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Development of a multivariate model to predict significant coronary artery disease in Thai patients with left ventricular systolic dysfunction and determine the applicability of coronary angiography: a single-center, retrospective, case–control study

Abstract

Background

Coronary angiography (CAG) or stress imaging has been performed in almost all Thai patients with left ventricular (LV) systolic dysfunction. If CAG results reveal insignificant coronary stenosis, such patients are diagnosed with nonischemic cardiomyopathy (NICM); however, CAG is considered to provide no benefit and may even harm these patients because it is invasive.

Objectives

To identify predictors associated with significant coronary artery disease (CAD) (stenosis) in Thai patients with LV systolic dysfunction without angina and without LV regional wall motion abnormality and create a prediction score.

Method

Retrospective data from patients at a single tertiary-care center with LV systolic dysfunction (LV ejection fraction <50%) diagnosed between August 2000 and October 2014 were separated into a group with ischemic cardiomyopathy (ICM) and a group with NICM according to CAG. Predictors associated with CAD found in normal populations were determined. Multivariate analysis was used to identify predictors associated with significant coronary stenosis in patients with LV systolic dysfunction to develop a model to create a prediction score.

Results

We included data registered from 240 Thai patients with LV systolic dysfunction. Predictors associated with ICM were age (>60 years), sex (male), and a history of diabetes mellitus (DM). Predictors associated with NICM were body mass index (BMI) >25 kg/m2 and the presence of left bundle branch block (LBBB) on electrocardiography. A simplified equation to predict significant CAD in patients with LV systolic dysfunction is: 3(male sex) + 3(age >60 y) – 5(BMI >25 kg/m2) - 5(LBBB) + 5(DM) - 5. The sensitivity and specificity of this score are 60.5% and 85.1%, respectively.

Conclusion

Our prediction score has modest sensitivity, but high specificity for predicting significant CAD and can be used to determine who should not undergo CAG.

Open access
Perioperative insulin therapy

Abstract

Surgical patients commonly develop hyperglycemia secondary to the neuroendocrine stress response. Insulin treatment of hyperglycemia is required to overcome the perioperative catabolic state and acute insulin resistance. Besides its metabolic actions on glucose metabolism, insulin also displays nonmetabolic physiological effects. Preoperative glycemic assessment, maintenance of normoglycemia, and avoidance of glucose variability are paramount to optimize surgical outcomes. This review discusses the basic physiology and effects of insulin as well as practical issues pertaining to its management during the perioperative period.

Open access
Serum lipids and brain-derived neurotrophic factor in a cross-section of male students with symptoms of depression at a university in Iran: an observational study

Abstract

Background

Depression is a neuroprogressive disorder that is characterized by neurotransmitter derangement and decreased neurogenesis and neurotrophic factors including brain-derived neurotrophic factor (BDNF).

Objectives

To determine the lipid profiles and BDNF levels in university students at an institution in Iran and association of these factors with Beck Depression Inventory (BDI) scores.

Methods

We conducted an observational study of a cross-section of male students at the Ahvaz Jundishapur University of Medical Sciences in Iran. For each of the 100 participants, a BDI score was obtained and serum levels of BDNF were measured by enzyme-linked immunosorbent assay. Levels of serum lipids, including cholesterol, triglycerides, low-density lipoprotein (LDL), and high-density lipoprotein (HDL), were measured using a biochemical analyzer. Castelli’s risk index type I (CRI-I), Castelli’s risk index type II (CRI-II), CRI-I = TG/HDL-C and CRI-II = LDL-cholesterol/ HDL-cholesterol, and atherogenic index of plasma (AIP), AIP = log (triglycerides/HDL-cholesterol), were calculated.

Results

Based on BDI scores, lower levels of BDNF, triglycerides, cholesterol, and HDL, but higher levels of LDL were found in participants with higher BDI scores. CRI-I was also increased in participants with depression.

Conclusion

The levels of BDNF and lipid factors are associated with the severity of depression in Iranian male university students. Deranged levels of BDNF and lipids may predispose depressed students to cardiovascular diseases.

Open access
Effect of distraction task on driving performance of experienced taxi drivers

Abstract

Background

Driving performance is influenced by human, vehicular, and environmental factors.

Objectives

To investigate the effects of distraction tasks, such as sending a text message (STM) and searching a navigation device (SN), on the driving performance of experienced taxi drivers.

Methods

Twelve male taxi drivers (age: 56.3 ± 4.4 y; experience: 28.4 ± 6.4 y) and 14 female taxi drivers (age: 55.5 ± 3.5 y; experience: 19.4 ± 5.0 y) drove in a simulator at a constant speed (90 km/h) for 2 min while maintaining a gap of 30 m from the car in front, also traveling at 90 km/h. Participants were instructed to drive only for the first 1 min (control phase). For an additional 1 min (task phase), they were instructed to drive only, drive + STM, or drive + SN.

Results

Compared with driving only, during driving + STM or driving + SN, the drivers’ skin conductance level was relatively increased, suggesting that the distraction task increased the drivers’ workload and sympathetic nervous system activity. Compared with driving only, during driving + STM or driving + SN, the average distance from the car in front, speed deviation, and anterior–posterior and medial–lateral coefficients of variation increased, suggesting that maintaining the instructed gap and speed, and the longitudinal and transverse control of the car, was more difficult because of the distraction task.

Conclusions

Even for highly experienced taxi drivers, distraction tasks increased workload, increased the difficulty of vehicle control, and detracted from safe driving.

Open access
Exploring the association between glucose-6-phosphate dehydrogenase deficiency and color blindness in Southeast Asia

Abstract

Background

Glucose-6-phosphate dehydrogenase (G6PD) deficiency poses problems for the treatment of Plasmodium vivax malaria, as the 8-aminoquinolines, used to eliminate liver hypnozoites, cause hemolysis in G6PD-deficient individuals.G6PD deficiency is an X-linked disorder that can be linked to other conditions determined by genes located nearby on the Xq28 band of the X chromosome, including red–green color blindness. A Karen population has undergone recent positive selection for G6PD deficiency with extended long-range haplotypes around G6PD.

Objectives

To determine the association between G6PD deficiency and color blindness in a Karen population that lives in an area endemic for P. vivax and that is already known to display long-range haplotypes around G6PD because of the recent positive selection of the Mahidol G6PD deficiency allele.

Method

We examined the phenotypic association between G6PD deficiency and color blindness.

Results

Of 186 male participants successfully assessed for color blindness using the Ishihara 38 plates test, 10 (5.4%) were red–green color blind, while 1 individual was totally color blind. There was a nonsignificant trend toward negative association (repulsion) between G6PD deficiency and red–green color blindness; 34/35 individuals with the Mahidol variant of G6PD deficiency had normal vision, while 9 of the 10 red–green color blind individuals were G6PD normal. A single individual had both conditions.

Conclusions

Despite the long-range haplotype associated with G6PD deficiency in this population, color blindness is not informative in terms of predicting G6PD deficiency in this population. The most likely explanation is that there are multiple genetic causes of red–green color blindness.

Open access
Incidence and etiology of maxillofacial trauma: a retrospective analysis of King Chulalongkorn Memorial Hospital in the past decade

Abstract

Background

Maxillofacial injury is a common injury in trauma patients. The incidence, associated injuries and causes have been never reported for King Chulalongkorn Memorial Hospital (KCMH).

Objectives

To report the incidence, associated injuries, age groups, treatments, and behavioral risks in maxillofacial patients who were admitted to KCMH in the past decade.

Methods

We conducted a retrospective descriptive analysis of patients from January 1, 2006, to December 31, 2015, to evaluate the age groups, causes, sites of facial bone fracture, associated injuries, treatments, and behavioral risks.

Results

There were 1,275 patients (79% male and 21% female). The most common age group was 21–30 years (30.6%), followed by 11–20 years (19.5%) and 31–40 years (18.8%). The most common cause of injury was motorcycle accident (39.7%), and the most common associated injury was head injury (58%). The total number of fractures were 1,526, with the most common fracture site being the zygomaticomaxillary complex (38.6%), followed by mandible (21.8%) and nasal bone (17.8%). Most fractures were treated using open reduction and internal fixation with plates and screws.

Conclusions

The main cause of maxillofacial injury is motorcycle accident even though the government launched a policy named “Decade of Action for Road Safety 2011–2020” to reduce road traffic deaths. Thailand continues to need stronger law enforcement to reduce risky motorcycle driving behavior.

Open access
Niosomes: a review of their structure, properties, methods of preparation, and medical applications

Abstract

Target-specific drug-delivery systems for the administration of pharmaceutical compounds enable the localization of drugs to diseased sites. Various types of drug-delivery systems utilize carriers, such as immunoglobulins, serum proteins, synthetic polymers, liposomes, and microspheres. The vesicular system of niosomes, with their bilayer structure assembled by nonionic surfactants, is able to enhance the bioavailability of a drug to a predetermined area for a period. The amphiphilic nature of niosomes promotes their efficiency in encapsulating lipophilic or hydrophilic drugs. Other additives, such as cholesterol, can be used to maintain the rigidity of the niosomes’ structure. This narrative review describes fundamental aspects of niosomes, including their structural components, methods of preparation, limitations, and current applications to various diseases.

Open access