Areca Nut Chewing and the Risk of Re-hospitalization and Mortality Among Patients With Acute Coronary Syndrome in Pakistan / 예방의학회지

OBJECTIVES: Areca nut is widely consumed in many parts of the world, especially in South and Southeast Asia, where cardiovascular disease (CVD) is also a huge burden. Among the forms of CVD, acute coronary syndrome (ACS) is a major cause of mortality and morbidity. Research has shown areca nut chewing to be associated with diabetes, hypertension, oropharyngeal and esophageal cancers, and CVD, but little is known about mortality and re-hospitalization secondary to ACS among areca nut users and non-users. METHODS: A prospective cohort was studied to quantify the effect of areca nut chewing on patients with newly diagnosed ACS by categorizing the study population into exposed and non-exposed groups according to baseline chewing status. Cox proportional hazards models were used to examine the associations of areca nut chewing with the risk of re-hospitalization and 30-day mortality secondary to ACS. RESULTS: Of the 384 ACS patients, 49.5% (n=190) were areca users. During 1-month of follow-up, 20.3% (n=78) deaths and 25.1% (n=96) re-hospitalizations occurred. A higher risk of re-hospitalization was found (adjusted hazard ratio [aHR], 2.05; 95% confidence interval [CI], 1.29 to 3.27; p=0.002) in areca users than in non-users. Moreover, patients with severe disease were at a significantly higher risk of 30-day mortality (aHR, 2.77; 95% CI, 1.67 to 4.59; p < 0.001) and re-hospitalization (aHR, 2.72; 95% CI, 1.73 to 4.26; p < 0.001). CONCLUSIONS: The 30-day re-hospitalization rate among ACS patients was found to be significantly higher in areca users and individuals with severe disease. These findings suggest that screening for a history of areca nut chewing may help to identify patients at a high risk for re-hospitalization due to secondary events.

Perinatal outcome among fasting and non fasting mothers during the month of Ramadan

Objective: To compare the perinatal outcome among fasting and non fasting pregnant mothers

Methods: A total of 180 women, who came for delivery in the labor suite were included, after verbal informed consent. These women were divided in two groups fasting [n=100], and non-fasting [n=80]

Results: The mean age of the mothers was 27.16 +/- 4.27 years in the fasting group and 27.36 +/- 4.92 years in nonfasting group. The average BMI of mothers was 25.31 +/- 3.26 kg/m[2]in fasting group while 25.64 +/- 3.58 kg/m[2] in non-fasting group. Perinatal outcomes, the birth weight, head circumference and mid arm circumference were almost similar between the two groups. Weight of placenta was 537.80 +/- 80.01g in fasting group while 540.50 +/- 84.29 g in non-fasting group and height of baby was 45.79 +/- 3.07 cm in fasting group while 46.61 +/- 2.92 cm in non-fasting group. In fasting group, placenta weight was 531.5 +/- 92.80 g in boys while 544.8 +/- 62.79 g in girls and ratio of placental to birth weight was 18.8 +/- 2.28 in boys while 19.4 +/- 2.70 in girls

Conclusion: Maternal fasting affects placental weight and length of baby, with effect more pronounced in male babies

Prognostic role of acellular mucin pools in patients with rectal cancer after pathological complete response to preoperative chemoradiation: systematic review and meta-analysis

The prognostic implication of acellular mucin pools [AMP] in rectal cancer is controversial. There is no Level-I evidence regarding their prognostic impact. This systematic review was performed to determine the impact of AMP on survival in patients with rectal cancer, who demonstrate pathological complete response [PCR] to preoperative chemoradiation [CRT]. A systematic literature review was performed by searching MEDLINE and EMBASE database. For overall survival, the overall random effect model favored mucin negative tumors [HR=2, 95% CI=0.8-4.8] with heterogeneity [I-squared=0, p=0.6]. However, the pooled analysis was not significant due to small sample. For disease-free survival, four studies showed HR >1; however, the pooled random effect model indicated little difference in risk [HR=1.06, 95% CI=0.4-2.4] with heterogeneity [I-squared=49.5%, p=0.07]. No definite prognostic role of AMP in rectal cancer patients with PCR was found. These results, however, should be interpreted with caution