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Frequency, risk and predictors of type 2 myocardial infarction hospitalizations in young obese patients: A nationwide population-based analysis in the United States. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Obesity in the young population is emerging as a challenging health concern. Though there is a rising prevalence of obesity and its potential association with demand ischemia-related myocardial infarction, data remains non-existent to evaluate the association of obesity or higher body mass index (BMI) with type 2 myocardial infarction (T2MI). We aim to identify the frequency, risk and predictors of T2MI in young hospitalized obese patients compared to non-obese patients in this population-based study.
Methods
We used National Inpatient Sample (2018, ICD-10 codes) to identify T2MI in young (18-44 years) hospitalized patients. Obesity was identified from comorbidities or using diagnostic codes for BMI>30 kg/m2. We performed multivariable regression analysis for the primary outcome of odds of T2MI in young obese patients compared to non-obese patients. The frequency of T2MI was compared between obese vs non-obese patients in overall and subgroup populations. Sociodemographic characteristics and comorbidities in T2MI-obese vs. T2MI-non-obese cohorts were also compared. A p<0.05 was considered a threshold for statistical significance.
Results
Out of 1,268,255 young hospitalized patients with obesity, 555 had T2MI. T2MI was significantly higher in young obese than non-obese (44 T2MI/100000 hospitalizations in young obese patients vs. 17 T2MI/100000 hospitalizations in young non-obese patients, overall 0.04% in obese vs. 0.02% in non-obese, p<0.001). Multivariate analysis revealed higher odds of T2MI in obese than nonobese when adjusted for demographics (aOR 2.65, 95% CI:2.42-2.90, p<0.001) and social demographics with comorbidities (aOR 1.60, 95% CI:1.24-2.07, p<0.001). In young obese, higher risk was found with advancing age (OR 1.07, 95% CI 1.03-1.11, p=0.001), in males than females (aOR 2.70, p<0.001), and blacks (aOR 2.22, p=0.011) and Native Americans (OR 3.91, 95% CI: 1.13-13.49, p=0.011) vs whites. Comorbidities including chronic obstructive pulmonary disease (OR 1.86), chronic kidney disease (CKD, OR 2.36), rheumatoid arthritis/collagen vascular disease (RA/CVD, OR 3.04) Iin young obese patients independently increased the risk of T2MI hospitalizations [Table 1]. The T2MI-obese cohort had a significantly higher rate of hyperlipidemia, hypertension, diabetes, COPD, and prior history of MI and TIA/stroke compared to the T2MI-nonobese cohort [Table 2].
Conclusion
This nationwide analysis revealed a significantly higher risk of T2MI in young obese patients compared to nonobese after excluding patients with concomitant diagnoses of T1MI. Males, blacks compared to females and whites, and comorbidities including COPD, CKD and RA/CVD predicted a higher risk of T2MI in young obese patients. Future studies are warranted to evaluate the role of higher body mass index in myocardial oxygen demand-supply mismatch and short-term/long-term risk and outcomes of T2MI.
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Nationwide frequency, risk and outcomes of type-2 myocardial infarction in patients with versus without previously revascularized myocardial infarction (type 1). Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Type 2 myocardial infarction (T2MI), due to a mismatch between myocardial oxygen demand and supply, is being increasingly recognized with improved diagnostics. The upsetting concern of developing T2MI in patients with prior revascularized occlusive acute myocardial infarction (AMI) or type 1 MI (T1MI) makes it crucial to define the clinical profile and outcomes of T2MI in revascularized patients of ACS.
Purpose
To determine the risk and prognosis of T2MI in patients who had previously had coronary revascularization (PCI or CABG)
Methods
We used the National Inpatient Sample (2018) dataset from the United States to identify T2MI adult hospitalizations using ICD-10 codes and define our study arm as T2MI excluding secondary T1MI diagnoses but having prior revascularized (with percutaneous coronary intervention or coronary artery bypass grafting) AMI. We then compared demographics and comorbidities in T2MI cohort with vs without personal history of revascularized AMI. We used multivariate analysis to study the odds of T2MI hospitalizations with prior revascularized AMI and in-hospital outcomes (all-cause mortality, cardiogenic shock and resource utilization) adjusting for confounders.
Results
There were 33155 T2MI adult hospitalizations after excluding AMI (median age 71 years, 50.6% male, 67.3% white); 1435 (4.3%) had previously revascularized AMI. T2MI in the study arm had higher chances of hospitalization with prior revascularized AMI when adjusted for socio-demographics (aOR 6.92, 95% CI:6.50-7.36, p<0.001) and socio-demographics with comorbidities (aOR 5.70, 95%CI: 5.48-5.94, p<0.001) (Table 1). Study arm often had elderly (≥65 years old, 78.4% vs 65.8%), male (66.6% vs 49.9%), white (76.7% vs 66.9%), upper socio-economic class (20.2 vs 16.8%), patients who were often admitted to non-electively (99.3 vs 97.1%) and to rural (10.5 vs 9.3%) hospitalizations compared to control arm. The study arm had a significantly higher prevalence of diabetes mellitus, hyperlipidemia, peripheral vascular disease, chronic obstructive pulmonary disease, renal failure, deficiency anemias, prior TIA/stroke, depression and smoking. T2MI cohort with prior revascularized AMI did not show any significant association with in-hospital all-cause mortality (1.7 vs 3.0%, aOR 0.49, 95%CI 0.18-1.34, p=0.164) and cardiogenic shock (1.7% vs 2.1%, p=0.399) however, had lower hospital expenditure (median USD 31273 vs 36567) and fewer transfers to other facilities (19.5 vs 22.1%) than those without prior revascularized AMI (Table 2).
Conclusion
Population-based analysis of this nationally representative sample revealed up to six times higher risk of developing T2MI in patients with prior history of AMI (revascularized) but without any significant impact on all-cause in-hospital mortality or cardiogenic shock. Future studies are warranted to assess the short-term/long-term outcomes of T2MI in high risk patient population with previously revascularized AMI.
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Ischemic Cardiomyopathy Evaluation With Coronary Calcium Score And Ct Angiogram. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
IntroductionInterpersonal sensitivity can be explained as a personality trait in which there is an excessive and expanded awareness of the behavior and emotions of others. Individuals having high interpersonal sensitivity are sensitive to interpersonal relationships and self-deficiencies in comparison to others. Studies report that high interpersonal sensitivity can cause low self-esteem and feelings of insecurity.ObjectivesThe objective of this study was to examine the level of interpersonal sensitivity in individuals with an at-risk mental state (ARMS) for psychosis compared to the individuals not at risk for psychosis.MethodsA total sample of 50 individuals was recruited from Bahria University, Karwan-e-Hayat and Karachi Psychiatric Hospital: 25 with ARMS for psychosis and 25 participants who were not ARMS, according to scores on Schizophrenia Proneness Inventory-Adult (SPI-A). All of the participants then responded to self-report questionnaire on Interpersonal Sensitivity Measure.ResultsResults showed that the group with ARMS had a significantly higher interpersonal sensitivity on average (112.5) as compared to healthy individuals (91.8). Results show significant difference in both of the groups (t = –5.049; P < .0001) indicating that interpersonal sensitivity in people with ARMS was relatively high compared to those who were not at risk.ConclusionThis study suggests that being ‘hypersensitive’ to interpersonal interactions is a psychological feature of the potentially prodromal phase of psychosis. Addressing difficulties in interpersonal relationships and offering early psychotherapeutic interventions can be beneficial, not only in averting serious illness, but preventing loss to individual and national productivity.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Feasibility of the stress and anger management program on children with high functioning autism spectrum disorder in a sample population from Karachi. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.1290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
IntroductionResearch shows that individuals with Autism Spectrum Disorder, struggle with emotional competence as compared to their typically developing counterparts. This leads to internalizing (stress) and externalizing (anger management) problems in the affected population. The stress and anger management program (STAMP) designed by Scarpa et al. is a manualized treatment protocol with good clinical efficacy.ObjectiveThe objective of the present study is to test the feasibility and suitability of STAMP as a systematized treatment protocol in Karachi and to enable the sample population, to become emotionally competent.AimThe aim is to evaluate the effectiveness of STAMP on the reduction of symptoms in the sample population.MethodTen children with high functioning autism spectrum disorder will be selected from various institutes in Karachi, and randomized to experimental and waitlist control group after pre-intervention assessment. Upon completion of the intervention with the experimental group, the waitlist control group will be offered the intervention. Both the groups will be assessed, immediately after the intervention, followed by a one-month follow up assessment.ResultsIt is expected that STAMP will significantly reduce the incidence of problem behaviours as measured by the standardized assessment questionnaires from the manual; as well as significantly reduce the severity of scores on the internalizing and externalizing components of the strength and difficulties questionnaire, in the experimental group as compared to the control group.ConclusionIt is expected that the results of the present study could be utilized to train mental health professionals in Karachi for systematized treatment of ASD and related problems.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Development and assessment of a mobile phone-based intervention to reduce maternal depression and improve child health. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.2276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
IntroductionPostnatal depression is known to cause disability and suffering in women and negative consequences both for their infants and their families, with huge costs globally. Several studies from low and middle income countries (LAMIC) have demonstrated that effectively delivered psychological interventions are cost effective for improving maternal and child health, but access to these interventions is limited in both the low and high income countries.ObjectiveThe objective of the study is to develop and test a mobile phone-based intervention (TechMotherCare), which will include components of cognitive behavioural therapy (CBT) and child development related psychoeducation.AimThe aim of the study is to examine the feasibility and acceptability of the TechMotherCare intervention.MethodsA total of 36 participants will be recruited from health centers in Karachi, Pakistan for this 2-arm randomized pilot study. The TechMotherCare App intervention will be based on principles of CBT and learning-through-play (LTP) a parenting intervention and will assess the real-time depressive symptoms of participants and respond, using intelligent real time therapy (iRTT) dependent on symptoms reported by participants.ResultsOutcome assessments will be completed after 3 months (end of intervention). In-depth qualitative interviews will also be conducted with participants pre- and post-intervention. The trial is ongoing and we will present both the qualitative and quantitative results.ConclusionsThe results of this pilot trial will inform the design of a larger randomised controlled trial using a mobile based technology platform to address the huge treatment gap in LAMICs.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Depression and quality of life in hospitalised patients with congestive heart failure (CHF): A cross-sectional study from Karachi, Pakistan. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.1405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
IntroductionThere is strong association between depression and mortality rates among patients with CHF. Despite the massive burden of cardiac disease as well as that of depression in Pakistan, there is limited data regarding the prevalence of depression in patients suffering from CHF. The aim of this study was to assess prevalence of depression in patients with CHF and to compare the health related quality of life of depressed and non-depressed patients with CHF.MethodsA total of 1009 patients diagnosed with CHF were recruited from different public hospitals in Karachi, Pakistan. Depression was assessed at baseline using the Beck Depression Inventory (BDI) and health related quality of life was assessed using Euro Qol (EQ-5D).ResultsOf the 1009 participants recruited to the study, 66.4% (n = 670) met the threshold for depression using the BDI measure. Of the depressed patients, 66.7% (n = 447) were male. Preliminary results indicate that participants who were depressed at baseline had poorer health related quality of life on EQ-5D measures as compared to those who were non-depressed (mean EQ-5D descriptive score 10.45 in depressed patients vs 7.37 in non-depressed patients and mean EQ-5D visual scale score 35.09 in depressed patients vs 52.19 in non-depressed patients).ConclusionConsidering the high prevalence of depression and its serious negative impact on quality of life of patients suffering from chronic physical illness, it is important to design and test culturally adapted psychosocial interventions to reduce depression and improve quality of life for these patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Differential responses of one hundred tomato genotypes grown under cadmium stress. GENETICS AND MOLECULAR RESEARCH 2015; 14:13162-71. [DOI: 10.4238/2015.october.26.12] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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EPA-1000 – No one ever asked about it! barriers in access to mental health services for women accessing treatment from primary care in Karachi. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78298-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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P02-377 - Antidepressants and group psychosocial treatment for depression: an rct from a low income country. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)71379-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
Amino-idazoxan coupled to hemocyanine was used to raise anti-idazoxan antibodies in the rabbit. The antibodies were affinity purified with an amino-idazoxan affinity column. Binding studies with [3H]idazoxan showed a dissociation constant of 2.2 +/- 1.4 nM. The specificity spectrum of these antibodies indicates that the imidazoline part of idazoxan is more important for recognition than the benzodioxan ring as imidazoline substances (clonidine, cirazoline) are powerful competitors of [3H]idazoxan binding on the antibodies. Catecholamines or imidazoles were unable to displace [3H]idazoxan from the antibodies. These anti-idazoxan antibodies present specificity similarities with the imidazoline receptor as did our previously obtained anti-clonidine antibodies. Affinity-purified antibodies represent useful tools for studying the imidazoline receptors particularly with an anti-idiotypic approach.
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Abstract
Objectives: The purpose of this study to assess the effect of oligohydramnios on perinatal outcome especially at third trimester of pregnancy. Methods: This prospective and observational study was conducted in a private specialized hospital at Dhaka city from January to December 2009. In this study 78 singleton pregnant females with gestational age from 28 - 42 weeks with less amniotic fluid index (AFI) were analyzed for perinatal outcome. Data were expressed as number (percentage). Proportion test was performed for comparison between two groups , P value <0.05 was taken as level of significance. Results:Women with oligohydramnios were significantly associated with an abnormal antepartum fetal heart rate (FHR), meconium stained fluid, Apgar score less than 7 or NICU admission. Also subjects with AFI of 5.0 cm or less had a higher rate of cesarean section for fetal distress. Conclusions: Antepartum oligohydramnios is associated with an increased risk of fetal heart rate abnormalities. Although in our population it is not predictive of adverse perinatal outcome as measured by low apgar score and NICU admission, yet this may be reflective of the aggressive antepartum and intrapartum management that these patients received. DOI: http://dx.doi.org/10.3329/bjms.v11i1.9820 BJMS 2012; 11(1): 33-36
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