Smartphone electrocardiogram for detecting atrial fibrillation after a cerebral ischaemic event: a multicentre randomized controlled trial

Aims: Atrial fibrillation (AF) is a preventable cause of ischaemic stroke but it is often undiagnosed and undertreated. The utility of smartphone electrocardiogram (ECG) for the detection of AF after ischaemic stroke is unknown. The aim of this study is to determine the diagnostic yield of 30-day smartphone ECG recording compared with 24-h Holter monitoring for detecting AF ≥30 s. Methods and results: In this multicentre, open-label study, we randomly assigned 203 participants to undergo one additional 24-h Holter monitoring (control group, n = 98) vs. 30-day smartphone ECG monitoring (intervention group, n = 105) using KardiaMobile (AliveCor®, Mountain View, CA, USA). Major inclusion criteria included age ≥55 years old, without known AF, and ischaemic stroke or transient ischaemic attack (TIA) within the preceding 12 months. Baseline characteristics were similar between the two groups. The index event was ischaemic stroke in 88.5% in the intervention group and 88.8% in the control group (P = 0.852). AF lasting ≥30 s was detected in 10 of 105 patients in the intervention group and 2 of 98 patients in the control group (9.5% vs. 2.0%; absolute difference 7.5%; P = 0.024). The number needed to screen to detect one AF was 13. After the 30-day smartphone monitoring, there was a significantly higher proportion of patients on oral anticoagulation therapy at 3 months compared with baseline in the intervention group (9.5% vs. 0%, P = 0.002). Conclusions: Among patients ≥55 years of age with a recent cryptogenic stroke or TIA, 30-day smartphone ECG recording significantly improved the detection of AF when compared with the standard repeat 24-h Holter monitoring. Keywords: Anticoagulation; Atrial fibrillation; Cryptogenic stroke; Digital health; Smartphone electrocardiogram.

Meta-analysis Followed by Replication Identifies Loci in or near CDKN1B, TET3, CD80, DRAM1, and ARID5B as Associated with Systemic Lupus Erythematosus in Asians

Systemic lupus erythematosus (SLE) is a prototype autoimmune disease with a strong genetic involvement and ethnic differences. Susceptibility genes identified so far only explain a small portion of the genetic heritability of SLE, suggesting that many more loci are yet to be uncovered for this disease. In this study, we performed a meta-analysis of genome-wide association studies on SLE in Chinese Han populations and followed up the findings by replication in four additional Asian cohorts with a total of 5,365 cases and 10,054 corresponding controls. We identified genetic variants in or near CDKN1B, TET3, CD80, DRAM1, and ARID5B as associated with the disease. These findings point to potential roles of cell-cycle regulation, autophagy, and DNA demethylation in SLE pathogenesis. For the region involving TET3 and that involving CDKN1B, multiple independent SNPs were identified, highlighting a phenomenon that might partially explain the missing heritability of complex diseases

The level of knowledge, attitude and practice on complementary feeding among caregivers in Kampung Jeriah, Sibu, Sarawak from 23rd September 2013 to 8th December 2013

Background: The period for complementary feeding is crucial for young infants. Lack of awareness in knowledge, attitude and practice towards complementary feeding among caregivers will lead to improper practice of complementary feeding which may affect the health of children under their care. Objective: The purpose of this study is to determine the level of knowledge, attitude, and practice (KAP) on complementary feeding among caregivers in Kampung Jeriah, Sibu, Sarawak. Methods: This is a cross-sectional study done among 60 caregivers in Kampung Jeriah, Sibu, Sarawak. Non-probability sampling method was adopted to select at least one caregiver from each household in the village. A self-administered style of data collection was used. The data was analysed for descriptive data of mean, median, frequencies and standard deviation using SPSS version 20.0. Results: Among the respondents, the levels of KAP are 61.7%, 50% and 60% respectively. In this study, the respondents with lower income have significantly better knowledge regarding complementary feeding (p=0.01). The results also showed that respondents aged 25-44 years old had good practice towards complementary feeding as compared to younger or older group, which is reflected in the p value 0.032. Almost half of the respondents with good level of knowledge (48.6%) started to give complementary food to their child at age 6 months old. Conclusion: Generally, the respondents had a satisfactory level of knowledge and practices towards complementary feeding. However. the level of attitude on complementary feeding was relatively low compared to the level of knowledge and practice. Statistically, there was no significant correlation between the three components (knowledge, attitude and practice on complementary feeding). It was recommended that more health education should be held by the health authority on complementary feeding so that the knowledge, attitude and practice of caregivers on the topic could be improved. II