Proportion and Factors Associated with Zinc Deficiency in Acute Diarrhea Patients

Background: Zinc may affect the intestinal immune response. No data has been available on zinc deficiency in adult patients with diarrhea, especially for Indonesian population. Zinc metabolism, etiologies, pathogenesis and clinical course of diarrhea may have various effects on zinc concentration in different population. This study aimed to determine the proportion of zinc deficiency in patients with acute diarrhea, including its associated factors. Method: A cross-sectional study was conducted in patients with acute diarrhea at outpatient clinics and emergency wards of four hospitals between August 2010 and March 2011. A serum zinc concentration of < 10.7 µmol/L was set as cut-off value for zinc deficiency. Data was analyzed by using Chi-square test. Results: There were 101 subjects, 54.5% were female, the median age was 26 years, median duration of acute diarrhea was 5 days, and the median frequency was 6 times/day. About 95% patients had nutritional status of subjective global assessment (SGA) A and the mean value of body mass index was 19.3 ± 0.70 kg/m2. Approximately 88.1% patients had severe infective diarrhea based on hydration status. About 69.3% patients were zinc deficient with the mean serum zinc concentration of 9.26 ± 2.95 µ mol/L. We found a significant correlation between the severity of diarrhea and zinc deficiency in patients with acute diarrhea. Conclusion: The proportion of zinc deficiency in acute diarrhea patients was quite large although the mean serum zinc level was still below the National Health and Nutrition Examination Survey (NHANES) reference value. The severity of diarrhea has been proven to be significant that affects zinc deficiency in acute diarrhea patients

Data mining experiments on the Angiotensin II-Antagonist in Paroxysmal Atrial Fibrillation (ANTIPAF-AFNET 2) trial: ‘Exposing the invisible’

Aims: The aims of this study include (i) pursuing data-mining experiments on the Angiotensin II-Antagonist in Paroxysmal Atrial Fibrillation (ANTIPAF-AFNET 2) trial dataset containing atrial fibrillation (AF) burden scores of patients with many clinical parameters and (ii) revealing possible correlations between the estimated risk factors of AF and other clinical findings or measurements provided in the dataset. Methods: Ranking Instances by Maximizing the Area under a Receiver Operating Characteristics (ROC) Curve (RIMARC) is used to determine the predictive weights (Pw) of baseline variables on the primary endpoint. Chi-square automatic interaction detector algorithm is performed for comparing the results of RIMARC. The primary endpoint of the ANTIPAF-AFNET 2 trial was the percentage of days with documented episodes of paroxysmal AF or with suspected persistent AF. Results: By means of the RIMARC analysis algorithm, baseline SF-12 mental component score (Pw = 0.3597), age (Pw = 0.2865), blood urea nitrogen (BUN) (Pw = 0.2719), systolic blood pressure (Pw = 0.2240), and creatinine level (Pw = 0.1570) of the patients were found to be predictors of AF burden. Atrial fibrillation burden increases as baseline SF-12 mental component score gets lower; systolic blood pressure, BUN and creatinine levels become higher; and the patient gets older. The AF burden increased significantly at age >76. Conclusions: With the ANTIPAF-AFNET 2 dataset, the present data-mining analyses suggest that a baseline SF-12 mental component score, age, systolic blood pressure, BUN, and creatinine level of the patients are predictors of AF burden. Additional studies are necessary to understand the distinct kidney-specific pathophysiological pathways that contribute to AF burden. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016

Teratogenic risk and contraceptive counselling in psychiatric practice: analysis of anticonvulsant therapy

<p>Background: Anticonvulsants have been used to manage psychiatric conditions for over 50 years. It is recognised that some, particularly valproate, carbamazepine and lamotrigine, are human teratogens, while others including topiramate require further investigation. We aimed to appraise the documentation of this risk by psychiatrists and review discussion around contraceptive issues.</p> <p>Methods: A retrospective review of prescribing patterns of four anticonvulsants (valproate, carbamazepine, lamotrigine and topiramate) in women of child bearing age was undertaken. Documented evidence of discussion surrounding teratogenicity and contraceptive issues was sought.</p> <p>Results: Valproate was most commonly prescribed (n=67). Evidence of teratogenic risk counselling at medication initiation was sub-optimal – 40% of individuals prescribed carbamazepine and 22% of valproate. Documentation surrounding contraceptive issues was also low- 17% of individuals prescribed carbamazepine and 13% of valproate.</p> <p>Conclusion: We found both low rates of teratogenic risk counselling and low rates of contraception advice in our cohort. Given the high rates of unplanned pregnancies combined with the relatively high risk of major congenital malformations, it is essential that a detailed appraisal of the risks and benefits associated with anticonvulsant medication occurs and is documented within patients’ psychiatric notes.</p&gt

The European Network for Translational Research in Atrial Fibrillation (EUTRAF): objectives and initial results.

Atrial fibrillation (AF) is the most common sustained arrhythmia in the general population. As an age-related arrhythmia AF is becoming a huge socio-economic burden for European healthcare systems. Despite significant progress in our understanding of the pathophysiology of AF, therapeutic strategies for AF have not changed substantially and the major challenges in the management of AF are still unmet. This lack of progress may be related to the multifactorial pathogenesis of atrial remodelling and AF that hampers the identification of causative pathophysiological alterations in individual patients. Also, again new mechanisms have been identified and the relative contribution of these mechanisms still has to be established. In November 2010, the European Union launched the large collaborative project EUTRAF (European Network of Translational Research in Atrial Fibrillation) to address these challenges. The main aims of EUTRAF are to study the main mechanisms of initiation and perpetuation of AF, to identify the molecular alterations underlying atrial remodelling, to develop markers allowing to monitor this processes, and suggest strategies to treat AF based on insights in newly defined disease mechanisms. This article reports on the objectives, the structure, and initial results of this network

Proximity effects and Andreev reflection in mesoscopic SNS junction with perfect NS interfaces

Low temperature transport measurements on superconducting film - normal metal wire - superconducting film (SNS) junctions fabricated on the basis of 6 nm thick superconducting polycrystalline PtSi films are reported. The structures with the normal metal wires of two different lengths L=1.5 $\mu$m and L=6$\mu$m and the same widths W=0.3$\mu$m are studied. Zero bias resistance dip related to pair current proximity effect is observed for all junctions whereas the subharmonic energy gap structure originating from phase coherent multiple Andreev reflections have occurs only in the SNS junctions with short wires.Comment: ReVTex, 4 pages, 4 eps figures include

Separately contacted edge states: A new spectroscopic tool for the investigation of the quantum Hall effect

Using an innovative combination of a quasi-Corbino sample geometry and the cross-gate technique, we have developed a method that enables us to separately contact single edge channels in the quantum Hall regime and investigate equilibration among them. Performing 4-point resistance measurements, we directly obtain information on the energetic and geometric structure of the edge region and the equilibration-length for current transport across the Landau- as well as the spin-gap. Based on an almost free choice in the number of participating edge channels and their interaction-length a systematic investigation of the parameter-space becomes possible.Comment: 8 pages, 7 figure

Hepatopulmonary hydatidosis in a ten-year-old girl: a case report

<p>Abstract</p> <p>Introduction</p> <p>Hydatid disease is a parasitic infection caused by the tapeworm <it>Echinococcus granulosus </it>and is characterised by cystic lesions in the liver and lungs. Concomitant pulmonary and hepatic localization of hydatid cysts in childhood is unusual and represents a distinct clinical entity called hepatopulmonary hydatidosis.</p> <p>Case presentation</p> <p>A ten-year-old Caucasian girl, a permanent resident of rural Greece, was admitted to hospital reporting a nonspecific symptomatology compatible with a diagnosis of viral infection. Chest radiography revealed a large homogenous circular opacity in the right lung field. On the basis of imaging studies, a diagnosis of hydatidosis was made with synchronous hepatic and pulmonary involvement, successfully managed through a single-stage transthoracic surgical approach.</p> <p>Conclusion</p> <p>This case report highlights the necessity of realizing that hydatid disease continues to be a public health problem, which often remains asymptomatic for years. Therefore, the presence of any homogeneous cystic spherical opacity on routine chest radiography should raise the suspicion of hydatid disease, mainly in endemic areas such as Greece. General practitioners and physicians involved in pediatric care need to be familiar with the diagnosis and management of the variable clinical manifestations of hydatid disease. Taking into consideration that hepatopulmonary hydatidosis represents a special entity that requires a different therapeutic approach may positively affect its economic and social-related burden.</p

Colitis Tuberculosis

Tuberculosis (TB) is a significant public health problem worldwide. Indonesia is a country with the third highest prevalence of TB in the world after China and India. TB infection can attack all organs of the human body. TB in digestive system is one of the extrapulmonary TB manifestations and comprises of 3- 16% of all extrapulmonary TB cases. This type of TB may affect digestive system, peritoneum, mesentery lymphatic glands, liver, and spleen. Digestive system is affected in 66-75% of patients with abdominal TB. The ileocaecal region is most commonly affected. The manifestation of abdominal TB is not specific. Precise diagnostic approach and supporting results are needed to determine final diagnosis. However, there is no single examination adequate enough to diagnose abdominal TB. If the diagnosis can be established early, this disease could then be managed with conventional anti-TB drugs. Treatment for both 6-9 months period and 18-24 months period has been proven effective in management of extrapulmonary TB. In countries with high abdominal TB prevalence, initiation of anti-TB therapy is allowed if there are the clinical features present. Diagnosis can be determined when the patient has therapeutic response against the the anti-TB treatment

Application of the RIMARC algorithm to a large data set of action potentials and clinical parameters for risk prediction of atrial fibrillation

Ex vivo recorded action potentials (APs) in human right atrial tissue from patients in sinus rhythm (SR) or atrial fibrillation (AF) display a characteristic spike-and-dome or triangular shape, respectively, but variability is huge within each rhythm group. The aim of our study was to apply the machine-learning algorithm ranking instances by maximizing the area under the ROC curve (RIMARC) to a large data set of 480 APs combined with retrospectively collected general clinical parameters and to test whether the rules learned by the RIMARC algorithm can be used for accurately classifying the preoperative rhythm status. APs were included from 221 SR and 158 AF patients. During a learning phase, the RIMARC algorithm established a ranking order of 62 features by predictive value for SR or AF. The model was then challenged with an additional test set of features from 28 patients in whom rhythm status was blinded. The accuracy of the risk prediction for AF by the model was very good (0.93) when all features were used. Without the seven AP features, accuracy still reached 0.71. In conclusion, we have shown that training the machine-learning algorithm RIMARC with an experimental and clinical data set allows predicting a classification in a test data set with high accuracy. In a clinical setting, this approach may prove useful for finding hypothesis-generating associations between different parameters. © 2014, International Federation for Medical and Biological Engineering