Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 239

Search results for: Acute coronary syndrome

239 Acute Coronary Syndrome Prediction Using Data Mining Techniques- An Application

Authors: Tahseen A. Jilani, Huda Yasin, Madiha Yasin, C. Ardil

Abstract:

In this paper we use data mining techniques to investigate factors that contribute significantly to enhancing the risk of acute coronary syndrome. We assume that the dependent variable is diagnosis – with dichotomous values showing presence or  absence of disease. We have applied binary regression to the factors affecting the dependent variable. The data set has been taken from two different cardiac hospitals of Karachi, Pakistan. We have total sixteen variables out of which one is assumed dependent and other 15 are independent variables. For better performance of the regression model in predicting acute coronary syndrome, data reduction techniques like principle component analysis is applied. Based on results of data reduction, we have considered only 14 out of sixteen factors.

Keywords: Acute coronary syndrome (ACS), binary logistic regression analyses, myocardial ischemia (MI), principle component analysis, unstable angina (U.A.).

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238 Microalbuminuria in Essential Hypertension

Authors: Sharan Badiger, Prema T. Akkasaligar, Sandeep HM, Biradar MS

Abstract:

Essential hypertension (HTN) usually clusters with other cardiovascular risk factors such as age, overweight, diabetes, insulin resistance and dyslipidemia. The target organ damage (TOD) such as left ventricular hypertrophy, microalbuminuria (MA), acute coronary syndrome (ACS), stroke and cognitive dysfunction takes place early in course of hypertension. Though the prevalence of hypertension is high in India, the relationship between microalbuminuria and target organ damage in hypertension is not well studied. This study aim at detecting MA in essential hypertension and its relation to severity of HTN, duration of HTN, body mass index (BMI), age and TOD such as HTN retinopathy and acute coronary syndrome The present study was done in 100 patients of essential hypertension non diabetics admitted to B.L.D.E.University-s Sri B.M.Patil Medical College, Bijapur, from October 2008 to April 2011. The patients underwent detailed history and clinical examination. Early morning 5 ml of urine sample was collected & MA was estimated by immunoturbidometry method. The relationship of MA with the duration & severity of HTN, BMI, age, sex and TOD's like hypertensive retinopathy, ACS was assessed by univariate analysis. The prevalence of MA in this study was found to be 63 %. In that 42% were male & 21% were female. In this study a significant association between MA and the duration of hypertension (p = 0.036) & (OR =0.438). Longer the duration of hypertension, more possibility of microalbumin in urine. Also there was a significant association between severity of hypertension and MA (p=0.045) and (OR=0.093). MA was positive in 50 (79.4%) patients out of 63, whose blood pressure was >160/100 mm Hg. In this study a significant association between MA and the grades of hypertensive retinopathy (p =0.011) and acute coronary syndrome (p = 0.041) (OR =2.805). Gender and BMI did not pose high risk for MA in this study.The prevalence of MA in essential hypertension is high in this part of the community and MA will increase the risk of developing target organ damage.Early screening of patients with essential hypertension for MA and aggressive management of positive cases might reduce the burden of chronic kidney diseases and cardiovascular diseases in the community.

Keywords: Acute coronary syndrome, Essential hypertension, Microalbuminuria, Target organ damage

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237 A Review of Pharmacological Prevention of Peri-and Post-Procedural Myocardial Injury after Percutaneous Coronary Intervention

Authors: Syed Dawood Md. Taimur, Md. Hasanur Rahman, Syeda Fahmida Afrin, Farzana Islam

Abstract:

The concept of myocardial injury, although first recognized from animal studies, is now recognized as a clinical phenomenon that may result in microvascular damage, no-reflow phenomenon, myocardial stunning, myocardial hibernation and ischemic preconditioning. The final consequence of this event is left ventricular (LV) systolic dysfunction leading to increased morbidity and mortality. The typical clinical case of reperfusion injury occurs in acute myocardial infarction (MI) with ST segment elevation in which an occlusion of a major epicardial coronary artery is followed by recanalization of the artery. This may occur spontaneously or by means of thrombolysis and/or by primary percutaneous coronary intervention (PCI) with efficient platelet inhibition by aspirin (acetylsalicylic acid), clopidogrel and glycoprotein IIb/IIIa inhibitors. In recent years, percutaneous coronary intervention (PCI) has become a well-established technique for the treatment of coronary artery disease. PCI improves symptoms in patients with coronary artery disease and it has been increasing safety of procedures. However, peri- and post-procedural myocardial injury, including angiographical slow coronary flow, microvascular embolization, and elevated levels of cardiac enzyme, such as creatine kinase and troponin-T and -I, has also been reported even in elective cases. Furthermore, myocardial reperfusion injury at the beginning of myocardial reperfusion, which causes tissue damage and cardiac dysfunction, may occur in cases of acute coronary syndrome. Because patients with myocardial injury is related to larger myocardial infarction and have a worse long-term prognosis than those without myocardial injury, it is important to prevent myocardial injury during and/or after PCI in patients with coronary artery disease. To date, many studies have demonstrated that adjunctive pharmacological treatment suppresses myocardial injury and increases coronary blood flow during PCI procedures. In this review, we highlight the usefulness of pharmacological treatment in combination with PCI in attenuating myocardial injury in patients with coronary artery disease.

Keywords: Coronary artery disease, Percutaneous coronary intervention, Myocardial injury, Pharmacology.

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236 Prone Positioning and Clinical Outcomes of Mechanically Ventilated Patients with Severe Acute Respiratory Distress Syndrome

Authors: Maha Salah Abdullah Ismail, Mahmoud M. Alsagheir, Mohammed Salah Abd Allah

Abstract:

Acute respiratory distress syndrome (ARDS) is characterized by permeability pulmonary edema and refractory hypoxemia. Lung-protective ventilation is still the key of better outcome in ARDS. Prone position reduces the trans-pulmonary pressure gradient, recruiting collapsed regions of the lung without increasing airway pressure or hyperinflation. Prone ventilation showed improved oxygenation and improved outcomes in severe hypoxemic patients with ARDS. This study evaluates the effect of prone positioning on mechanically ventilated patients with ARDS. A quasi-experimental design was carried out at Critical Care Units, on 60 patients. Two tools were utilized to collect data; Socio demographic, medical and clinical outcomes data sheet. Results of the present study indicated that prone position improves oxygenation in patients with severe respiratory distress syndrome. The study recommended that use prone position in patients with severe ARDS, as early as possible and for long sessions. Also, replication of this study on larger probability sample at the different geographical location is highly recommended.

Keywords: Acute respiratory distress syndrome, Critical care, Mechanical ventilation and Prone position.

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235 Computational Study on Cardiac-Coronary Interaction in Terms of Coronary Flow-Pressure Waveforms in Presence of Drugs: Comparison Between Simulated and In Vivo Data

Authors: C. De Lazzari, E. Del Prete, I. Genuini, F. Fedele

Abstract:

Cardiovascular human simulator can be a useful tool in understanding complex physiopathological process in cardiocirculatory system. It can also be a useful tool in order to investigate the effects of different drugs on hemodynamic parameters. The aim of this work is to test the potentiality of our cardiovascular numerical simulator CARDIOSIM© in reproducing flow/pressure coronary waveforms in presence of two different drugs: Amlodipine (AMLO) and Adenosine (ADO). In particular a time-varying intramyocardial compression, assumed to be proportional to the left ventricular pressure, was related to the venous coronary compliances in order to study its effects on the coronary blood flow and the flow/pressure loop. Considering that coronary circulation dynamics is strongly interrelated with the mechanics of the left ventricular contraction, relaxation, and filling, the numerical model allowed to analyze the effects induced by the left ventricular pressure on the coronary flow.

Keywords: Cardiovascular system, Coronary blood flow, Hemodynamic, Numerical simulation.

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234 The Association of Matrix Metalloproteinase-3 Gene -1612 5A/6A Polymorphism with Susceptibility to Coronary Artery Stenosis in an Iranian Population

Authors: M. Seifi, S. Fallah, M. Firoozrai

Abstract:

Matrix metalloproteinase-3 (MMP3) is key member of the MMP family, and is known to be present in coronary atherosclerotic. Several studies have demonstrated that MMP-3 5A/6A polymorphism modify each transcriptional activity in allele specific manner. We hypothesized that this polymorphism may play a role as risk factor for development of coronary stenosis. The aim of our study was to estimate MMP-3 (5A/6A) gene polymorphism on interindividual variability in risk for coronary stenosis in an Iranian population.DNA was extracted from white blood cells and genotypes were obtained from coronary stenosis cases (n=95) and controls (n=100) by PCR (polymerase chain reaction) and restriction fragment length polymorphism techniques. Significant differences between cases and controls were observed for MMP3 genotype frequencies (X2=199.305, p< 0.001); the 6A allele was less frequently seen in the control group, compared to the disease group (85.79 vs. 78%, 6A/6A+5A/6A vs. 5A/5A, P≤0.001). These data imply the involvement of -1612 5A/6A polymorphism in coronary stenosis, and suggest that probably the 6A/6A MMP-3 genotype is a genetic susceptibility factor for coronary stenosis.

Keywords: Coronary artery stenosis, matrixmetalloproteinase-3, polymorphism, polymerase chain reaction.

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233 Applying the Regression Technique for Prediction of the Acute Heart Attack

Authors: Paria Soleimani, Arezoo Neshati

Abstract:

Myocardial infarction is one of the leading causes of death in the world. Some of these deaths occur even before the patient reaches the hospital. Myocardial infarction occurs as a result of impaired blood supply. Because the most of these deaths are due to coronary artery disease, hence the awareness of the warning signs of a heart attack is essential. Some heart attacks are sudden and intense, but most of them start slowly, with mild pain or discomfort, then early detection and successful treatment of these symptoms is vital to save them. Therefore, importance and usefulness of a system designing to assist physicians in early diagnosis of the acute heart attacks is obvious. The main purpose of this study would be to enable patients to become better informed about their condition and to encourage them to seek professional care at an earlier stage in the appropriate situations. For this purpose, the data were collected on 711 heart patients in Iran hospitals. 28 attributes of clinical factors can be reported by patients; were studied. Three logistic regression models were made on the basis of the 28 features to predict the risk of heart attacks. The best logistic regression model in terms of performance had a C-index of 0.955 and with an accuracy of 94.9%. The variables, severe chest pain, back pain, cold sweats, shortness of breath, nausea and vomiting, were selected as the main features.

Keywords: Coronary heart disease, acute heart attacks, prediction, logistic regression.

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232 A Retrospective Drug Utilization Study of Antiplatelet Drugs in Patients with Ischemic Heart Disease

Authors: K. Jyothi, T. S. Mohamed Saleem, L. Vineela, C. Gopinath, K. B. Yadavender Reddy

Abstract:

Objective: Acute coronary syndrome is a clinical condition encompassing ST segments elevation myocardial infraction, Non ST segment is elevation myocardial infraction and un stable angina is characterized by ruptured coronary plaque, stress and myocardial injury. Angina pectoris is a pressure like pain in the chest that is induced by exertion or stress and relived with in the minute after cessation of effort or using sublingual nitroglycerin. The present research was undertaken to study the drug utilization pattern of antiplatelet drugs for the ischemic heart disease in a tertiary care hospital. Method: The present study is retrospective drug utilization study and study period is 6months. The data is collected from the discharge case sheet of general medicine department from medical department Rajiv Gandhi institute of medical sciences, Kadapa. The tentative sample size fixed was 250 patients. Out of 250 cases 19 cases was excluded because of unrelated data. Results: A total of 250 prescriptions were collected for the study according to the inclusion criteria 233 prescriptions were diagnosed with ischemic heart disease 17 prescriptions were excluded due to unrelated information. out of 233 prescriptions 128 are male (54.9%) and 105 patients are were female (45%). According to the gender distribution, the prevalence of ischemic heart disease in males are 90 (70.31%) and females are 39 (37.1%). In the same way the prevalence of ischemic heart disease along with cerebrovascular disease in males are 39 (29.6%) and females are 66 (62.6%). Conclusion: We found that 94.8% of drug utilization of antiplatelet drugs was achieved in the Rajiv Gandhi institute of medical sciences, Kadapa from 2011-2012.

Keywords: Angina pectoris, aspirin, clopidogrel, myocardial infarction.

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231 Computational Study of Blood Flow Analysis for Coronary Artery Disease

Authors: Radhe Tado, Ashish B. Deoghare, K. M. Pandey

Abstract:

The aim of this study is to estimate the effect of blood flow through the coronary artery in human heart so as to assess the coronary artery disease.Velocity, wall shear stress (WSS), strain rate and wall pressure distribution are some of the important hemodynamic parameters that are non-invasively assessed with computational fluid dynamics (CFD). These parameters are used to identify the mechanical factors responsible for the plaque progression and/or rupture in left coronary arteries (LCA) in coronary arteries.The initial step for CFD simulations was the construction of a geometrical model of the LCA. Patient specific artery model is constructed using computed tomography (CT) scan data with the help of MIMICS Research 19.0. For CFD analysis ANSYS FLUENT-14.5 is used.Hemodynamic parameters were quantified and flow patterns were visualized both in the absence and presence of coronary plaques. The wall pressure continuously decreased towards distal segments and showed pressure drops in stenotic segments. Areas of high WSS and high flow velocities were found adjacent to plaques deposition.

Keywords: Computational fluid dynamics, hemodynamics, velocity, strain rate, wall pressure, wall shear stress.

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230 Eosinophils and Platelets: Players of the Game in Morbid Obese Boys with Metabolic Syndrome

Authors: Orkide Donma, Mustafa M. Donma

Abstract:

Childhood obesity, which may lead to increased risk for heart diseases in children as well as adults, is one of the most important health problems throughout the world. Prevalences of morbid obesity and metabolic syndrome (MetS) are being increased during childhood age group. MetS is a cluster of metabolic and vascular abnormalities including hypercoagulability and an increased risk of cardiovascular diseases (CVDs). There are also some relations between some components of MetS and leukocytes. The aim of this study is to investigate complete blood cell count parameters that differ between morbidly obese boys and girls with MetS diagnosis. A total of 117 morbid obese children with MetS consulted to Department of Pediatrics in Faculty of Medicine Hospital at Namik Kemal University were included into the scope of the study. The study population was classified based upon their genders (60 girls and 57 boys). Their heights and weights were measured and body mass index (BMI) values were calculated. WHO BMI-for age and sex percentiles were used. The values above 99 percentile were defined as morbid obesity. Anthropometric measurements were performed. Waist-to-hip and head-to-neck ratios as well as homeostatic model assessment of insulin resistance (HOMA-IR) were calculated. Components of MetS (central obesity, glucose intolerance, high blood pressure, high triacylglycerol levels, low levels of high density lipoprotein cholesterol) were determined. Hematological variables were measured. Statistical analyses were performed using SPSS. The degree for statistical significance was p ≤ 0.05. There was no statistically significant difference between the ages (11.2±2.6 years vs 11.2±3.0 years) and BMIs (28.6±5.2 kg/m2 vs 29.3±5.2 kg/m2) of boys and girls (p ≥ 0.05), respectively. Significantly increased waist-to-hip ratios were obtained for boys (0.94±0.08 vs 0.91±0.06; p=0.023). Significantly elevated values of hemoglobin (13.55±0.98 vs 13.06±0.82; p=0.004), mean corpuscular hemoglobin concentration (33.79±0.91 vs 33.21±1.14; p=0.003), eosinophils (0.300±0.253 vs 0.196±0.197; p=0.014), and platelet (347.1±81.7 vs 319.0±65.9; p=0.042) were detected for boys. There was no statistically significant difference between the groups in terms of neutrophil/lymphocyte ratios as well as HOMA-IR values (p ≥ 0.05). Statistically significant gender-based differences were found for hemoglobin as well as mean corpuscular hemoglobin concentration and hence, separate reference intervals for two genders should be considered for these parameters. Eosinophils may contribute to the development of thrombus in acute coronary syndrome. Eosinophils are also known to make an important contribution to mechanisms related to thrombosis pathogenesis in acute myocardial infarction. Increased platelet activity is observed in patients with MetS and these individuals are more susceptible to CVDs. In our study, elevated platelets described as dominant contributors to hypercoagulability and elevated eosinophil counts suggested to be related to the development of CVDs observed in boys may be the early indicators of the future cardiometabolic complications in this gender.

Keywords: Children, complete blood count, gender, metabolic syndrome.

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229 Leadership´s Controlling via Complexity Investigation in Crisis Scenarios

Authors: Jiří Barta, Oldřich Svoboda, Jiří. F. Urbánek

Abstract:

In this paper will be discussed two coin´s sides of crisis scenarios dynamics. On the one's side is negative role of subsidiary scenario branches in its compactness weakening by means unduly chaotic atomizing, having many interactive feedbacks cases, increasing a value of a complexity here. This negative role reflects the complexity of use cases, weakening leader compliancy, which brings something as a ´readiness for controlling capabilities provision´. Leader´s dissatisfaction has zero compliancy, but factual it is a ´crossbar´ (interface in fact) between planning and executing use cases. On the other side of this coin, an advantage of rich scenarios embranchment is possible to see in a support of response awareness, readiness, preparedness, adaptability, creativity and flexibility. Here rich scenarios embranchment contributes to the steadiness and resistance of scenario mission actors. These all will be presented in live power-points ´Blazons´, modelled via DYVELOP (Dynamic Vector Logistics of Processes) on the Conference.

Keywords: Leadership, Controlling, Complexity, DYVELOP, Scenarios.

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228 Clash of Civilizations without Civilizational Groups: Revisiting Samuel P. Huntington´s Clash of Civilizations Theory

Authors: Jamal Abdi

Abstract:

This paper is largely a response/critique of Samuel P. Huntington´s Clash of Civilizations thesis. The overriding argument is that Huntington´s thesis is characterized by failure to distinguish between ´groups´ and ´categories´. Multinational civilizations overcoming their internal collective action problems, which would enable them to pursue a unified strategy vis-à-vis the West, is a rather foundational assumption in his theory. Without assigning sufficient intellectual attention to the processes through which multinational civilizations may gain capacity for concerted action i.e. become a group, he contended that the post-cold-war world would be shaped in large measure by interactions among seven or eight major civilizations. Thus, failure in providing a convincing analysis of multi-national civilizations´ transition from categories to groups is a significant weakness in Huntington´s clash theory. It is also suggested that so-called Islamic terrorism and the war on terror is not to be taken as an expression of presence of clash between a Western and an Islamic civilization, as terrorist organizations would be superfluous in a world characterized by clash of civilizations. Consequences of multinational civilizations becoming a group are discussed in relation to contemporary Western superiority.

Keywords: Clash of civilizations, groups, categories, groupism.

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227 Acute Myocardial Infarction Associated with Ingestion of Herbal Mixtures Containing Acetylcholinesterase Inhibitors: A Case Study

Authors: M. Hakami, A. Jammaly, I. Attafi, M. Oraiby, M. Jeraiby

Abstract:

We reviewed an unusual case of a 65-year-old male taking an herbal mixture containing compounds with anticholinesterase activity for a long period of time, presented with acute my myocardial infarction and multiple organ dysfunction syndrome followed by death. Clinically, there are findings correlated with anticholinesterase activity, such as bilateral miosis, diaphoresis, vomiting and fasciculation without a history of any toxic ingestion or exposure. Gas chromatography–mass spectrometry screening studies identified the presence of thymol, anethole in the herbal extract and butylated hydroxytoluene in the blood sample. Hence, with this case report, we intend to highlight the necessity of evaluating the long-term use of the herbal mixture.

Keywords: Cholinesterase inhibitors, thymol, anethole, butylated hydroxytoluene, cardiac toxicity and myocardial infarction.

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226 Numerical Simulation of Restenosis in a Stented Coronary Artery

Authors: Weronika Kurowska-Nouyrigat, Jacek Szumbarski

Abstract:

Nowadays, cardiac disease is one of the most common cause of death. Each year almost one million of angioplasty interventions and stents implantations are made all over the world. Unfortunately, in 20-30% of cases neointimal proliferations leads to restenosis occurring within the following period of 3-6 months. Three major factors are believed to contribute mostly to the edge restenosis: (a) mechanical damage of the artery-s wall caused by the stent implantation, (b) interaction between the stent and the blood constituents and (c) endothelial growth stimulation by small (lower that 1.5 Pa) and oscillating wall shear stress. Assuming that this last actor is particularly important, a numerical model of restenosis basing on wall shear stress distribution in the stented artery was elaborated. A numerical simulations of the development of in-stent restenosis have been performed and realistic geometric patterns of a progressing lumen reduction have been obtained

Keywords: Coronary artery disease, coronary blood flow, instent restenosis.

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225 3D Shape Modelling of Left Ventricle: Towards Correlation of Myocardial Scintigraphy Data and Coronarography Result

Authors: A. Ben Abdallah, H. Essabbah, M. H. Bedoui

Abstract:

The myocardial sintigraphy is an imaging modality which provides functional informations. Whereas, coronarography modality gives useful informations about coronary arteries anatomy. In case of coronary artery disease (CAD), the coronarography can not determine precisely which moderate lesions (artery reduction between 50% and 70%), known as the “gray zone", are haemodynamicaly significant. In this paper, we aim to define the relationship between the location and the degree of the stenosis in coronary arteries and the observed perfusion on the myocardial scintigraphy. This allows us to model the impact evolution of these stenoses in order to justify a coronarography or to avoid it for patients suspected being in the gray zone. Our approach is decomposed in two steps. The first step consists in modelling a coronary artery bed and stenoses of different location and degree. The second step consists in modelling the left ventricle at stress and at rest using the sphercical harmonics model and myocardial scintigraphic data. We use the spherical harmonics descriptors to analyse left ventricle model deformation between stress and rest which permits us to conclude if ever an ischemia exists and to quantify it.

Keywords: Spherical harmonics model, vascular bed, 3D reconstruction, left ventricle, myocardial scintigraphy.

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224 Scenarios of Societal Security and Business Continuity Cycles

Authors: Jiří F. Urbánek, Jiří Barta

Abstract:

Societal security, continuity scenarios and methodological cycling approach explained in this article. Namely societal security organizational challenges ask implementation of international standards BS 25999-2 & global ISO 22300 which is a family of standards for business continuity management system. Efficient global organization system is distinguished of high entity´s complexity, connectivity & interoperability, having not only cooperative relations in a fact. Competing business have numerous participating ´enemies´, which are in apparent or hidden opponent and antagonistic roles with prosperous organization system, resulting to a crisis scene or even to a battle theatre. Organization business continuity scenarios are necessary for such ´a play´ preparedness, planning, management & overmastering in real environments.

Keywords: Business Continuity, Societal Security Crisis Scenarios Cycles.

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223 Angiographic Evaluation of ETT (Treadmill) Positive Patients in a Tertiary Care Hospital of Bangladesh

Authors: Syed Dawood Md. Taimur, Saidur Rahman Khan, Farzana Islam

Abstract:

To evaluate the factors which predetermine the coronary artery disease in patients having positive Exercise Tolerance Test (ETT) that is treadmill results and coronary artery findings. This descriptive study was conducted at Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh from 1st January, 2014 to 31st August, 2014. All patients who had done ETT (treadmill) for chest pain diagnosis were studied. One hundred and four patients underwent coronary angiogram after positive treadmill result. Patients were divided into two groups depending upon the angiographic findings, i.e. true positive and false positive. Positive treadmill test patients who have coronary artery involvement these are called true positive and who have no involvement they are called false positive group. Both groups were compared with each other. Out of 104 patients, 81 (77.9%) patients had true positive ETT and 23 (22.1%) patients had false positive ETT. The mean age of patients in positive ETT was 53.46± 8.06 years and male mean age was 53.63±8.36 years and female was 52.87±7.0 years. Sixty nine (85.19%) male patients and twelve (14.81%) female patients had true positive ETT, whereas 15 (65.21%) males and 8 (34.79%) females had false positive ETT, this was statistically significant (p<0.032) in the two groups (sex) in comparison of true and false positive ETT. The risk factors of these patients like diabetes mellitus, hypertension, dyslipidemia, family history and smoking were seen among these patients. Hypertensive patients having true positive which were statistically significant (p<0.004) and diabetic, dyslipidemic patients having true positive which were statistically significant (p<0.032 & 0.030).True positive patients had family history were 68(83.95%) and smoking were 52 (64.20%), where family history patients had statistically significant (p<0.017) between two groups of patients and smokers were significant (p<0.012). 46 true positive patients achieved THR which was not statistically significant (P<0.138) and 79 true patients had abnormal resting ECG whether it was significant (p<0.036). Amongst the vessels involvement the most common was LAD 55 (67.90 %) followed by LCX 42 (51.85%), RCA 36 (44.44%), and the LMCA was 9 (11.11%). 40 patients (49.38%) had SVD, 26 (30.10%) had DVD, 15(18.52%) had TVD and 23 had normal coronary arteries. It can be concluded that among the female patients who have positive ETT with normal resting ECG, who had achieved target heart rate are likely to have a false positive test result. Conversely male patients, resting abnormal ECG who had not achieved THR, symptom limited ETT, have a hypertension, diabetes, dyslipidemia, family history and smoking are likely to have a true positive treadmill test result.

Keywords: Exercise tolerance test, Coronary artery disease, Coronary angiography, True positive, False positive.

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222 The Experiences of Coronary Heart Disease Patients: Biopsychosocial Perspective

Authors: Christopher C. Anyadubalu

Abstract:

Biological, psychological and social experiences and perceptions of healthcare services in patients medically diagnosed of coronary heart disease were investigated using a sample of 10 participants whose responses to the in-depth interview questions were analyzed based on inter-and-intra-case analyses. The results obtained revealed that advancing age, single status, divorce and/or death of spouse and the issue of single parenting negatively impacted patients- biopsychosocial experiences. The patients- experiences of physical signs and symptoms, anxiety and depression, past serious medical conditions, use of self-prescribed medications, family history of poor mental/medical or physical health, nutritional problems and insufficient physical activities heightened their risk of coronary attack. Collectivist culture served as a big source of relieve to the patients. Patients- temperament, experience of different chronic life stresses/challenges, mood alteration, regular drinking, smoking/gambling, and family/social impairments compounded their health situation. Patients were satisfied with the biomedical services rendered by the healthcare personnel, whereas their psychological and social needs were not attended to. Effective procedural treatment model, a holistic and multidimensional approach to the treatment of heart disease patients was proposed.

Keywords: Biopsychosocial, Coronary Heart Disease, Experience, Patients, Perception, Perspective.

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221 Influence of Apo E Polymorphism on Coronary Artery Disease

Authors: S. Fallah, M. Seifi, M. Firoozrai, T. Godarzi, M. Jafarzadeh, L. H. Ghohari

Abstract:

The ε4 allele of the ε2, ε3 and ε4 protein isoform polymorphism in the gene encoding apolipoprotein E (Apo E) has previously been associated with increased cardiac artery disease (CAD); therefore to investigate the significance of this polymorphism in pathogenesis of CAD in Iranian patients with stenosis and control subjects. To investigate the association between  Apo E polymorphism and coronary artery disease we performed a comparative case control study of the frequency of Apo E  polymorphism in One hundred CAD patients with stenosis who underwent coronary angiography (>50% stenosis) and 100 control subjects (<10% stenosis). The Apo E alleles and genotypes were determined by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). We observed an association between the Apo E polymorphism and CAD in this study. These data suggest that the Apo ε4 and ε2 alleles increase the risk for CAD in Iranian population (χ2 =4.26, p= 0.05, OR=2 and χ2 =0.38, p=0.53, OR=1.2). These results suggest that ε4 and ε2 alleles are risk factors for stenosis.

Keywords: Arterial blood vessels, atherosclerosis, cholesterol.

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220 Development of an Immunoassay Platform for Diagnosis of Acute Kidney Injury

Authors: T. Bovornvirakit, K. Viravaidya

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Acute kidney injury (AKI) is a new worldwide public health problem. A diagnosis of this disease using creatinine is still a problem in clinical practice. Therefore, a measurement of biomarkers responsible for AKI has received much attention in the past couple years. Cytokine interleukin-18 (IL-18) was reported as one of the early biomarkers for AKI. The most commonly used method to detect this biomarker is an immunoassay. This study used a planar platform to perform an immunoassay using fluorescence for detection. In this study, anti-IL-18 antibody was immobilized onto a microscope slide using a covalent binding method. Make-up samples were diluted at the concentration between 10 to 1000 pg/ml to create a calibration curve. The precision of the system was determined using a coefficient of variability (CV), which was found to be less than 10%. The performance of this immunoassay system was compared with the measurement from ELISA.

Keywords: Acute kidney injury, Acute renal failure, Antibody immobilization, Interleukin-18

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219 Unsupervised Segmentation Technique for Acute Leukemia Cells Using Clustering Algorithms

Authors: N. H. Harun, A. S. Abdul Nasir, M. Y. Mashor, R. Hassan

Abstract:

Leukaemia is a blood cancer disease that contributes to the increment of mortality rate in Malaysia each year. There are two main categories for leukaemia, which are acute and chronic leukaemia. The production and development of acute leukaemia cells occurs rapidly and uncontrollable. Therefore, if the identification of acute leukaemia cells could be done fast and effectively, proper treatment and medicine could be delivered. Due to the requirement of prompt and accurate diagnosis of leukaemia, the current study has proposed unsupervised pixel segmentation based on clustering algorithm in order to obtain a fully segmented abnormal white blood cell (blast) in acute leukaemia image. In order to obtain the segmented blast, the current study proposed three clustering algorithms which are k-means, fuzzy c-means and moving k-means algorithms have been applied on the saturation component image. Then, median filter and seeded region growing area extraction algorithms have been applied, to smooth the region of segmented blast and to remove the large unwanted regions from the image, respectively. Comparisons among the three clustering algorithms are made in order to measure the performance of each clustering algorithm on segmenting the blast area. Based on the good sensitivity value that has been obtained, the results indicate that moving kmeans clustering algorithm has successfully produced the fully segmented blast region in acute leukaemia image. Hence, indicating that the resultant images could be helpful to haematologists for further analysis of acute leukaemia.

Keywords: Acute Leukaemia Images, Clustering Algorithms, Image Segmentation, Moving k-Means.

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218 The Incidence of Metabolic Syndrome in Women with Impaired Reproductive Function According to Astana, Kazakhstan

Authors: A. T. Nakysh, A. S. Idrisov, S. A. Baidurin

Abstract:

This work presents the results of a study the incidence of metabolic syndrome (MetS) in women with impaired reproductive function (IRF) according to the data of Astana, Kazakhstan. The anthropometric, biochemical and instrumental studies were conducted among 515 women, of which 53 patients with MetS according to IDF criteria, 2006, were selected. The frequency of occurrence of the IRF, due to MetS is 10.3% of cases according to the data of Astana. In women of childbearing age with IRF and the MetS, blood pressure (BP), indicators of carbohydrate and lipid metabolism were significantly higher and the level of high density lipoprotein (HDL) significantly lower compared to the same in women with the IRF without MetS. The hyperandrogenism, the hyperestrogenemia, the hyperprolactinemia and the hypoprogesteronemia were found in the patients with MetS and IRF, indicating the impact of MetS on the development of the polycystic ovary syndrome in 28% of cases and hyperplastic processes of the myometrium in 20% of cases.

Keywords: Dyslipidemia, insulin resistance, metabolic syndrome, reproductive disorders, obesity.

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217 A 3D Approach for Extraction of the Coronaryartery and Quantification of the Stenosis

Authors: Mahdi Mazinani, S. D. Qanadli, Rahil Hosseini, Tim Ellis, Jamshid Dehmeshki

Abstract:

Segmentation and quantification of stenosis is an important task in assessing coronary artery disease. One of the main challenges is measuring the real diameter of curved vessels. Moreover, uncertainty in segmentation of different tissues in the narrow vessel is an important issue that affects accuracy. This paper proposes an algorithm to extract coronary arteries and measure the degree of stenosis. Markovian fuzzy clustering method is applied to model uncertainty arises from partial volume effect problem. The algorithm employs: segmentation, centreline extraction, estimation of orthogonal plane to centreline, measurement of the degree of stenosis. To evaluate the accuracy and reproducibility, the approach has been applied to a vascular phantom and the results are compared with real diameter. The results of 10 patient datasets have been visually judged by a qualified radiologist. The results reveal the superiority of the proposed method compared to the Conventional thresholding Method (CTM) on both datasets.

Keywords: 3D coronary artery tree extraction, segmentation, quantification, fuzzy clustering, and Markov random field

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216 Bone Mineral Density and Frequency of Low-Trauma Fractures in Ukrainian Women with Metabolic Syndrome

Authors: Vladyslav Povoroznyuk, Larysa Martynyuk, Iryna Syzonenko, Liliya Martynyuk

Abstract:

Osteoporosis is one of the important problems in postmenopausal women due to an increased risk of sudden and unexpected fractures. This study is aimed to determine the connection between bone mineral density (BMD) and trabecular bone score (TBS) in Ukrainian women suffering from metabolic syndrome. Participating in the study, 566 menopausal women aged 50-79 year-old were examined and divided into two groups: Group A included 336 women with no obesity (BMI ≤ 29.9 kg/m2), and Group B – 230 women with metabolic syndrome (diagnosis according to IDF criteria, 2005). Dual-energy X-ray absorptiometry was used for measuring of lumbar spine (L1-L4), femoral neck, total body and forearm BMD and bone quality indexes (last according to Med-Imaps installation). Data were analyzed using Statistical Package 6.0. A significant increase of lumbar spine (L1-L4), femoral neck, total body and ultradistal radius BMD was found in women with metabolic syndrome compared to those without obesity (p < 0.001) both in their totality and in groups of 50-59 years, 60-69 years, and 70-79 years. TBS was significantly higher in non-obese women compared to metabolic syndrome patients of 50-59 years and in the general sample (p < 0.05). Analysis showed significant positive correlation between body mass index (BMI) and BMD at all levels. Significant negative correlation between BMI and TBS (L1-L4) was established. Despite the fact that BMD indexes were significantly higher in women with metabolic syndrome, the frequency of vertebral and non-vertebral fractures did not differ significantly in the groups of patients.

Keywords: Bone mineral density, trabecular bone score, metabolic syndrome, fracture.

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215 Professional Burn out of Teachers: Reasons and Regularities

Authors: Dabyltayeva R. Y., Smatova K.B., Кabekenov G., Toleshova U., Shagyrbayeva M.

Abstract:

In recent years in Kazakhstan, as well as in all countries, we have been talking not only about the professional stress, but also professional Burnout Syndrome of employees. Burnout is essentially a response to chronic emotional stress – manifests itself in the form of chronic fatigue, despondency, unmotivated aggression, anger, and others. This condition is due to mental fatigue among teachers as a sort of payment for overstrain when professional commitments include the impact of “heat your soul", emotional investment. The emergence of professional Burnout among teachers is due to the system of interrelated and mutually reinforcing factors relating to the various levels of the personality: individually-psychological level is psychodynamic special subject characteristics of valuemotivational sphere and formation of skills and habits of selfregulation; the socio-psychological level includes especially the Organization and interpersonal interaction of a teacher. Signs of the Burnout were observed in 15 testees, and virtually a symptom could be observed in every teacher. As a result of the diagnosis 48% of teachers had the signs of stress (phase syndrome), resulting in a sense of anxiety, mood, heightened emotional susceptibility. The following results have also been got:-the fall of General energy potential – 14 pers. -Psychosomatic and psycho vegetative syndrome – 26 pers. -emotional deficit-34 pers. -emotional Burnout Syndrome-6 pers. The problem of professional Burnout of teachers in the current conditions should become not only meaningful, but particularly relevant. The quality of education of the younger generation depends on professional development; teachers- training level, and how “healthy" teachers are. That is why the systematic maintenance of pedagogic-professional development for teachers (including disclosure of professional Burnout Syndrome factors) takes on a special meaning.

Keywords: Professional burnout syndrome, adaptive syndrome, stage of depletion syndrome, symptoms and characteristics of burnout, prophylactic of professional destruction techniques.

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214 Neuropalliative Care in Patients with Progressive Neurological Disease in Czech Republic: Study Protocol

Authors: R. Bužgová, R. Kozáková, M. Škutová, M. Bar, P. Ressner, P. Bártová

Abstract:

Introduction: Currently, there has been an increasing concern about the provision of palliative care in non-oncological patients in both professional literature and clinical practice. However, there is not much scientific information on how to provide neurological and palliative care together. The main objective of the project is to create and to verify a concept of neuro-palliative and rehabilitative care for patients with selected neurological diseases in an advanced stage of the disease and also to evaluate bio-psychosocial and spiritual needs of these patients and their caregivers related to the quality of life using created standardized tools. Methodology: Triangulation of research methods (qualitative and quantitative) will be used. A concept of care and assessment tools will be developed by analyzing interviews and focus groups. Qualitative data will be analyzed using grounded theory. The concept of care will be tested in the context of the intervention study. Using quantitative analysis, we will assess the effect of an intervention provided on the saturation of needs, quality of life, and quality of care. A research sample will be made up of the patients with selected neurological diseases (Parkinson´s syndrome, motor neuron disease, multiple sclerosis, Huntington’s disease), together with patients´ family members. Based on the results, educational materials and a certified course for health care professionals will be created. Findings: Based on qualitative data analysis, we will propose the concept of integrated care model combining neurological, rehabilitative and specialist palliative care for patients with selected neurological diseases in different settings of care and services. Patients´ needs related to quality of life will be described by newly created and validated measuring tools before the start of intervention (application of neuro-palliative and palliative approach) and then in the time interval. Conclusion: Based on the results, educational materials and a certified course for doctors and health care professionals will be created.

Keywords: Multidisciplinary approach, neuropalliative care, research, quality of life.

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213 Development of Requirements Analysis Tool for Medical Autonomy in Long-Duration Space Exploration Missions

Authors: Lara Dutil-Fafard, Caroline Rhéaume, Patrick Archambault, Daniel Lafond, Neal W. Pollock

Abstract:

Improving resources for medical autonomy of astronauts in prolonged space missions, such as a Mars mission, requires not only technology development, but also decision-making support systems. The Advanced Crew Medical System - Medical Condition Requirements study, funded by the Canadian Space Agency, aimed to create knowledge content and a scenario-based query capability to support medical autonomy of astronauts. The key objective of this study was to create a prototype tool for identifying medical infrastructure requirements in terms of medical knowledge, skills and materials. A multicriteria decision-making method was used to prioritize the highest risk medical events anticipated in a long-term space mission. Starting with those medical conditions, event sequence diagrams (ESDs) were created in the form of decision trees where the entry point is the diagnosis and the end points are the predicted outcomes (full recovery, partial recovery, or death/severe incapacitation). The ESD formalism was adapted to characterize and compare possible outcomes of medical conditions as a function of available medical knowledge, skills, and supplies in a given mission scenario. An extensive literature review was performed and summarized in a medical condition database. A PostgreSQL relational database was created to allow query-based evaluation of health outcome metrics with different medical infrastructure scenarios. Critical decision points, skill and medical supply requirements, and probable health outcomes were compared across chosen scenarios. The three medical conditions with the highest risk rank were acute coronary syndrome, sepsis, and stroke. Our efforts demonstrate the utility of this approach and provide insight into the effort required to develop appropriate content for the range of medical conditions that may arise.

Keywords: Decision support system, event sequence diagram, exploration mission, medical autonomy, scenario-based queries, space medicine.

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212 Pre-Clinical Studying of Antitumor Ramon Preparation: Acute Toxicity

Authors: Raissa A. Muzychkina, Irina M. Korulkina, Dmitriy Yu. Korulkin

Abstract:

In article the data of acute toxicity for pre-clinical researches of Ramon preparation is described. Ramon effects to clinical characteristics of blood, cardio-vascular system, hepatotoxic and diuretic effects were studied.

Keywords: Cancer, toxicity, antitumor activity, pre-clinical testing, anthraquinones, phytopreparation, Ramon.

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211 An Improved Data Mining Method Applied to the Search of Relationship between Metabolic Syndrome and Lifestyles

Authors: Yi Chao Huang, Yu Ling Liao, Chiu Shuang Lin

Abstract:

A data cutting and sorting method (DCSM) is proposed to optimize the performance of data mining. DCSM reduces the calculation time by getting rid of redundant data during the data mining process. In addition, DCSM minimizes the computational units by splitting the database and by sorting data with support counts. In the process of searching for the relationship between metabolic syndrome and lifestyles with the health examination database of an electronics manufacturing company, DCSM demonstrates higher search efficiency than the traditional Apriori algorithm in tests with different support counts.

Keywords: Data mining, Data cutting and sorting method, Apriori algorithm, Metabolic syndrome

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210 A Medical Resource Forecasting Model for Emergency Room Patients with Acute Hepatitis

Authors: R. J. Kuo, W. C. Cheng, W. C. Lien, T. J. Yang

Abstract:

Taiwan is a hyper endemic area for the Hepatitis B virus (HBV). The estimated total number of HBsAg carriers in the general population who are more than 20 years old is more than 3 million. Therefore, a case record review is conducted from January 2003 to June 2007 for all patients with a diagnosis of acute hepatitis who were admitted to the Emergency Department (ED) of a well-known teaching hospital. The cost for the use of medical resources is defined as the total medical fee. In this study, principal component analysis (PCA) is firstly employed to reduce the number of dimensions. Support vector regression (SVR) and artificial neural network (ANN) are then used to develop the forecasting model. A total of 117 patients meet the inclusion criteria. 61% patients involved in this study are hepatitis B related. The computational result shows that the proposed PCA-SVR model has superior performance than other compared algorithms. In conclusion, the Child-Pugh score and echogram can both be used to predict the cost of medical resources for patients with acute hepatitis in the ED.

Keywords: Acute hepatitis, Medical resource cost, Artificial neural network, Support vector regression.

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