Effect of apolipoprotein E genotype variation on the risk of premature ischaemic heart disease

Apolipoprotein E is expressed by 3 allelic genes, £2, £3 and £4, on Chromosome 19. ApoE isoforms are distinguished by residues at positions 112 and 158. We analysed blood from 83 first year medical students for: Total cholesterol and triglycerides, HDLC, LDLC, ApoA-1 and B levels. For ApoE genotypes, DNA were extracted from huffy coat amplified by PCR, restricted by endonuclease, electrophoresed on polyacrylamide gel and visualised by ethidium bromide staining. The genotypes obtained were: E-3/3(64%), E-4/3(27%), E-3/2(5%), and E-4/2(4%), and gene frequencies were: £2(0.04), e3(0.80), £4(0.16). The E-3/3 genotype contributed to hypercholesterolemia, low HDLC, high LDLC high ApoB. The E-4/2 genotype gave the opposite effect of E-3/3. The E-4/3 genotype exhibited hypertriglyceridemia, low LDLC and low ApoB. The E-3/2 genotype manifested normotriglyceridemia, high HDLC, low ApoA-I and low AlB ratio. We conclude that the E-3/3 genotype had the highest risk for premature heart disease. Those with the other genotypes (E-4/3, E-4/2 and E-3/2) had lower risk of premature heart disease

Penilaian aras feritin serum di kalangan pekerja pejabat wanita di bandar Kota Bharu

Satu kajian hirisan-lintang telah dijalankan ke atas pekerja pejabat di Daerah Kota Bharu.Responden terdiri daripada 52 pekerja lelaki dan 70 pekerja wanita yang berumur di antara I 8 hingga 45 tahun.Kajian ini bertujuan untuk mengetahui aras feritin serum dan status zat besi di kalangan mereka.Kajian ini mendapati purata aras hemoglobin di kalangan pekerja lelaki dan wanita ialah masing-masing 15.1 ± 1.3 dan 13.7 ± 1.4.Purata aras feritin serum di kalangan pekerja lelaki ialah 81.2 ± 45.7, manakala di kalangan pekerja wanita ialah 37.2 ± 25.5. Terdapat seramai 3.9% (2 orang) pekerja lelaki dan 7.1% (5 orang) pekerja wanita mengalami kekurangan zat besi tanpa anemia.Manakala terdapat seramai 1.9% (1 orang) pekerja lelaki dan 2.9% (2 orang) pekerja wanita mengalami kekurangan zat besi dengan anemia (kekurangan zat besi yang teruk).Hampir separuh daripada pekerja wanita (47.1% atau 33 orang) didapati mempunyai simpanan zat besi yang rendah (feritin serum 12- 34.9). Masalah simpanan zat besi yang rendah di kalangan pekerja lelaki adalah lebih rendah iaitu seramai 11.5% atau 6 orang. Daripada keputusan kajian ini dapatlah disimpulkan bahawa pekerja wanita adalah golongan yang mempunyai risiko tinggi mengalami kekurangan zat besi. Oleh yang demikian langkah-langkah tertentu patut diambil oleh pihak yang berkaitan dalam menangani masalah ini

The Effect of Delayed Transportation of Blood Samples on Serum Bilirubin Values in Neonates

Background: Delays in transporting blood samples may cause inaccurate results. Samples may be exposed to light or heat during delays, resulting in the degradation of analytes, for example, bilirubin. This study was done to determine the effect of delays in the transportation of blood samples on serum bilirubin test results. Methods: Samples taken from neonates admitted to a tertiary hospital with jaundice were included in the study. The samples were collected through venipuncture in 3 labelled containers. The first container was sent immediately to the laboratory, while the second and third containers were sent after being kept in the ward for 1 and 3 hours, respectively. Bilirubin values were measured colourimetrically at a wavelength of 578 nm using a Roche Hitachi 912 Chemistry Analyser upon arrival in the laboratory. Results: A total of 36 serum samples were studied. The mean of the indirect bilirubin measurements for 0-, 1-, and 3-hour samples were 174 (SD 68.65), 186.97 (SD 60.47), and 184.56 (SD 66.93), respectively. There was a significant difference in the mean indirect bilirubin measurement of 1-hour samples (P = 0.047, 95% CI ˗24.66 to ˗1.18) and 3-hour samples (P = 0.045, 95% CI -19.77 to -0.23) compared with 0-hour samples. There were no significant differences observed in either the mean total bilirubin or the mean direct bilirubin measurements of different time intervals. Conclusion: This study confirms that delays in the transportation of blood samples influence the bilirubin test results

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London