Search results for: high risk cardiac patients.

Authors: V. Thulasi Bai, Srivatsa S. K.

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Deaths from cardiovascular diseases have decreased substantially over the past two decades, largely as a result of advances in acute care and cardiac surgery. These developments have produced a growing population of patients who have survived a myocardial infarction. These patients need to be continuously monitored so that the initiation of treatment can be given within the crucial golden hour. The available conventional methods of monitoring mostly perform offline analysis and restrict the mobility of these patients within a hospital or room. Hence the aim of this paper is to design a Portable Cardiac Telemedicine System to aid the patients to regain their independence and return to an active work schedule, there by improving the psychological well being. The portable telemedicine system consists of a Wearable ECG Transmitter (WET) and a slightly modified mobile phone, which has an inbuilt ECG analyzer. The WET is placed on the body of the patient that continuously acquires the ECG signals from the high-risk cardiac patients who can move around anywhere. This WET transmits the ECG to the patient-s Bluetooth enabled mobile phone using blue tooth technology. The ECG analyzer inbuilt in the mobile phone continuously analyzes the heartbeats derived from the received ECG signals. In case of any panic condition, the mobile phone alerts the patients care taker by an SMS and initiates the transmission of a sample ECG signal to the doctor, via the mobile network.

Keywords: WET, ECG analyzer, Bluetooth, mobilecellular network, high risk cardiac patients.

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Authors: L. Bikulciene, E. Venskaityte, G. Jarusevicius

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Nonstationary and nonlinear signals generated by living complex systems defy traditional mechanistic approaches, which are based on homeostasis. Previous our studies have shown that the evaluation of the interactions of physiological signals by using special analysis methods is suitable for observation of physiological processes. It is demonstrated the possibility of using deep physiological model, based on the interpretation of the changes of the human body’s functional states combined with an application of the analytical method based on matrix theory for the physiological signals analysis, which was applied on high risk cardiac patients. It is shown that evaluation of cardiac signals interactions show peculiar for each individual functional changes at the onset of hemodynamic restoration procedure. Therefore, we suggest that the alterations of functional state of the body, after patients overcome surgery can be complemented by the data received from the suggested approach of the evaluation of functional variables’ interactions.

Keywords: Cardiac diseases, Complex systems theory, ECG analysis, matrix analysis.

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Authors: Reeta Devi, Hitender Kumar Tyagi, Dinesh Kumar

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In present scenario, cardiovascular problems are growing challenge for researchers and physiologists. As heart disease have no geographic, gender or socioeconomic specific reasons; detecting cardiac irregularities at early stage followed by quick and correct treatment is very important. Electrocardiogram is the finest tool for continuous monitoring of heart activity. Heart rate variability (HRV) is used to measure naturally occurring oscillations between consecutive cardiac cycles. Analysis of this variability is carried out using time domain, frequency domain and non-linear parameters. This paper presents HRV analysis of the online dataset for normal sinus rhythm (taken as healthy subject) and sudden cardiac death (SCD subject) using all three methods computing values for parameters like standard deviation of node to node intervals (SDNN), square root of mean of the sequences of difference between adjacent RR intervals (RMSSD), mean of R to R intervals (mean RR) in time domain, very low-frequency (VLF), low-frequency (LF), high frequency (HF) and ratio of low to high frequency (LF/HF ratio) in frequency domain and Poincare plot for non linear analysis. To differentiate HRV of healthy subject from subject died with SCD, k –nearest neighbor (k-NN) classifier has been used because of its high accuracy. Results show highly reduced values for all stated parameters for SCD subjects as compared to healthy ones. As the dataset used for SCD patients is recording of their ECG signal one hour prior to their death, it is therefore, verified with an accuracy of 95% that proposed algorithm can identify mortality risk of a patient one hour before its death. The identification of a patient’s mortality risk at such an early stage may prevent him/her meeting sudden death if in-time and right treatment is given by the doctor.

Keywords: Early stage prediction, heart rate variability, linear and non linear analysis, sudden cardiac death.

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Authors: Sharan Badiger, Prema T. Akkasaligar, Deepak Kadeli

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Human Immunodeficiency Virus is known to affect almost all organ systems in the body. In addition to central nervous system it also affects the autonomic nervous system. Autonomic nervous dysfunction has been known to severely affect the quality of life in human immunodeficiency virus positive patients. It is known to have caused fatal consequences in late stages of the disease in patients who go in for invasive diagnostic or therapeutic procedures. The aim of this review is to determine the incidence, clinical significance and frequency of cardiac autonomic neuropathy in patients human immunodeficiency virus infection.

Keywords: Autonomic nervous system, autonomic nervous dysfunction, cardiac autonomic dysfunction, human immunodeficiency virus.

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Authors: Farhan Ismaeel Dakheel, Raoof Smko, K. Negrat, Abdelsalam Almarimi

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In this paper we used data mining techniques to identify outlier patients who are using large amount of drugs over a long period of time. Any healthcare or health insurance system should deal with the quantities of drugs utilized by chronic diseases patients. In Kingdom of Bahrain, about 20% of health budget is spent on medications. For the managers of healthcare systems, there is no enough information about the ways of drug utilization by chronic diseases patients, is there any misuse or is there outliers patients. In this work, which has been done in cooperation with information department in the Bahrain Defence Force hospital; we select the data for Cardiac patients in the period starting from 1/1/2008 to December 31/12/2008 to be the data for the model in this paper. We used three techniques for finding the drug utilization for cardiac patients. First we applied a clustering technique, followed by measuring of clustering validity, and finally we applied a decision tree as classification algorithm. The clustering results is divided into three clusters according to the drug utilization, for 1603 patients, who received 15,806 prescriptions during this period can be partitioned into three groups, where 23 patients (2.59%) who received 1316 prescriptions (8.32%) are classified to be outliers. The classification algorithm shows that the use of average drug utilization and the age, and the gender of the patient can be considered to be the main predictive factors in the induced model.

Keywords: Data Mining, Clustering, Classification, Drug Utilization..

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Authors: I. Boroňová, J. Bernasovská, J. Kmec, E. Petrejčíková

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Dilated cardiomyopathy (DCM) is a severe cardiovascular disorder characterized by progressive systolic dysfunction due to cardiac chamber dilatation and inefficient myocardial contractility often leading to chronic heart failure. Recently, a genome-wide association studies (GWASs) on DCM indicate that the ZBTB17 gene rs10927875 single nucleotide polymorphism is associated with DCM. The aim of the study was to identify the distribution of ZBTB17 gene rs10927875 polymorphism in 50 Slovak patients with DCM and 80 healthy control subjects using the Custom Taqman®SNP Genotyping assays. Risk factors detected at baseline in each group included age, sex, body mass index, smoking status, diabetes and blood pressure. The mean age of patients with DCM was 52.9±6.3 years; the mean age of individuals in control group was 50.3±8.9 years. The distribution of investigated genotypes of rs10927875 polymorphism within ZBTB17 gene in the cohort of Slovak patients with DCM was as follows: CC (38.8%), CT (55.1%), TT (6.1%), in controls: CC (43.8%), CT (51.2%), TT (5.0%). The risk allele T was more common among the patients with dilated cardiomyopathy than in normal controls (33.7% versus 30.6%). The differences in genotype or allele frequencies of ZBTB17 gene rs10927875 polymorphism were not statistically significant (p=0.6908; p=0.6098). The results of this study suggest that ZBTB17 gene rs10927875 polymorphism may be a risk factor for susceptibility to DCM in Slovak patients with DCM. Studies of numerous files and additional functional investigations are needed to fully understand the roles of genetic associations.

Keywords: Dilated cardiomyopathy, SNP polymorphism, ZBTB17 gene.

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Authors: Tahsien Mohamed Okasha, Warda Youssef Mohamed Morsy, Hanan Elsayed Zaghla

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We hypothesized that post cardiac arrest patients with Glasgow Coma Scale (GCS) score of less than 8 and who will be exposed to therapeutic hypothermia protocol will exhibit improvement in their neurological performance. 17 subjects were enrolled in this study all over one year. The study was carried out using Quasi-experimental research design. Four tools were used for data collection of this study: Demographic and medical data sheet, Post cardiac arrest health assessment sheet, Bedside Shivering Assessment Scale (BSAS), and Glasgow Pittsburgh cerebral performance category scale (CPC). The mean age was X̅ ± SD = 53 ± 8.122 years, 47.1% were arrested because of cardiac etiology. 35.3% subjects were initially arrested in form of ventricular tachycardia (VT), 23.5% initially arrested in form of ventricular fibrillation (VF), and 29.4% in form of A-Systole. Favorable neurological outcome was seen among 70.6%. There was significant statistical difference in WBC, Platelets, blood gases value, random blood sugar. Also, initial arrest rhythm, etiology of cardiac arrest, and shivering status were significantly correlated with cerebral performance categories score. Therapeutic hypothermia has positive effects on neurological performance among post cardiac arrest patients with GCS score of less than 8. Replication of the study on larger probability sample, with randomized control trial design is recommended with further study for suggesting nursing protocol for patients undergoing therapeutic hypothermia is recommended.

Keywords: Therapeutic hypothermia, neurological performance, after resuscitation from cardiac arrest, initial arrest rhythm.

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Authors: Dalyah Y. Al-Jamal, Maryam H. Eshtaiwi, Liyakathunisa Syed

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Connecting health services with technology has a huge demand as people health situations are becoming worse day by day. In fact, engaging new technologies such as Internet of Things (IOT) into the medical services can enhance the patient care services. Specifically, patients suffering from chronic diseases such as cardiac patients need a special care and monitoring. In reality, some efforts were previously taken to automate and improve the patient monitoring systems. However, the previous efforts have some limitations and lack the real-time feature needed for chronic kind of diseases. In this paper, an improved process model for patient monitoring system specialized for cardiac patients is presented. A survey was distributed and interviews were conducted to gather the needed requirements to improve the cardiac patient monitoring system. Business Process Model and Notation (BPMN) language was used to model the proposed process. In fact, the proposed system uses the IOT Technology to assist doctors to remotely monitor and follow-up with their heart patients in real-time. In order to validate the effectiveness of the proposed solution, simulation analysis was performed using Bizagi Modeler tool. Analysis results show performance improvements in the heart monitoring process. For the future, authors suggest enhancing the proposed system to cover all the chronic diseases.

Keywords: Business process model and notation, cardiac patient, cardiac monitoring, heart monitoring, healthcare, internet of things, remote patient monitoring system, process model, telemedicine, wearable sensors.

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Authors: Amirali Shirazibeheshti, Tarik Radwan, Alireza Ettefaghian, Farbod Khanizadeh, George Wilson, Cristina Luca

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Anticholinergic medication has been associated with events such as falls, delirium, and cognitive impairment in older patients. To further assess this, anticholinergic burden scores have been developed to quantify risk. A risk model based on clustering was deployed in a healthcare management system to cluster patients into multiple risk groups according to anticholinergic burden scores of multiple medicines prescribed to patients to facilitate clinical decision-making. To do so, anticholinergic burden scores of drugs were extracted from the literature which categorizes the risk on a scale of 1 to 3. Given the patients’ prescription data on the healthcare database, a weighted anticholinergic risk score was derived per patient based on the prescription of multiple anticholinergic drugs. This study was conducted on 300,000 records of patients currently registered with a major regional UK-based healthcare provider. The weighted risk scores were used as inputs to an unsupervised learning algorithm (mean-shift clustering) that groups patients into clusters that represent different levels of anticholinergic risk. This work evaluates the association between the average risk score and measures of socioeconomic status (index of multiple deprivation) and health (index of health and disability). The clustering identifies a group of 15 patients at the highest risk from multiple anticholinergic medication. Our findings show that this group of patients is located within more deprived areas of London compared to the population of other risk groups. Furthermore, the prescription of anticholinergic medicines is more skewed to female than male patients, suggesting that females are more at risk from this kind of multiple medication. The risk may be monitored and controlled in a healthcare management system that is well-equipped with tools implementing appropriate techniques of artificial intelligence.

Keywords: Anticholinergic medication, socioeconomic status, deprivation, clustering, risk analysis.

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Authors: Mohamed A. Hammad, Dzul Azri Mohamed Noor, Syed Azhar Syed Sulaiman, Ahmed A. Khamis, Abeer Kharshid, Nor Azizah Aziz

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The effect of statins dose intensity (SDI) on glycemic control in patients with existing diabetes is unclear. Also, there are many contradictory findings were reported in the literature; thus, it is limiting the possibility to draw conclusions. This project was designed to compare the effect of SDI on glycated hemoglobin (HbA1c%) control in outpatients with Type 2 diabetes in the endocrine clinic at Hospital Pulau Pinang, Malaysia, between July 2015 and August 2016. A prospective cohort study was conducted, where records of 345 patients with Type 2 diabetes (Moderate-SDI group 289 patients and high-SDI cohort 56 patients) were reviewed to identify demographics and laboratory tests. The target of glycemic control (HbA1c < 7% for patient < 65 years, and < 8% for patient ≥ 65 years) was estimated, and the results were presented as descriptive statistics. From 289 moderate-SDI cohorts with a mean age of 57.3 ± 12.4 years, only 86 (29.8%) cases were shown to have controlled glycemia, while there were 203 (70.2%) cases with uncontrolled glycemia with confidence interval (CI) of 95% (6.2–10.8). On the other hand, the high-SDI group of 56 patients with Type 2 diabetes with a mean age 57.7±12.4 years is distributed among 11 (19.6%) patients with controlled diabetes, and 45 (80.4%) of them had uncontrolled glycemia, CI: 95% (7.1–11.9). The study has demonstrated that the relative risk (RR) of uncontrolled glycemia in patients with Type 2 diabetes that used high-SDI is 1.15, and the excessive relative risk (ERR) is 15%. The absolute risk (AR) is 10.2%, and the number needed to harm (NNH) is 10. Outpatients with Type 2 diabetes who use high-SDI of statin have a higher risk of uncontrolled glycemia than outpatients who had been treated with a moderate-SDI.

Keywords: Cohort study, diabetes control, dose intensity, HbA1c, Malaysia, statin, Type 2 diabetes mellitus, uncontrolled glycemia.

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Authors: M. Izzat Md. Nor, N. Jaffar, N. Zaitulakma Md. Zain, N. Izyanti Mohd Suppian, S. Balakrishnan, G. Kandavello

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During the Coronavirus (COVID-19) pandemic, Malaysia has been focusing on building herd immunity by introducing vaccination programs into the community. Hospital Standard Operating Procedures (SOP) were developed to prevent inpatient transmission. In this study, we focus on the positivity rate of inpatient Person Under Surveillance (PUS) becoming COVID-19 positive and compare this to the national rate in order to see the outcomes of the patient who becomes COVID-19 positive in relation to their vaccination status. This is a retrospective observational study carried out from 1 January until 30 March 2022 in Institut Jantung Negara (IJN). There were 5,255 patients admitted during the time of this study. Pre-admission Polymerase Chain Reaction (PCR) swab was done for all patients. Patients with positive PCR on pre-admission screening were excluded. The patients who had exposure to COVID-19-positive staff or patients during hospitalization were defined as PUS and were quarantined and monitored for potential COVID-19 infection. Their frequency and risk of exposure (WHO definition) were recorded. On the final day of quarantine, a second PCR swab was performed on PUS patients who exhibit clinical deterioration, whether or not they exhibit COVID-19 symptoms. The severity of COVID-19 infection was defined as category 1-5A. All patients' vaccination status was recorded, and they were divided into three groups: fully immunised, partially immunised, and unvaccinated. We analysed the positivity rate of PUS patients becoming COVID-positive, outcomes, and correlation with the vaccination status. The ratio of positive inpatient PUS to the total inpatient PUS is 492; only 13 became positive, giving a positivity rate of 2.6%. Eight (62%) had multiple exposures. The majority, 8/13(72.7%), had a high-risk exposure, and the remaining 5 had medium-risk exposure. Four (30.8%) were boosted, 7(53.8%) were fully vaccinated, and 2(15.4%) were partial/unvaccinated. Eight patients were in categories 1-2, whilst 38% were in categories 3-5. Vaccination status did not correlate with COVID-19 Category (P = 0.641). One (7.7%) patient died due to COVID-19 complications and sepsis. Within the first quarter of 2022, our institution's positivity rate (2.6%) is significantly lower than the country's (14.4%). High-risk exposure and multiple exposures to positive COVID-19 cases increased the risk of PUS becoming COVID-19 positive despite their underlying vaccination status.

Keywords: COVID-19, boosted, high risk, Malaysia, quarantine, vaccination status.

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Authors: Suken Nayak, Aditya Kambli, Bharati Ingale, Gauri Shukla

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The technological concepts such as wireless hospital and portable cardiac telemetry system require the development of physiological signal acquisition devices to be easily integrated into the hospital database. In this paper we present the low cost, portable wireless ECG acquisition hardware that transmits ECG signals to a dedicated computer.The front end of the system obtains and processes incoming signals, which are then transmitted via a microcontroller and wireless Bluetooth module. A monitoring purpose Bluetooth based end user application integrated with patient database management module is developed for the computers. The system will act as a continuous event recorder, which can be used to follow up patients who have been resuscitatedfrom cardiac arrest, ventricular tachycardia but also for diagnostic purposes for patients with arrhythmia symptoms. In addition, cardiac information can be saved into the patient-s database of the hospital.

Keywords: ECG, Bluetooth communication, monitoring application, patient database

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Authors: Mustafa M. Donma, Orkide Donma

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Zinc (Zn) is a vital element required for growth and development particularly in children. It exhibits some protective effects against cardiovascular diseases (CVDs). Zn may be a potential biomarker of cardiovascular health. High sensitive cardiac troponin T (hs-cTnT) and cardiac myosin binding protein C (cMyBP-C) are new generation markers used for prediagnosis, diagnosis and prognosis of CVDs. The aim of this study is to determine Zn as well as new generation cardiac markers’ profiles in children with normal body mass index (N-BMI), obese (OB), morbid obese (MO) children and children with metabolic syndrome (MetS) findings. The association among them will also be investigated. Four study groups were constituted. The study protocol was approved by the institutional Ethics Committee of Tekirdag Namik Kemal University. Parents of the participants filled informed consent forms to participate in the study. Group 1 is composed of 44 children with N-BMI. Group 2 and Group 3 comprised 43 OB and 45 MO children, respectively. 45 MO children with MetS findings were included in Group 4. World Health Organization age- and sex-adjusted BMI percentile tables were used to constitute groups. These values were 15-85, 95-99 and above 99 for N-BMI, OB and MO, respectively. Criteria for MetS findings were determined. Routine biochemical analyses including Zn were performed. hs-cTnT and cMyBP-C concentrations were measured by enzyme-linked immunosorbent assay. Data were analyzed by using SPSS software. p < 0.05 was accepted as significant. Four groups were matched for age and gender. Decreased Zn concentrations were measured in Groups 2, 3 and 4 compared to Group 1. Groups did not differ from one another in terms of hs-cTnT. There were statistically significant differences between cMyBP-C levels of MetS group and N-BMI as well as OB groups. There was an increasing trend going from N-BMI group to MetS group. There were statistically significant negative correlations between Zn and hs-cTnT as well as cMyBP-C concentrations in MetS group. In conclusion, inverse correlations detected between Zn and new generation cardiac markers (hs-TnT and cMyBP-C) have pointed out that decreased levels of Zn accompany increased levels of hs-cTnT as well as cMyBP-C in children with MetS. This finding emphasizes that both Zn and these new generation cardiac markers may be evaluated as biomarkers of cardiovascular health during severe childhood obesity precipitated with MetS findings and also suggested as the messengers of the future risk in the adulthood periods of children with MetS.

Keywords: Cardiac myosin binding protein-C, cardiovascular diseases, children, high sensitive cardiac troponin T, obesity.

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

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

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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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Authors: F. Pourhasanzade, S. H. Sabzpoushan

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Computer modeling has played a unique role in understanding electrocardiography. Modeling and simulating cardiac action potential propagation is suitable for studying normal and pathological cardiac activation. This paper presents a 2-D Cellular Automata model for simulating action potential propagation in cardiac tissue. We demonstrate a novel algorithm in order to use minimum neighbors. This algorithm uses the summation of the excitability attributes of excited neighboring cells. We try to eliminate flat edges in the result patterns by inserting probability to the model. We also preserve the real shape of action potential by using linear curve fitting of one well known electrophysiological model.

Keywords: Cellular Automata, Action Potential Propagation, cardiac tissue, Isotropic Pattern, accurate shape of cardiac actionpotential.

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Authors: M. Nosik, I. Rymanova, N. Adamovich, S. Sevostyanihin, K. Ryzhov, Y. Kuimova, A. Kravtchenko, N. Sergeeva, A. Sobkin

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HIV and Tuberculosis (TB) infections each speed the other's progress. HIV-infection increases the risk of TB disease. At the same time, TB infection is associated with clinical progression of HIV-infection. HIV+TB co-infected patients are also at higher risk of acquiring new opportunistic infections. An important feature of disease progression and clinical outcome is the innate and acquired immune responses. HIV and TB, however, have a spectrum of dysfunctions of the immune response. As cytokines play a crucial role in the immunopathology of both infections, it is important to study immune interactions in patients with dual infection HIV+TB. Plasma levels of proinflammatory cytokines IL-2, IFN-γ and immunoregulating cytokines IL-4, IL-10 were evaluated in 75 patients with dual infection HIV+TB, 58 patients with HIV monoinfection and 50 patients with TB monoinfection who were previously naïve for HAART. The decreased levels of IL-2, IFN-γ, IL-4 and IL-10 were observed in patients with dual infection HIV+TB in comparison with patients who had only HIV or TB which means the profound suppression of Th1 and Th2 cytokine secretion. Thus, those cytokines could possibly serve as immunological markers of progression of HIV-infection in patients with TB.

Keywords: HIV, Tuberculosis, TB, HIV associated with TB, Th1/ Th2 cytokine expression.

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Authors: Leena Korpinen, Rauno Pääkkönen, Fabriziomaria Gobba, Vesa Virtanen

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The number of persons with implanted cardiac pacemakers (PM) has increased in Western countries. The aim of this paper is to investigate the possible situations where persons with a PM may be exposed to extremely low frequency (ELF) electric (EF) and magnetic fields (MF) that may disturb their PM. Based on our earlier studies, it is possible to find such high public exposure to EFs only in some places near 400 kV power lines, where an EF may disturb a PM in unipolar mode. Such EFs cannot be found near 110 kV power lines. Disturbing MFs can be found near welding machines. However, we do not have measurement data from welding. Based on literature and earlier studies at Tampere University of Technology, it is difficult to find public EF or MF exposure that is high enough to interfere with PMs.

Keywords: Cardiac Pacemaker, Electric Field, Magnetic Field.

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Authors: Hae-Yeoun Lee

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Quantification of cardiac function is performed by calculating blood volume and ejection fraction in routine clinical practice. However, these works have been performed by manual contouring, which requires computational costs and varies on the observer. In this paper, an automatic left ventricle segmentation algorithm on cardiac magnetic resonance images (MRI) is presented. Using knowledge on cardiac MRI, a K-mean clustering technique is applied to segment blood region on a coil-sensitivity corrected image. Then, a graph searching technique is used to correct segmentation errors from coil distortion and noises. Finally, blood volume and ejection fraction are calculated. Using cardiac MRI from 15 subjects, the presented algorithm is tested and compared with manual contouring by experts to show outstanding performance.

Keywords: Cardiac MRI, Graph searching, Left ventricle segmentation, K-means clustering.

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Authors: A. Lubis, S. S. Pasulu, Z. Hikmah, A. Endaryanto, A. Harsono

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Infection by group A streptococci (GAS) can trigger an autoantibody that cause a poststreptococcal reactive arthritis (PSRA). Four patients with PSRA aged 10 years to 14 years old with the main complaint of joint pain for five days to 10 days after suffering a fever and sore throat. The joint pain was persistent, additive, and non migratory. All patients revealed an increase in erythrocyte sedimentation rate (ESR) and anti-streptolysin O (ASLO), but the chest x-ray, electrocardiography, and echocardiography were normal. Bone imaging showed no destruction on the affected joint. Jones Criteria were not fulfilled in all patients. Erythromycin and ibuprofen were given in all patients and an improvement was shown. Erythromycin was continued for one year and routine controls were conducted for cardiac evaluation. The prognosis of all the patients was good.

Keywords: Arthritis, group A streptococcus, autoantibody, Jones criteria.

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Authors: Amir Ghasemlouei, Alireza Khalaj

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Breast cancer is in the top rate of cancer. We analyzed the prevalence of obesity and its association with breast cancer and finally we reviewed 25 article that 320 patient and 320 control which enrolled to our study. The distribution of breast cancer patients and controls with respect to their anthropometric indices in patients with higher weight, which was statistically significant (60.2 ± 10.2 kg) compared with control group (56.1 ± 11.3 kg). The body mass index of patients was (26.06+/-3.42) and significantly higher than the control group (24.1+/-1.7). Obesity leads to increased levels of adipose tissue in the body that can be stored toxins and carcinogens to produce a continuous supply. Due to the high level of fat and the role of estrogen in a woman which is endogenous estrogen of the tumor and regulates the activities of growth steroids, obesity has confirmed as a risk factor for breast cancer. Our study and other studies have shown that obesity is a risk factor for breast cancer. And it can be prevented with a weight loss intervention for breast cancer in the future.

Keywords: Breast cancer, review study, obesity, overweight.

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

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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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Authors: Chih-Hsiang Chang, Fang-Jyun Su

Abstract:

This paper explores whether stock characteristics influence the herding formation among investors in the US equity market. To extend the research scope of the existing literature, this paper further examines the role that stock risk characteristics play in the US equity market, and the way they influence investors’ decision-making. First, empirical results show that whether general stocks or high-risk stocks, there are no herding behaviors among the investors in the US equity market during the whole research period or during four great events. Moreover, stock characteristics have great influence on investors’ trading decisions. Finally, there is a bidirectional lead-lag relationship of the herding formation between high-risk stocks and low-risk stocks, but the influence of high-risk stocks on the low-risk stocks is stronger than that of low-risk stocks on the high-risk stocks.

Keywords: Stock characteristics, herding formation, investment decision, US equity market, lead-lag relationship.

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Authors: S. Dabiran

Abstract:

Chest pain is one of the most prevalent complaints among adults that cause the people to attend to medical centers. The aim was to determine the prevalence and risk factors of chest pain among over 30 years old people in Tehran. In this cross-sectional study, 787 adults took part from Apr 2005 until Apr 2006. The sampling method was random cluster sampling and there were 25 clusters. In each cluster, interviews were performed with 32 over 30 years old, people lived in those houses. In cases with chest pain, extra questions asked. The prevalence of CP was 9% (71 cases). Of them 21 cases (6.5%) were in 41-60 year age ranges and the remainders were over 61 year old. 19 cases (26.8%) mentioned CP in resting state and all of the cases had exertion onset CP. The CP duration was 10 minutes or less in all of the cases and in most of them (84.5%), the location of pain mentioned left anterior part of chest, left anterior part of sternum and or left arm. There was positive history of myocardial infarction in 12 cases (17%). There was significant relation between CP and age, sex and between history of myocardial infarction and marital state of study people. Our results are similar to other studies- results in most parts, however it is necessary to perform supplementary tests and follow up studies to differentiate between cardiac and non-cardiac CP exactly.

Keywords: Chest pain, myocardial infarction, risk factor, prevalence

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Authors: Arundhati Devi Maibam, K. Ingocha Singh

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Cervical cancer is preventable if detected early. Determination of risk factors is essential to plan screening programmes to prevent the disease. To study the demographic risk factors of cervical cancer among Manipuri women, information on age, marital status, educational level, monthly family income and socioeconomic status were collected through a pre-tested interview schedule. In this study, 64 incident cases registered at the RT Dept, RIMS (Regional Institute of Medical Sciences), Imphal, Manipur, India during 2008-09 participated. Data were entered in Microsoft Excel and the results were expressed in percentages. Among the 64 patients with cervical cancer, 56 (88.9%) were in the age group of 40+ years. The majority of the patients were from rural areas (68.75%) and 31.25% were from urban areas. The majority of the patients were Hindus (73%), 55(85.9%) were of low educational level, 43(67.2%) were married, and 36 (56.25%) belonged to Class IV socioeconomic status. In conclusion, if detected early, cervical cancer is preventable and curable. The potential risk factors need to be identified and women in the risk group need to be motivated for screening. Affordable screening programmes and health care resources will help in lessening the burden of the disease.

Keywords: Cervical cancer, Manipuri women, RIIMS, Socio-demographic risk factors.

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Authors: Hooman Hoodat, Hassan Rashidi

Abstract:

Despite various methods that exist in software risk management, software projects have a high rate of failure. When complexity and size of the projects are increased, managing software development becomes more difficult. In these projects the need for more analysis and risk assessment is vital. In this paper, a classification for software risks is specified. Then relations between these risks using risk tree structure are presented. Analysis and assessment of these risks are done using probabilistic calculations. This analysis helps qualitative and quantitative assessment of risk of failure. Moreover it can help software risk management process. This classification and risk tree structure can apply to some software tools.

Keywords: Risk analysis, risk assessment, risk classification, risk tree.

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Authors: Leonardo Juan Ramírez López, Javier Oswaldo Rodriguez Velasquez

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We have designed a Holter that measures the heart´s activity for over 24 hours, implemented a prediction methodology, and generate alarms as well as indicators to patients and treating physicians. Various diagnostic advances have been developed in clinical cardiology thanks to Holter implementation; however, their interpretation has largely been conditioned to clinical analysis and measurements adjusted to diverse population characteristics, thus turning it into a subjective examination. This, however, requires vast population studies to be validated that, in turn, have not achieved the ultimate goal: mortality prediction. Given this context, our Insight Research Group developed a mathematical methodology that assesses cardiac dynamics through entropy and probability, creating a numerical and geometrical attractor which allows quantifying the normalcy of chronic and acute disease as well as the evolution between such states, and our Tigum Research Group developed a holter device with 12 channels and advanced computer software. This has been shown in different contexts with 100% sensitivity and specificity results.

Keywords: Entropy, mathematical, prediction, cardiac, holter, attractor.

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Authors: F. Kovács, K. Kádár, G. Hosszú, Á. T. Balogh, T. Zsedrovits, N. Kersner, A. Nagy, Gy. Jeney

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The paper presents a novel screening method to indicate congenital heart diseases (CHD), which otherwise could remain undetected because of their low level. Therefore, not belonging to the high-risk population, the pregnancies are not subject to the regular fetal monitoring with ultrasound echocardiography. Based on the fact that CHD is a morphological defect of the heart causing turbulent blood flow, the turbulence appears as a murmur, which can be detected by fetal phonocardiography (fPCG). The proposed method applies measurements on the maternal abdomen and from the recorded sound signal a sophisticated processing determines the fetal heart murmur. The paper describes the problems and the additional advantages of the fPCG method including the possibility of measurements at home and its combination with the prescribed regular cardiotocographic (CTG) monitoring. The proposed screening process implemented on a telemedicine system provides an enhanced safety against hidden cardiac diseases.

Keywords: Cardiac murmurs, fetal phonocardiography, screening of CHDs, telemedicine system.

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Authors: M. Hoxha, V. Capra, C. Buccellati, A. Sala, C. Cena, R. Fruttero, M. Bertinaria, G. E. Rovati

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Today COXIBs are used in the treatment of arthritis and many other painful conditions in selected patients with high gastrointestinal risk and low cardiovascular (CV) risk. Previously, we have identified an unexpected mechanism of action of a traditional non-steroidal anti-inflammatory drug (NSAID) (diclofenac) and a specific inhibitor of cyclooxygenase-2 (COXIB) (lumiracoxib) demonstrating that they possess weak competitive antagonism at the thromboxane receptor (TP). We hypothesize that modifying the structure of a known COXIB so that it becomes also a more potent TP antagonist will preserve the anti-inflammatory and gastrointestinal safety typical of COXIBs and prevent the CV risk associated with long term therapy.

Keywords: Cyclooxygenase, inflammation, lumiracoxib, thromboxane A2.

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Authors: Mustafa M. Donma, Sule G. Kacmaz, Ahsen Yilmaz, Savas Guzel, Orkide Donma

Abstract:

Obesity, as excessive fat accumulation in the body, is a global health problem. The prevalence of obesity and its complications increase due to easy access to high-energy food and decreased physical activity. Cardiovascular diseases (CVDs) constitute a significant part of obesity-related morbidity and mortality. Since the effects of obesity on cardiovascular system may start during childhood without clinical findings, elucidating the mechanisms of cardiovascular changes associated with childhood obesity became more important. In this study, we aimed to investigate some biochemical parameters which may be involved in obesity-related pathologic processes of CVDs. One hundred and seventy-seven children were included in the study, and they were divided into four groups based upon WHO criteria and presence of the metabolic syndrome (MetS): children with normal-BMI, obesity, morbid obesity, and MetS. High-sensitive cardiac troponin T (hs-cTnT), cardiac myosin binding protein C (cMyBP-C), trimethylamine N-oxide (TMAO), soluble tumor necrosis factor-like weak inducer (sTWEAK), chromogranin A (CgA), multimerin-2 levels, and other biochemical parameters were measured in serum samples. Anthropometric measurements and clinical findings of the children were recorded. Statistical analyses were performed. Children with normal-BMI had significantly higher CgA levels than children with obesity, morbid obesity, and MetS (p < 0.05). Cardiac MyBP-C levels of children with MetS were significantly higher than of children with normal-BMI and OB children (p < 0.05). There was no significant difference in hs-cTnT, sTWEAK, TMAO and multimerin-2 between the groups (p>0.05). These results suggested that cMyBP-C and CgA molecules may be involved in the pathogenesis of obesity-related CVDs.

Keywords: biomarker, cardiovascular diseases, children, obesity

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