, опитування, наявність у минулому переломів, їх кількість та обставини їх виникнення, визначення ІМТ; 2) лабораторні (загальний та біохімічний аналіз крові, визначення РФ методом латекс- аглютинації, оцінку титру АТ ЦЦП методом ELISA (діагностична межа ≥15 ум. од./мл); 3) мінеральну щільність кісткової тканини визначали з використанням подвійного рентгенівського денситометра ДРХ-А (Dualenergy X-Ray Absorptiometry) фірми LUNAR (США) на рівні поперекового відділу хребта. У пацієнтів з МЩКТ на рівні поперекового відділу хребта ≤ -2,5 SD діагностували остеопороз; у пацієнтів, у яких рівень МЩКТ &lt; -1 SD і ≥ -2,5 – SD- остеопенію; індекс Z (відхилення мінеральної щільності кістки від середнього значення у хворих відповідного віку), індекс Т (відхилення від референтного значення пікової кісткової маси у здорових осіб молодого віку); 4) статистичні.Результати. Денситометричні показники у когорті хворих з НАСГ вказують на значне зниження МЩКТ, порівняно з пацієнтами без ураження печінки. У більшості жінок з РА та супутнім ураженням печінки у постменопаузальному періоді відзначали явища остеопенії і остеопорозу (ОП). Серед пацієнтів із мінімальною активністю РА в поєднанні з НАСГ була незначна кількість обстежених із остеопорозом, у хворих на РА ІІ ступеня активності частка їх із остеопенією і остеопорозом розподілилася з невеликими відмінностями, хоча за відсотковим значенням переважали хворі з остеопенією. Найбільша кількість пацієнтів, яка становила групу максимальної активності РА, була представлена остеопорозом. Остеодефіцитні стани асоціювалися із ожирінням у пацієнтів з РА та НАСГ. За умов позитивності АТ ЦЦП кількість хворих із остеопорозом достовірно більша, ніж із нормальною мінеральною щільністю кісткової тканини і остеопенією. Пацієнти із серопозитивним РА мали статистично значущий вищий ризик виникнення остеодефіцитних станів і частіше хворіли на остеопороз, ніж особи із серонегативним РА. У більшої когорти хворих з РА в поєднанні з НАСГ діагностовано переломи в анамнезі: з остеопенією – у 6 (10,34%) осіб, з остеопорозом – у 12 (20,69%) хворих.Висновки. Серед хворих на РА із супутнім НАСГ діагностовано явища остеопенії та остеопорозу в 87,93 % випадків. Вивчення структурно-функціонального стану кісткової тканини поперекового відділу хребта в жінок до менопаузи і в постменопаузальному період із РА та супутнім НАСГ, порівняно з пацієнтами, які не мали супутнього ураження печінки, демонструвало достовірно вищий відсоток розвитку остеодефіцитних станів, який асоціювався із супутнім ожирінням, активністю РА, наявністю АТ ЦЦП і РФ як за кількісними значеннями МЩКТ, так й за частотою реєстрації даних станів.

Risk of life-threatening arrhythmias in smoking patients

Despite the prophylactic medicine achievements through the past decade, tobacco smoking remains one of the main risk factors of appearance and progression of diseases, which are accompanied by the high population mortality. Aim : development of the new approaches of complications prediction, prophylaxis and treatment in patients with high and very high total cardiovascular risk, which are based on the heart rhythm turbulence evaluation. Materials and Methods : 603 patients were chosen for the research. All patients were divided into tree groups. The first – patients with IHD without concomitant risk factors, such as smoking, obesity, metabolic syndrome. The second – patients, who smoke for more than 2 years (people with very high cardiovascular risk by SCORE scale). The third group – patients with metabolic syndrome without IHD or hypertension (patients with high cardiovascular risk). Control group included 149 patients. Holter monitoring of the heart rhythm was performed in patients with high and very high cardiovascular risk by the SCORE scale with myocardial infarction to study the specifications of the heart rhythm turbulence. Plasma calcium and magnesium levels were measured to establish the correlation between appearance and progression of ventricular arrhythmia and increase of the heart rhythm turbulence phenomenon. Results . The prevalence of ventricular and supraventricular arrhythmia is reliably higher among the smokers than among healthy persons. The highest percentage of the ventricular extrasystoles both the early appearing extrasystoles and the group extrasystoles is observed among smokers. Among healthy people every fourth person has deviations in heart rhythm turbulence indices, and every seventeenth has significant deviations and high risk of cardiac sudden death. Smokers have reliable decrease of calcium and increase of magnesium plasma levels. People with heart rhythm turbulence, metabolic syndrome and hypertension have reliable increased in calcium plasma concentration compared with people with metabolic syndrome but without hypertension. Conclusions. 1) Smoking contributes to increase the polytopic extrasystoles prevalence. 2) Smokers have higher acceleration and deceleration levels of the heart rhythm turbulence. 3) Changes of calcium and magnesium plasma levels in smokers do not cause the ventricular extrasystole. 4) Studying of the heart rhythm turbulence is available marker of fatal arrhythmias occurrence predicting.

Incidence of HIV, its predictors and risk factors in children

Background: Children mostly acquire HIV (Human immunodeficiency syndrome) infection from their parents. There is need to know the HIV status of their parents, associated risk factors and predictors so as to make effective strategies to prevent this disease and save the coming/future generation from this deadly disease. The objective of the study was to know incidence of HIV, its predictors and risk factors in children. Study Setting: This is a Hospital based observation study conducted in Department of Pediatrics, Govt. Medical College, Amritsar.Methods: In this study, all patients admitted to Pediatrics department, irrespective of presenting complaints were evaluated for presence of any of risk factors/predictors as mentioned in Proforma and those children having any of risk factors/predictors were selected, consent was taken and undergone detailed clinical evaluation and investigations for HIV.Results: Incidence of HIV in all patients admitted to children ward was 1.21% (27/2227) and children who had one or more risk factor or predictor was 6.58% (27/410). Weight loss, Failure to thrive (44.44%), Diarrhoea (37.03%), Fever (70.37%), Oral Candidiasis (22.2%), Pulmonary Tuberculosis (11.11%) and Generalized Lymphadenopathy (18.51%) were significant predictors in present study. High risk behaviour of parents (37.30%) and mother's HIV positivity (62.92%) were significant high risk factors, however needle prick (18.5%) was also equally significant in present study.Conclusions: Children brought with various signs and symptoms of HIV or born to high risk behaviour practicing parents and/or HIV positive mother, physician must get their patients tested for HIV (as per NACO Guidelines) so that infected children diagnosed early and referred to a specialized centre for treatment and follow up.

ONCOLOGIC OUTCOMES OF RADICAL PROSTATECTOMY AND PROGNOSTIC STRATIFICATION IN PATIENTS WITH CLINICALLY LOCALLY ADVANCED PROSTATE CANCER

Oncologic outcomes of radical prostatectomy in 106 patients with clinically locally advanced prostate cancer were demonstrated. The mean follow-up was 50.6 (12-129) months. 5-year recurrence-free survival was 47.7 %, 5-year cancer-specific and overall survival - 85.8 %. Patients were devided into three different risk groups: low risk patients had PSA level &lt;20 ng/ml, biopsy Gleason score ≤6 and absence of the seminal vesicle invasion of cancer; intermediate risk was noted when the patient had only one of poor prognostic factors (PSA ≥20 ng/ml or biopsy Gleason score≥7 or presence of cancer invasion to the seminal vesicle) and high risk patients had 2 or 3 poor prognostic factors. For patients of low, intermediate and high risk the biochemical reccurence rates were 14.3 %, 37.1 % and 70.2 %, respectively (p=0.002). The patients of intermediate and high risk had clinically significant higher risk of biochemical reccurence than those of low risk with odds ratio 3.0 and 8.5, respectively. Such grouping may help in guiding the individualized treatment for these patients.

Cardiac Computed Tomography and Magnetic Resonance Imaging in the Evaluation of Mitral and Tricuspid Valve Disease: Implications for Transcatheter Interventions.

Transcatheter interventions to treat mitral and tricuspid valve disease are becoming increasingly available because of the growing number of elderly patients with significant comorbidities or high operative risk. Thorough clinical and imaging evaluation in these patients is essential. The latter involves both characterization of the mechanism and severity of valvular disease as well as determining the hemodynamic consequences and extent of ventricular remodeling, which is an important predictor of future outcomes. Moreover, an assessment of the suitability and risk of complications associated with device-specific therapies is also an important component of the preprocedural evaluation in this cohort. Although echocardiography including 2-dimensional and 3-dimensional methods has an important role in the initial assessment and procedural guidance, cross-sectional imaging, including both computed tomographic imagning and cardiac magnetic resonance imaging, is increasingly being integrated into the evaluation of mitral and tricuspid valve disease. In this review, we discuss the role of cross-sectional imaging in mitral and tricuspid valve disease, primarily valvular regurgitation assessment, with an emphasis on the preprocedural evaluation and implications for transcatheter interventions.

Peri-implant bleeding on probing: a cross-sectional multilevel analysis of associated factors.

The objective was to evaluate the association between peri-implant bleeding on probing (BoP) and probing depth. Other factors regarding patients, implants, and sites were taken into consideration. Consecutive adult patients with ≥1 dental implant were eligible. Two calibrated operators examined the patients. BoP was the outcome variable. The effects of patient, implant and site factors on BoP were assessed using a 3-level logistic model. Fifty-two patients for a total of 92 implants and 552 sites were included in the analysis. The BoP was observed in 217 sites (39%). The odds ratio increased by 1.81 (95% CI from 1.47 to 2.23; P<0.0001) for each 1mm increment in probing pocket depth. A significant higher risk was observed also for interproximal vs. approximal surfaces (OR=1.55; 95% CI from 1.02 to 2.36; P=0.0402). Peri-implant bleeding was associated with site-specific factors.

The efficacy of stratifying patients with laparoscopic gastrectomy at age, body mass index and preoperative serum C-reactive protein level for predicting an incidence ratio of postoperative complications.

31 Background: Wide variety of Predictive factors (PF) of postoperative complications (PC) in patients with gastric cancer(GC) that have undergone laparoscopic gastrectomy(LG) has been reported. The aim of this study is to devise simple PF for PC for LG that can estimate risk of PC preoperatively. Methods: Two hundred and ninety-eight patients that have been underwent curative LG against GC during May 2012 to March 2016 were enrolled. Patients’ characteristics, preoperative (pre-) laboratory data, operative information and pathological factors were analyzed. Also PC with Clavien-Dindo classification Grade (CD)≥II (PC≥II), pancreatic fistula (PF), intraabdominal abscess (IA), pneumonia (PN) and anastomotic leakage (AL) with CD≥III were examined. Results: Patients with pStage I, II, III and IV was 83%, 11%, 5.6% and 0.4%, respectively. Patients with PC≥II, PF or IA, PN and AL was 17.4%, 5%, 1% and 2.3%, respectively. Patients with PC≥II were significantly elder (p=0.01) and had higher pre-serum-C-reactive protein level (CRP) (p=0.02). Also, patients with AL had significantly higher Body Mass Index (BMI) (p=0.04). We devised “ABC score” by Age, BMI and CRP. It is defined as a number of factors in age, BMI and CRP that are higher than cutoff value of 66 years’ old, 23 kg/m2 and 0.04 mg/dL, respectively. Patients with ABCs 0, 1, 2, and 3 were 26%, 33%, 34% and 7%, respectively. Patients with ABCs 3 had significant high risk of PC≥II and AL (HR 2.8, p=0.03 and HR 9.9, p=0.004, respectively). Also we found higher ABCs has higher risk of AL (HR1.2, p=0.07 for ABCs 2 and HR2.2, p=0.04 for ABCs 3). Conclusions: ABCs can be a PF for PC in patients with LG. Especially it may evaluate an incidence ratio of AL.

Better care provided to patients with tuberculosis at county designated TB hospitals (CTD) compared to non-CTDs in rural China

BackgroundThe primary unit of tuberculosis (TB) medical care in China is the county TB dispensary or county designated hospital (CTD), where patients can receive free diagnosis and treatment. However, a substantial number of patients seek their anti-TB treatment from general health facilities (Non-CTDs). This study aimed to investigate the first anti-TB treatment experience and choice of health facilities of retreated TB patients and their determinants.MethodsA cross-sectional study was conducted in Jiangsu, Shandong and Sichuan provinces. All registered re-treated TB patients were investigated using a structured questionnaire covering information on demographics, socio-economic characteristics, and previous anti-TB treatment experiences.ResultsTotally, 75.3% of 544 patients visited CTD directly for initial treatment. Patients who were female (OR:1.71, 95% CI: 1.01-2.87), over 40 years of age (OR:2.80, 95% CI: 1.24-6.33), from Jiangsu (OR:3.07, 95% CI: 1.57-6.01) and Sichuan (OR:4.47, 95% CI: 2.29-8.73) and those diagnosed before 2005 (OR:6.87, 95% CI: 4.24-11.13) had a significant higher risk receiving their initial treatment at a non-CTD. Patients were more likely to have standardized diagnosis and treatment regimens in CTD (89.8%) than in non-CTDs (65.9%). Patients treated in non-CTDs versus in CTD had a lower possibility to complete their treatment course during first TB episode (χ2 = 3.926, P = 0.048), but there was no significant difference in the cure rate between different facilities (CTD 60.8%, Non-CTDs 59.1%). Patients in non-CTDs incurred higher costs (1,360 CNY) than those treated in CTD (920CNY).ConclusionCTD play a key role in the National Tuberculosis Control Program. Patients should be guided to seek health care in county designated hospital, where they are more likely to receive appropriate examinations, treatment regimens and rigorous supervision, and to bear a lighter economic burden.

Evaluation of ECG Abnormalities in Patients with Asymptomatic Type 2 Diabetes Mellitus.

Diabetes Mellitus (DM) is the most common chronic disease. DM is considered a Cardiovascular Disease (CVD) risk equivalent. Its macrovascular complications are associated with two-fold increased risk of premature atherosclerotic CVD. Most of the diabetics with cardiovascular involvement are asymptomatic. Electro Cardio Graph (ECG) abnormalities are found to be predictors of silent ischaemia in asymptomatic persons. An abnormal ECG response is associated with statistically significant high risk for cardiac mortality and morbidity. The aim of the study was to evaluate ECG changes in asymptomatic Type 2 DM patients. A cross-sectional comparative study was conducted in a tertiary care hospital in North India. One hundred diabetics presenting to Medicine OPD/IPD were included in the study who had no symptoms of heart disease and no diabetic complications. Fifty person with age and sex matched controls were included in the study. Relevant history and physical examination findings were recorded in a protocol. The variables studied were: gender, age, smoking, physical activity, and waist circumference, Body Mass Index (BMI) and blood pressure. Resting ECG was recorded. Mean age of asymptomatic diabetic patients was 50.3±11.90 years (age range 25-75 years). In this study, none of the control group had ECG abnormality whereas, 26% asymptomatic diabetics had ECG abnormalities. Most of the asymptomatic cases with ECG changes had 5-10 year of duration of diabetes mellitus; 70% patients with ECG changes had poor glycaemic control, increased triglyceride and decreased High Density Lipoprotein (HDL) levels. Most common abnormality observed was ST-T changes, followed by Left Atrial Enlargement (LAE), Left Ventricular Hypertrophy (LVH), Left Bundle Branch Block (LBBB) and Right Bundle Branch Block (RBBB). ECG changes are present in quarter of asymptomatic Type 2 DM patients. However, nonspecific ST-T changes, LVH and LAE are common.

The impact of conisation on pregnancy outcome.

The objective of present study was to investigate whether conisation is associated with adverse pregnancy outcomes in Flanders, Belgium. Therefore a retrospective cohort study was conducted at the Antwerp University Hospital. The study was approved by the Ethical Committee and based on a questionnaire as well as on medical records. Confounders, like smoking, alcohol use, drug use, chronic illness, and gynaecological disorders during pregnancy were all taken into account. A multiple logistic regression was performed for an association between adverse pregnancy outcomes and confounders. The study showed that there was association between conisation, low birth weight, and caesarean section. After conisation there was a significantly higher risk of 3.275 on a low birth weight. The risk of a caesarean section after conisation was tripled. A gynaecological disorder during the pregnancy had a significantly higher risk of delivering a child with a low birth weight and a higher risk of a caesarean section. Smoking and a chronic illness gave a significant higher risk of caesarean section. Conisation is easy to perform and highly effective in the prevention of cervical cancer. Conisation has a high morbidity, as it is associated with severe adverse pregnancy outcome. A conisation should therefore only be performed on a true indication; otherwise it will be the victim of its own success.

Matching pursuit-based compressive sensing in a wearable biomedical accelerometer fall diagnosis device

There is a significant high fall risk population, where individuals are susceptible to frequent falls and obtaining significant injury, where quick medical response and fall information are critical to providing efficient aid. This article presents an evaluation of compressive sensing techniques in an accelerometer-based intelligent fall detection system modelled on a wearable Shimmer biomedical embedded computing device with Matlab. The presented fall detection system utilises a database of fall and activities of daily living signals evaluated with discrete wavelet transforms and principal component analysis to obtain binary tree classifiers for fall evaluation. 14 test subjects undertook various fall and activities of daily living experiments with a Shimmer device to generate data for principal component analysis-based fall classifiers and evaluate the proposed fall analysis system. The presented system obtains highly accurate fall detection results, demonstrating significant advantages in comparison with the thresholding method presented. Additionally, the presented approach offers advantageous fall diagnostic information. Furthermore, transmitted data accounts for over 80% battery current usage of the Shimmer device, hence it is critical the acceleration data is reduced to increase transmission efficiency and in-turn improve battery usage performance. Various Matching pursuit-based compressive sensing techniques have been utilised to significantly reduce acceleration information required for transmission.

Abstract 12824: Mortality Outcomes at 30 Days and 1 Year After Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction Due to Unprotected Left Main Coronary Artery Occlusion

Introduction: Patients with acute myocardial infarction (AMI) due to unprotected left main coronary artery (ULMCA) occlusion are often critically ill at presentation. Emergency surgical revascularization is often associated with significant time delay and high mortality risk, as such, primary percutaneous coronary intervention (PCI) has been advocated as the preferred form of reperfusion therapy. Data on the clinical outcomes in this setting however remains limited. Hypothesis: We hypothesised that primary PCI is a feasible revascularization therapy in AMI due to ULMCA occlusion and the identification of the predictors of outcomes would aid in clinical decision-making. Methods: From 2005 to 2015, 71 patients with AMI due to ULMCA occlusion who underwent primary PCI had their outcomes evaluated retrospectively. Given the complex data interrelationships, a generalized structural equation model was applied for identifying the predictors of 30-day and 1-year mortality. All statistical analyses were conducted at 5% level of significance. Results: Majority of the patients (mean age 58.0 ±11.5, 90.1% male) had cardiogenic shock (64.7%) and cardiac arrest (70.1%) and 71.8% were intubated. Procedural success was achieved in 87.3% of patients. Mortality at 30-day was 59.1%, including 16.9% intra-procedural deaths. Cardiogenic shock (Adjusted odds ratio [AOR] 12.1), cardiac arrest (AOR 12.0) and intubation (AOR 282.0) were significantly associated with 30-day mortality. Additionally, a QRS duration of &gt;130 milliseconds on the presenting electrocardiogram was also predictive of cardiogenic shock (AOR 4.5) and 30-day mortality (AOR 10.0). All-cause mortality at 1 year was 63.4% and for which QRS duration &gt;130 milliseconds (AOR 25.4), cardiac arrest (AOR 8.8) and intubation (AOR 16.9) remained predictive of mortality but not cardiogenic shock (AOR 1.8, p &gt;0.05). Conclusion: In conclusion, ULMCA occlusion is associated with a high incidence of 30-day mortality despite successful primary PCI. Patients presenting with a broad QRS complex, cardiogenic shock, cardiac arrest, or requiring intubation have a particularly poor prognosis. However, after thirty days, the mid-term survival rate of the remaining patients appeared favorable.

THE RELATION BETWEEN PSYCHOSOCIAL WORK FACTORS AND MUSCULOSKELETAL SYMPTOMS AMONG COMPUTER WORKERS

INTRODUCTION: Several epidemiological studies have shown that intensive computer work and other factors of work organization, involving physical and psychosocial exposure to computer work, are associated with increased risk of neck and upper extremity disorders.OBJECTIVES:The aim of this study is to present psychosocial work factors and their relationship to musculoskeletal symptoms among computer workers.MATERIAL AND METHODS: The Copenhagen Psychosocial Questionnaire (COPSOQ) for assessing psychosocial factors at work was used to assess 800 computer workers.RESULTS: The results showed that most respondents often worked at a high pace; sometimes received support from superiors, and were little satisfied with work. There was a positive correlation (r = 0.3) between quantitative demands at work and neck symptoms.CONCLUSION: Particular attention should be paid to psychosocial factors of the work environment, especially those with a significant high risk of workers acquiring musculoskeletal symptoms, in relation to assistance in the work environment, management, workload, and increasing autonomy at work.

Genetic Variation in CD166 Gene and Its Association with Bladder Cancer Risk in North Indian Population.

Adhesion molecules play a key role in cancer progression and tumorigenesis. Genetic polymorphism of adhesion molecules may alter the normal functioning thereby leading to bladder cancer susceptibility. Hence we aimed to evaluate three SNPs of CD166 gene (CD166rs6437585 C/T, CD166rs10511244 C/T, and CD166rs1157 A/G) in bladder cancer patients and normal controls of North Indian population. A total of 270 healthy controls and 240 confirmed bladder cancer patients were recruited for this study. Three SNPs of CD166 gene viz. CD166rs6437585 C/T, CD166rs10511244 C/T, and CD166rs1157 A/G were selected for this study. CD166rs6437585 C/T and CD166rs10511244 C/T were genotyped by Taqman allelic discrimination assay and CD166rs1157 A/G was genotyped by PCR-RFLP. The statistical analysis was done using the SPSS software, version 16.0 (SPSS, Chicago, IL), and p<0.05 was considered statistically significant. Haplotypic analysis was done by using SNP analyzer version 1.2A. CD166rs6437585 C/T and CD166rs10511244 C/T showed significant association with reduced risk in bladder cancer while CD166rs1157 A/G showed significant high risk along with association at genotypic and allelic levels. Haplotypic analysis showed 1.8-folds risk in CCG combination, whereas CTA and TCG showed significant association with reduced risk. Further stratification on the basis of smoking, tumor grade/stage and BGC therapy revealed no association of these three polymorphic sites of CD166. Our study suggests that CD166rs6437585 C/T and CD166rs10511244 C/T are predictive for the reduced risk of bladder cancer, whereas CD166rs1157 A/G had shown significant association with high risk of bladder cancer in North Indians. This somehow suggests that CD166rs1157 A/G can be used as a marker for risk prediction of bladder cancer.