Performance of the TIMI risk score in predicting mortality after primary percutaneous coronary intervention in elderly women: Results from a developing country

Background: Despite women undergoing primary percutaneous coronary intervention (PPCI) having a higher rate of adverse outcomes than men, data evaluating prognostic risk scores, especially in elderly women, remains scarce. This study was conducted to validate the predictive value of Thrombolysis in Myocardial Infarction (TIMI) risk score in elderly female patients. Materials and Methods: This was a retrospective analysis of elderly (\u3e65 years) female patients who underwent PPCI for ST-elevated myocardial infarction (STEMI) from October 2016 to September 2018. Patients\u27 demographic details and elements of TIMI risk score including age, co-morbidities, Killip classification; weight, anterior MI and total ischemic time were extracted from hospital records. The primary outcome was in-hospital mortality and post-discharge mortality reported on telephonic follow-up. Results: A total of 404 elderly women with a median age of 70 years were included. The mean TIMI score was 5.25±1.45 with 40.3% (163) patients of TIMI score \u3e 5. In-hospital mortality rate was 6.4% (26) and was found to be associated with TIMI score (p\u3c0.001). The in-hospital mortality rate increased from 3.1% at TIMI score of 0-4 to 34.6% at the score of 8. On follow-up (16.43±7.40 months) of 211 (55.8%) patients, the overall mortality rate was 20.3%, and this was also associated with TIMI score (p\u3c0.001). The mortality rate increased from 5.6% at the score of 0-4 to 54.5% at the score of 8. The predictive values (area under the curve) of TIMI risk score for in-hospital and post-discharge mortality were 0.709 (95% CI 0.591-0.827; p \u3c0.001) and 0.689 (95% CI 0.608-0.770; p \u3c0.001), respectively. Conclusion: Increased adverse outcomes were observed with higher TIMI risk score for in hospital and post-discharge follow-up. Therefore, the prognostic TIMI risk score is a robust tool in predicting both in-hospital as well as post-discharge mortality in elderly females

Waqf ilmi in UiTM Negeri Sembilan; creating awareness and acceptance through A-I-D-A model perspective

Purpose - The future success of socio-economic wellbeing significantly contributed from the nation’s education other than the economic growth. Knowledge should be the main aspect that need to be considered by a human to growth, even Islam itself is emphasized by the very first word of the first verse revealed in the Quran, “iqra” which literally means read. In fact, education is important for a sustainable development of the society other than to reduce poverty and otherreligious purposes.Responding to this issue, waqf in higher education started growing as a mechanism in developing knowledgeable intellectuals other than providing an infrastructure for educational purposes. Through this, individual can contribute to the society not only by having cash or assets, but also by contributing the knowledge and expertise to the community which is called as “waqf ilmi”. The unique features and good track of waqf in the prominent universities in the world has raised awareness for public universities in Malaysia to adopt waqf.However, the level of awareness should be instilled at an early date of the introduction of waqf ilmi as the waqf concept in Malaysia, specific in higher education is still at perceived level and less satisfactory.Hence, to foster the practice of waqf in higher learning institution, this study aims to promote the fundamental understanding by creating an awareness towards waqf ilmi within the community in Universiti Teknologi MARA (UiTM), Negeri Sembilan.A study starts with an explanation of waqf ilmi and how it can be implemented here.Then, a structured questionnaire was distributed to whom were selected randomly within 3 campuses of UiTMCNS to share their understanding and awareness on waqf ilmu using A-I-D-A model as a benchmark of measurement. The result of this study can be used as a starting point by various parties to promote waqf ilmi as a norm of educational development of the society.Methodology - Waqf has been executed to benefit in many aspects not only limited to religious purposes but also education, healthcare, national security, commercial and business activities, transportation facilities, shelter and food for the needy and poor. The awareness and correct understanding of waqf should be possessed by -R Hussin, RA Rashid (2017)

Metabolic aspects of surgical subcutaneous fat removal: An umbrella review and implications for future research

Although obesity is a preventable disease, maintaining a normal body weight can be very challenging and difficult, which has led to a significant increase in the demand for surgical subcutaneous fat removal (SSFR) to improve physical appearance. The need for SSFR is further exacerbated because of the global rise in the number of bariatric surgeries, which is currently the single most durable intervention for mitigating obesity. Fat tissue is now recognized as a vital endocrine organ that produces several bioactive proteins. Thus, SSFR-mediated weight (fat) loss can potentially have significant metabolic effects; however, currently, there is no consensus on this issue. This review focuses on the metabolic sequelae after SSFR interventions for dealing with cosmetic body appearance. Data was extracted from existing systematic reviews and the diversity of possible metabolic changes after SSFR are reported along with gaps in the knowledge and future directions for research and practice. We conclude that there is a potential for metabolic sequelae after SSFR interventions and their clinical implications for the safety of the procedures as well as for our understanding of subcutaneous adipose tissue biology and insulin resistance are discussed

Survival Benefit for Individuals With Constitutional Mismatch Repair Deficiency Undergoing Surveillance

PURPOSE: Constitutional mismatch repair deficiency syndrome (CMMRD) is a lethal cancer predisposition syndrome characterized by early-onset synchronous and metachronous multiorgan tumors. We designed a surveillance protocol for early tumor detection in these individuals. PATIENTS AND METHODS: Data were collected from patients with confirmed CMMRD who were registered in the International Replication Repair Deficiency Consortium. Tumor spectrum, efficacy of the surveillance protocol, and malignant transformation of low-grade lesions were examined for the entire cohort. Survival outcomes were analyzed for patients followed prospectively from the time of surveillance implementation. RESULTS: A total of 193 malignant tumors in 110 patients were identified. Median age of first cancer diagnosis was 9.2 years (range: 1.7-39.5 years). For patients undergoing surveillance, all GI and other solid tumors, and 75% of brain cancers were detected asymptomatically. By contrast, only 16% of hematologic malignancies were detected asymptomatically (P \u3c .001). Eighty-nine patients were followed prospectively and used for survival analysis. Five-year overall survival (OS) was 90% (95% CI, 78.6 to 100) and 50% (95% CI, 39.2 to 63.7) when cancer was detected asymptomatically and symptomatically, respectively (P = .001). Patient outcome measured by adherence to the surveillance protocol revealed 4-year OS of 79% (95% CI, 54.8 to 90.9) for patients undergoing full surveillance, 55% (95% CI, 28.5 to 74.5) for partial surveillance, and 15% (95% CI, 5.2 to 28.8) for those not under surveillance (P \u3c .0001). Of the 64 low-grade tumors detected, the cumulative likelihood of transformation from low-to high-grade was 81% for GI cancers within 8 years and 100% for gliomas in 6 years. CONCLUSION: Surveillance and early cancer detection are associated with improved OS for individuals with CMMRD

REVISÃO INTEGRATIVA SOBRE AS INFECÇÕES SEXUALMENTE TRANSMISSÍVEIS EM GESTANTES E A IMPORTÂNCIA DO PRÉ-NATAL

Pregnancy is the period that encompasses a series of physiological transformations in a woman's body from the moment fertilization begins. The WHO in 2016 estimated the occurrence of around 376.4 million cases in the population aged between 15 and 49 years, the fertile age for women. It raised awareness about the risks of infections in pregnant women and the occurrence of vertical transmission of these infections. Among the main cases are syphilis, HIV, gonorrhea and viral hepatitis. This article aims to carry out an integrative review on sexually transmitted infections in pregnant women, the importance of prenatal care, providing a broad view of the aspects that lead to the infection, the risks of these STIs and the relationship with monitoring during the gestational period to reduce of risks in newborns. It is noteworthy that topics such as STIs, condom use and family planning must be addressed in health environments and schools, places where adolescents trust and believe in the information, in addition to it being reliable. Studies show the importance of the information passed on during female and male prenatal care, and that preventive measures such as sexual abstinence and the use of condoms in the context of a monogamous relationship, to protect the fetus from infections, were not well received by both pregnant women and by their partners. It is concluded that prenatal care is an important health action not only in the early detection of STIs but in their prevention.El embarazo es el período que abarca una serie de transformaciones fisiológicas en el cuerpo de la mujer desde el momento en que comienza la fecundación. En 2016, la ONU estima alrededor de 376,4 millones de casos en la población femenina en edad fértil. Generó conciencia sobre los riesgos de infecciones en mujeres embarazadas y la ocurrencia de transmisión vertical de estas infecciones. Este artículo tiene como objetivo realizar una revisión integradora sobre las infecciones de transmisión sexual en la gestante, la importancia del cuidado prenatal, brindando una visión amplia de los aspectos que conducen a la infección, los riesgos de estas ITS y la relación con el seguimiento durante el período gestacional. para reducir riesgos en recién nacidos. Es de destacar que temas como las ITS, el uso del condón y la planificación familiar deben ser abordados en ambientes de salud y escuelas, lugares donde los adolescentes confíen y crean en la información, además de que ésta sea confiable. Los estudios demuestran la importancia de la información transmitida durante el cuidado prenatal femenino y masculino, y que medidas preventivas como la abstinencia sexual y el uso de preservativos en el contexto de una relación monógama, para proteger al feto de infecciones, no fueron bien recibidas por ambos. mujeres embarazadas y por sus parejas. Se concluye que la atención prenatal es una acción de salud importante no sólo en la detección temprana de las ITS sino en su prevención.A gestação é o período que compreende uma série de transformações fisiológicas no seu corpo da mulher desde o momento em que se inicia a fertilização, formação do embrião, feto e posteriormente o nascimento do ser humano. A Organização Mundial da Saúde em 2016 estimou a ocorrência de cerca de 376,4 milhões de casos na população com faixa-etária entre 15 e 49 anos, a idade fértil para as mulheres. Acendeu alerta sobre os riscos de infecções em gestantes e a ocorrência de transmissão vertical dessas infecções.  Dentre os principais casos encontram-se sífilis, HIV, gonorreia e hepatites virais. Este artigo objetiva realizar uma revisão integrativa sobre as infecções sexualmente transmissíveis em gestantes a importância do pré-natal, fornecendo ampla visão sobre os aspectos que levam ao quadro de infecção, os riscos dessas IST e a relação com o acompanhamento durante o período gestacional para diminuição dos riscos em recém-nascidos. Destaca-se que os temas como IST, uso de preservativos e planejamento familiar devem ser trabalhados nos ambientes de saúde e escolas, locais onde as adolescentes confiam e acreditam nas informações, além delas serem fidedignas. Os estudos mostram a importância das informações repassadas durante o pré-natal feminino e masculino, e que medidas preventivas como abstinência sexual e uso de preservativos no contexto de uma relação monogâmica, para proteger o feto de infecções, não foram bem recebidas tanto pelas gestantes quanto por seus parceiros. Conclui-se que o pré-natal é uma ação em saúde importante não só na detecção precoce das IST mas na prevenção delas.A gestação é o período que compreende uma série de transformações fisiológicas no corpo da mulher a partir do momento em que se inicia a fecundação, formação do embrião, feto e posteriormente o nascimento do ser humano. Em 2016, a Organização Mundial de Saúde estimou a ocorrência de cerca de 376,4 milhões de casos na população com idades compreendidas entre os 15 e os 49 anos, a idade fértil das mulheres. Alertou para os riscos de infeções em mulheres grávidas e para a ocorrência de transmissão vertical destas infeções.  Este artigo tem como objetivo realizar uma revisão integrativa sobre as infeções sexualmente transmissíveis em gestantes, a importância da assistência pré-natal, fornecendo uma visão ampla sobre os aspetos que levam à infeção, os riscos dessas ISTs e a relação com o acompanhamento durante o período gestacional para reduzir os riscos em recém-nascidos. Vale ressaltar que temas como ISTs, uso de preservativos e planejamento familiar devem ser abordados em ambientes de saúde e escolas, locais onde os adolescentes confiam e acreditam nas informações, além de serem confiáveis. Os estudos mostram a importância das informações repassadas durante o pré-natal feminino e masculino, e que medidas preventivas como abstinência sexual e uso de preservativo no contexto de uma relação monogâmica, para proteger o feto de infeções, não foram bem recebidas tanto pelas gestantes quanto por seus parceiros. Conclui-se que o pré-natal é uma importante ação de saúde não só na deteção precoce das ISTs, mas também na sua prevenção

Natural history, with clinical, biochemical and molecular characterization, of classical homocystinuria in the Qatari population

Classical homocystinuria (HCU) is the most common inborn error of metabolism in Qatar, with an incidence of 1:1800, and is caused by the Qatari founder p.R336C mutation in the CBS gene. This study describes the natural history and clinical manifestations of HCU in the Qatari population. A single center study was performed between 2016 and 2017 in 126 Qatari patients, from 82 families. Detailed clinical and biochemical data were collected and Stanford-Binet intelligence, quality of life and adherence to treatment assessments were conducted prospectively. Patients were assigned to one of three groups, according to mode of diagnosis: 1) Late Diagnosis Group (LDG), 2) Family Screening Group (FSG), and 3) Newborn Screening Group (NSG). Of the 126 patients, 69 (55%) were in the LDG, 44 (35%) in the NSG, and 13 (10%) in the FSG. The leading factors for diagnosis in the LDG were ocular manifestations (49%), neurological manifestations (45%), thromboembolic events (4%), and hyperactivity and behavioral changes (1%). Both FSG and NSG groups were asymptomatic at time of diagnosis. NSG had significantly higher IQ, QoL, and adherence values compared with the LDG. The LDG and FSG had significantly higher Met levels than the NSG. The LDG also had significantly higher tHcy levels than the NSG and FSG. Regression analysis confirmed these results even when adjusting for age at diagnosis, current age or adherence. These findings increase understanding of the natural history of HCU and highlight the importance of early diagnosis and treatment. This article is protected by copyright. All rights reserved.Qatar National Research Fund , Grant/Award Number: 7‐355‐3‐08

The unfinished agenda of communicable diseases among children and adolescents before the COVID-19 pandemic, 1990-2019: a systematic analysis of the Global Burden of Disease Study 2019

BACKGROUND: Communicable disease control has long been a focus of global health policy. There have been substantial reductions in the burden and mortality of communicable diseases among children younger than 5 years, but we know less about this burden in older children and adolescents, and it is unclear whether current programmes and policies remain aligned with targets for intervention. This knowledge is especially important for policy and programmes in the context of the COVID-19 pandemic. We aimed to use the Global Burden of Disease (GBD) Study 2019 to systematically characterise the burden of communicable diseases across childhood and adolescence. METHODS: In this systematic analysis of the GBD study from 1990 to 2019, all communicable diseases and their manifestations as modelled within GBD 2019 were included, categorised as 16 subgroups of common diseases or presentations. Data were reported for absolute count, prevalence, and incidence across measures of cause-specific mortality (deaths and years of life lost), disability (years lived with disability [YLDs]), and disease burden (disability-adjusted life-years [DALYs]) for children and adolescents aged 0-24 years. Data were reported across the Socio-demographic Index (SDI) and across time (1990-2019), and for 204 countries and territories. For HIV, we reported the mortality-to-incidence ratio (MIR) as a measure of health system performance. FINDINGS: In 2019, there were 3·0 million deaths and 30·0 million years of healthy life lost to disability (as measured by YLDs), corresponding to 288·4 million DALYs from communicable diseases among children and adolescents globally (57·3% of total communicable disease burden across all ages). Over time, there has been a shift in communicable disease burden from young children to older children and adolescents (largely driven by the considerable reductions in children younger than 5 years and slower progress elsewhere), although children younger than 5 years still accounted for most of the communicable disease burden in 2019. Disease burden and mortality were predominantly in low-SDI settings, with high and high-middle SDI settings also having an appreciable burden of communicable disease morbidity (4·0 million YLDs in 2019 alone). Three cause groups (enteric infections, lower-respiratory-tract infections, and malaria) accounted for 59·8% of the global communicable disease burden in children and adolescents, with tuberculosis and HIV both emerging as important causes during adolescence. HIV was the only cause for which disease burden increased over time, particularly in children and adolescents older than 5 years, and especially in females. Excess MIRs for HIV were observed for males aged 15-19 years in low-SDI settings. INTERPRETATION: Our analysis supports continued policy focus on enteric infections and lower-respiratory-tract infections, with orientation to children younger than 5 years in settings of low socioeconomic development. However, efforts should also be targeted to other conditions, particularly HIV, given its increased burden in older children and adolescents. Older children and adolescents also experience a large burden of communicable disease, further highlighting the need for efforts to extend beyond the first 5 years of life. Our analysis also identified substantial morbidity caused by communicable diseases affecting child and adolescent health across the world. FUNDING: The Australian National Health and Medical Research Council Centre for Research Excellence for Driving Investment in Global Adolescent Health and the Bill & Melinda Gates Foundation

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely