Clinical characteristics, management and 1-year outcomes of patients with acute coronary syndrome in Iran: The Iranian Project for Assessment of Coronary Events 2 (IPACE2)

Objectives: To assess contemporary data on characteristics, management and 1-year postdischarge outcomes in Iranian patients hospitalised with acute coronary syndrome (ACS). Setting: 11 tertiary care hospitals in 5 major cities in the Islamic Republic of Iran. Participants: Patients aged �20 and �80 years discharged alive with confirmed diagnosis of ACS including ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and high-risk unstable angina (HR-UA). Primary and secondary outcome measures: Patients were followed up regarding the use of medications and the end points of the study at 1 month and 1 year after discharge. The primary end point of the study was 1-year postdischarge major adverse cardiac and cerebrovascular events (MACCEs), defined as mortality (cardiac and non-cardiac), ACS and cerebrovascular attack (stroke and/or transient ischaemic attack). The secondary end points were hospital admission because of congestive heart failure, revascularisation by coronary artery bypass grafting surgery or percutaneous coronary intervention (PCI), and major and minor bleeds. Results: A total of 1799 patients (25.7 STEMI and 74.3 HR-UA/NSTEMI) discharged alive with confirmed diagnosis of ACS were included in the final analysis. During hospitalisation, the majority of the patients received aspirin (98.6), clopidogrel (91.8), anticoagulants (93.4), statins (94.3) and β-blockers (89.3). Reperfusion therapy was performed in 62.6 of patients with STEMI (46.3 thrombolytic therapy and 17.3 primary PCI). The mean door-to-balloon and door-to-needle times were 82.9 and 45.6 min, respectively. In our study, 64.7 and 79.5 of the patients in HR-UA/NSTEMI and STEMI groups, respectively, underwent coronary angiography. During the 12 months after discharge, MACCEs occurred in 15.0 of all patients. Conclusions: Our study showed that the composition of Iranian patients with ACS regarding the type of ACS is similar to that in developed European countries and is unlike that in developing countries of the Middle East and Africa. We found that our patients with ACS are treated with high levels of adherence to guideline-recommended in-hospital medications

Incorporation of Eye-Tracking and Gaze Feedback to Characterize and Improve Radiologist Search Patterns of Chest X-rays: A Randomized Controlled Clinical Trial

Diagnostic errors in radiology often occur due to incomplete visual assessments by radiologists, despite their knowledge of predicting disease classes. This insufficiency is possibly linked to the absence of required training in search patterns. Additionally, radiologists lack consistent feedback on their visual search patterns, relying on ad-hoc strategies and peer input to minimize errors and enhance efficiency, leading to suboptimal patterns and potential false negatives. This study aimed to use eye-tracking technology to analyze radiologist search patterns, quantify performance using established metrics, and assess the impact of an automated feedback-driven educational framework on detection accuracy. Ten residents participated in a controlled trial focused on detecting suspicious pulmonary nodules. They were divided into an intervention group (received automated feedback) and a control group. Results showed that the intervention group exhibited a 38.89% absolute improvement in detecting suspicious-for-cancer nodules, surpassing the control group's improvement (5.56%, p-value=0.006). Improvement was more rapid over the four training sessions (p-value=0.0001). However, other metrics such as speed, search pattern heterogeneity, distractions, and coverage did not show significant changes. In conclusion, implementing an automated feedback-driven educational framework improved radiologist accuracy in detecting suspicious nodules. The study underscores the potential of such systems in enhancing diagnostic performance and reducing errors. Further research and broader implementation are needed to consolidate these promising results and develop effective training strategies for radiologists, ultimately benefiting patient outcomes.Comment: Submitted for Review in the Journal of the American College of Radiology (JACR

Epidemic assessment of bacterial agents in osteomyelitis and their antibiotic resistance pattern determination

The aim of the present study was to determine the causative agents of osteomyelitis and specifying their antibiotic resistance pattern in patients referred to pediatrics ward of Imam Khomeini Hospital. This study has been performed in Tehran during January to December 2006. In this study, Synovial fluid was taken from 90 patients who referred to pediatrics ward of Imam Khomeini. Samples were examined by direct test, culture and biochemical tests. In next step, antibiogram by disk diffusion method (Kirby-Bauer Test) was established on each positive sample and finally, the results were analyzed. Of 90 examined samples, 27 bacterial cases were isolated; Staphylococcus aureus with 55.9 was the most epidemic agent and Klebsiella sp., coagulase negative Staphylococci, Streptococcus pneumoniae and Enterobacter sp. were the next common agents, respectively. However, it was revealed that more than 40 Staphylococcus aureus are sensitivity to Vacomycin, Gentamicin, Sulfamethoxazole and Erythromycin and most of gram negative Rods isolated of were sensitivity to Amikacin, Ampicillin and Cephalothin (50-100). The most of bacteria (Staphylococcus aureus, coagulase negative Staphylococci, Streptococcus pneumoniae and Enterobacter sp.) were sensitive to Vancomycin, gentamicin and Cephalothin. Similar to previous results, it was proved either in our study that Staphylococcus aureus is the main agent of osteomyelitis and gram negative bacteria with coagulase negative Staphylococci and Streptococci are other agents. Also, it was observed that the most isolated bacteria had high antibiotic resistance to common drugs. © 2008 Asian Network for Scientific Information

Genome-Wide Association of Implantable Cardioverter-Defibrillator Activation With Life-Threatening Arrhythmias

OBJECTIVES: To identify genetic factors that would be predictive of individuals who require an implantable cardioverter-defibrillator (ICD), we conducted a genome-wide association study among individuals with an ICD who experienced a life-threatening arrhythmia (LTA; cases) vs. those who did not over at least a 3-year period (controls). BACKGROUND: Most individuals that receive implantable cardioverter-defibrillators never experience a life-threatening arrhythmia. Genetic factors may help identify who is most at risk. METHODS: Patients with an ICD and extended follow-up were recruited from 34 clinical sites with the goal of oversampling those who had experienced LTA, with a cumulative 607 cases and 297 controls included in the analysis. A total of 1,006 Caucasian patients were enrolled during a time period of 13 months. Arrhythmia status of 904 patients could be confirmed and their genomic data were included in the analysis. In this cohort, there were 704 males, 200 females, and the average age was 73.3 years. We genotyped DNA samples using the Illumina Human660 W Genotyping BeadChip and tested for association between genotype at common variants and the phenotype of having an LTA. RESULTS AND CONCLUSIONS: We did not find any associations reaching genome-wide significance, with the strongest association at chromosome 13, rs11856574 at P = 5×10⁻⁶. Loci previously implicated in phenotypes such as QT interval (measure of the time between the start of the Q wave and the end of the T wave as measured by electrocardiogram) were not found to be significantly associated with having an LTA. Although powered to detect such associations, we did not find common genetic variants of large effect associated with having a LTA in those of European descent. This indicates that common gene variants cannot be used at this time to guide ICD risk-stratification. TRIAL REGISTRATION: ClinicalTrials.gov NCT00664807

Towards different enterprise architecture project types

This research is in the enterprise architecture (EA) research field. EA is a developing discipline that in broad terms emphasizes all aspects of organizational design and development, including enabling information technology. However, there are various interpretations and understandings of EA, with little agreement on them. Therefore, organizations use EA in numerous ways to achieve different goals. These vary from purely information technology- (IT) related, internal business and IT-related to business environment-related goals. Enterprise architects also have different understandings of EA, which influence the way they perform EA work and consequently EA deliverables and achievement of EA project goals. In this paper a preliminary list of different EA project types is compiled through a hermeneutic literature review, aiming to establish a comprehensive list of EA project types. It is suggested that knowledge of different EA project types assist in the selection of suitable enterprise architects to achieve specific EA project goals.http://www.springer.com/series/7911hj2021Informatic

Diagnostically Challenging Epithelial Odontogenic Tumors: A Selective Review of 7 Jawbone Lesions

Considerable variation in the clinicopathologic presentation of epithelial odontogenic tumors can sometimes be confusing and increase the chance of misdiagnosis. Seven diagnostically challenging jawbone lesions are described. There were 2 cases of mistaken identity in our ameloblastoma file. One unicystic type, initially diagnosed and treated as a lateral periodontal cyst, showed destructive recurrence 6 years postoperatively. The other globulomaxillary lesion was managed under the erroneous diagnosis of adenomatoid odontogenic tumor and recurred 4 times over an 11-year period. This tumor was found in retrospect to be consistent with an adenoid ameloblastoma with dentinoid. The diagnosis of cystic squamous odontogenic tumor (SOT) occurring as a radicular lesion of an impacted lower third molar was one of exclusion. Of two unsuspected keratocystic odontogenic tumors, one depicted deceptive features of pericoronitis, while the other case has long been in our files with the diagnosis of globulomaxillary SOT. Two cases of primary intraosseous squamous cell carcinoma appeared benign clinically and exhibited unexpected findings; an impacted third molar began to erupt in association with the growth of carcinoma and another periradicular carcinoma showed dentinoid formation. Cases selectively reviewed in this article present challenging problems which require clinical and radiographic correlation to avoid potential diagnostic pitfalls

A TaqMan real-time PCR assay for Rhizoctonia cerealis and its use in wheat and soil

Rhizoctonia cerealis causes sharp eyespot in cereals and the pathogen survives as mycelia or sclerotia in soil. Real-time Polymerase Chain Reaction (qPCR) assays based on TaqMan chemistry are highly suitable for use on DNA extracted from soil. We report here the first qPCR assay for R. cerealis using TaqMan primers and a probe based on a unique Sequence Characterised Amplified Region (SCAR). The assay is highly specific and did not amplify DNA from a range of other binucleate Rhizoctonia species or isolates of anastomosis groups of Rhizoctonia solani. The high sensitivity of the assay was demonstrated in soils using a bulk DNA extraction method where 200 μg sclerotia in 50 g of soil were detected. DNA of the pathogen could also be amplified from asymptomatic wheat plants. Using the assay on soil samples from fields under different crop rotations, R. cerealis was most frequently detected in soils where wheat was grown or soil under pasture. It was detected least frequently in fields where potatoes were grown. This study demonstrates that assays derived from SCAR sequences can produce specific and sensitive qPCR assays