ABSTRACT
Background - Although patients with ST elevation myocardial infarction should be ideally treated with primary coronary intervention (PCI), due to limited availability of PCI capable hospitals, thrombolysis remains the mainstay treatment in Myanmar. It is imperative that evidence is necessary to prove the efficacy and safety of thrombolysis in district hospital setting in Myanmar. Methods - Patients with acute myocardial infarction were studied during a period of 21 months in the medical ward of Insein General Hospital (IGH), a (300 bedded) hospital which has no facilities for PCI. Streptokinase was used for thrombolysis. Study was set up to achieve “call to needle time of 25 minutes”. Primary endpoint was ST resolution at 90 minutes post-thrombolysis and secondary endpoint was 7 days survival post-thrombolysis. Adverse reactions including haemorrhage were recorded. Results - One hundred and eighteen patients (78%) out of one hundred and fifty one study cases were eligible for thrombolysis. Among the thrombolysis patients, male to female ratio was 1.63 and mean age was 60 years (22 - 86 yr). Median time of thrombolysis since onset of pain was 4.7 hours. Primary end point of ST resolution at 90 min was achieved in 58% (69/118) in thrombolysis group and 0% (0/33) in non-thrombolysis group. Secondary end point of 7 day survival was achieved in 89% (105/118) in thrombolysis group and 6% (2/33) in non-thrombolysis group. Thrombolysis favours ST resolution (p < 0.0001) and 7 day survival (p < 0.0001) better than non-thrombolysis. Statistically non-significant minor bleeding (gum bleeding and epistaxis) was observed in 3% (4/118) (p = 0.52) in the treatment group but there was no fatal bleeding and anaphylaxis. Conclusion - Thrombolysis using streptokinase is safe and highly effective in acute ST-elevation myocardial infarction in district hospital setting.
Subject(s)
Myocardial Infarction , Thrombolytic TherapyABSTRACT
Childhood obesity is increasing at an alarming rate both in developed and developing countries, has been approaching as global pandemics proportion. Global prevalence of overweight and obesity rose by 27.5% for adults and 47.1% for children between 1980 and 2013, Global estimate suggests the number of overweight and obese individuals increased from 857 million in 1980 to 2.1 billion in 2013. In 2010 the prevalence of childhood overweight and obesity was estimated at 11.7% in developed countries and 6.1% in developing countries.
Subject(s)
Obesity , Child HealthABSTRACT
<p><b>INTRODUCTION</b>We assessed awareness of diabetes and diabetic retinopathy in a Singaporean Malay population. We hypothesised that poor awareness is associated with poorer control of diabetic retinopathy risk factors (glycaemic and blood pressure levels) and suboptimal treatment with laser therapy.</p><p><b>MATERIALS AND METHODS</b>A population-based survey of 3280 (78.7% response rate) persons among Singaporean Malays aged between 40 and 80 years old. Diabetes was defined in persons with random glucose >or=11.1mmoL/L, use of diabetic medication, or a previous physician diagnosis. Diabetic retinopathy was graded from retinal photographs following the modified Airlie House classification. Patient awareness was assessed via structured interviews. Glycosylated haemoglobin was measured from venous blood.</p><p><b>RESULTS</b>Of the 3280 study participants, 768 had diabetes, of whom 13.2% (n = 101) were unaware of their diabetes status. Participants unaware of their diabetes status had significantly higher mean glycosylated haemoglobin (9.7% vs 8.2%, P <0.001), systolic blood pressure (160.0 mmHg vs 153.7 mmHg, P = 0.01) and diastolic blood pressure (83.5 mmHg vs 78.5 mmHg, P <0.001), compared to participants who were aware. Of the 272 (35.4%) participants detected to have diabetic retinopathy, 83.4% (n = 227) were unaware of having retinopathy. Of the 77 with vision-threatening retinopathy, laser treatment had been performed in only 55.6% of those unaware of having retinopathy.</p><p><b>CONCLUSION</b>In a sample of Malays with diabetes, high proportions were unaware of their disease. Unawareness was associated with poorer control of diabetic retinopathy risk factors. Only half of persons who were unaware that they had vision-threatening diabetic retinopathy had received laser treatment. These data highlight room for improvement in diabetic retinopathy prevention through better patient education and screening.</p>