Copy number variation of CNVesv27061 analysis among young adults with high blood pressure using optimized droplet digital polymerase chain reaction (ddPCR) method

Several reports and databases on genomic variants have associated variation in DNA sequences (≥ 1kb), or copy number variation (CNV), with susceptibility to common diseases. However, very few reports are found on hypertension and no study has been reported on CNV in prehypertensive and hypertensive young adult Malaysians. In this comparative cross-sectional study, 133 young adults were recruited, comprising of normotensive (45 subjects), prehypertensive (40 subjects) and mild hypertensive (48 subjects) subjects. DNA for CNV determination was extracted from 3 ml of blood samples collected. CNV esv27061 was analysed using optimized droplet digital polymerase chain reaction (ddPCR) method which has enhanced sensitivity and precision. Frequency distribution patterns of CNV among mild hypertensives showed highest peak copy-number-gain (number of copies more than 2) particularly in copy numbers 3 and 5. The prehypertensive subjects exhibited marked increase in copy number 5 when compared with normotensives. All the subjects in this study showed low frequency distribution pattern for copy numbers 2, 6 and 7. This discovery emphasizes the importance of frequency patterns in determining CNV status of prehypertensive and mild hypertensive subjects. Optimization method in this study showed that the detection of CNV esv27061 is possible in our sample population

Implementation of emergency-based thrombolysis : an achievable option for rural hospitals in developing countries

Background In developing countries such as Malaysia, the primary mode for revascularization is via thrombolytic therapy. This is only effective when instituted within a small time window and pre-hospital delay is a major concern. In a region where the mean house-to-door times can be as long as 8.5 hours, there is an urgent need to reduce the door-to-needle times. Methods Emergency-based thrombolysis was initiated at Hospital Tengku Ampuan Afzan Kuantan, a 600-bed regional hospital in Malaysia. One hundred and thirty three patients with acute ST elevation myocardial infarction patients were screened. 39 patients were recruited in the 4 months prior to the implementation date and 94 patients were recruited after. The mean house-to-door, door-to-needle times were recorded. Results The majority of patients were male 88.7%, with a mean age of 56.4 � 10.3 years. The median presentation time (house-to-door) was 117.50 minutes before and 136.00 minutes after (p � 0.213, Mann- Whitney U) minutes. The median door-to-needle time was 100.00 minutes before and 50.00 minutes after (p � 0.031). The mortality rates were 12.8% before and 11.70% (p�0.87, Fisher exact test) after mplementation of Emergency-based thrombolysis. Conclusion Implementation of Emergency-based thrombolysis has markedly improved the door-to-needle times and resulted in a trend towards reduced mortality rates in acute ST-elevation myocardial infarction

Compliance with the Malaysian National critical practice guidelines on the administration of thrombolytic agents in acute st-elevation myocardial infarction

Background In developing countries such as Malaysia, the primary mode for revascularization is via thrombolytic therapy. In 2001, the 1st Edition of the Malaysian Clinical Practice Guideline advised the door-to-needle time of 60 minutes. This has been revised in the 2nd Edition (2007) to 30 minutes. This study aims to evaluate the mean door-to-needle times following the implementation of Emergency Department-based thrombolysis. Methods Accident and Emergency-based (A�E) thrombolysis was initiated at Hospital Tengku Ampuan Afzan Kuantan, Malaysia. Ninety four patients with acute ST elevation myocardial infarction patients were screened and 75 patients were recruited. The mean house-to-door, door-to-needle times were recorded. Results The majority of patients were male (89.3%), of Malay ethnicity (84%), presenting with anterior MI (69.3%) with a mean age of 57.0 � 9.52 years. The mean door-to-needle time was 80.54 � 84.8 minutes (116.46 � 109.00 minutes before the implementation). Only 20% achieved the 30-minute door-to-needle time and only 65.3% achieved the 60 minute door-to-needle time. The reasons for late thrombolysis were quoted as late referrals from A�E (50%), hypertensive emergency (22%), resuscitation (17%) and others (11%). Conclusion Implementation of Emergency-based thrombolysis has improved the door-to-needle times but more staff education and training is required due to the high rate ofblate A�E identification and late referrals

Causes of in-hospital delay for door-to-needle times in patients presenting with acute ST-Elevation Myocardial Infarct in Rural Malaysia

Study Objective: Background: In developing countries such as Malaysia, the primary mode for revascularization is via thrombolytic therapy. The Malaysian Clinical Practice Guideline on acute ST-elevation myocardial infarction advised the implementation of a 30-minute door-to-needle time. This study aims to evaluate the mean door-to-needle times and the reasons for in-hospital delays. Methods: Ninety four patients with acute ST elevation myocardial infarction patients were screened and 75 patients were recruited in this prospective observational study. The mean door-to-needle times were recorded and the reasons for delays in door-to-needle times were elucidated. Results: The majority of patients were male (89.3%), of Malay ethnicity (84%), presenting with anterior MI (69.3%) with a mean age of 57.0 � 9.52 years. The mean door-to-needle time was 80.54 � 84.8 minutes. Only 20% achieved the 30- minute door-to-needle time and only 65.3% achieved the 60 minute door-to-needle time. The reasons for late thrombolysis were quoted as late referrals from A�E (50%), hypertensive emergency (22%), resuscitation (17%) and others (11%). Conclusion: There is significant in-hospital delay in administrating thrombolytic agents for patients presenting with acute ST-elevation myocardial infarction. Some of the delays were unavoidable (hypertensive emergency and hypotension or VT/VF requiring resuscitation) but the majority of the delay is due to late referrals from A�E to attending cardiology on-call officers

Enter evaluation of mitral inflow velocity profile: optimal through plane location for mitral inflow assessment with cardiac magnetic resonance

Diastology is usually assessed using transthoracic echocardiography (TTE). Velocity‐encoded phase‐contrast imaging permits evaluation with cardiac magnetic resonance (CMR). Heterogeneous contour locations have been used to measure mitral (MV) inflow velocities and the optimal contour location is uncertain. We evaluated CMR MV inflow velocities against TTE to identify the optimal location

Tissue injury characterization by pre-contrast T1 mapping post myocardial infarction

Shah M Azarisman, Andrew Li, Dennis T Wong, James D Richardson, Seng Keong Chua, Luay Samaraie, Samuel L Sidharta, Timothy Glenie, Kerry Williams, Ben Koschade, Karen Teo, Matthew Worthley, Stephen G Worthle

Optimal planimetry location for MRI-derived mitral inflow velocity assessment of diastolic function

Shah M Azarisman, Andrew Li, James D Richardson, Dennis T Wong, Seng Keong Chua, Michael Cursaro, Vince Schirripa, Kerry Williams, Ben Koschade, Mitra Shirazi, Julie Bradley, Karen Teo, Matthew Worthley, Stephen G Worthle

Multidimensional prognostic indices for use in COPD patient care. A systematic review

Contains fulltext : 98117.pdf (publisher's version ) (Open Access)BACKGROUND: A growing number of prognostic indices for chronic obstructive pulmonary disease (COPD) is developed for clinical use. Our aim is to identify, summarize and compare all published prognostic COPD indices, and to discuss their performance, usefulness and implementation in daily practice. METHODS: We performed a systematic literature search in both Pubmed and Embase up to September 2010. Selection criteria included primary publications of indices developed for stable COPD patients, that predict future outcome by a multidimensional scoring system, developed for and validated with COPD patients only. Two reviewers independently assessed the index quality using a structured screening form for systematically scoring prognostic studies. RESULTS: Of 7,028 articles screened, 13 studies comprising 15 indices were included. Only 1 index had been explored for its application in daily practice. We observed 21 different predictors and 7 prognostic outcomes, the latter reflecting mortality, hospitalization and exacerbation. Consistent strong predictors were FEV1 percentage predicted, age and dyspnoea. The quality of the studies underlying the indices varied between fairly poor and good. Statistical methods to assess the predictive abilities of the indices were heterogenic. They generally revealed moderate to good discrimination, when measured. Limitations: We focused on prognostic indices for stable disease only and, inevitably, quality judgment was prone to subjectivity. CONCLUSIONS: We identified 15 prognostic COPD indices. Although the prognostic performance of some of the indices has been validated, they all lack sufficient evidence for implementation. Whether or not the use of prognostic indices improves COPD disease management or patients' health is currently unknown; impact studies are required to establish this