Echocardiographic characteristics of electrocardiographically unrecognized myocardial infarctions in a community population

Unrecognized myocardial infarction (UMI) as diagnosed by surveillance electrocardiography has been shown to carry the same poor prognosis as recognized myocardial infarction (RMI). The echocardiographic characteristics of UMI have never been studied before. Due to a similar prognosis, we hypothesized that UMI and RMI would exhibit similar degrees of echocardiographic ventricular dysfunction. We studied a random community cohort of 2,042 adults who were > or =45 years of age in a cross-sectional setting in Olmsted County, Minnesota. RMI was diagnosed by review of medical records and UMI was diagnosed if the electrocardiogram met MI criteria without a previous MI recorded in the medical record. All subjects underwent transthoracic echocardiography. We identified 80 patients who had UMI and 101 who had RMI. In bivariate analyses, a stepwise increase in echocardiographic abnormalities was observed from participants who had no MI to UMI to RMI: respective mean ejection fractions were 63%, 61%, and 55; prevalences in left ventricular enlargement were 13%, 22%, and 52%; mean left ventricular mass indexes were 98, 103, and 118 g/m(2); prevalences in regional wall motion abnormality were 2%, 13%, and 42%; and prevalences in diastolic dysfunction were 25%, 56%, and 65% (p for trend <0.0001 for all comparisons). After adjusting for standard coronary risk factors, patients who had UMI continued to exhibit significant abnormalities in systolic dysfunction, diastolic dysfunction, and regional wall motion abnormality, although to a lesser extent than patients who had RMI. In conclusion, patients who have UMI manifest structural abnormalities more commonly than do patients who have no MI but less commonly than do those who have RMI. The similar prognosis after UMI and RMI cannot be explained by comparable degrees of ventricular damage.     

Costs of medical services for patients with HIV/AIDS in Khon Kaen, Thailand

OBJECTIVE: To estimate the savings and cost of providing highly active antiretroviral therapy (HAART) to adult patients with AIDS under Universal Coverage (UC) in Khon Kaen Province, Thailand. DESIGN: Micro-costing of outpatient and inpatient services of two referral hospitals, and cost modelling. SETTING: Khon Kaen Regional Hospital and Northeast Regional Infectious Hospital. PATIENTS: Adult patients who resided in Khon Kaen and made outpatient visits at and/or those who were discharged from those hospitals from 1 December 2001 to 28 February 2002. MAIN OUTCOME MEASURE: The average cost per outpatient visit and per inpatient day. Based on these figures, the savings and cost of providing HAART to adult patients with AIDS under UC at outpatient settings in this province were estimated. RESULTS: The average cost per outpatient visit with and without antiretroviral drugs (ARV) was US$294.2 and US$26.1, respectively. The average cost per inpatient day with and without ARV drugs was US$368.1 and US$43.8, respectively. The net annual cost of HAART was estimated to be US$5 674 629. This is equivalent to 20.0% of the annual UC budget for adults in this province in 2002. Sensitivity analysis and projection to the year 2006 were conducted. CONCLUSION: A large increase in the budget would be required to provide HAART to all adult patients with AIDS under UC. However, the sensitivity analysis showed it would be an affordable policy option if low-cost antiretroviral drugs were successfully introduced. This type of analysis would be useful to assess the financial implications of providing HAART in public health systems worldwide.     

Prevalence of potentially reversible conditions in dementia and mild cognitive impairment in a geriatric clinic

Aim: To examine the prevalence of potentially reversible conditions in dementia and mild cognitive impairment (MCI) patients in a geriatric clinic. Methods: We retrospectively reviewed the medical records of patients who attended the outpatient geriatric clinic at Siriraj Hospital, Bangkok between January 2005 and December 2010. We collected the data regarding potentially reversible conditions of cognitive impairment. Results: There were 233 patients newly diagnosed with dementia and 60 patients diagnosed with MCI. We found potentially reversible causes of dementia in 17 patients (7.3%). The causes were hypothyroidism (2.6%), B12 deficiency (1.7%), normal pressure hydrocephalus (NPH) (0.9%), depression (0.9%), folate deficiency (0.4%), reactive Venereal Disease Research Laboratory (VDRL; 0.4%) and chronic subdural hematoma (CSH; 0.4%). The patients with NPH and CSH were clinically suspicious for having such conditions before the investigations, while patients with low B12 level, low folate level, hypothyroidism and VDRL+ were not. In the MCI group, we found potentially reversible causes in two patients (3.3%), these were B12 deficiency (1.7%) and hypothyroidism (1.7%). Clinical improvement after treatment of the potentially reversible conditions was seen in four patients (one NPH, one subdural hematoma and two with depression) in dementia group (1.7%) and none in the MCI group. All were partially reversed. Conclusion: Routine investigations might be more warranted for metabolic conditions (B12 level and hypothyroidism) as clinical presentations are not suggestive of the conditions. However, reversibility of dementia might not occur in these cases. Neuroimaging should be performed selectively as clinically indicated. Truly reversible conditions are rare and occur in surgical and depressive patients. Geriatr Gerontol Int 2012; 12: 59–64.     

Event free survival at 24 months is a strong surrogate prognostic endpoint of peripheral T cell lymphoma

Event free survival at 24 months (EFS24) has been described as a powerful predictor for outcome in several subtypes of B cell lymphoma. However, it was limitedly described in T cell lymphoma. We explored the implication of EFS24 as a predictor marker for peripheral T cell lymphoma (PTCL). We reviewed 293 systemic PTCL patients at 13 nationwide major university hospitals in Thailand from 2007 to 2014. The median event free survival (EFS) and overall survival (OS) of PTCL patients in our cohort was 16.3 and 27.7 months with corresponding 2‐year EFS and 2‐year OS of 45.8% and 51.9%, respectively. A total of 118 patients achieved EFS24 (no events during the first 24 mo). Patients who achieved EFS24 had better OS than patients who did not (2‐y OS 92% vs 18.8%; HR, 0.1; P < .001). The standardized mortality ratio of patients achieving EFS24 was 18.7 (95% CI, 14.6‐22.8). Multivariable analysis demonstrated performance status, histologic subtype, remission status, and EFS24 achievement as independent predictors for OS. Our study affirmed the value of EFS24 as a powerful prognostic factor for PTCL. Further validation in prospective study setting is warranted.