Search results for: high risk cardiac patients.

Authors: Marcos A. Dullius, Ramon C. Fernandes, Divanízia N. Souza

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The aim of this study was to develop a dynamic cardiac phantom for quality control in myocardial scintigraphy. The dynamic heart phantom constructed only contained the left ventricle, made of elastic material (latex), comprising two cavities: one internal and one external. The data showed a non-significant variation in the values of left ventricular ejection fraction (LVEF) obtained by varying the heart rate. It was also possible to evaluate the ejection fraction (LVEF) through different arrays of image acquisition and to perform an intercomparison of LVEF by two different scintillation cameras. The results of the quality control tests were satisfactory, showing that they can be used as parameters in future assessments. The new dynamic heart phantom was demonstrated to be effective for use in LVEF measurements. Therefore, the new heart simulator is useful for the quality control of scintigraphic cameras.

Keywords: sheart, nuclear medicine, phantom

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Authors: Renato Dedic, Madjid Allili, Roger Lecomte, Adbelhamid Benchakroun

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The class of geometric deformable models, so-called level sets, has brought tremendous impact to medical imagery. In this paper we present yet another application of level sets to medical imaging. The method we give here will in a way modify the speed term in the standard level sets equation of motion. To do so we build a potential based on the distance and the gradient of the image we study. In turn the potential gives rise to the force field: F~F(x, y) = P ∀(p,q)∈I ((x, y) - (p, q)) |ÔêçI(p,q)| |(x,y)-(p,q)| 2 . The direction and intensity of the force field at each point will determine the direction of the contour-s evolution. The images we used to test our method were produced by the Univesit'e de Sherbrooke-s PET scanners.

Keywords: PET, Cardiac, Heart, Mouse, Geodesic, Geometric, Level Sets, Deformable Models, Edge Detection, Segmentation.

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Authors: James A. Nelson

Abstract:

The history of technology and banking is examined as it relates to risk and technological determinism. It is proposed that the services that banks offer are determined by technology and that banks must adopt new technologies to be competitive. The adoption of technologies paradoxically forces the adoption of other new technologies to protect the bank from the increased risk of technology. This cycle will lead to bank examiners and regulators to focus on human behavior, not on the ever changing technology.

Keywords: Banking, information security, risk, technologicaldeterminism.

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Authors: Luc Cessieux, French Navy, Adrien Derock, DCNS/IMATH

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Security risk models have been successful in estimating the likelihood of attack for simple security threats. However, modeling complex system and their security risk is even a challenge. Many methods have been proposed to face this problem. Often difficult to manipulate, and not enough all-embracing they are not as famous as they should with administrators and deciders. We propose in this paper a new tool to model big systems on purpose. The software, takes into account attack threats and security strength.

Keywords: Security, risk management, threat, modelization.

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Authors: Nermin Ozgulbas, Ali Serhan Koyuncugil

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One of the biggest problems of SMEs is their tendencies to financial distress because of insufficient finance background. In this study, an Early Warning System (EWS) model based on data mining for financial risk detection is presented. CHAID algorithm has been used for development of the EWS. Developed EWS can be served like a tailor made financial advisor in decision making process of the firms with its automated nature to the ones who have inadequate financial background. Besides, an application of the model implemented which covered 7,853 SMEs based on Turkish Central Bank (TCB) 2007 data. By using EWS model, 31 risk profiles, 15 risk indicators, 2 early warning signals, and 4 financial road maps has been determined for financial risk mitigation.

Keywords: Early Warning Systems, Data Mining, Financial Risk, SMEs.

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Authors: Razan Salem

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Men and women have different approaches towards investing, both in terms of strategies and risk attitudes. This study aims to focus mainly on investigating the financial risk behaviors of Arab women investors and to examine the financial risk tolerance levels of Arab women relative to Arab men investors. Using survey data on 547 Arab men and women investors, the results of Wilcoxon Signed-Rank (One-Sample) test Mann-Whitney U test reveal that Arab women are risk-averse investors and have lower financial risk tolerance levels relative to Arab men. Such findings can be explained by the fact of women's nature and lower investment literacy levels. Further, the current political uncertainty in the Arab region may be considered as another explanation of Arab women’s risk aversion behavior. The study's findings support the existing literature by validating the stereotype of “women are more risk-averse than men” in the Arab region. Overall, when it comes to investment and financial behaviors, women around the world behave similarly.

Keywords: Arab region, financial risk behavior, gender differences, women investors.

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Authors: Anders Thorsèn, Behrooz Sangchoolie, Peter Folkesson, Ted Strandberg

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As more parts of the power grid become connected to the internet, the risk of cyberattacks increases. To identify the cybersecurity threats and subsequently reduce vulnerabilities, the common practice is to carry out a cybersecurity risk assessment. For safety classified systems and products, there is also a need for safety risk assessments in addition to the cybersecurity risk assessment to identify and reduce safety risks. These two risk assessments are usually done separately, but since cybersecurity and functional safety are often related, a more comprehensive method covering both aspects is needed. Some work addressing this has been done for specific domains like the automotive domain, but more general methods suitable for, e.g., Intelligent Distributed Grids, are still missing. One such method from the automotive domain is the Security-Aware Hazard Analysis and Risk Assessment (SAHARA) method that combines safety and cybersecurity risk assessments. This paper presents an approach where the SAHARA method has been modified to be more suitable for larger distributed systems. The adapted SAHARA method has a more general risk assessment approach than the original SAHARA. The proposed method has been successfully applied on two use cases of an intelligent distributed grid.

Keywords: Intelligent distribution grids, threat analysis, risk assessment, safety, cybersecurity.

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Authors: Ehsan Bashiri

Abstract:

A 7-step method (with 25 sub-steps) to assess risk of air pollutants is introduced. These steps are: pre-considerations, sampling, statistical analysis, exposure matrix and likelihood, doseresponse matrix and likelihood, total risk evaluation, and discussion of findings. All mentioned words and expressions are wellunderstood; however, almost all steps have been modified, improved, and coupled in such a way that a comprehensive method has been prepared. Accordingly, the SADRA (Statistical Analysis-Driven Risk Assessment) emphasizes extensive and ongoing application of analytical statistics in traditional risk assessment models. A Sulfur Dioxide case study validates the claim and provides a good illustration for this method.

Keywords: Criteria air pollutants, Matrix of risk, Riskassessment, Statistical analysis.

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Authors: E. Harrer, M. Mauerhofer, T. Werginz

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As a result of intensive competition, the building sector is suffering from a high degree of rivalry. Furthermore, there can be observed an unbalanced distribution of project risks. Clients are aimed to shift their own risks into the sphere of the constructors or planners. The consequence of this is that the number of conflicts between the involved parties is inordinately high or even increasing; an alternative approach to counter on that developments are cooperative project forms in the construction sector. This research compares conventional contract models and models with partnering agreements to examine the influence on project risks by an early integration of the involved parties. The goal is to show up deviations in different project stages from the design phase to the project transfer phase. These deviations are evaluated by a survey of experts from the three spheres: clients, contractors and planners. By rating the influence of the participants on specific risk factors it is possible to identify factors which are relevant for a smooth project execution.

Keywords: Collaborative work, construction industry, contract-models, influence, partnering, project management, risk.

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Authors: Aparna Viswanath

Abstract:

Electricity spot prices are highly volatile under optimal generation capacity scenarios due to factors such as nonstorability of electricity, peak demand at certain periods, generator outages, fuel uncertainty for renewable energy generators, huge investments and time needed for generation capacity expansion etc. As a result market participants are exposed to price and volume risk, which has led to the development of risk management practices. This paper provides an overview of risk management practices by market participants in electricity markets using financial derivatives.

Keywords: Financial Derivatives, Forward, Futures, Options, Risk Management.

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Authors: Imen Dhaou

Abstract:

This study examines conditional Value at Risk by applying the GJR-EVT-Copula model, and finds the optimal portfolio for eight Dow Jones Islamic-conventional pairs. Our methodology consists of modeling the data by a bivariate GJR-GARCH model in which we extract the filtered residuals and then apply the Peak over threshold model (POT) to fit the residual tails in order to model marginal distributions. After that, we use pair-copula to find the optimal portfolio risk dependence structure. Finally, with Monte Carlo simulations, we estimate the Value at Risk (VaR) and the conditional Value at Risk (CVaR). The empirical results show the VaR and CVaR values for an equally weighted portfolio of Dow Jones Islamic-conventional pairs. In sum, we found that the optimal investment focuses on Islamic-conventional US Market index pairs because of high investment proportion; however, all other index pairs have low investment proportion. These results deliver some real repercussions for portfolio managers and policymakers concerning to optimal asset allocations, portfolio risk management and the diversification advantages of these markets.

Keywords: CVaR, Dow Jones Islamic index, GJR-GARCH-EVT-pair copula, portfolio optimization.

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Authors: Daniel F. García, Adrián Fernández

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Today, computer systems are more and more complex and support growing security risks. The security managers need to find effective security risk assessment methodologies that allow modeling well the increasing complexity of current computer systems but also maintaining low the complexity of the assessment procedure. This paper provides a brief analysis of common security risk assessment methodologies leading to the selection of a proper methodology to fulfill these requirements. Then, a detailed analysis of the most effective methodology is accomplished, presenting numerical examples to demonstrate how easy it is to use.

Keywords: Computer security, qualitative and quantitative methods, risk assessment methodologies, security risk assessment.

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Authors: O. E. Okafor, L. U. S. Ezeanyika, C. G. Nkwonta, C. J. Okonkwo

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The effect of processing on plasma lipid profile and atherogenic indices of rats fed Artocarpus heterophyllus seed diets at different concentrations were investigated. Fifty five rats were used for this study, they were divided into eleven groups of five rats each (one control group and ten test groups), the test groups were fed raw, boiled, roasted, fermented and soaked diets at 10% and 40% concentrations. The study lasted for thirty five days. The diets led to significant decrease (p<0.05) in plasma cholesterol and triacylglycerol of rats fed 10% and 40% concentrations of the diets, and a significant increase (p<0.05) in high density lipoprotein (HDL) levels at 40% concentrations of the test diets. The diets also produced decrease in low density lipoprotein (LDL), very low density lipoprotein (VLDL), cardiac risk ratio (CRR), atherogenic index of plasma (AIP) and atherogenic coefficient (AC) at 40% concentrations except the soaked group that showed slight elevation of LDL, CRR, AC and AIP at 40% concentration. Artocarpus heterophyllus seeds could be beneficial to health because of its ability to increase plasma HDL and reduce plasma LDL, VLDL, cholesterol, triglycerides and atherogenic indices at higher diet concentration.

Keywords: Artocarpus heterophyllus, atherogenic indices, concentrations, lipid profile.

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Authors: H. Merhni, A. Sbiti, I. Ratbi, A. Sefiani

Abstract:

The proximal spinal muscular atrophy (SMA) is a group of neuromuscular disorders characterized by progressive muscle weakness due to the degeneration and loss of anterior motor neurons of the spinal cord. Depending on the age of onset of symptoms and their evolution, four types of SMA, varying in severity, result in a mutations of the SMN gene (survival of Motor neuron). We have analyzed the DNA of 295 patients referred to our genetic counseling; since January 1996 until October 2014; for suspected SMA. The homozygous deletion of exon 7 of the SMN gene was found in 133 patients; of which, 40.6% were born to consanguineous parents. In countries like Morocco, where the frequency of heterozygotes for SMA is high, genetic testing should be offered as first-line and, after careful clinical assessment, especially in newborns and infants with congenital hypotonia unexplained and prognosis compromise. The molecular diagnosis of SMA allows a quick and certainly diagnosis, provide adequate genetic counseling for families at risk and suggest, for couples who want prenatal diagnosis. The analysis of the SMN gene is a perfect example of genetic testing with an excellent cost/benefit ratio that can be of great interest in public health, especially in low-income countries. We emphasize in this work for the benefit of the generalization of molecular diagnosis of SMA by the technique of PCR-enzymatic digestion in other centers in Morocco.

Keywords: Exon7, PCR-digestion, SMA, SMN gene.

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Authors: Mahmoud A. El-Banna

Abstract:

The need to increase the efficiency of health care systems is becoming an obligation, and one of area of improvement is the discharge process. The objective of this work is to minimize the patients discharge time (for insured patients) to be less than 50 minutes by using six sigma approach, this improvement will also: lead to an increase in customer satisfaction, increase the number of admissions and turnover on the rooms, increase hospital profitability.Three different departments were considered in this study: Female, Male, and Paediatrics. Six Sigma approach coupled with simulation has been applied to reduce the patients discharge time for pediatrics, female, and male departments at hospital. Upon applying these recommendations at hospital: 60%, 80%, and 22% of insured female, male, and pediatrics patients respectively will have discharge time less than the upper specification time i.e. 50 min.

Keywords: Discharge Time, Healthcare, Hospitals, Patients, Process Improvement, Six Sigma, Simulation

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Authors: D. A. Binas, M. Konidari, C. Bourgioti, L. Angela Moulopoulou, T. L. Economopoulos, G. K. Matsopoulos

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High grade ovarian epithelial cancer (OEC) is the most fatal gynecological cancer and poor prognosis of this entity is closely related to considerable intratumoral genetic heterogeneity. By examining imaging data, it is possible to assess the heterogeneity of tumorous tissue. This study presents a methodology for aligning, segmenting and finally visualizing information from various magnetic resonance imaging series, in order to construct 3D models of heterogeneity maps from the same tumor in OEC patients. The proposed system may be used as an adjunct digital tool by health professionals for personalized medicine, as it allows for an easy visual assessment of the heterogeneity of the examined tumor.

Keywords: K-means segmentation, ovarian epithelial cancer, quantitative characteristics, registration, tumor visualization.

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Authors: Nina V. Zaitseva, Pavel Z. Shur, Nina G. Atiskova

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Nowadays harmonization of sanitary and hygienic standards of environmental quality with international standards is crucial part of integration of Russia into the international community. Harmonization of Russian and international ambient air quality standards may be realized by risk-based standards development. In this paper approaches to risk-based standards development and examples of these approaches implementation are presented.

Keywords: Harmonization, health risk assessment, evolutionary modelling, benchmark level, nickel, manganese.

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Authors: Eberechi Weli, Michael Todinov

Abstract:

The gap between the selection of risk-reduction options in the railway industry and the task of their effective implementation results in compromised safety and substantial losses. An effective risk management must necessarily integrate the evaluation phases with the implementation phase. This paper proposes an essential categorisation of risk reduction measures that best addresses a standard railway industry portfolio. By categorising the risk reduction options into design, operational, procedural and technical options, it is guaranteed that the efforts of the implementation facilitators (people, processes and supporting systems) are systematically harmonised. The classification is based on an integration of fundamental principles of risk reduction in the railway industry with the systems engineering approach.

This paper argues that the use of a similar classification approach is an attribute of organisations possessing a superior level of risk-reduction readiness. The integration of the proposed rational classification structure provides a solid ground for effective risk reduction.

Keywords: Cost effectiveness, organisational readiness, risk reduction, railway, system engineering.

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Authors: Fong-Woon Lai

Abstract:

The risk sphere in business is fast changing and expanding. Almost anything has become a risk factor that will have potent, direct, and far reaching impacts on business. This paper examines the intensity of enterprise risk management (ERM) practices among the Malaysian public listed companies. The paper espouses a ERM framework comprising fourteen important implementation elements and processes. Results of the analysis indicate that the intensity of ERM implementation among the respondents is in the ‘good’ category of the semantic scale, which is deemed encouraging vis-à-vis the country’s regulatory regime.

Keywords: Enterprise risk management, implementation framework, ERM practices.

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Authors: Anthony Bawa, Konstantinos Banitsas

Abstract:

Rheumatism is a muscular disorder that affects the muscles of the upper and lower limbs. This condition could potentially progress to impair the movement of patients. This study aims to investigate the hip muscular imbalance in patients with chronic rheumatism. A clinical trial involving a total of 15 participants, made up of 10 patients and five control subjects, took place in KATH Hospital between August and September. Participants recruited for the study were of age 54 ± 8 years, weight 65 ± 8 kg, and height 176 ± 8 cm. Muscle signals were recorded from the rectus femoris, and vastus lateralis on the right and left hip of participants. The parameters used in determining the hip muscular imbalances were the maximum voluntary contraction (MVC%), the mean difference, and hip muscle fatigue levels. The mean signals were compared using a t-test, and the metrics for muscle fatigue assessment were based on the root mean square (RMS), mean absolute value (MAV) and mean frequency (MEF), which were computed between the hip muscles of participants. The results indicated that there were significant imbalances in the muscle coactivity between the right and left hip muscles of patients. The patients’ MVC values were observed to be above 10% when compared with control subjects. Furthermore, the mean difference was seen to be higher with p > 0.002 among patients, which indicated clear differences in the hip muscle contraction activities. The findings indicate significant hip muscular imbalances for patients with rheumatism compared with control subjects. Information about the imbalances among patients will be useful for clinicians in designing therapeutic muscle-strengthening exercises.

Keywords: Muscular, imbalances, rheumatism, hip.

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Authors: Preeda Sansakorn, Min An

Abstract:

In order to be capable of dealing with uncertainties, subjectivities, including vagueness arising in building construction projects, the application of fuzzy reasoning technique based on fuzzy set theory is proposed. This study contributes significantly to the development of a fuzzy reasoning safety risk assessment model for building construction projects that could be employed to assess the risk magnitude of each hazardous event identified during construction, and a third parameter of probability of consequence is incorporated in the model. By using the proposed safety risk analysis methodology, more reliable and less ambiguities, which provide the safety risk management project team for decision-making purposes.

Keywords: Safety risks assessment, building construction safety, fuzzy reasoning, construction risk assessment model, building construction projects.

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Authors: Huei-Wen Lin

Abstract:

This paper is to clarify the relationship of individual investor types, risk tolerance and herding bias. The questionnaire survey investigation is conducted to collect 389 valid and voluntary individual investors and to examine how the risk tolerance plays as a mediator between four types of personality and herding bias. Based on featuring BB&K model and reviewing the prior literature of psychology, a linear structural model are constructed and further used to evaluate the path of herding formation through the analysis of Structural Equation Modeling (SEM). The results showed that more impetuous investors would be prone to herding bias directly, but rather exhibit higher risk tolerance. However, risk tolerance would fully mediate between the level of confidence (i.e., confident or anxious) and herding bias, but not mediate between the method of action (careful or impetuous) for individual investors.

Keywords: Herding, investor types, risk tolerance.

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Authors: Weiming Hu, Xu Li, Xiaonan Li, Zhong Xu, Li Yuan, Xuan Dong

Abstract:

Maneuver decision-making plays a critical role in high-performance intelligent driving. This paper proposes a risk assessment-based decision-making network (RADMN) to address the problem of driving strategy for the commercial vehicle. RADMN integrates two networks, aiming at identifying the risk degree of collision and rollover and providing decisions to ensure the effectiveness and reliability of driving strategy. In the risk assessment module, risk degrees of the backward collision, forward collision and rollover are quantified for hazard recognition. In the decision module, a deep reinforcement learning based on multi-objective optimization (DRL-MOO) algorithm is designed, which comprehensively considers the risk degree and motion states of each traffic participant. To evaluate the performance of the proposed framework, Prescan/Simulink joint simulation was conducted in highway scenarios. Experimental results validate the effectiveness and reliability of the proposed RADMN. The output driving strategy can guarantee the safety and provide key technical support for the realization of autonomous driving of commercial vehicles.

Keywords: Decision-making strategy, risk assessment, multi-objective optimization, commercial vehicle.

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Authors: Youngseok Lee, Dongjin Chung, Youngjin Kim

Abstract:

R&D risk management has been suggested as one of the management approaches for accomplishing the goals of public R&D investment. The investment in basic science and core technology development is the essential roles of government for securing the social base needed for continuous economic growth. And, it is also an important role of the science and technology policy sectors to generate a positive environment in which the outcomes of public R&D can be diffused in a stable fashion by controlling the uncertainties and risk factors in advance that may arise during the application of such achievements to society and industry. Various policies have already been implemented to manage uncertainties and variables that may have negative impact on accomplishing public R& investment goals. But we may derive new policy measures for complementing the existing policies and for exploring progress direction by analyzing them in a policy package from the viewpoint of R&D risk management.

Keywords: Risk management, Public R&D policy, Science andtechnology policy, Performance management.

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Authors: Mitsuhiro Taniyama, Yuu Hidaka, Masato Arai, Satoshi Kai, Hiromi Igawa, Hiroshi Yajima, Ryoichi Sasaki

Abstract:

Along with the progress of our information society, various risks are becoming increasingly common, causing multiple social problems. For this reason, risk communications for establishing consensus among stakeholders who have different priorities have become important. However, it is not always easy for the decision makers to agree on measures to reduce risks based on opposing concepts, such as security, privacy and cost. Therefore, we previously developed and proposed the “Multiple Risk Communicator" (MRC) with the following functions: (1) modeling the support role of the risk specialist, (2) an optimization engine, and (3) displaying the computed results. In this paper, MRC program version 1.0 is applied to the personal information leakage problem. The application process and validation of the results are discussed.

Keywords: Decision Making, Personal Information Leakage Problem, Risk Communication, Risk Management

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Authors: Sadovska V.

Abstract:

The progress of concentrations of particular heavy metals was assessed in chosen localities in region Moravia, the Czech Republic, from 2007 to 2009. Particular metals were observed in localities with various types and characterization of zone. Pb, Ni, As and Cd were emphasized as a result of their toxicity and potential adverse health effect to the exposed population. The progress of metal concentrations and their health effects in the most polluted localities were examined. According to the results, the air pollution limit values were not exceeded. Based on the health risk assessment, the probability of developing tumorous diseases is acceptable, except for the increased probability of cancer risk from long-term exposure to As.

Keywords: Air pollution, heavy metals, health risk assessment, individual lifetime cancer risk

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Authors: L. Lindsay, S. A. Coleman, D. Kerr, B. J. Taylor, A. Moorhead

Abstract:

Cognitive decline and frailty is apparent in older adults leading to an increased likelihood of the risk of falling. Currently health care professionals have to make professional decisions regarding such risks, and hence make difficult decisions regarding the future welfare of the ageing population. This study uses health data from The Irish Longitudinal Study on Ageing (TILDA), focusing on adults over the age of 50 years, in order to analyse health risk factors and predict the likelihood of falls. This prediction is based on the use of machine learning algorithms whereby health risk factors are used as inputs to predict the likelihood of falling. Initial results show that health risk factors such as long-term health issues contribute to the number of falls. The identification of such health risk factors has the potential to inform health and social care professionals, older people and their family members in order to mitigate daily living risks.

Keywords: Classification, falls, health risk factors, machine learning, older adults.

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Authors: Mária Hudáková, Mária Lusková

Abstract:

This report is focused on widening the theoretical knowledge as well as controlling practical application from the risk management point of view, regarding to dynamic business changes that have occurred in Slovakia which recently has been considered to be an environment full of risk and uncertainty. The idea of the report is the proposal of the controlling operation model in the course of risk management process in an enterprise operating in Slovakia, by which the controller is able to identify early risk factors in suggested major areas of the business management upon appropriate business information integration, consecutive control and prognoses and to prepare in time full-value documents in order to suggest measures for reduction thereof. Dealing with risk factors, that can quickly limit the growth potential of the enterprise, is an essential part of managerial activities on each level. This is the reason why mutual unofficial, ergo collegial cooperation of individual departments is necessary for controlling application from the business risk management point of view. An important part of the report is elaborated survey of the most important risk factors existing in major management areas of enterprises operating in Slovakia. The outcome of the performed survey is a catalogue of the most important enterprise risk factors. The catalogue serves for better understanding risk factors affecting the Slovak enterprises, their importance and evaluation.

Keywords: Controlling, information system, risks management, risk factor, crisis of enterprise.

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Authors: Nader Nabhani, Amir Tofighi

Abstract:

Nanotechnology is the science of creating, using and manipulating objects which have at least one dimension in range of 0.1 to 100 nanometers. In other words, nanotechnology is reconstructing a substance using its individual atoms and arranging them in a way that is desirable for our purpose. The main reason that nanotechnology has been attracting attentions is the unique properties that objects show when they are formed at nano-scale. These differing characteristics that nano-scale materials show compared to their nature-existing form is both useful in creating high quality products and dangerous when being in contact with body or spread in environment. In order to control and lower the risk of such nano-scale particles, the main following three topics should be considered: 1) First of all, these materials would cause long term diseases that may show their effects on body years after being penetrated in human organs and since this science has become recently developed in industrial scale not enough information is available about their hazards on body. 2) The second is that these particles can easily spread out in environment and remain in air, soil or water for very long time, besides their high ability to penetrate body skin and causing new kinds of diseases. 3) The third one is that to protect body and environment against the danger of these particles, the protective barriers must be finer than these small objects and such defenses are hard to accomplish. This paper will review, discuss and assess the risks that human and environment face as this new science develops at a high rate.

Keywords: Nanotechnology, risk assessment, environment.

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Authors: Mustafa M. Donma, Orkide Donma

Abstract:

Metabolic syndrome (MetS) is a severe health problem caused by morbid obesity, the severest form of obesity. The components of MetS are rather stable in adults. However, the diagnosis of MetS in morbid obese (MO) children still constitutes a matter of discussion. The aim of this study was to develop a formula, which facilitated the diagnosis of MetS in MO children and was capable of discriminating MO children with and without MetS findings. The study population comprised MO children. Age and sex-dependent body mass index (BMI) percentiles of the children were above 99. Increased blood pressure, elevated fasting blood glucose (FBG), elevated triglycerides (TRG) and/or decreased high density lipoprotein cholesterol (HDL-C) in addition to central obesity were listed as MetS components for each child. Two groups were constituted. In the first group, there were 42 MO children without MetS components. Second group was composed of 44 MO children with at least two MetS components. Anthropometric measurements including weight, height, waist and hip circumferences were performed during physical examination. BMI and homeostatic model assessment of insulin resistance (HOMA-IR) values were calculated. Informed consent forms were obtained from the parents of the children. Institutional Non-Interventional Clinical Studies Ethics Committee approved the study design. Routine biochemical analyses including FBG, insulin (INS), TRG, HDL-C were performed. The performance and the clinical utility of Diagnostic Obesity Notation Model Assessment Metabolic Syndrome Index (DONMA MetS index) [(INS/FBG)/(HDL-C/TRG)*100] was tested. Appropriate statistical tests were applied to the study data. p value smaller than 0.05 was defined as significant. MetS index values were 41.6 ± 5.1 in MO group and 104.4 ± 12.8 in MetS group. Corresponding values for HDL-C values were 54.5 ± 13.2 mg/dl and 44.2 ± 11.5 mg/dl. There was a statistically significant difference between the groups (p < 0.001). Upon evaluation of the correlations between MetS index and HDL-C values, a much stronger negative correlation was found in MetS group (r = -0.515; p = 0.001) in comparison with the correlation detected in MO group (r = -0.371; p = 0.016). From these findings, it was concluded that the statistical significance degree of the difference between MO and MetS groups was highly acceptable for this recently introduced MetS index. This was due to the involvement of all of the biochemically defined MetS components into the index. This is particularly important because each of these four parameters used in the formula is a cardiac risk factor. Aside from discriminating MO children with and without MetS findings, MetS index introduced in this study is important from the cardiovascular risk point of view in MetS group of children.

Keywords: Fasting blood glucose, high density lipoprotein cholesterol, insulin, metabolic syndrome, morbid obesity, triglycerides.

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