Quantitative plaque analysis in coronary artery disease

BACKGROUND: Coronary artery disease is the commonest cause of death worldwide and clinicians have struggled to limit the associated inexorable tide of morbidity and mortality over the past few decades. Most often patients only become aware that they have coronary artery disease when they are admitted to hospital with chest pain. Computed tomography coronary angiography has revolutionised our ability to detect even mild coronary artery disease, improving the prognosis of those with symptoms of stable angina. However, its effectiveness is somewhat limited by physician reliance on the singular factor of the severity of coronary artery stenosis. The ability to characterise and to quantify the extent of coronary artery disease can incrementally improve the prognostic capability of coronary computed tomography angiography in patients with stable angina. However, we have yet to determine whether quantifying plaque is of benefit in the more unstable populations of patients who present to the Emergency Department with acute chest pain. Such patients may or may not have suffered a myocardial infarction. Moreover, in those who have myocardial infarction, this may or may not be due to plaque rupture. Computed tomography and quantitative plaque analysis could provide a novel avenue to assist both in the diagnosis and risk stratification of this patient population. Given this background, there are several questions that we put forward. These include: 1) Can plaque be accurately and reproducibly quantified in patients with a high burden of coronary artery disease? 2) Is there value in quantifying plaque in patients who have had myocardial infarction excluded? 3) In those with myocardial infarction, can quantitative plaque analysis assist in the differentiation between type 1 and type 2 myocardial infarction? 4) Does quantification of plaque burden predict recurrent events and mortality in patients who present with acute chest pain to the Emergency Department? METHODS AND RESULTS: In study one, twenty patients with known multivessel disease underwent repeated computed tomography coronary angiography 2 weeks apart. Coronary artery segments were analysed using semi-automated software by two trained observers to determine intraobserver, interobserver and interscan reproducibility. Overall, 149 coronary arterial segments were analysed. There was excellent intraobserver, interobserver and interscan agreement for all plaque volume measurements. There were no substantial interscan differences for measures of plaque burden. Whilst low-attenuation plaque volume had relatively wider 95% limits of agreement, this reflected the lower absolute volumes of low-attenuation plaque in this cohort of patients with advanced coronary disease. In study two, quantitative plaque analysis was performed on CT coronary angiograms of 242 patients recruited in a single-centre cross-sectional observational study. Patients with acute chest pain who had had myocardial infarction excluded were dichotomised by plasma high-sensitivity cardiac troponin I concentration into low (<5 ng/L, n=81) and intermediate (≥5 ng/L, n=161) risk groups. There was a higher burden of plaque in the intermediate risk group compared to the low risk group. Moreover, low-attenuation plaque burden was associated with intermediate-risk plasma troponin concentrations after adjustment for clinically relevant characteristics suggesting plaque instability may contribute to the underlying cardiovascular risk of these patients. In study three, a post-hoc analysis of two prospective clinical studies of patients with acute chest pain was conducted. Patients were classified as type 1 myocardial infarction, type 2 myocardial infarction or chest pain without infarction. The diagnosis of type 2 myocardial infarction was adjudicated by an expert panel due to the inherent difficulties in making this diagnosis. Quantitative plaque analysis was conducted in 155 patients with type 1 myocardial infarction, 36 patients with type 2 myocardial infarction and 136 patients with chest pain without infarction. We showed that patients with type 1 myocardial infarction had a significantly greater burden of total, non-calcified and low-attenuation plaque compared to those with type 2 myocardial infarction. Low-attenuation plaque was an independent predictor of type 1 myocardial infarction and had better discrimination than non-calcified plaque and even severity of coronary artery stenosis. This suggests that quantitative plaque analysis holds potential to help differentiate between these diagnoses thereby assisting in guiding patient management. In study four, quantitative plaque analysis was conducted on 404 patients who presented to the Emergency Department with suspected acute coronary syndrome. Patients underwent early coronary CT angiography and were followed up for 12 months. We assessed the association between plaque burden and the primary endpoint of 1-year all cause death or non-fatal myocardial infarction and compared this to traditional markers of risk including the GRACE score and the presence of obstructive coronary disease. Following the index admission, 25 patients went on to have an event. Events were associated with larger burdens of all plaque subtypes. Total, non-calcified and low-attenuation plaque were the strongest predictors of future events, and these associations were independent of GRACE score and presence of obstructive coronary disease. Plaque burden therefore was a major predictor of 1-year death or recurrent myocardial infarction in patients who present to hospital with suspected acute coronary syndrome. CONCLUSION: We have demonstrated that quantitative plaque analysis is a reliable tool and gives precise results even in patients with a large burden of coronary atherosclerosis. This technique can be applied to all patients who attend the hospital and are suspected of having acute coronary syndrome. When troponin concentrations do not reach the threshold to diagnose myocardial infarction according to the Universal Definition, quantifying the low-attenuation plaque burden of those with an intermediate concentration of troponin is a powerful risk stratification tool that may assist in the decision to pursue more intensive preventative medical therapy. When myocardial infarction is diagnosed but clinicians are not sure if this is due to plaque rupture or a supply and demand mismatch, the burden of low-attenuation plaque can assist in decision making and help guide downstream medical investigation and management. Finally, in all the above situations, the burden of plaque and low-attenuation plaque in particular can identify those patients at highest risk of recurrent cardiovascular events, further risk stratifying patients in the short to medium term. Taken together, these four studies provide major impetus for future prospective clinical trials that could base treatment decisions on the burden of high-risk low-attenuation plaque

Resistência microbiana a drogas em linhagens de Escherichia coli isoladas de fontes alimentares

A variety of foods and environmental sources harbor bacteria that are resistant to one or more antimicrobial drugs used in medicine and agriculture. Antibiotic resistance in Escherichia coli is of particular concern because it is the most common Gram-negative pathogen in humans. Hence this study was conducted to determine the antibiotic sensitivity pattern of E. coli isolated from different types of food items collected randomly from twelve localities of Hyderabad, India. A total of 150 samples comprising; vegetable salad, raw egg-surface, raw chicken, unpasteurized milk, and raw meat were processed microbiologically to isolate E. coli and to study their antibiotic susceptibility pattern by the Kirby-Bauer method. The highest percentages of drug resistance in isolates of E. coli were detected from raw chicken (23.3%) followed by vegetable salad (20%), raw meat (13.3%), raw egg-surface (10%) and unpasteurized milk (6.7%). The overall incidence of drug resistant E. coli was 14.7%. A total of six (4%) Extended Spectrum β-Lactamase (ESBL) producers were detected, two each from vegetable salads and raw chicken, and one each from raw egg-surface and raw meat. Multidrug resistant strains of E. coli are a matter of concern as resistance genes are easily transferable to other strains. Pathogen cycling through food is very common and might pose a potential health risk to the consumer. Therefore, in order to avoid this, good hygienic practices are necessary in the abattoirs to prevent contamination of cattle and poultry products with intestinal content as well as forbidding the use of untreated sewage in irrigating vegetables.Variedade de alimentos e fontes ambientais contem bactérias resistentes a uma ou mais drogas antimicrobianas usadas em medicina e agricultura. Resistência antibiótica pela Escherichia coli é particularmente preocupante porque ela é o patógeno mais comum Gram negativo em humanos. Portanto este estudo foi conduzido para determinar o aspecto de sensibilidade antibiótica da E. coli isolados de diferentes tipos de alimentos obtidos ao acaso de 12 localidades de Hyderabad, India. Um total de 150 amostras compreendendo saladas, vegetais, superfícies de ovos crus, galinhas cruas, leite não pasteurizado e carne crua foram processados microbiologicamente para isolar E. coli e estudar o quadro de sensibilidade antibiótica pelo método de Kirby-Bauer. A maior percentagem de resistência à droga foi isolada de E. coli obtidos de galinha crua (23,3%) seguido de saladas e vegetais (20%), carne crua (13,3%), superfície do ovo cru (10%) e leite não pasteurizado (6,7%). Incidência total de E. coli resistente foi de 14,7%. Um total de seis (4%) Extended Spectrum β-Lactamase (ESBL) produtores foram detectados, dois cada de salada de vegetais e galinha crua e um cada de superfície de ovo cru e carne crua. Espécies resistentes a múltiplas drogas de E. coli são matéria de preocupação uma vez que os genes de resistência podem facilmente ser transferidos para outras linhagens. O ciclo do patógeno é muito comum nos alimentos e pode ser risco potencial para a saúde do consumidor. Portanto, para evitar isto boas práticas de higiene são necessárias nos abatedouros para prevenir a contaminação de gado e aves com conteúdo intestinal assim como proibir o uso de águas de esgoto não tratadas para irrigar vegetais

Prevalence of prediabetes, diabetes, and Its associated risk factors among males in Saudi Arabia: A population-based survey

Objectives: The study aims at determining the prevalence of prediabetes and diabetes and at ascertaining some concomitant risk factorsamong males in Saudi Arabia.Methods: A population-based cross-sectional study including 381 Saudi adult males from different institutions was recruited. Odds ratios for diabetes risk and risk factors were calculated using log-binomial and multinomial logistic regression, using STATA version 12.Results: The participants included 381 diabetic males with a median age of 45 years, average body mass index of 25 ± 40 kg/m2, whereas waist circumferences ranged from 66 to 180 cm in the male study population. In addition, 27.82% had normal BMI, 32.28% were overweight, and 36.22% were obese. Around 36% had higher waist circumference, that is, \u3e102 cm. Age, BMI, marital status, and educational attainment were statistically significant predictors for prediabetes and diabetes.Conclusion: This study found that the prevalence of diabetes and prediabetes was 9.2% and 27.6%, respectively, for male Al-Kharj study population. The factors that increase the risk of diabetes and prediabetes include older age, obesity and overweight, being married, smoker, and having a civilian job and less education. All these factors were found statistically significant except smoking status and job type. In order to evaluate the causal relationship of these factors, prospective studies are required in future

Prevalence of prediabetes, diabetes and Its predictors among females in alkharj, saudi arabia: A cross-sectional study.

BACKGROUND/OBJECTIVE: The prevalence of prediabetes and diabetes is reaching epidemic proportions across the globe. Therefore, this study aims to determine the prevalence of prediabetes and diabetes, together with its accompanying risk factors, among young females. METHODS: An exploratory cross-sectional survey was conducted with 638 Saudi females in Alkharj, Saudi Arabia. Statistical analysis was carried out using STATA version 14. Odds ratios for the risk of diabetes and associated factors were calculated using log-binomial and multinomial logistic regression. Standardized prevalence and strata-specific prevalence of diabetes and prediabetes for different risk factors were also calculated. FINDINGS: The study revealed that nondiabetics and prediabetics were more prevalent between the ages of 18 and 24 years, while diabetic patients were consistently between 25 to 44 years of age. The average value for HbA1c in females was 5.44. Regression analysis shows that being older, married, obese, a smoker or less educated significantly increases the risk for both prediabetes and diabetes. Mutivariable analysis revealed obesity had a significant association with both prediabetes and diabetes. Prediabetics were 2.35 times more likely to be obese as compared to nondiabetics, with 95% CI (1.38-3.99). Similarly, diabetics were 6.67 times more likely to be obese compared to nondiabetics 95% CI (1.68-26.42). CONCLUSION: Our study shows the prevalence of diabetes and prediabetes among females from Al Kharj was 3.8% and 18.8%, respectively. The diabetic and prediabetic female participants had higher mean BMI and waist circumference, were older in age, were married, and smoked as compared to nondiabetics. In the context of the findings of our study, and keeping in view the the burden of this disease globally and in our population, it has now become extremely important to understand these factors and encourage health-promoting behaviors to construct effective interventions

Certificates verification on the block chain

All certificates, including those for secondary school graduation, high school diplomas, and college degrees, have been converted to digital form and made accessible to students at higher education institutions. It's essential for learners to keep track of their diplomas. It is a complex and time-consuming process for the institution or organization to verify or authenticate a certificate's validity. This application would aid in the safekeeping of the certificates on the block chain. Digital certificates are created by first digitising the original paper certificates. The certificate's hash code value is generated using the chaotic technique. It is then added to the block chain. The mobile application is used to verify these certifications. We can make digital certificate verification more reliable and safe by implementing block chains

Polyethylene Glycol-3350 (Miralax®)+1.9-L sports drink (Gatorade®)+2 tablets of bisacodyl results in inferior bowel preparation for colonoscopy compared with Polyethylene Glycol-Ascorbic Acid (MoviPrep®)

BACKGROUND/AIMS: Polyethylene glycol (PEG)-3350, approved by Food and Drug Administration (FDA) only for constipation, combined with 1.9 L of sports drink (SD) (GatoradeR) and bisacodyl (B) is commonly used in outpatient practice for bowel preparation due to cited patient satisfaction and tolerability of this specific regimen. We aim to compare PEG-3350 (MiralaxR) with PEG-AA-based (MoviPrepR) in terms of efficacy, patient satisfaction, and the effects of these two regimen on serum electrolytes. MATERIALS AND METHODS: This study is a prospective, single-blinded, block randomized trial comparing single-dose PEG-3350+SD+B to split-dose 2-L PEG-AA in the outpatient endoscopy unit in patients undergoing colonoscopy. Basic metabolic profiles were checked on the day of randomization and on the day of procedure. Patients completed a survey on the day of procedure. Bowel preparation quality was assessed using the Boston Bowel Preparation Scale (BBPS) by two endoscopists and a nurse present during the procedure. RESULTS: We randomized 150 patients (74 PEG-3350+SD+B and 76 PEG-AA). The PEG-AA group had significantly higher BBPS scores in the right colon by Endoscopist 1, Nurse, and Endoscopist 2 (p 0.005, CONCLUSION: Use of single-dose PEG-3350+SD+B results in inferior bowel preparation for colonoscopy compared with split-dose PEGAA and does not provide any advantage in regards to patient satisfaction. We therefore recommend discontinuing the use of PEG 3350 for bowel preparation