The Moroccan Genetic Disease Database (MGDD): a database for DNA variations related to inherited disorders and disease susceptibility

National and ethnic mutation databases provide comprehensive information about genetic variations reported in a population or an ethnic group. In this paper, we present the Moroccan Genetic Disease Database (MGDD), a catalogue of genetic data related to diseases identified in the Moroccan population. We used the PubMed, Web of Science and Google Scholar databases to identify available articles published until April 2013. The Database is designed and implemented on a three-tier model using Mysql relational database and the PHP programming language. To date, the database contains 425 mutations and 208 polymorphisms found in 301 genes and 259 diseases. Most Mendelian diseases in the Moroccan population follow autosomal recessive mode of inheritance (74.17%) and affect endocrine, nutritional and metabolic physiology. The MGDD database provides reference information for researchers, clinicians and health professionals through a user-friendly Web interface. Its content should be useful to improve researches in human molecular genetics, disease diagnoses and design of association studies. MGDD can be publicly accessed at http://mgdd.pasteur.ma.     

Case fatality of bleeding and recurrent venous thromboembolism during,initial therapy with direct oral anticoagulants: A systematic review

Introduction

The frequency and case fatality of venous thromboembolism (VTE) and major bleeding during the initial 3 months of therapy in those treated for symptomatic VTE with either direct oral anticoagulants (DOACs) or vitamin K antagonists (VKA) are important clinically relevant outcomes. We sought to measure it during the initial months of anticoagulation for symptomatic VTE.

Material and Methods

We searched MEDLINE, EMBASE, and CENTRAL to identify studies that enrolled patients with acute symptomatic VTE treated with DOACs or VKA and reported data on bleeding, VTE recurrence and death. Studies were evaluated according to a priori inclusion criteria and critically appraised using established internal validity criteria. Single-proportion random-effects models were used to pool estimates.

Results

Of the 2453 citations retrieved, 5 RCTs that enrolled 24,507 patients were included. The rate of major bleeding was 1.8 (95% CI: 1.3-2.5) and 3.1 (95% CI: 2.4-3.9) per 100 patient-years in DOAC and VKA arms, respectively. The rate of VTE recurrence was 3.7 (95% CI: 2.7-4.7) and 4.1 (95% CI: 3.0-5.4) per 100 patient-years of DOAC and VKA, respectively. The case fatality rate of bleeding was significantly higher in the VKA arms 10.4% (95% CI: 6.6-15.4) compared to DOACs 6.1% (95% CI: 2.7-11.7; p value for difference = 0.029) with no statistical difference between the case fatalities for recurrent VTE. The rate of death from either definite major bleeding or definite recurrent VTE was 0.27 (95% CI: 0.16-0.40) and 0.46 (95% CI: 0.32-0.63) per 100 patient-years for DOACs and VKAs respectively, resulting in a number needed to treat of 875 for DOACs to prevent one death.

Conclusion

DOACs are attractive alternatives to VKAs for initial treatment of symptomatic VTE, with lower frequency and case fatality for major bleeding. However, the incremental safety benefit of DOACs over VKAs is small, with large numbers needed to treat.     

Usefulness of radiofrequency ablation of supraventricular tachycardia to decrease inappropriate shocks from implantable cardioverter-defibrillators

Inappropriate implantable cardioverter-defibrillator (ICD) therapies can lead to significant adverse events and increased mortality. These therapies are often the result of supraventricular tachycardias (SVTs). The objective of this study was to evaluate the incidence of SVT leading to inappropriate shocks in a large cohort of patients with ICDs and assess the efficacy of radiofrequency ablation (RFA) in decreasing these therapies. Patients with ICDs and recurrent SVTs were identified. A cohort of patients with ICD therapies subsequently underwent electrophysiologic study and RFA. Eighty-four patients (13%) were found to have SVT leading to 122 inappropriate ICD shocks and 130 episodes of antitachycardia pacing therapies. Median time to SVT onset after ICD implantation was 269 days. Electrophysiologic studies were performed in 30 patients. Successful RFA was performed for atrial tachycardia, atrial flutter, or atrioventricular nodal reentrant tachycardia in 22 patients. Ninety-five percent of patients who underwent successful SVT ablation had no further inappropriate ICD therapies compared to 63% of patients in whom ablation was not performed during a mean follow-up of 20.7 ± 11.9 months. In conclusion, SVT is responsible for a significant number of inappropriate ICD therapies. RFA is an effective strategy to substantially decrease subsequent inappropriate ICD therapies.     

Prevalence, predictors, and outcomes of conservative medical management in non-ST-segment elevation acute coronary syndromes in Gulf RACE-2

We assessed the prevalence, predictors, and in-hospital and long-term outcomes of conservative medical management for patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) compared with percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG). This prospective study conducted from October 2008 to June 2009 in 65 hospitals from 6 Arabian Gulf countries included 30-day and 1-year mortality follow-up for 3661 patients. Compared with conservative management group (2859 patients; 78.1%), the PCI group (638; 17.4%) had significantly better unadjusted and adjusted in-hospital (odds ratio [OR]: 0.40, 95% confidence interval [CI]: 0.17-0.97), 30-day (OR: 0.44, 95% CI: 0.24-0.76) and 1-year (OR: 0.58, 95% CI: 0.40-0.87) mortality rates. Comparison with the CABG group (164; 4.5%) yielded similar results with inclusion of patients scheduled for CABG after hospital discharge. Independent predictors of conservative medical management were mainly country of residence and history of prior CABG.     

Relationship between white blood cell count and in-hospital outcomes in acute coronary syndrome patients from the Middle East

We evaluated the relationship between admission white blood cell (WBC) count and in-hospital outcomes in acute coronary syndrome (ACS) patients from the Middle East. Data were analyzed from 7806 consecutive patients with ACS who were divided into 4 groups (G) according to their WBC count (× 10(9)/L; G1: < 6.00; G2: 6.00-9.99; G3: 10.00-11.99; G4: ≥ 12.00). After significant covariate adjustment, those in G4 were 68% more likely to have cardiogenic shock than those in G1 (95% confidence interval [CI]: 1.05-2.68; P = .030) and G2 (odds ratio [OR], 2.02; 95% CI: 1.51-2.71; P < .001). Those in G4 were 2.02 times (95% CI: 1.11-3.67; P = .021) and 65% (95% CI: 1.17-2.32; P = .004) more likely to die in hospital than those in G1 and G2, respectively. Admission WBC count is an independent risk factor for in-hospital cardiogenic shock and mortality, in Middle Eastern patients with ACS. Novel therapeutic agents targeting WBCs in patients with ACS may improve outcomes.     

Comparison of immediate complete denture, tooth and implant-supported overdenture on vertical dimension and muscle activity

PURPOSE

To compare the changes in the occlusal vertical dimension, activity of masseter muscles and biting force after insertion of immediate denture constructed with conventional, tooth-supported and Implant-supported immediate mandibular complete denture.

MATERIALS AND METHODS

Patients were selected and treatment was carried out with all the three different concepts i.e, immediate denture constructed with conventional (Group A), tooth-supported (Group B) and Implant-supported (Group C) immediate mandibular complete dentures. Parameters of evaluation and comparison were occlusal vertical dimension measured by radiograph (at three different time intervals), Masseter muscle electromyographic (EMG) measurement by EMG analysis (at three different positions of jaws) and bite force measured by force transducer (at two different time intervals). The obtained data were statistically analyzed by using ANOVA-F test at 5% level of significance. If the F test was significant, Least Significant Difference test was performed to test further significant differences between variables.

RESULTS

Comparison between mean differences in occlusal vertical dimension for tested groups showed that it was only statistically significant at 1 year after immediate dentures insertion. Comparison between mean differences in wavelet packet coefficients of the electromyographic signals of masseter muscles for tested groups was not significant at rest position, but significant at initial contact position and maximum voluntary clench position. Comparison between mean differences in maximum biting force for tested groups was not statistically significant at 5% level of significance.

CONCLUSION

Immediate complete overdentures whether tooth or implant supported prosthesis is recommended than totally mucosal supported prosthesis.