Factors influencing late stage of breast cancer at presentation in a district Hospital - Segamat Hospital, Johor.

INTRODUCTION: In Malaysia, late stage presentation of breast cancer (stage III or IV) has been a healthcare problem that varies geographically throughout the country. This study aims to understand the factors influencing late stage of breast cancer at presentation among Malaysian women in Segamat Hospital, Johor, which is a district hospital. METHODS: A retrospective descriptive study was conducted on secondary data of all newly diagnosed breast cancer women from 1st August 2011 to 28th February 2014. Secondary data includes age, ethnicity, marital status, family history, education level, occupation, presenting symptom, duration of symptom, tumour size, tumour pathology, tumour grading, oestrogen, progesterone and HER-2 receptor status were collected and analysed using SPSS version 20.0.0. RESULT: In total, data from 52 women was analysed and two women were excluded for incompleteness as these women defaulted. Late stage at presentation was 59.6% of all new cases (17.3% stage III and 42.3% stage IV). The commonest age group of all women diagnosed with breast cancer was in the 5th decade. Majority of them were Malay, married and housewives with no family history of breast cancer. The statistically significant factors associated with late stage at presentation include Malay ethnicity (p=0.019), presenting symptoms other than breast lump (p=0.047), and duration of breast lump more than 3 months (p=0.009). DISCUSSION/CONCLUSION: The study demonstrated presentation at late stage of breast cancer is a major health concern among Malaysian women in district hospital. This may be attributed to different sociocultural beliefs, strong belief in complementary and alternative medicine, lack of awareness, and difficult accessibility to healthcare services.

Assessment of the correlation between two defining criteria for bidirectional isthmic block in the ablation of typical atrial flutter.

BACKGROUND: A complete, bidirectional conduction block in the cavotricuspid isthmus (CTI) represents the end-point of the typical atrial flutter ablation. We investigated the correlation between two criteria for successful ablation, one based on the atrial bipolar electrogram morphology before and after complete CTI conduction block, compared to the standard criteria of differential pacing and reversal in the right atrial depolarization sequence during coronary sinus (CS) pacing. METHOD: We conducted a retrospective study in 111 patients (81 males, average age 62±10 years) who underwent an atrial flutter ablation during September 2007 - July 2009 in the Cardiology - Rehabilitation Hospital, UMF Cluj-Napoca. We assessed the presence of a bidirectional block at the end of the procedure using the standard criteria. We then analyzed the morphology of the bipolar atrial electrograms adjacent to the ablation line, before and after CTI conduction block. RESULTS: A change from a qRs morphology to a rSr' morphology when pacing from the coronary sinus and from a rsr' morphology to a QRS morphology when pacing from the low-lateral right atrium was associated with a CTI conduction block. Sensitivity (Se), specificity(Sp), positive predictive value (PPV), negative predictive value (NPV) were 96%, 89%, 99% and 67% respectively. CONCLUSION: Our study suggests that the analysis of the atrial bipolar electrogram next to the ablation line before and after CTI ablation may be used as a reliable criterion to validate CTI conduction block due to its high sensitivity, specificity and positive predictive value.

[The correlation between NT-proBNP plasma levels and heart failure syndrome]. / Corelatii intre nivelul plasmatic al NT-proBNP si sindromul de insuficienta cardiaca.

UNLABELLED: proBNP represents the precursor of the brain natriuretic peptide (BNP) and is released by the cardio-myocytes as a result of the myocardial stretch. It is fractioned into two components, BNP and NT-proBNP. We use more often the determination of NT-proBNP levels in laboratory tests because of its prolonged biological half-time (60-120 minutes, much longer than the BNP half-life). AIM: To determine a link between the plasmatic levels of NT-proBNP and heart failure syndrome (HFS). MATERIAL AND METHOD: We studied 40 patients admitted in the Internal Medicine Clinic of the Western University "Vasile Goldis" Arad, during a two years period (2004-2005). Every patient had a clinical examination, an echocardiography and the determination of NT-proBNP levels. For the determination of the BNP plasmatic levels we used a special kit Elecsys proBNP, which is now largely available. The NT-proBNP levels were correlated with the HFS diagnosis (the presence of dyspnea and the ejection fraction). RESULTS: In 29 patients the NT-proBNP levels were above the upper limit of 125 pg/ml, 86% of them being clinically diagnosed with HFS. 11 patients had BNP levels in the normal values range and 4 of them were clinically diagnosed with HFS. Correlating the NT-proBNP plasma levels and NYHA class of HF we could establish some guidelines regarding the critical BNP values upon which the diagnostic of HFS is almost certain. The minimum level of BNP at which a patient was diagnosed with HF was 89.9 pg/ml. Levels above 125 pg/ml predicts o risk six times higher for HFS. DISCUSSIONS: The BNP plasma values may be modified in hepatic or renal failure, which can cause false high levels of hormone. These situation should be considered possible error sources of diagnosis if the HFS is evaluated only by the means of NT-proBNP plasma levels. CONCLUSIONS: The dosage of plasma levels of NT-proBNP is useful into patients with suspected HFS, if the other methods of diagnosis are not reliable. There is a link between the NT-proBNP plasma levels and the NYHA HFS class. However only the dosage of BNP is not sufficient for a correct diagnosis of HFS.