Missed Opportunities for Coronary Heart Disease Diagnoses: Primary Care Experience

Cilj Istražiti propuštene prilike da se u primarnoj zdravstvenoj zaštiti otkriju postojeće koronarne srčane bolesti koje prethodno nisu bile dijagnosticirane i rizične čimbenike koji su povezani s njima. Methods Istraživanje je obuhvatilo 850 osoba starijih od 30 godina, koji u povijesti bolesti nisu imali koronarnu srčanu bolest, a bili su pacijenti centra primarne zdravstvene zaštite u prigradskom dijelu grada Antalya u Turskoj. Prikupili smo podatke o njihovoj dobi, spolu, stupnju izobrazbe, zdravstvenom osiguranju, prihodima, pušenju i fizičkim aktivnostima. Pacijente s nedijagnosticiranom koronarnom srčanom bolešću otkrili smo s pomoću Roseova upitnika, fizikalnim pregledom i elektrokardiogramom. Mjerili smo im visinu, težinu, krvni tlak, serumsku koncentraciju glukoze i kolesterola, a indeks tjelesne težine i omjer opsega struka i bokova smo izračunali. Svakom je pacijentu dodijeljen broj bodova za rizične čimbenike koji su uključivali dob, spol, pušenje, sistolički krvani tlak i koncentraciju kolesterola. Za svakoga je pojedinca izračunat rizik da u sljedećem desetljeću razvije koronarnu srčanu bolest. Rezultati Bilo je 126 (14.8%) prethodno nedijagnosticiranih slučajeva nedijagnosticirane koronarne srčane bolesti. Ukupni srednji (±standardna devijacija) broj bodova za rizik dobivanja koronarne srčane bolesti u sljedećem desetljeću bio je 6.1±6.8. Bolesti koje potiču razvitak koronarne srčane bolesti – hipertenzije, šećerne bolesti i hiperkolesterolemije otkrivene su u 255 (30.4%), odnosno u 70 (8.2%) i u 364 (43.4%) ispitanika. Debljina je utvrđena u 315 (37.1%) ispitanika, a 222 (26.1%) su bili pušači. Za osobe koje se koriste primarnom zdravstvenom zaštitom procijenjeni postotni rizik za razvitak koronarne srčane bolesti u sljedećem desetljeću bio je 7 do 45% za muškarce i 2 do 45% za žene. Zaključak U primarnoj se zdravstvenoj zaštiti propušta prilika za bolje otkrivanje koronarne srčane bolesti kao i topoglednih rizičnih čimbenika. Potrebno je poduzeti mjere da se oni na vrijeme otkrivaju.Aim To investigate missed opportunities to reveal existing but not formerly diagnosed coronary heart disease cases and related risk factors in primary health care. Methods The study comprised 850 people aged over 30 years with no known history of coronary heart disease, receiving health services from a primary care center located in a suburban area of Antalya, Turkey. Data on their age, gender, education level, health insurance status, income, smoking behavior, and physical activities were collected. Undiagnosed coronary heart disease patients were determined by the Rose questionnaire, physical examination, and electrocardiogram. Height and weight, blood pressure, serum glucose and cholesterol levels were measured, and body-mass index and waist-hip ratio calculated. Each patient was given a risk score regarding age, smoking behavior, tolic blood pressure, and cholesterol levels. Estimated risk ratio of each person for developing coronary heart disease in the next decade was determined. Results The number of formerly undiagnosed coronary heart disease cases was 126 (14.8%). Overall mean (±standard deviation) risk score for developing coronary heart disease in the next decade in study group was 6.1 ± 6.8. Diseases facilitating development of coronary heart disease: hypertension, diabetes, and hypercholesterolemia were present in 255 (30.4%), 70 (8.2%), and 364 (43.4%) participants, respectively. Obesity was detected in 315 (37.1%) subjects and there were 222 (26.1%) current smokers. For patients who attended primary health care, the estimated percentage risk for developing coronary heart disease in the next ten years was 7 to 45% in men and 2 to 45% in women. Conclusion Opportunities to reveal coronary heart disease and its risk factors are being missed in primary care. Measures should be taken to ensure timely diagnosis of coronary heart disease and related risk factors

The incidence of smoking and risk factors for smoking initiation in medical faculty students: cohort study

BACKGROUND: Medical education requires detailed investigation because it is a period during which the attitudes and behaviors of physicians develop. The purpose of this study was to calculate the yearly smoking prevalence and incidence rates of medical faculty students and to identify the risk factors for adopting smoking behaviour. METHODS: This is a cohort study in which every student was asked about their smoking habits at the time of first registration to the medical faculty, and was monitored every year. Smoking prevalence, yearly incidence of initiation of smoking and average years of smoking were calculated in analysis. RESULTS: At the time of registration, 21.8% of the students smoked. At the end of six years, males had smoked for an average of 2.6 ± 3.0 years and females for 1.0 ± 1.8 years (p < 0.05). Of the 93 medical students who were not smokers at the time of registration, 30 (32.3%) were smokers at the end of the 6 years of the course. CONCLUSION: The first 3 years of medical education are the most risky period for initiation of smoking. We found that factors such as being male, having a smoking friend in the same environment and having a high trait anxiety score were related to the initiation of smoking. Targeted smoking training should be mandatory for students in the Medical Faculty

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Rate and Risk Factors of the Advanced Adenomas Among Diminutive Colorectal Polyps

Only 49 % of diminutive colorectal polyps are neoplastic, but a tiny percentage contains advanced histology. We aimed to determine the rate of advanced diminutive polyps and to evaluate the influence of age, gender, number, and localization. Patients undergoing a videocolonoscopy in October 2010 and April 2012 were collected prospectively. Subjects with polyps 25 % and a high degree of dysplasia were categorized as polyps with advanced histology. Two hundred eight diminutive polyps were identified in 102 patients. Twenty (9.6 %) diminutive polyps in 13 (12.74 %) patients showed advanced histology. The probability of having an advanced diminutive polyp was higher in patients who have more than one polyp or have polyps localized all along the colon or only to the distal part (p < 0.001 and p = 0.002). Having more than one polyp increases the likelihood of having advanced diminutive polyp according to a multivariate analysis (p = 0.003). Polyps accompanying any dysplastic diminutive polyp, being one of multiple polyps, and distributed all along the colon or localized to only the distal part have an increased probability of being an advanced diminutive polyp (p < 0.001, p = 0.047, p < 0.001, and p = 0.008). Multivariate logistic regression demonstrated that only any accompanying dysplastic diminutive polyp increases the probability of a polyp being advanced diminutive (p = 0.034). Diminutive polyps could have advanced histology. Multiple polyps located in the whole colorectum or to the distal part or accompanying any advanced polyps may harbor an advanced histology and should be removed

The miR125b as biomarkers in the early diagnosis of bladder cancer

Objective: Bladder cancer (BCa) is the fifth most common cancer and the second most common urinary tract cancer in worldwide. BCa accounts for 3% of all cancers and is particularly common in developed countries. Material and methods: Eighteen of the 20 patients included in the study were male, 2 were female, mean age was 65.1±12.1(range:37-75) years. The control group consisted of 19 male one female, mean age was 60.3±11.2 (range:40-70) years. A total of seven miRNAs, let-7c, miR-155, miR-125b, miR-141 miR-145, miR 181 and miR 192 were evaluated in two groups. Results: MiRNAs of bladder cancer patients and healthy individuals were compared according to endogenous miR 181 and miR 192 Delta CT values, miR125b values of bladder cancer cases were found to be significantly higher than healthy controls.(p=0.021) In our study, miR125b, which we found specific and sensitive in endogenous controls, was compatible with studies in the literature. As conclusion, we emphasize that mir125b can be used as a predictor in bladder cancer compared with the literature.The current study was funded by Republic of Turkey, Ministry of Science and Industry, KOSGEB Antalya Directorate within the scope of the project entitled “MicroRNA kits in the early diagnosis of cancer” conducted by AGTC Özel Genetik Sağlık Hizm. Tur. San. Tic. Ltd. Şti. Grand Number: 008078553

Use of MicroRNAs as biomarkers in the early diagnosis of prostate cancer

Introduction: Prostate cancer (PCa) is a common type of cancer in western countries and prominent cause of mortality in men. The aim of the study was to evaluate miRNAs as biomarkers in PCa in healthy individuals and prostate cancer with patients, and examined the effect of miRNA levels on tumour mass. Material and methods: Twenty prostate cases, age (mean and range) 61,4±12.1 (45-73), and twenty healthy men, age 59,3±11.2 (44-70) were included to the study. Seven miRNAs including two internal controls (Let7c, miR125b, miR141, miR145, miR 155, miR181 ve miR192) were evaluated in two groups. Results: The mean and range of prostate spesific antigen (PSA) in cancer cases and healthy individuals were 6.79±2.84 ng/ml (2.25-14.7) and 3.8±2.2 ng/ml (1.3-7.8) respectively. The level of miR141 was significantly lower in PCa cases than healthy individuals (p=0,004), and miR155 was significantly higher (p=0,005) in PCa cases. Both miRNAs were explored sensitive and specific in the ROC analysis. Tumour mass were found to be associated with the level of miR-125b and miR-145. Conclusion: validation studies are required in wider patient groups in the subject of tumor effect and miRNA biomarkers in prostate cancerThe current study was funded by Republic of Turkey, Ministry of Science and Industry, KOSGEB Antalya Directorate within the scope of the project entitled “MicroRNA kits in the early diagnosis of cancer” conducted by AGTC Özel Genetik Sağlık Hizm. Tur. San. Tic. Ltd. Şti. Grand Number: 008078553

The importance of MicroRNA 29a as a biomarker in colon cancer

Introduction: Colon cancer (CC) has become one of the most common diseases in recent years.The incidence of (CC) varies greatly worldwide, depending on lifestyle, environment, and genetic causes. Endoscopy is invasive and expensive for early detection. Therefore, there is a need to develop reliable and non-invasive markers for the early diagnosis of CC. MicroRNAs (miRNAs) have attracted attention as promising biomarkers in other cancers In this study, our aim is to determine whether miRNAs are biomarkers in the early diagnosis of colon cancer. Materials and Methods: Twenty patients diagnosed with colon cancer and twenty healthy individuals of the same age and gender were selected as the control group. Four miRNAs (let-7g, miR-29a, miR-155, miR-200c) selected and MiR 181 and miR 192 used as the endogenous control group in line with their binding potentials and gene expression levels. They were measured with StepOne ™ Real-Time PCR. Results: mir29a was significantly high AUCs, thus the sensitivity and specificity values of was 100.0% and 64.3%. Common to all studies was MiR29a as sensitive and spesific like in our study. Conclusion: miR29a, is a hopeful miRNA in the early diagnosis of colon cancer, prognosis and treatment of the disease. Further validation studies are needed.The current study was funded by Republic of Turkey, Ministry of Science and Industry, KOSGEB Antalya Directorate within the scope of the project entitled “MicroRNA kits in the early diagnosis of cancer” conducted by AGTC Özel Genetik Sağlık Hizm. Tur. San. Tic. Ltd. Şti. Grand Number: 0080785533

The importance of MicroRNA 106b as a biomarker in gastric cancer

Objective: Gastric cancer (GC) is the fourth most common malignant disease worldwide, and it is observed 2-3 times more frequently in men than in women. It is important to make an early diagnosis in GC, by using screening methods such as serological markers and histological precursor. MiRNAs circulating in the blood have come to the fore in the early diagnosis of GC. In this study, our aim was to detect the most specific and sensitive microRNA by studying the microRNAs in the patient and control groups. Material and methods: Fourteen patients diagnosed with gastric cancer and fourteen healthy individuals of the same age and gender were selected as the control group. Three miRNAs (miR-34a, miR106b, miR-223 and miR 181 and miR 192 used as the endogenous control group in line with their binding potentials and gene expression levels. Results: Only miR106b was upregulated and statiscally important compared with the endogenous control miR181 for patients and healthy individuals (p:0.022). Conclusion: MiR-106b may have an important role in both the early diagnosis. Further extensive studies are needed.The current study was funded by Republic of Turkey, Ministry of Science and Industry, KOSGEB Antalya Directorate within the scope of the project entitled “MicroRNA kits in the early diagnosis of cancer” conducted by AGTC Özel Genetik Sağlık Hizm. Tur. San. Tic. Ltd. Şti. Grand Number: 0080785533