Early perfluorodecalin lung distension in infants with congenital diaphragmatic hernia

Background/Purpose: Pulmonary hypoplasia contributes to mortality in infants with severe congenital diaphragmatic hernia (CDH). Accelerated postnatal lung growth with perfluorocarbon lung distension has been demonstrated in animals. The authors present a study measuring perfluorodecalin distension in neonates with severe CDH on extracorporeal membrane oxygenation (ECMO) support. Methods: Six consecutive neonates with CDH requiring ECMO support were recruited. The lungs were filled with perfluorodecalin, and continuous positive airway pressure was applied for 6 to 10 days (mean, 7.7 days [plusmn] 0.7). The perfluorodecalin was exchanged 4 times a day. Radiographic lung projections were measured, and from 2-dimensional measurements an estimated lung volume was calculated using the ECMO cannula as reference. Results: Perfluorodecalin instillation started soon after starting ECMO support (mean, 13.5 [plusmn] 5.3 hours). The volume required to fill the lungs increased significantly (P [lt ] .02). The radiographic dimension of the affected lung increased significantly (mean percentage increase, 272%; P [lt ] .02). The contralateral lung dimension also increased (mean percentage increase 51%; P [lt ] .02). CDH repair was undertaken on ECMO in all cases. All patients survived (follow-up, 3 to 42 months). Conclusions: This protocol of early perfluorodecalin lung distension in infants with severe CDH on ECMO support resulted in significant radiographic lung enlargement. Clinical outcomes are encouraging. Possible mechanisms include alveolar recruitment, alveolar dilatation, and accelerated postnatal lung growth. J Pediatr Surg 38:17-20.     

Long-term mortality and medical care charges in patients with severe sepsis

OBJECTIVE: To estimate long-term mortality and medical care charges among patients with severe sepsis. DESIGN: Retrospective cohort study. SETTING: Large, integrated, geographically diverse, U.S. health-insurance claims database covering three million lives annually. PATIENTS: All persons with bacterial or fungal infections and acute organ dysfunction (severe sepsis) who were hospitalized between January 1, 1991, and August 31, 2000. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All patients were followed from the date of hospitalization with severe sepsis (index admission) to August 31, 2000, disenrollment from the health plan, or death, whichever occurred first. Measures of interest included mortality and medical care charges and were estimated for the index admission, the 90- and 180-day periods following the index admission, and annually thereafter (up to 5 yrs), using techniques of survival analysis. A total of 16,019 patients were identified who met study entrance criteria. Most patients (81.2%) were >/=65 yrs of age; 53.4% were men. Mortality was 21.2% for the index admission, 51.4% at 1 yr, and 74.2% at 5 yrs. Mean cumulative total medical care charges were 44,600 US dollars for the index admission, 78,500 US dollars at 1 yr, and 118,800 US dollars at 5 yrs. Hospitalization accounted for the largest component of total medical care charges. CONCLUSIONS: Mortality and economic costs are high in patients with severe sepsis, during the period of acute illness as well as subsequently.     

Factors associated with low health-related quality of life among younger and older Thai patients with non-valvular atrial fibrillation

Purpose

The aim of this study was to investigate the factors associated with low health-related quality of life (HRQoL) compared between younger and older Thai patients with non-valvular atrial fibrillation (NVAF).

Methods

This is a cross-sectional analysis of baseline data from a prospective NVAF registry from 24 hospitals located across Thailand. Patient demographic, clinical, lifestyle, and medication data were collected at baseline. EuroQOL/EQ-5D-3L was used to assess HRQoL. Health utility was calculated for the entire study population, and low HRQoL was defined as the lowest quartile. Multivariate logistic regression was used to identify factors that significantly predict low HRQoL among younger and older (≥?65 years) patients with NVAF.

Results

Among the 3218 participants that were enrolled, 61.0% were aged older than 65 years. Mean HRQoL was lower in older than in younger patients (0.72?±?0.26 vs. 0.84?±?0.20; p?<?0.001). Factors associated with low HRQoL among younger NVAF patients were the treatment-related factors bleeding history (p?=?0.006) and taking warfarin (p?=?0.001). Among older patients, the NVAF-related complications ischemic stroke or TIA, heart failure (HF), and dementia (all p?<?0.001) were all significantly associated with low HRQoL. Dementia is the factor that most adversely influences low HRQoL among older NVAF. Interestingly, symptomatic NVAF was found to be a protective factor for low HRQoL (p?<?0.001).

Conclusions

Bleeding history and taking warfarin among younger patients, and ischemic stroke/TIA, HF, and dementia among older patients are significant predictors of low HRQoL. These factors should be taken into consideration when selecting treatment options for patients with NVAF.

     

Physical check-up and blood data analysis in the Thai elderly of Chaingmai Province, Thailand

Introduction:   Chiangmai is one of the provinces in Northern Thailand. The Aging population has increased rapidly since family planning commenced in 1972. For the surveillance of aging, we started a health investigation of the elderly over 60 years of age in the suburban area of Chiangmai since 1997 with the Nippon Medical School Team.
Materials and Method:   Medical examination was carried out for the elderly (male = 34, female = 73) at Department of Family Medicine, Chiangmai University, Chiangmai Thailand in August 2002. Chula Mental Test (CMT) was used for cognitive function and Geriatric Depression Scale was used for evaluation of depressive condition.
Results:   The major health problems of this group of elderly in Chiangmai Province were visual acuity abnormality (98.1%), anemia (66.4%), hypertension (37.4%), dental caries (29%), bone and joint disease (23.4%), cardiovascular disease (11.2%), gingivitis (11.2%), diabetes mellitus (9.3%), digestive system disease (8.4%), and presbycrusis (8.4%). The prevalence of cognitive impairment and depression were 0.9 and 2.8%, respectively. The prevalence of high cholesterol, triglyceride, and LDL cholesterol were 43.9, 29.0, and 15.9%, respectively. The prevalence of high BUN, creatinine, and uric acid were 17.8, 11.2, and 29.9%, respectively. The prevalence of high GOT, GPT, gamma GT, ZTT, and TTT were 4.7, 1.9, 53.3, 35.5, and 21.5%, respectively. The prevalence of low hemoglobin was 66.4%.
Conclusion:   There was a high prevalence of anemia and hyperlipidemia in this group of elderly in Chiangmai Province. The analysis of background factors and further investigation should be carried out continuously.     

Rapid detection of early typhoid fever in endemic community children by the TUBEX O9-antibody test

Typhoid remains a global public health problem, and quick accurate immunodiagnosis is needed. Here, we examined the performance of the 5-min TUBEX O9-antibody detection kit in 243 outpatients (mostly children and infants) in their first week of fever and 57 healthy subjects in the Bangladesh community. Based on culture results, TUBEX was 91.2% (31/34) sensitive and 82.3% (172/209) specific in febrile subjects. However, specificity was better in nonfebrile healthy subjects (89.5%, 51/57) or in febrile individuals who serologically had dengue fever (90.5%, 57/63), suggesting that some culture-negative febrile individuals could be truly typhoidal. These individuals were also positive in an anti-crude O9 enzyme-linked immunosorbent assay (ELISA) and the Widal test. Regression analysis of the TUBEX and ELISA results showed good concordance between them, better with the combined IgM-IgG ELISA than with IgM alone, suggesting that TUBEX detects IgM antibodies not necessarily by themselves, as previously reported, but with the help of IgG antibodies.     

Promoter hypermethylation inactivate tumor suppressor FAM134B and is associated with poor prognosis in colorectal cancer

The present study aims to examine promoter methylation status of FAM134B in a large cohort of patients with colorectal adenocarcinomas. The clinical significances and correlations of FAM134B promoter methylation with its expression are also analysed. Methylation‐specific high‐resolution melt‐curve analysis followed by sequencing was used to identify FAM134B promoter methylation in colorectal adenomas (N = 32), colorectal adenocarcinomas (N = 164), matched adjacent non‐neoplastic colorectal mucosae (N = 83) and colon cancer cell lines (N = 4). FAM134B expression was studied by real‐time quantitative polymerase chain reaction, immunohistochemistry, and Western blots. FAM134B promoter methylation was more frequent in adenocarcinomas (52%; 85/164) when compared to that of adenomas (28%; 9/32) and non‐neoplastic mucosae (35%; 29/83). Cancer cells exhibited higher methylation when compared to non‐neoplastic cells. FAM134B promoter methylation was inversely correlated with low FAM134B copy number and mRNA/protein expressions, whereas in‐vitro demethylation has restored FAM134B expression in colon cancer cells. FAM134B promoter methylation was associated with high histological grade (P = .025), presence of peri‐neural infiltration (P = .012), lymphovascular invasion (P = .021), lymph node metastasis (P = .0001), distant metastasis (P = .0001) and advanced pathological stages (P = .0001). In addition, FAM134B promoter methylation correlated with cancer recurrence and poor survival rates of patients with colorectal adenocarcinomas. To conclude, FAM134B promoter methylation plays a key role in regulating FAM134B expression in vitro and in vivo, which in turn contributes to the prediction of the biological aggressiveness of colorectal adenocarcinomas. Furthermore, FAM134B methylation might act as a marker in predicting clinical prognosis in patients with colorectal adenocarcinomas.     

Rapid screening test for tuberculosis using a 38-kDa antigen from Mycobacterium tuberculosis

A screening test for the diagnosis of tuberculosis by immunodot (Idt) is described, using an antigen of Mycobacterium tuberculosis, namely, a 38-kDa glycoprotein which has shown great specificity in previous serologic analyses. The test was used to examine 28 sera from patients with lung tuberculosis. Of these, 85% were positive by micro-ELISA and by the Idt test herein described. Control sera from healthy subjects (n=20) gave negative results for ELISA and for Idt, which indicates that the screening test is highly specific. The test is easy to handle and requires no equipment and is therefore particularly useful for field studies. J. Clin. Lab. Anal. 12:126–129, 1998. © 1998 Wiley-Liss, Inc.     

SAMe-TT2R2 score for prediction of suboptimal time in therapeutic range in a Thai population with atrial fibrillation

INTRODUCTIONInternational normalised ratio (INR) control is an important factor in patients with non-valvular atrial fibrillation (NVAF) being treated with warfarin. INR control was previously reported to be poorer among Asians compared to Westerners. We aimed to validate the SAMe-TT₂R₂ score for prediction of suboptimal INR control (defined as time in therapeutic range [TTR] < 65% in the Thai population) and to investigate TTR among Thai NVAF patients being treated with warfarin.METHODSINR data from patients enrolled in a multicentre NVAF registry was analysed. Clinical and laboratory data was prospectively collected. TTR was calculated using the Rosendaal method. Baseline data was compared between patients with and without suboptimal INR control. Univariate and multivariate analyses were performed to identify variables independently associated with suboptimal INR control.RESULTSA total of 1,669 patients from 22 centres located across Thailand were included. The average age was 69.1 ± 10.7 years, and 921 (55.2%) were male. The mean TTR was 50.5% ± 27.5%; 1,125 (67.4%) had TTR < 65%. Univariate analysis showed hypertension, diabetes mellitus, heart failure, renal disease and SAMe-TT₂R₂ score to be significantly different between patients with and without optimal TTR. The SAMe-TT₂R₂ score was the only factor that remained statistically significant in multivariate analysis. The C-statistic for the SAMe-TT₂R₂ score in the prediction of suboptimal TTR was 0.54.CONCLUSIONSAMe-TT₂R₂ score was the only independent predictor of suboptimal TTR in NVAF patients being treated with warfarin. However, due to the low C-statistic, the score may have limited discriminative power.