Sex Differences in Outcomes after Stroke in Patients with Diabetes in Ontario, Canada.

BACKGROUND: Outcomes after stroke in those with diabetes are not well characterized, especially by sex and age. We sought to calculate the sex- and age-specific risk of cardiovascular outcomes after ischemic stroke among those with diabetes. METHODS: Using population-based demographic and administrative health-care databases in Ontario, Canada, all patients with diabetes hospitalized with index ischemic stroke between April 1, 2002, and March 31, 2012, were followed for death, stroke, and myocardial infarction (MI). The Kaplan-Meier survival analysis and Fine-Gray competing risk models estimated hazards of outcomes by sex and age, unadjusted and adjusted for demographics and vascular risk factors. RESULTS: Among 25,495 diabetic patients with index ischemic stroke, the incidence of death was higher in women than in men (14.08 per 100 person-years [95% confidence interval [CI], 13.73-14.44] versus 11.89 [11.60-12.19]) but was lower after adjustment for age and other risk factors (adjusted hazard ratio [HR], .95 [.92-.99]). Recurrent stroke incidence was similar by sex, but men were more likely to be readmitted for MI (1.99 per 100 person-years [1.89-2.10] versus 1.58 [1.49-1.68] among females). In multivariable models, females had a lower risk of readmission for any event (HR, .96 [95% CI, .93-.99]). CONCLUSIONS: In this large, population-based, retrospective study among diabetic patients with index stroke, women had a higher unadjusted death rate but lower unadjusted incidence of MI. In adjusted models, females had a lower death rate compared with males, although the increased risk of MI among males persisted. These findings confirm and quantify sex differences in outcomes after stroke in patients with diabetes

Cardiac troponin T estimation post elective stent implantation and prediction of early and late outcomes

Background: Coronary artery disease (CAD) is a major cause of mortality and morbidity. Per Cutaneous Interventions (PCI) is emerging as the mainstay of treatment for CAD. Periprocedural myocardial necrosis, which can range from a low-level elevation of cardiac biomarkers to a large myocardial infarction, is an important complication of PCI. There are conflicting reports regarding peri-procedural biomarker elevation and adverse outcome. It is in this context we have undertaken this study to assess the prognostic significance of cardiac troponin T elevation after elective stent implantation.Methods: The study population included 100 consecutive patients who underwent elective PCI with stent implantation in cardiology unit of Medical College, Trivandrum. Serial cardiac enzyme levels were measured in all patients undergoing the procedure. CPK was measured at 8 hrs, 16 hrs and 24 hrs and Troponin T was measured at 8hrs and 24 hrs. post PCI. In hospital events were documented and patients were on follow up for a period of 1 year. Primary endpoints of death, myocardial infarction, recurrent ischemia leading to revascularization were noted.Results: In our study population of 100 patients there were 87 males and 13 females. Among them 50% had unstable angina, 18% had exertional angina and 32% were post myocardial infarction patients. In this group of hundred patients 79% had single vessel disease, 18% had two vessels and 3% had triple vessel disease. A total of 103 stents were deployed. Mean CPK levels were CPK-1 (80.11+36.19), mean CPK-2 (83.91± 34.8) and mean CPK-3 (86.32+57.80). Mean Troponin T-1 was 0.04+0.1 and mean Troponin-2 was 0.06+0.145. In this study, we compared late onset angina with Troponin and CPK positivity and found that both Troponin-1 & Troponin-2 had significant correlation with late onset angina.Conclusions: Periprocedural Troponin T is more sensitive than CPK in predicting late events. Thrombus containing lesions and bifurcation lesions were significantly associated with elevation in Troponin T. No significant Troponin T elevations were noted in patients with diabetes mellitus and those containing calcified lesions. Drug eluting stents were associated with a relatively lesser Troponin T elevations but not statistically significant

A study of clinical profile of cardiac dysfunction in patients with HIV infection

Background: HIV infection is a major health problem across the entire world including India. The introduction of anti-retroviral therapy (ART) have led to a significant reduction in opportunistic infections and hence increased life expectancy of HIV-infected individuals. This resulted in an increase in prevalence of cardiovascular diseases among these individuals. Aim was to study the clinical profile of cardiac dysfunction in patients with HIV infection and to find whether CD-4 influence on the disease pattern and severity.Methods: This study was a cross sectional study conducted in Sixty HIV infected patients who attended Anti-Retroviral Therapy Centre, Government Medical College, Thiruvananthapuram, Kerala, India during a period of fifteen months. Patients underwent a thorough clinical examination and other relevant investigations including CD-4 count, ECG and transthoracic echocardiography.Results: In our study it was found that cardiac involvement is common even in asymptomatic HIV infected patients. Cardiac manifestations observed were left ventricular diastolic dysfunction (25%), left ventricular hypertrophy (15%), dilated cardiomyopathy (15%), pericardial effusion (13.3%) and mild pulmonary artery hypertension (10%). Cardiac involvement is more common in those with low CD-4 count. Among these conditions Concentric Left Ventricular Hypertrophy had a statistically significant correlation with CD-4 count.Conclusions: We observed that some form of cardiac involvement was common even in asymptomatic HIV infected patients and cardiac involvement was inversely associated with CD-4 Count of the patient. Transthoracic echocardiography is a good non-invasive tool for the early detection of cardiac abnormalities. Cardiac involvement can be easily overlooked in these patients as symptoms can be attributed to associated co morbid illnesses, so every HIV infected patients should undergo a thorough clinical examination and relevant cardiac evaluation at the time of diagnosis and periodically to decrease cardiac associated morbidity and mortality

Predictors of angiographic restenosis in patients with coronary artery disease who have undergone percutaneous coronary intervention with drug eluting stents

Background: Percutaneous transluminal coronary angioplasty (PTCA) is now widely accepted as a nonsurgical revascularization procedure for selected patients with CAD. In-stent restenosis (ISR) is a frequent complication after PCI which limits its long-term efficacy. Identification of those clinical and angiographic characteristics that may predict the risk of restenosis is extremely important to eliminate restenosis. In this context we conducted this study to assess the profile of patients with drug eluting stents - ISR with an emphasis on demographic characteristics, risk factors, mode of presentation and coronary angiographic characterization.Methods: This study was a Case control study based on the catheterization registry of all patients who have undergone PCI with DES during the period from October 2012 to April 2015. All patients who have undergone PCI with DES and repeat coronary angiogram for evaluation of symptoms and detected to have ISR during same period were taken as case and age matched patients who had previously undergone PCI with DES and repeat coronary angiogram for evaluation of symptoms between 1/10/2012 to 30/4/2015 and detected to have fully patent stents were taken as control.Results: A total of 26 patients were detected to have ISR during the study period as per the study protocol with equal number of age matched controls. The most common presentation of ISR was as chronic stable angina (70%). Binary logistic regression analysis of 6 factors namely diabetes, hypertension, lesion type, stent diameter, stent length and stent overlap found significant in univariate analysis, showed only the lesion type to be statistically significant with p value of 0.023.Conclusions: Patients who have undergone PCI with DES particularly for complex lesions, diabetics with longer stents, lesser diameter stents and overlapping stents need to be meticulously followed up to rule out the possibility of restenosis, as in a small number of patients the presentation could be ACS with comparatively bad prognosis

Effects and consequences of small-scale cage culture technology adoption in Kerala

Small-scale fish farming is critical in ensuring food security and employment in many developing countries. Small-scale cage culture for Etroplus suratensis was introduced in the state by the Department of Fisheries, Government of Kerala with the same objectives. The demand for the species has shown considerable increase in the recent years and f m gate prices are as high as Rs 450kg in the peak season. Elevation to the status of State Fish has also helped the culture of the species in attracting the attention of policy makers leading to promotion of its culture. Cage culture in brackishwater bodies, a relatively new technology to the State, was popularized among the tsunami affected fishermen along with extension and technical support. The implementation of cage culture was promoted through the Brackishwater Fish Farmers' Development Agency (BFFDAs) and Agency for Development ofAquaculture Kerala (ADAK), two subsidiaries of the Department of Fisheries, Government of Kerala. The present study probes the effects and consequences of cage culture technology adoption among farmers based on primary data collected from sample respondents during the initial year of culture

Surname lists to identify South Asian and Chinese ethnicity from secondary data in Ontario, Canada: a validation study

<p>Abstract</p> <p>Background</p> <p>Surname lists are useful for identifying cohorts of ethnic minority patients from secondary data sources. This study sought to develop and validate lists to identify people of South Asian and Chinese origin.</p> <p>Methods</p> <p>Comprehensive lists of South Asian and Chinese surnames were reviewed to identify those that uniquely belonged to the ethnic minority group. Surnames that were common in other populations, communities or ethnic groups were specifically excluded. These surname lists were applied to the Registered Persons Database, a registry of the health card numbers assigned to all residents of the Canadian province of Ontario, so that all residents were assigned to South Asian ethnicity, Chinese ethnicity or the General Population. Ethnic assignment was validated against self-identified ethnicity through linkage with responses to the Canadian Community Health Survey.</p> <p>Results</p> <p>The final surname lists included 9,950 South Asian surnames and 1,133 Chinese surnames. All 16,688,384 current and former residents of Ontario were assigned to South Asian ethnicity, Chinese ethnicity or the General Population based on their surnames. Among 69,859 respondents to the Canadian Community Health Survey, both lists performed extremely well when compared against self-identified ethnicity: positive predictive value was 89.3% for the South Asian list, and 91.9% for the Chinese list. Because surnames shared with other ethnic groups were deliberately excluded from the lists, sensitivity was lower (50.4% and 80.2%, respectively).</p> <p>Conclusions</p> <p>These surname lists can be used to identify cohorts of people with South Asian and Chinese origins from secondary data sources with a high degree of accuracy. These cohorts could then be used in epidemiologic and health service research studies of populations with South Asian and Chinese origins.</p

Sex Differences in Outcomes after Stroke in Patients with Diabetes in Ontario, Canada.

BACKGROUND: Outcomes after stroke in those with diabetes are not well characterized, especially by sex and age. We sought to calculate the sex- and age-specific risk of cardiovascular outcomes after ischemic stroke among those with diabetes. METHODS: Using population-based demographic and administrative health-care databases in Ontario, Canada, all patients with diabetes hospitalized with index ischemic stroke between April 1, 2002, and March 31, 2012, were followed for death, stroke, and myocardial infarction (MI). The Kaplan-Meier survival analysis and Fine-Gray competing risk models estimated hazards of outcomes by sex and age, unadjusted and adjusted for demographics and vascular risk factors. RESULTS: Among 25,495 diabetic patients with index ischemic stroke, the incidence of death was higher in women than in men (14.08 per 100 person-years [95% confidence interval [CI], 13.73-14.44] versus 11.89 [11.60-12.19]) but was lower after adjustment for age and other risk factors (adjusted hazard ratio [HR], .95 [.92-.99]). Recurrent stroke incidence was similar by sex, but men were more likely to be readmitted for MI (1.99 per 100 person-years [1.89-2.10] versus 1.58 [1.49-1.68] among females). In multivariable models, females had a lower risk of readmission for any event (HR, .96 [95% CI, .93-.99]). CONCLUSIONS: In this large, population-based, retrospective study among diabetic patients with index stroke, women had a higher unadjusted death rate but lower unadjusted incidence of MI. In adjusted models, females had a lower death rate compared with males, although the increased risk of MI among males persisted. These findings confirm and quantify sex differences in outcomes after stroke in patients with diabetes

A Tunable Band Stop Filter for Ku Band Communication Systems Using DGS and MEMS Switches

This paper presents a tunable bandstop filter based on an interdigital defected ground structure (DGS) and microelectromechanical (MEMS) switches. The switches are positioned over the bends of the DGS. Depending the switch that is actuated, the effective slot length of the DGS varies and hence the resonant frequency. The resonant frequencies can be further varied by varying the individual branch lengths. The proposed design is modified with three additional MEMS switches in each branch to alter its effective length. The design procedure for varying the branch lengths, and mechanical design of the MEMS switches is also presented. The additional switches create a large number of switching states filling the entire Ku- band with closely spaced resonant frequencies

Statin safety in chinese: A population-based study of older adults

Background Compared to Caucasians, Chinese achieve a higher blood concentration of statin for a given dose. It remains unknown whether this translates to increased risk of serious statinassociated adverse events amongst Chinese patients. Methods We conducted a population-based retrospective cohort study of older adults (mean age, 74 years) newly prescribed a statin in Ontario, Canada between 2002 and 2013, where 19,033 Chinese (assessed through a validated surname algorithm) were matched (1:3) by propensity score to 57,099 non-Chinese. This study used linked healthcare databases. Findings The follow-up observation period (mean 1.1, maximum 10.8 years) was similar between groups, as were the reasons for censoring the observation period (end of follow-up, death, or statin discontinuation). Forty-seven percent (47%) of Chinese were initiated on a higher than recommended statin dose. Compared to non-Chinese, Chinese ethnicity did not associate with any of the four serious statin-associated adverse events assessed in this study [rhabdomyolysis hazard ratio (HR) 0.61 (95% CI 0.28 to 1.34), incident diabetes HR 1.02 (95% CI 0.80 to 1.30), acute kidney injury HR 0.90 (95% CI 0.72 to 1.13), or all-cause mortality HR 0.88 (95% CI 0.74 to 1.05)]. Similar results were observed in subgroups defined by statin type and dose. Conclusions We observed no higher risk of serious statin toxicity in Chinese than matched non-Chinese older adults with similar indicators of baseline health. Regulatory agencies should review available data, including findings from our study, to decide if a change in their statin dosing recommendations for people of Chinese ethnicity is warranted

Incidence of Inflammatory Bowel Disease in South Asian and Chinese People: A Population-Based Cohort Study from Ontario, Canada.

BACKGROUND: Inflammatory bowel disease (IBD) is now a global disease with incidence increasing throughout Asia. AIM: To determine the incidence of IBD among South Asians and Chinese people residing in Ontario, Canada's most populous province. METHODS: All incident cases of IBD in children (1994-2015) and adults (1999-2015) were identified from population-based health administrative data. We classified South Asian and Chinese ethnicity using immigration records and surnames. We determined standardized incidence of IBD and adjusted incidence rate ratio (aIRR) in South Asians and Chinese compared to the general population. RESULTS: Among 16,230,638 people living in Ontario, standardized incidence of IBD per 100,000 person-years was 24.7 (95% CI 24.4-25.0), compared with 14.6 (95% CI 13.7-15.5) in 982,472 South Asians and with 5.4 (95% CI 4.8-5.9) in 764,397 Chinese. The risk of IBD in South Asians was comparable to the general population after adjusting for immigrant status and confounders (aIRR 1.03, 95% CI 0.96-1.10). South Asians had a lower risk of Crohn's disease (CD) (aIRR 0.66, 95% CI 0.60-0.77), but a higher risk of ulcerative colitis (UC) (aIRR 1.47, 95% CI 1.34-1.61). Chinese people had much lower rates of IBD (aIRR 0.24, 95% CI 0.20-0.28), CD (aIRR 0.21, 95% CI 0.17-0.26), and UC (aIRR 0.28, 95% CI 0.23-0.25). CONCLUSION: Canadians of South Asian ethnicity had a similarly high risk of developing IBD compared to other Canadians, and a higher risk of developing UC, a finding distinct from the Chinese population. Our findings indicate the importance of genetic and environmental risk factors in people of Asian origin who live in the Western world