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Fulltext Prevalence of non-steroidal anti-inflammatory drugs (NSAIDs) use in Malaysian adults and associated factors: a population-based survey

Maria Awaluddin S, Noor Ani Ahmad, Balkish Mahadir Naidu, Muslimah Yusof, Mohamad Aznuddin Abd Razak, Mohd Kamal Ariff Abdul Ghani

Malaysian Journal of Public Health Medicine, 2017;17(3):58-65.

Chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with adverse effects. However, NSAIDs are among the most popular pain killers and easily available over the counter. This study aimed to determine the prevalence of NSAIDs use in Malaysian adults and among those with chronic diseases such as arthritis, kidney disease, hypertension, heart disease and asthma. It also examined the factors associated with NSAIDs use. Data from the National Health Morbidity Survey (NHMS) 2011, a nation-wide survey was analysed. A total of 18231 respondents aged 18 years and above responded to this module. Multivariate logistic regression was used to investigate the association between NSAIDs use and associated factors. The overall prevalence of NSAIDs use among Malaysian adults was 14.2% (95%CI 13.3-15.1). Of the respondents, 4.2% (95%CI 3.8-4.7) took NSAIDs once daily. NSAIDs use was highly associated with those who were ever-told to have arthritis (aOR: 3.03; 95%CI 2.60-3.52) and have difficulty of performing daily activities or work (aOR: 2.06; 95%CI 1.86-2.28). Those who were ever-told to have kidney disease (aOR: 2.36; 95%CI 1.74-3.20), ever-told to have asthma (aOR: 1.36; 95%CI 1.17-1.58), ever-told to have heart disease (aOR: 1.34; 95%CI 1.08-1.65), known hypertension (aOR: 1.22; 95%CI 1.08-1.37) also were associated with NSAIDs use. By socio-demographic profiles, NSAIDs use was positively associated with those who have government benefit scheme or private health insurance (aOR: 1.44; 95%CI 1.31-1.58), higher education level (aOR: 1.35; 95%CI 1.20-1.51), higher household income (aOR: 1.26; 95%CI 1.11-1.44, aOR: 1.12; 95%CI 1.02-1.24), currently working (aOR: 1.25; 95%CI 1.13-1.39) and female (aOR: 1.17; 95%CI 1.07-1.28). NSAIDs use was less likely among those aged 60 years and above (aOR: 0.83; 95% CI 0.72-0.97), Chinese (aOR: 0.41; 95% CI 0.36-0.47) and ‘Others’ ethnicity (aOR: 0.82; 95% CI 0.67-0.99) compared to Malay ethnicity. NSAIDs use is prevalent in Malaysian adults and associated with co-morbidities and higher socio-demographic status, thus appropriate awareness should be promoted and highlighted in the community.
Study name: National Health and Morbidity Survey (NHMS-2011)

Matched MeSH terms: Heart Diseases
Epidemiology and outcome of older patients presenting with dyspnoea to emergency departments

Kelly AM, Keijzers G, Klim S, Craig S, Kuan WS, Holdgate A, et al.

Age Ageing, 2021 01 08;50(1):252-257.
PMID: 32997140 DOI: 10.1093/ageing/afaa121

OBJECTIVES: To describe the epidemiology and outcomes of non-traumatic dyspnoea in patients aged 75 years or older presenting to emergency departments (EDs) in the Asia-Pacific region.
METHODS: A substudy of a prospective interrupted time series cohort study conducted at three time points in EDs in Australia, New Zealand, Singapore, Hong Kong and Malaysia of patients presenting to the ED with dyspnoea as a main symptom. Data were collected over three 72-h periods and included demographics, co-morbidities, mode of arrival, usual medications, ED investigations and treatment, ED diagnosis and disposition, and outcome. The primary outcomes of interest are the epidemiology and outcome of patients aged 75 years or older presenting to the ED with dyspnoea.
RESULTS: 1097 patients were included. Older patients with dyspnoea made up 1.8% [95% confidence interval (CI) 1.7-1.9%] of ED presentations. The most common diagnoses were heart failure (25.3%), lower respiratory tract infection (25.2%) and chronic obstructive pulmonary disease (17.6%). Hospital ward admission was required for 82.6% (95% CI 80.2-84.7%), with 2.5% (95% CI 1.7-3.6%) requiring intensive care unit (ICU) admission. In-hospital mortality was 7.9% (95% CI 6.3-9.7%). Median length of stay was 5 days (interquartile range 2-8 days).
CONCLUSION: Older patients with dyspnoea make up a significant proportion of ED case load, and have a high admission rate and significant mortality. Exacerbations or worsening of pre-existing chronic disease account for a large proportion of cases which may be amenable to improved chronic disease management.

Matched MeSH terms: Heart Failure
Abdominal obesity and its associated factors among older adults in Malaysia

Baharudin Shaharuddin A, Abdul Aziz NS, Ahmad MH, Manjit Singh JS, Chan YY, Palaniveloo L, et al.

Geriatr Gerontol Int, 2020 Dec;20 Suppl 2:68-72.
PMID: 33370864 DOI: 10.1111/ggi.13962

AIM: The rise in the prevalence of abdominal obesity (AO), in particular, has become a major concern as it contributes to diabetes, hypertension, high cholesterol, heart disease and certain types of cancer. The aim of this study is to determine the prevalence and associated factors of AO among older adults aged ≥60 years in Malaysia.
METHODS: This was a nationwide cross-sectional study using two-stage stratified random sampling. In total, 3977 older adults aged ≥60 years were involved in this study. Socio-demography characteristics were obtained using self-administered questionnaire. AO was measured using waist circumference and classified according to the cut-off values of ≥90 cm for men and ≥80 cm for women based on the WHO recommendation. Descriptive and multiple logistic regression analysis using a complex sample design were performed for data analysis.
RESULTS: Our findings showed that 2371 (67.3%) older adults had AO. Older adults who were from urban areas (69.7%), of women (78.4%), married (66.7%), with tertiary education (73.6%) and unemployed (70.9%) had the highest prevalence of AO. Those from urban areas (adjusted odds ratio [aOR] = 1.29), women (aOR = 3.12), unemployed (aOR = 1.14), diagnosed with hypertension (aOR = 1.56) and diabetes mellitus (aOR = 2.08) were also significantly associated with a higher risk of AO.
CONCLUSIONS: This study identified several risk factors that are associated with AO among older adults in Malaysia. Such information is important and needed to improve the healthcare system systematically, enable nutrition screening and appropriate intervention to combat the growing AO in Malaysia. Geriatr Gerontol Int 2020; 20: 68-72.

Matched MeSH terms: Heart Diseases
Effects of glycyrrhizic acid on right atrial pressure and pulmonary vasculature in rats

Ruszymah BH, Nabishah BM, Aminuddin S, Khalid BA

Clin Exp Hypertens, 1995 Apr;17(3):575-91.
PMID: 7613529

Glycyrrhizic acid (GCA) the active component of liquorice acts by inhibiting 11 beta-hydroxysteroid dehydrogenase (11 beta-OHSD) which catalyses the reversible conversion of cortisol to cortisone. The aim of this study was to examine the effect of GCA on pulmonary arterial pressure. Male Sprague-Dawley rats (200g) received drinking water containing 0.1 mg/ml and 1.0 mg/ml GCA for 12 weeks. Tail blood pressure (BP) was recorded every three weeks and serum Na+ and K+ were measured at the beginning and the end of the experiment. Right atrial pressure (RAP) were measured at the end of 12 weeks just before the animals were sacrificed. Lung tissues were taken for histological examination using the elastic-van Gieson (EVG) staining method. There was a significant increase in tail BP in GCA treated rats compared to controls, for both dosages used. This was associated with an increase in serum Na+ and a decrease in K+ level. The mean RAP increased significantly from 2.69 +/- 0.23 mmHg to 4.47 +/- 0.32 mmHg (P < 0.001) in 0.1 mg/ml GCA treated rats and 6.86 +/- 0.54 mmHg (P < 0.0001) in rats receiving 1.0 mg/ml GCA in their drinking water. Histological examination showed increased thickness of pulmonary arterial wall (P < 0.0001). In conclusion GCA caused an increase in right atrial pressure as well as thickening of the pulmonary vessels suggesting pulmonary hypertension.

Matched MeSH terms: Heart Atria
Rate adaptive pacing in an intracardiac pacemaker

Lloyd M, Reynolds D, Sheldon T, Stromberg K, Hudnall JH, Demmer WM, et al.

Heart Rhythm, 2017 02;14(2):200-205.
PMID: 27871854 DOI: 10.1016/j.hrthm.2016.11.016

BACKGROUND: The Micra transcatheter pacemaker was designed to have similar functionality to conventional transvenous VVIR pacing systems. It provides rate adaptive pacing using a programmable 3-axis accelerometer designed to detect patient activity in the presence of cardiac motion.
OBJECTIVE: The purpose of this study was to evaluate the system's performance during treadmill tests to maximum exertion in a subset of patients within the Micra Transcatheter Pacing Study.
METHODS: Patients underwent treadmill testing at 3 or 6 months postimplant with algorithm programming at physician discretion. Normalized sensor rate (SenR) relative to the programmed upper sensor rate was modeled as a function of normalized workload in metabolic equivalents (METS) relative to maximum METS achieved during the test. A normalized METS and SenR were determined at the end of each 1-minute treadmill stage. The proportionality of SenR to workload was evaluated by comparing the slope from this relationship to the prospectively defined tolerance margin (0.65-1.35).
RESULTS: A total of 69 treadmill tests were attempted by 42 patients at 3 and 6 months postimplant. Thirty tests from 20 patients who completed ≥4 stages with an average slope of 0.86 (90% confidence interval 0.77-0.96) confirmed proportionality to workload. On an individual test basis, 25 of 30 point estimates (83.3%) had a normalized slope within the defined tolerance range (range 0.46-1.08).
CONCLUSION: Accelerometer-based rate adaptive pacing was proportional to workload, thus confirming rate adaptive pacing commensurate to workload is achievable with an entirely intracardiac pacing system.

Matched MeSH terms: Heart Rate
Fulltext Cytogenetic and clinical profile of Down syndrome in Northeast Malaysia

Azman BZ, Ankathil R, Siti Mariam I, Suhaida MA, Norhashimah M, Tarmizi AB, et al.

Singapore Med J, 2007 Jun;48(6):550-4.
PMID: 17538755

This study was designed to evaluate the karyotype pattern, clinical features and other systemic anomalies of patients with Down syndrome in Malaysia.

Matched MeSH terms: Heart Defects, Congenital
Fulltext Comparison of the VBM laryngeal tube and laryngeal mask airway for ventilation during manual in-line neck stabilisation

Noor Zairul M, Khairul Faizi A

Singapore Med J, 2006 Oct;47(10):892-6.
PMID: 16990966

INTRODUCTION: The purpose of this study is to assess whether the newly-developed VBM (Medizintechnik GmbH, Sulz, Germany) laryngeal tube (LT) is able to provide adequate ventilation and oxygenation to patients with an unstable neck and require airway management. The haemodynamic responses to insertion between the two devices were also studied. We compared the LT to the laryngeal mask airway (LMA) as an alternative airway management tool in adult patients with unstable neck and who underwent intubation with manual in-line neck stabilisation.
METHODS: A randomised single-blinded prospective study was conducted involving a total of 40 American Society of Anesthesiology I and II pre-medicated patients who were divided into two groups, LT or LMA, for airway management during elective surgery. There were 20 patients for each group. After pre-oxygenation, anaesthesia was induced using intravenous (i.v.) fentanyl and i.v. propofol. The neuromuscular blockade was produced with either i.v. vecuronium or i.v. atracurium. The LT or LMA was inserted after neuromuscular blockade was confirmed using a peripheral nerve stimulator (train-of-four 1). A size 3, 4 or 5 LT or a size 3 or 4 LMA was inserted while the patient's head and neck were being stabilised by an assistant who held the sides of the neck and the mastoid processes (manual in-line stabilisation). If it was not possible to ventilate the lungs, or if end-tidal carbon dioxide and/or chest movement did not indicate a patent airway, the LT or LMA was removed. After three failed attempts, the study was terminated and the airway was secured in the most suitable manner determined by the anaesthetist. After successful placement of LT or LMA, anaesthesia was maintained with 66 percent nitrous oxide in oxygen and 2 minimum alveolar concentration sevoflurane. All patients received standard anaesthesia monitoring. The ease of insertion, the number of attempts needed to successfully secure the airway, episodes of desaturation (less than 95 percent) and end-tidal carbon dioxide at various time intervals were studied. The haemodynamic parameters such as systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate at different time intervals were also studied.
RESULTS: The study showed a statistically significant difference in time required for successful insertion between the groups; time required for LT was 24.8 +/- 7.7 seconds and LMA was 36.1 +/- 17.3 seconds (p-value equals 0.01). Both groups had no statistical differences (p-value is greater than 0.05) in number of attempts needed to achieve a patent airway, and the successful insertion rate was 100 percent for both groups. There were also no statistical differences in the haemodynamic response to insertion and the end-tidal carbon dioxide in this study.
CONCLUSION: We conclude that, under anaesthesia, the LT was a valuable and better alternative to LMA for ventilation and airway management when the patient's head and neck are stabilised by the manual in-line method.

Matched MeSH terms: Heart Rate
Fulltext Effects of Daily Probiotics Supplementation on Anxiety Induced Physiological Parameters among Competitive Football Players

Adikari AMGCP, Appukutty M, Kuan G

Nutrients, 2020 Jun 29;12(7).
PMID: 32610465 DOI: 10.3390/nu12071920

Competitive football players who undergo strenuous training and frequent competitions are more vulnerable to psychological disorders. Probiotics are capable of reducing these psychological disorders. The present study aimed to determine the effect of daily probiotics supplementation on anxiety induced physiological parameters among competitive football players. The randomized, double-blinded, placebo-controlled trial was conducted on 20 male footballers who received either probiotics (Lactobacillus Casei Shirota strain 3 × 1010 colony forming units (CFU) or a placebo drink over eight weeks. Portable biofeedback devices were used to measure the electroencephalography, heart rate, and electrodermal responses along with cognitive tests at the baseline, week 4, and week 8. Data were statistically analyzed using mixed factorial ANOVA and results revealed that there is no significant difference between the probiotic and placebo groups for heart rate (61.90 bpm ± 5.84 vs. 67.67 bpm ± 8.42, p = 0.09) and electrodermal responses (0.27 µS ± 0.19 vs. 0.41 µS ± 0.12, p = 0.07) after eight weeks. Similarly, brain waves showed no significant changes during the study period except for the theta wave and delta wave at week 4 (p < 0.05). The cognitive test reaction time (digit vigilance test) showed significant improvement in the probiotic group compared to the placebo (p < 0.05). In conclusion, these findings suggest that daily probiotics supplementation may have the potential to modulate the brain waves namely, theta (relaxation) and delta (attention) for better training, brain function, and psychological improvement to exercise. Further research is needed to elucidate the mechanism of current findings.

Matched MeSH terms: Heart Rate
Fulltext Factors prognosticating the outcome of decompressive craniectomy in severe traumatic brain injury: A Malaysian experience

Sharda P, Haspani S, Idris Z

Asian J Neurosurg, 2014 Oct-Dec;9(4):203-12.
PMID: 25685217 DOI: 10.4103/1793-5482.146605

OBJECTIVE: The objective of this prospective cohort study was to analyse the characteristics of severe Traumatic Brain Injury (TBI) in a regional trauma centre Hospital Kuala Lumpur (HKL) along with its impact of various prognostic factors post Decompressive Craniectomy (DC).
MATERIALS AND METHODS: Duration of the study was of 13 months in HKL. 110 consecutive patients undergoing DC and remained in our centre were recruited. They were then analysed categorically with standard analytical software.
RESULTS: Age group have highest range between 12-30 category with male preponderance. Common mechanism of injury was motor vehicle accident involving motorcyclist. Univariate analysis showed statistically significant in referral area (P = 0.006). In clinical evaluation statistically significant was the motor score (P = 0.040), pupillary state (P = 0.010), blood pressure stability (P = 0.013) and evidence of Diabetes Insipidus (P < 0.001). In biochemical status the significant statistics included evidence of coagulopathy (P < 0.001), evidence of acidosis (P = 0.003) and evidence of hypoxia (P = 0.030). In Radiological sector, significant univariate analysis proved in location of the subdural clot (P < 0.010), location of the contusion (P = 0.045), site of existence of both type of clots (P = 0.031) and the evidence of edema (P = 0.041). The timing of injury was noted to be significant as well (P = 0.061). In the post operative care was, there were significance in the overall stability in intensive care (P < 0.001), the stability of blood pressure, cerebral perfusion pressure, pulse rates and oxygen saturation (all P < 0.001)seen individually, post operative ICP monitoring in the immediate (P = 0.002), within 24 hours (P < 0.001) and within 24-48 hours (P < 0.001) period, along with post operative pupillary size (P < 0.001) and motor score (P < 0.001). Post operatively, radiologically significant statistics included evidence of midline shift post operatively in the CT scan (P < 0.001). Multivariate logistic regression with stepwise likelihood ratio (LR) method concluded that hypoxia post operatively (P = 0.152), the unmaintained Cerebral Perfusion Pressure (CPP) (P = 0.007) and unstable blood pressure (BP) (P = <0.001). Poor outcome noted 10.2 times higher in post operative hypoxia [OR10.184; 95% CI: 0.424, 244.495]. Odds of having poor outcome if CPP unmaintained was 13.8 times higher [OR: 13.754; CI: 2.050, 92.301]. Highest predictor of poor outcome was the unstable BP, 32 times higher [OR 31.600; CI: 4.530, 220440].
CONCLUSION: Our series represent both urban and rural population, noted to be the largest series in severe TBI in this region. Severe head injury accounts for significant proportion of neurosurgical admissions, resources with its impact on socio-economic concerns to a growing population like Malaysia. This study concludes that the predictors of outcome in severe TBI post DC were postoperative hypoxia, unmaintained cerebral perfusion pressure and unstable blood pressure as independent predictors of poor outcome. Key words: Decompressive craniectomy, prognostication of decompressive craniectomy, prognostication of severe head injury, prognostication of traumatic brain injury, severe head injury, severe traumatic brain injury, traumatic brain injury.
KEYWORDS: Decompressive craniectomy; prognostication of decompressive craniectomy; prognostication of severe head injury; prognostication of traumatic brain injury; severe head injury; severe traumatic brain injury; traumatic brain injury

Matched MeSH terms: Heart Rate
Fulltext Heart and bile acids - Clinical consequences of altered bile acid metabolism

Vasavan T, Ferraro E, Ibrahim E, Dixon P, Gorelik J, Williamson C

Biochim Biophys Acta Mol Basis Dis, 2018 04;1864(4 Pt B):1345-1355.
PMID: 29317337 DOI: 10.1016/j.bbadis.2017.12.039

Cardiac dysfunction has an increased prevalence in diseases complicated by liver cirrhosis such as primary biliary cholangitis and primary sclerosing cholangitis. This observation has led to research into the association between abnormalities in bile acid metabolism and cardiac pathology. Approximately 50% of liver cirrhosis cases develop cirrhotic cardiomyopathy. Bile acids are directly implicated in this, causing QT interval prolongation, cardiac hypertrophy, cardiomyocyte apoptosis and abnormal haemodynamics of the heart. Elevated maternal serum bile acids in intrahepatic cholestasis of pregnancy, a disorder which causes an impaired feto-maternal bile acid gradient, have been associated with fatal fetal arrhythmias. The hydrophobicity of individual bile acids in the serum bile acid pool is of relevance, with relatively lipophilic bile acids having a more harmful effect on the heart. Ursodeoxycholic acid can reverse or protect against these detrimental cardiac effects of elevated bile acids.

Matched MeSH terms: Heart/drug effects; Heart/physiopathology
Comparative study of immunopathophysiological responses induced by B. melitensis and its lipopolysaccharide in mouse model infected via intranasal route of exposure

Osman AY, Saharee AA, Jesse FF, Kadir AA

Microb Pathog, 2017 Sep;110:365-374.
PMID: 28710016 DOI: 10.1016/j.micpath.2017.07.014

In this study, we developed a mouse model and characterized the effects of intranasal inoculation of virulent Brucella melitensis strain 16M and its lipopolysaccharide (LPS). The effects of the exposure were compared with respective control groups. Both Brucella melitensis-infected and LPS-infected groups showed no significant clinical presentation with minor relevance in the mortality associated with the infection. In Brucella melitensis-infected group, significant histopathological changes in comparison to the LPS infected group with increase bacterial burden in the lungs, reproductive and reticuloendothelial organs were observed. However, both infected groups showed elevated levels of pro-inflammatory cytokine expression (IL-1β and IL6) and antibody production (IgM an IgG) as early as 3 days post-infection with predominance in LPS infected group. In contrast, low levels of sex related hormonal changes was recorded in both infected groups throughout the experimental period. This is the first detailed investigation comparing the infection progression and host responses in relation to the immunopathophysiological aspects in mouse model after intranasal inoculation with B. melitensis and its lipopolysaccharide. The study revealed a significant difference between infected and control groups with overlap in clinical, pathological, and immunological responses as well as sex related hormonal changes resulting from the infections.

Matched MeSH terms: Heart/drug effects; Heart/microbiology
Fulltext Association of dietary omega-3 fatty acids with prevalence of metabolic syndrome: the National Heart, Lung, and Blood Institute Family Heart Study

Lai YH, Petrone AB, Pankow JS, Arnett DK, North KE, Ellison RC, et al.

Clin Nutr, 2013 Dec;32(6):966-9.
PMID: 23711994 DOI: 10.1016/j.clnu.2013.05.002

Metabolic syndrome (MetS), characterized by abdominal obesity, atherogenic dyslipidemia, elevated blood pressure, and insulin resistance is a major public health concern in the United States. Omega-3 fatty acids have been relatively well studied in relation to many individual cardiovascular risk factors; however, their effects on MetS are not well established.
Fulltext Fluid Structure Interaction on Paravalvular Leakage of Transcatheter Aortic Valve Implantation Related to Aortic Stenosis: A Patient-Specific Case

Basri AA, Zuber M, Basri EI, Zakaria MS, Aziz AFA, Tamagawa M, et al.

Comput Math Methods Med, 2020;2020:9163085.
PMID: 32454886 DOI: 10.1155/2020/9163085

This study investigated the impact of paravalvular leakage (PVL) in relation to the different valve openings of the transcatheter aortic valve implantation (TAVI) valve using the fluid structure interaction (FSI) approach. Limited studies were found on the subject of FSI with regards to TAVI-PVL condition, which involves both fluid and structural responses in coupling interaction. Hence, further FSI simulation with the two-way coupling method is implemented to investigate the effects of hemodynamics blood flow along the patient-specific aorta model subjected to the interrelationship between PVL and the different valve openings using the established FSI software ANSYS 16.1. A 3D patient-specific aorta model is constructed using MIMICS software. The TAVI valve identical to Edward SAPIEN XT 26 (Edwards Lifesciences, Irvine, California), at different Geometrical Orifice Areas (GOAs), is implanted into the patient's aortic annulus. The leaflet opening of the TAVI valve is drawn according to severity of GOA opening represented in terms of 100%, 80%, 60%, and 40% opening, respectively. The result proved that the smallest percentage of GOA opening produced the highest possibility of PVL, increased the recirculatory flow proximally to the inner wall of the ascending aorta, and produced lower backflow velocity streamlines through the side area of PVL region. Overall, 40% GOA produced 89.17% increment of maximum velocity magnitude, 19.97% of pressure drop, 65.70% of maximum WSS magnitude, and a decrement of 33.62% total displacement magnitude with respect to the 100% GOA.

Matched MeSH terms: Heart Valve Prosthesis
Fulltext Association between prehospital field to emergency department delta shock index and in-hospital mortality in patients with torso and extremity trauma: A multinational, observational study

Kim DK, Jeong J, Shin SD, Song KJ, Hong KJ, Ro YS, et al.

PLoS One, 2021;16(10):e0258811.
PMID: 34695147 DOI: 10.1371/journal.pone.0258811

Hemorrhage, a main cause of mortality in patients with trauma, affects vital signs such as blood pressure and heart rate. Shock index (SI), calculated as heart rate divided by systolic blood pressure, is widely used to estimate the shock status of patients with hemorrhage. The difference in SI between the emergency department and prehospital field can indirectly reflect urgency after trauma. We aimed to determine the association between delta SI (DSI) and in-hospital mortality in patients with torso or extremity trauma. Patients with DSI >0.1 are expected to be associated with high mortality. This retrospective, observational study used data from the Pan-Asian Trauma Outcomes Study. Patients aged 18-85 years with abdomen, chest, upper extremity, lower extremity, or external injury location were included. Patients from China, Indonesia, Japan, Philippines, Thailand, and Vietnam; those who were transferred from another facility; those who were transferred without the use of emergency medical service; those with prehospital cardiac arrest; those with unknown exposure and outcomes were excluded. The exposure and primary outcome were DSI and in-hospital mortality, respectively. The secondary and tertiary outcome was intensive care unit (ICU) admission and massive transfusion, respectively. Multivariate logistic regression analysis was performed to test the association between DSI and outcome. In total, 21,534 patients were enrolled according to the inclusion and exclusion criteria. There were 3,033 patients with DSI >0.1. The in-hospital mortality rate in the DSI >0.1 and ≤0.1 groups was 2.0% and 0.8%, respectively. In multivariate logistic regression analysis, the DSI ≤0.1 group was considered the reference group. The unadjusted and adjusted odds ratios of in-hospital mortality in the DSI >0.1 group were 2.54 (95% confidence interval [CI] 1.88-3.42) and 2.82 (95% CI 2.08-3.84), respectively. The urgency of traumatic hemorrhage can be determined using DSI, which can help hospital staff to provide proper trauma management, such as early trauma surgery or embolization.

Matched MeSH terms: Heart Rate
Adjustments to warfarin dosing after gastric bypass and sleeve gastrectomy

Strong AT, Sharma G, Nor Hanipah Z, Tu C, Brethauer SA, Schauer PR, et al.

Surg Obes Relat Dis, 2018 05;14(5):700-706.
PMID: 29496441 DOI: 10.1016/j.soard.2017.12.021

BACKGROUND: Warfarin dosing after bariatric surgery may be influenced by alterations in gastrointestinal pH, transit time, absorptive surface area, gut microbiota, food intake, and adipose tissue.
OBJECTIVES: The aim of this study was to describe trends in warfarin dosing after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).
SETTING: Single academic center.
METHODS: All patients chronically on warfarin anticoagulation before RYGB or SG were retrospectively identified. Indications for anticoagulation, history of bleeding or thrombotic events, perioperative complications, and warfarin dosing were collected.
RESULTS: Fifty-three patients (RYGB n = 31, SG n = 22) on chronic warfarin therapy were identified (56.6% female, mean 54.4 ± 11.7 yr of age). Of this cohort, 34.0% had prior venous thromboembolic events, 43.4% had atrial fibrillation, and 5.7% had mechanical cardiac valves. Preoperatively, the average daily dose of warfarin was similar in the RYGB group (8.3 ± 4.1 mg) and SG group (6.9 ± 2.8 mg). One month after surgery, mean daily dose of warfarin was reduced 24.1% in the RYGB group (P

Matched MeSH terms: Heart Valve Prosthesis
Fulltext Lack of association of apolipoprotein E (Apo E) polymorphism with the prevalence of metabolic syndrome: the National Heart, Lung and Blood Institute Family Heart Study

Lai LY, Petrone AB, Pankow JS, Arnett DK, North KE, Ellison RC, et al.

Diabetes Metab Res Rev, 2015 Sep;31(6):582-7.
PMID: 25656378 DOI: 10.1002/dmrr.2638

OBJECTIVE: Metabolic syndrome (MetS), characterized by abdominal obesity, atherogenic dyslipidaemia, elevated blood pressure and insulin resistance, is a major public health concern in the United States. The effects of apolipoprotein E (Apo E) polymorphism on MetS are not well established.
METHODS: We conducted a cross-sectional study consisting of 1551 participants from the National Heart, Lung and Blood Institute Family Heart Study to assess the relation of Apo E polymorphism with the prevalence of MetS. MetS was defined according to the American Heart Association-National Heart, Lung and Blood Institute-International Diabetes Federation-World Health Organization harmonized criteria. We used generalized estimating equations to estimate adjusted odds ratios (ORs) for prevalent MetS and the Bonferroni correction to account for multiple testing in the secondary analysis.
RESULTS: Our study population had a mean age (standard deviation) of 56.5 (11.0) years, and 49.7% had MetS. There was no association between the Apo E genotypes and the MetS. The multivariable adjusted ORs (95% confidence interval) were 1.00 (reference), 1.26 (0.31-5.21), 0.89 (0.62-1.29), 1.13 (0.61-2.10), 1.13 (0.88-1.47) and 1.87 (0.91-3.85) for the Ɛ3/Ɛ3, Ɛ2/Ɛ2, Ɛ2/Ɛ3, Ɛ2/Ɛ4, Ɛ3/Ɛ4 and Ɛ4/Ɛ4 genotypes, respectively. In a secondary analysis, Ɛ2/Ɛ3 genotype was associated with 41% lower prevalence odds of low high-density lipoprotein [multivariable adjusted ORs (95% confidence interval) = 0.59 (0.36-0.95)] compared with Ɛ3/Ɛ3 genotype.
CONCLUSIONS: Our findings do not support an association between Apo E polymorphism and MetS in a multicentre population-based study of predominantly White US men and women.
Fulltext Pulmonary embolectomy in heparin-induced thrombocytopenia and thrombosis? Safety of heparin use

Sachithanandan A

Interact Cardiovasc Thorac Surg, 2010 Nov;11(5):681.
PMID: 20962169 DOI: 10.1510/icvts.2010.247460A
Matched MeSH terms: Heart Arrest, Induced
Fulltext EEG based evaluation of stereoscopic 3D displays for viewer discomfort

Malik AS, Khairuddin RN, Amin HU, Smith ML, Kamel N, Abdullah JM, et al.

Biomed Eng Online, 2015;14:21.
PMID: 25886584 DOI: 10.1186/s12938-015-0006-8

Consumer preference is rapidly changing from 2D to 3D movies due to the sensational effects of 3D scenes, like those in Avatar and The Hobbit. Two 3D viewing technologies are available: active shutter glasses and passive polarized glasses. However, there are consistent reports of discomfort while viewing in 3D mode where the discomfort may refer to dizziness, headaches, nausea or simply not being able to see in 3D continuously.

Matched MeSH terms: Heart Rate

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