Echocardiography, Transesophageal ; Electrodes, Implanted ; Heart Septal Defects, Atrial ; diagnostic imaging ; Humans ; Intraoperative Complications ; diagnostic imaging ; Male ; Middle Aged ; Pacemaker, Artificial

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia in singapore. We describe a cohort of multi-ethnic Asian patients with AF, with the aim to evaluate anticoagulation use and to identify factors predictive of stroke, bleeding and all-cause mortality. Materials and Methods: this was a single centre, retrospective cohort study. All patients with an admission diagnosis of AF between 1 January 2000 and 31 December 2010 were identified. Of these patients, those who had follow-up data up to 31 December 2012 were included in the study. results: there were 1095 eligible patients. the mean age was 67±14 years, mean cHADs2 score was 2±1 and mean HAs-bLED score 2±1. Of the 1095 patients, 657 (62.0%) had a cHADs2 score ≥ 2 but only 215 (32.7%) were eventually prescribed warfarin. Patients not on warfarin were older (p<0.0001) and were more likely females (p<0.0001). Among patients not on warfarin, 52% had HAs-bLED score ≤3. Multivariate analysis revealed that warfarin use and high HAs-bLED score were associated with increased bleeding risk. Age, Indian ethnicity and cHADs2 score were predictive of ischemic stroke. All-cause mortality was significantly related to age, presence of heart failure and HAs-bLED score. conclusions: Anticoagulation management of AF patients remains inadequate. Objective assessment of bleeding risks should be performed before withholding anticoagulation.

OBJECTIVE: To investigate the predictive factors for a non-diagnostic result and the final diagnosis of pulmonary lesions with an initial non-diagnostic result on CT-guided percutaneous transthoracic needle biopsy. MATERIALS AND METHODS: All percutaneous transthoracic needle biopsies performed over a 4-year period were retrospectively reviewed. The initial pathological results were classified into three categories—malignant, benign, and non-diagnostic. A non-diagnostic result was defined when no malignant cells were seen and a specific benign diagnosis could not be made. The demographic data of patients, lesions' characteristics, technique, complications, initial pathological results, and final diagnosis were reviewed. Statistical analysis was performed using binary logistic regression. RESULTS: Of 894 biopsies in 861 patients (male:female, 398:463; mean age 67, range 18–92 years), 690 (77.2%) were positive for malignancy, 55 (6.2%) were specific benign, and 149 (16.7%) were non-diagnostic. Of the 149 non-diagnostic biopsies, excluding 27 cases in which the final diagnosis could not be confirmed, 36% revealed malignant lesions and 64% revealed benign lesions. Predictive factors for a non-diagnostic biopsy included the size ≤ 15 mm, needle tract traversing emphysematous lung parenchyma, introducer needle outside the lesion, procedure time > 60 minutes, and presence of alveolar hemorrhage. Non-diagnostic biopsies with a history of malignancy or atypical cells on pathology were more likely to be malignant (p = 0.043 and p = 0.001). CONCLUSION: The predictive factors for a non-diagnostic biopsy were lesion size ≤ 15 mm, needle tract traversing emphysema, introducer needle outside the lesion, procedure time > 60 minutes, and presence of alveolar hemorrhage. Thirty-six percent of the non-diagnostic biopsies yielded a malignant diagnosis. In cases with a history of malignancy or the presence of atypical cells in the biopsy sample, a repeat biopsy or surgical intervention should be considered.
Adult ; Biopsy ; Biopsy, Needle ; Diagnosis ; Emphysema ; Hemorrhage ; Humans ; Logistic Models ; Lung ; Needles ; Pathology ; Retrospective Studies

This current study's goal is to summarize the literature regarding Antenatal Depression (AD) in the East Asian countries of Taiwan, China (including Hong Kong and Macau), Japan, and Korea. The main search utilized a Pub med Chinese Electronic Periodical Service (CEPS) literature review using keywords 'AD', and 'Prenatal Depression' with searches for 'Japan', 'Korea', 'Taiwan', 'Hong Kong' and Macau'. The rates of AD in East Asia appear to be relatively close to those in the Western literature, although certain studies showed slightly decreased rates. Many of the risk factors for AD were the same in the Eastern and Western literature. These risk factors included demographic factors such as younger age, smoking, low education and income, and unemployment. Other risk factors were physical symptoms such as menstrual pains and nausea. Finally, psychological factors such as a poor response to the pregnancy, poor spousal support, and poor family support were associated with AD. With regard to treatment, there were no studies examining the administration of psychotropic medications for AD. The literature from East Asia both confirmed many Western findings and made unique contributions to the literature on AD. The treatment of AD in East Asia appears to be an entity which, despite its morbidity, has not been adequately studied.
Asian Continental Ancestry Group ; China ; Demography ; Depression ; Dysmenorrhea ; Electronics ; Electrons ; Far East ; Female ; Hong Kong ; Humans ; Japan ; Korea ; Nausea ; Pregnancy ; Risk Factors ; Smoke ; Smoking ; Taiwan ; Unemployment ; Women's Health

Clinical trials have established the benefits of implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy (CRT) in the treatment of heart failure patients. As adjuncts to guideline-directed medical therapy, ICDs confer mortality benefits from sudden cardiac arrest, while CRT reduces mortality, hospitalisation rates and improves functional capacity. This review discusses the use of ICDs and CRT devices in heart failure management, outlining the evidence supporting their use, indications and contraindications.
Asian Continental Ancestry Group ; Cardiac Resynchronization Therapy ; Cardiology ; Clinical Trials as Topic ; Death, Sudden, Cardiac ; Defibrillators, Implantable ; Heart Failure ; diagnostic imaging ; epidemiology ; therapy ; Humans ; Practice Guidelines as Topic ; Singapore ; Ventricular Dysfunction, Left ; therapy

Cardiac Catheterization ; adverse effects ; Device Removal ; Humans ; Male ; Middle Aged

With the increased use of cardiac implantable electronic devices (CIEDs), it is increasingly important to recognise the unique challenges involved in the management of patients with CIEDs who are undergoing surgery. Practice advisories and consensus statements have been issued by the American Society of Anesthesiologists and the Heart Rhythm Society, advocating a multidisciplinary approach. This review discusses and presents a practical approach to perioperative CIED management in the Singapore context.
Algorithms ; Bradycardia ; surgery ; Cardiac Surgical Procedures ; Cardiology ; methods ; Decision Making ; Defibrillators, Implantable ; Hemodynamics ; Humans ; Intraoperative Period ; Pacemaker, Artificial ; Preoperative Period ; Radiography, Thoracic ; methods ; Singapore

INTRODUCTIONIn Singapore, the age-standardised event rates of myocardial infarction (MI) are 2- and 3-fold higher for Malays and Indians respectively compared to the Chinese. The objectives of this study were to determine the prevalence and quantity of coronary artery calcification (CAC) and non-calcified plaques across these 3 ethnic groups.

MATERIALS AND METHODSThis was a retrospective descriptive study. We identified 1041 patients (810 Chinese, 139 Malays, 92 Indians) without previous history of cardiovascular disease who underwent cardiac computed tomography for atypical chest pain evaluation. A cardiologist, who was blinded to the patients' clinical demographics, reviewed all scans. We retrospectively analysed all their case records.

RESULTSOverall, Malays were most likely to be active smokers (P = 0.02), Indians had the highest prevalence of diabetes mellitus (P = 0.01) and Chinese had the highest mean age (P <0.0001). The overall prevalence of patients with non-calcified plaques as the only manifestation of sub-clinical coronary artery disease was 2.1%. There was no significant difference in the prevalence of CAC, mean CAC score or prevalence of non-calcified plaques among the 3 ethnic groups. Active smoking, age and hypertension were independent predictors of CAC. Non-calcified plaques were positively associated with male gender, age, dyslipidaemia and diabetes mellitus.

CONCLUSIONThe higher MI rates in Malays and Indians in Singapore cannot be explained by any difference in CAC or non-calcified plaque. More research with prospective follow-up of larger patient populations is necessary to establish if ethnic-specific calibration of CAC measures is needed to adjust for differences among ethnic groups.

Adult ; Age Distribution ; Aged ; Analysis of Variance ; Asian Continental Ancestry Group ; statistics & numerical data ; Case-Control Studies ; China ; ethnology ; Coronary Artery Disease ; diagnostic imaging ; ethnology ; Coronary Vessels ; diagnostic imaging ; Diabetes Mellitus ; ethnology ; Dyslipidemias ; ethnology ; European Continental Ancestry Group ; statistics & numerical data ; Female ; Humans ; Hypertension ; ethnology ; India ; ethnology ; Malaysia ; ethnology ; Male ; Middle Aged ; Plaque, Atherosclerotic ; diagnostic imaging ; ethnology ; Prevalence ; Retrospective Studies ; Sex Distribution ; Singapore ; epidemiology ; ethnology ; Smoking ; ethnology ; Tomography, X-Ray Computed ; Vascular Calcification ; diagnostic imaging ; ethnology

BACKGROUNDWolf-Hirschhorn syndrome (WHS) results from the partial deletion of 4p. This study aimed to identify and fine map the chromosome deletion regions of Chinese children with Wolf-Hirschhorn syndrome among the developmental delay/mental retardation (DD/MR) patients.

METHODSWe analyzed the relationship of phenotype and genotype. Inclusion criteria were: moderate to severe DD/MR, no definite perinatal brain injury, and no trauma, toxication, hypoxia, infection of central nervous system; routine karyotyping was normal, no evidence of typical inherited metabolic disorder or specific neurodegenerative disorders from cranial neuro-imaging and blood/urinary metabolic diseases screening; no mutation of FMR1 in male patients, no typical clinical manifestation of Rett syndrome in female patients. Multiplex ligation-dependent probe amplification (MLPA) and Affymetrix genome-wide human SNP array 6.0 assays were applied to accurately define the exact size of subtelomeric aberration region of four WHS patients.

RESULTSAll four WHS patients presented with severe DD, hypotonia and microcephaly, failure to thrive, 3/4 patients with typical facial features and seizures, 2/4 patients with congenital heart defects and cleft lip/palate, 1/4 patients with other malformations. The length of the deletions ranged from 3.3 Mb to 9.8 Mb. Two of four patients had "classic" WHS, 1/4 patients had "mild"-to-"classic" WHS, and 1/4 patients had "mild" WHS.

CONCLUSIONSWHS patients in China appear to be consistent with those previously reported. The prevalence of signs and symptoms, distribution of cases between "mild" and "classic" WHS, and the correlation between length of deletion and severity of disease of these patients were all similar to those of the patients from other populations.

Adolescent ; Child ; Female ; Genotype ; Humans ; Male ; Mutation ; Phenotype ; Polymorphism, Single Nucleotide ; genetics ; Wolf-Hirschhorn Syndrome ; genetics ; pathology

OBJECTIVES: Screening for colorectal cancer is considered cost effective, but is underutilized in the U.S. Information on the efficiency of "tailored interventions" to promote colorectal cancer screening in primary care settings is limited. The paper reports the results of a cost effectiveness analysis that compared a survey-only control group to a Centers for Disease Control (CDC) web-based intervention (screen for life) and to a tailored interactive computer-based intervention. METHODS: A randomized controlled trial of people 50 and over, was conducted to test the interventions. The sample was 1224 partcipants 50-70 years of age, recruited from Kelsey-Seybold Clinic, a large multi-specialty clinic in Houston, Texas. Screening status was obtained by medical chart review after a 12-month follow-up period. An "intention to treat" analysis and micro costing from the patient and provider perspectives were used to estimate the costs and effects. Analysis of statistical uncertainty was conducted using nonparametric bootstrapping. RESULTS: The estimated cost of implementing the web-based intervention was $40 per person and the cost of the tailored intervention was $45 per person. The additional cost per person screened for the web-based intervention compared to no intervention was $2602 and the tailored intervention was no more effective than the web-based strategy. CONCLUSIONS: The tailored intervention was less cost-effective than the web-based intervention for colorectal cancer screening promotion. The web-based intervention was less cost-effective than previous studies of in-reach colorectal cancer screening promotion. Researchers need to continue developing and evaluating the effectiveness and cost-effectiveness of interventions to increase colorectal cancer screening.
Aged ; Colorectal Neoplasms/*diagnosis ; Cost-Benefit Analysis ; Early Detection of Cancer/*economics/*methods ; Female ; Health Promotion/*methods ; Humans ; *Internet ; Male ; Middle Aged ; Primary Health Care/organization & administration ; United States