CONTEXT: Spontaneous echo contrast (SEC) is a swirling smoke-like image seen inside the heart chambers or in the great vessels. Left Ventricular (LV) dysfunction is known to predispose patients to SEC. The management of SEC is still not as established. Even in patients with atrial fibrillation, SEC does not improve the prediction of cardio-embolic events beyond that of the clinical scoring.
METHODS: Retrospective cross-sectional study.
RESULTS: The study results included 89 patients with SEC. The mean age was 53.9 ± 14.3, with 67% males. The underlying cardiac condition were ischemic heart disease in 68%, non-ischemic cardiomyopathy in 19.3%, and rheumatic valvular heart disease in 12.5%. The most common comorbities were hypertension (54%), renal insufficiency (34%), and diabetes mellitus (34%). Nineteen percent of the patients were in atrial fibrillation. The location of the SEC was in the left ventricle in 90%. The mean ejection fraction was 34.8 ± 16.3% and the ejection fraction was < 35% in 64%. Eighty eight percent had segmental to global hypokinesia. The prevalence of cardio-embolic events was 10%, of which 9.0% presented as stroke, while only 1.0% presented with acute limb ischemia.
CONCLUSION AND RECOMMENDATIONS: SEC is an imaging phenomenon that is associated with LV dysfunction with 64% of the patients with an EF of ? 35%. The presence of SEC increases the occurrence of cardio- embolic events in this population with a prevalence of 10% compared to the reported incidence of 1.8 - 2.4% incidence among patients with LV systolic dysfunction. Albeit in higher percentages, the most common co-morbid conditions are also the same risk factors that are independently associated with increased cardiovascular events. That is why the association of SEC with cardio-embolic events as well as its management, is still not well established, and recommendations on anticoagulation still depend on established clinical scoring. Further study that would associate the different characteristics and co-morbid conditions of patients with SEC to cardio-embolic event is in order.

Human ; Male ; Female ; Adult ; Atrial Fibrillation ; Heart Ventricles ; Hypokinesia ; Embolism ; Stroke ; Coronary Artery Disease ; Diabetes Mellitus ; Heart Valve Diseases ; Renal Insufficiency ; Hypertension

Acquired intraabdominal arteriovenous fistula (AVF) is a rare disorder where the communication most commonly occurs between the abdominal aorta and inferior vena cava. Ilioiliac AVF has been reported previously, but is exceedingly rare. We present a case of acquired arteriovenous fistula of the right common iliac artery and left common iliac vein with extensive collateralization (ilioiliac AVF) in a 36-year-old female who presented with symptoms of high output congestive heart failure 18 years after sustaining an abdominal gunshot wound.

Human ; Female ; Adult ; Cardiac Output, High ; Heart Failure ; Arteriovenous Fistula ; Venous Thrombosis ; Wounds, Gunshot ; injuries ; Wounds and Injuries

Polymorphisms in metabolic genes have been shown to modulate susceptibility to oral cavity cancer. Cases (n=176) and controls (n=317) from the Filipino population were genotyped for selected polymorphisms in CYP1A1, GSTM1, GSTP1, GSTT1, NAT1 and NAT2. Medical and diet histories, occupational exposure and demographic data were also collected for all subjects. The CYP1A1m1/m1 genotype is protective against oral cancer, while being homozygous for the GSTP1 c.313G genotype and heterozygous for the NAT1*10 homozygotes and non-homozygotes for the CYP1A1 m1 allele. The risk from heterozygosity for the NAT1*10 allele was limited to subjects who were not homozygous for the GSTP1 c.313G genotype remained a significant oral cancer risk modifier, together with environmental variables, the homozygous GSTP1 c.313G genotype remained a significant oral cancer risk modifier, together with environmental risk factors, such as smoking, passive smoking, inverted smoking and tobacco chewing, and environmental protective factors, i.e. moderate consumption of fish sauce (patis) and shrimp paste (bagoong). The GSTP1 c.313G polymorphism increases susceptibility for oral cavity cancer in the Filipino population.

Cyp1a1 Protein, Human ; Cytochrome P-450 Cyp1a1 ; Tobacco Smoke Pollution ; Alleles ; Smoking ; Homozygote ; Ointments ; Protective Factors ; Glutathione Transferase ; Mouth Neoplasms ; Diet

INTRODUCTION: The coronary collateral circulation (CCC) is an alternative source of blood supply in coronary artery disease (CAD). The prognostic value of the presence of CCC at the time of acute coronary syndrome (ACS) is undefined with regards to hard outcomes, particularly reduction in mortality. The study's aim is to determine if the presence of CCC demonstrated by coronary angiography during an ACS is associated with a reduction in mortality. 

METHODS: We conducted a systematic search of studies using MEDLINE, EMBASE, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials databases in all languages and examined reference lists of studies. The inclusion criteria were 1) observational; 2) population included adults >19 years old with an acute coronary syndrome; 3) reported data on mortality in association with the presence or absence of CCC on angiography; and 4) should have controlled for confounders by using logistic regression analysis. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale for observational studies. The outcome of interest was reduction in all-cause mortality, assessed using Mantel-Haenzel analysis of random effects to compute for risk ratios.

RESULTS: Pooled analysis from 11 identified trials with 8,370 subjects showed that among patients with ACS who underwent coronary angiography, the presence of CCC showed a trend towards benefit in terms of mortality, but was not statistically different from those without CCC [RR 0.65, (95% CI 0.38 to 1.12), p<0.0001, I2=74%]. In those ACS patients with CCC treated with PCI, a significant reduction in mortality was found [RR 0.43, (95% CI 0.29 to 0.64), p< 0.0001, I2=0%].

CONCLUSION: The presence of CCC during ACS showed a trend towards mortality reduction. Further, among patients treated with PCI, those with CCC had an incrementally significant reduction in mortality compared to those without CCC.

Coronary Artery Disease ; Collateral Circulation ; Coronary Angiography ; Acute Coronary Syndrome ; Odds Ratio ; Prognosis ; Language ; Medline ; Logistic Models ; Coronary Circulation ; Qualitative Research ; Cardiovascular System

Objectives. Polymorphisms in metabolic genes which alter rates of bioactivation and detoxification have been shown to modulate susceptibility to colorectal cancer. This study sought to evaluate the colorectal cancer risk from environmental factors and to do polymorphism studies on genes that code for Phase I and II xenobiotic metabolic enzymes among Filipino colorectal cancer patients and matched controls. Methods. A total of 224 colorectal cancer cases and 276 controls from the Filipino population were genotyped for selected polymorphisms in GSTM1, GSTP1, GSTT1, NAT1 and NAT2. Medical and diet histories, occupational exposure and demographic data were also collected for all subject participants.Results. Univariate logistic regression of non-genetic factors identified exposure to UV (sunlight) (OR 1.99, 95% CI: 1.16-3.39) and wood dust (OR 2.66, 95% CI: 1.21-5.83) and moldy food exposure (OR 1.61, 95% CI:1.11-2.35) as risk factors; while the NAT2*6B allele (recessive model OR 1.51, 95% CI :1.06-2.16; dominant model OR 1.87, 95% CI: 1.05-3.33) and homozygous genotype (OR 2.19, 95% CI: 1.19-4.03) were found to be significant among the genetic factors. After multivariate logistic regression of both environmental and genetic factors, only UV radiation exposure (OR 2.08, 95% CI: 1.21-3.58) and wood dust exposure (OR 2.08, 95% CI: 0.95-5.30) remained to be significantly associated with increasing colorectal cancer risk in the study population.Conclusion. This study demonstrated that UV sunlight and wood dust exposure play a greater role in influencing colorectal cancer susceptibility than genotype status from genetic polymorphisms of the GST and the NAT` genes.
Colorectal Neoplasms ; Polymorphism, Genetic

Introduction : The increasing prevalence of children in conflict with the law is a problem in Metro Manila. This study aimed to understand the factors, specifically parental discipline, peer delinquency, and neighborhood disorganization that predispose a child to engage in delinquent acts. Methods: This was a correlational study in which children in conflict with the law who were institutionalized at the Manila Youth Reception Center were surveyed. The subjects were given three sets of questionnaires which measured parental discipline, peer delinquency, and neighborhood disorganization, respectively. Spearman's rho correlation coefficient was computed using SPSS. Results: Delinquent behavior is very weakly and positively correlated with peer delinquency (r = 0.18) and neighborhood status (r = 0.10), and is very weakly and inversely correlated with parental discipline (r - -0.10. These correlations were not statistically significant. Conclusion The study showed that parental discipline, peer delinquency, and neighborhood disorganization may influence a child's delinquent behavior.
Child, Institutionalized ; Parents