Global Outcome Assessment Life-long after stroke in young adults initiative-the GOAL initiative : study protocol and rationale of a multicentre retrospective individual patient data meta-analysis

Introduction Worldwide, 2 million patients aged 18-50 years suffer a stroke each year, and this number is increasing. Knowledge about global distribution of risk factors and aetiologies, and information about prognosis and optimal secondary prevention in young stroke patients are limited. This limits evidence-based treatment and hampers the provision of appropriate information regarding the causes of stroke, risk factors and prognosis of young stroke patients. Methods and analysis The Global Outcome Assessment Life-long after stroke in young adults (GOAL) initiative aims to perform a global individual patient data meta-analysis with existing data from young stroke cohorts worldwide. All patients aged 18-50 years with ischaemic stroke or intracerebral haemorrhage will be included. Outcomes will be the distribution of stroke aetiology and (vascular) risk factors, functional outcome after stroke, risk of recurrent vascular events and death and finally the use of secondary prevention. Subgroup analyses will be made based on age, gender, aetiology, ethnicity and climate of residence.Peer reviewe

Cost-Effectiveness of Screening Syphilis among Pregnant Women in Mongolia

[[abstract]]BACKGROUND: Maternal and congenital syphilis prevalence rates are currently rapidly increasing in Mongolia. The Ministry of Health has been implementing on-site rapid screening test (RT) intervention and same day treatment approach for maternal syphilis with the contribution of the WHO since November 2007. OBJECTIVES: To understand the cost- effectiveness (CE) of screening antenatal syphilis using the RT strategy, to compare this intervention with RPR testing strategy. And in order to estimate CE we found out maternal syphilis prevalence. METHODS: Ingredients-based cost data and epidemiological data were collected retrospectively. Descriptive analysis has done for prevalence of syphilis, and economic analysis has done to calculate costs. Stability of cost-effectiveness ratios were evaluated by the univariate sensitivity analysis. RESULTS: With antenatal syphilis prevalence of 3.0% (1.46% in urban and 5.7% in sub-urban area), the cost effectiveness was US$14.60/DALY for RT intervention and US$ 17.88/DALY for RPR intervention. CERs were more sensitive to the prevalence rate, sensitivity of tests, and DALY discount rate. CONCLUSION: Using the on-site antenatal rapid testing, same day treatment for positive results, and confirmed by RPR testing approach is cost-effective in Mongolia

Smokers with diabetes: Twice as deadly and shortened life by 15 years

Introduction Both smoking and diabetes are known to have health risks, but the extent of the risks when both co-existed are little known. Methods A cohort, consisting of 422,771 adults, was recruited successively during health surveillance between 1996 and 2008. Data from questionnaire, and results from fasting blood and other screening tests were collected. Hazard ratios (HR) came from Cox model and life expectancy from life table method. Results One quarter of the cohort were current smokers (23.2%), but only 7% had pre-diabetes and 6% diabetes. HR for all-cause mortality for smoking, 1.51, for diabetes, 2.02, but when co-existed, 3.38. Life span shortened 6 years for smokers, 9 years for diabetes, but 15 years for combined. HR for all cancer increased from 1.77 (smoking) or 1.42 (diabetes) to 2.87 (combined), for heart disease, from 1.43 (smoking) or 2.24 (diabetes) to 4.05 (combined), and for stroke, from 1.54 (smoking) or 1.82 (diabetes) to 2.69 (combined). Conclusions Smokers with diabetes became doubly deadly for all cause (1.51 to 3.38), all cancer (1.77 to 2.87) and heart disease (1.43 to 4.09) and shortened life expectancy by 15 years, from 6 years of smoking and 9 years of diabetes. Overwhelming majority of smokers were not aware of such a large risk. The large life expectancy risk could be leveraged to motivate smokers into smoking cessation

Prenatal diagnosis of coarctation of the aorta with ventricular septal defect: A case report

Objective: To present an accurate prenatal diagnosis of coarctation of the aorta with ventricular septal defect and to illustrate how early diagnosis in prenatal period with proper referral and counseling can optimize management. Case report: A case with coarctation of the aorta with ventricle septal defect was found to have an abnormal three vessel view at 12 weeks, and with close follow-ups, coarctation of the aorta with ventricle septal defect was diagnosed at 24 weeks. Following the support from a multidisciplinary team that provided counseling, diagnosis, and follow-ups, the pregnant woman decided to continue with the pregnancy and had a vaginal delivery at a medical center. The newborn made an uneventful recovery after undergoing cardiac surgery on day 9. Conclusion: The case demonstrates the role a fetal medicine team plays in diagnosing, supporting, and seamlessly transferring the congenital heart disease case from the first line obstetrician to the cardiac surgeon. A multi-disciplinary team approach was able to lead to improved perinatal outcome of the congenital heart disease case. Keywords: Aorta, Fetal, Prenatal, Ultrasound, VS