Trends, prevalence and associated factors of obesity among adults in a rural community in Thailand: serial cross-sectional surveys, 2012 and 2018.

BACKGROUND: Obesity is one principle risk factor increasing the risk of noncommunicable diseases including diabetes, hypertension and atherosclerosis. In Thailand, a 2014 study reported obesity (BMI ≥25 kg/m2) in a Thai population aged ≥15 years was 37.5, 32.9 and 41.8% overall and among males and females, respectively. The study aimed to determine trends in the prevalence of obesity among adults residing in a Thai rural community between 2012 and 2018 and investigate the associations between obesity and behavioral factors. METHODS: Serial cross-sectional studies were conducted in 2012 and 2018 among adults in Na-Ngam rural community. In 2012 and 2018, all 635 and 627 individuals, respectively, were interviewed using structured questionnaires related to demographics, risk behaviors, comorbidities and arthrometric measurement. Spot urine was collected by participants and obesity was defined as BMI ≥25 kg/m2. The risk factors for obesity were analyzed in the 2018 survey. RESULTS: A total of 1262 adults in Na-Ngam rural community were included in the study. The prevalence of obesity was 33.9% in 2012 and 44.8% in 2018 (P < 0.001). The average BMI increased from 23.9 ± 4.2 kg/m2 in 2012 to 25.0 ± 4.52 kg/m2 in 2018 (P < 0.001). Obesity was associated with higher age (AOR 0.99; 95%CI 0.97-0.99), smoking (AOR 0.52; 95%CI 0.28-0.94), instant coffee-mix consumption > 1 cup/week (AOR 1.44; 95%CI 1.02-2.04), higher number of chronic diseases (≥1 disease AOR 1.82; 95%CI 1.01-2.68, > 2 diseases AOR 2.15; 95%CI 1.32-3.50), and higher spot urine sodium level (AOR 1.002; 95%CI 0.99-1.01). CONCLUSION: Our data emphasized that obesity constituted a serious problem among adults residing in a rural community. A trend in significant increase was found regarding the prevalence of obesity and average BMI in the rural community over 6 years. Effective public health interventions should be provided at the community level to reduce BMI. Moreover, modifiable risk factors for obesity should be attenuated to inhibit the progression of metabolic syndrome, noncommunicable diseases and their complications.

Does amiodarone impact on apixaban levels? The effect of amiodarone on apixaban level among Thai patients with non-valvular Atrial Fibrillation.

BACKGROUND: Apixaban and amiodarone are drugs used for non-valvular atrial fibrillation (NVAF) in routine practice. The evidence about apixaban plasma levels in patients who receive apixaban with amiodarone, including bleeding outcomes, has been limited. This study aimed to compare the apixaban plasma levels and bleeding outcomes between apixaban monotherapy and apixaban with amiodarone groups. METHODS: This study was a prospective, observational, and single-center research which was conducted from January 2021 to January 2022 in NVAF patients who received apixaban at a tertiary care hospital located in the center of Bangkok, Thailand. RESULTS: Thirty-three patients were measured for their median (5th-95th percentile) apixaban plasma levels. The trough of apixaban plasma level (Ctrough) were 108.49 [78.10-171.52] and 162.05 [87.94-292.88] µg/L in the apixaban monotherapy and apixaban with amiodarone groups, respectively (p = 0.028). Additionally, the peaks of apixaban plasma level (Cpeak) were 175.36 [122.94-332.34] and 191 [116.88-488.21] µg/L in the apixaban monotherapy and apixaban with amiodarone groups, respectively (p = 0.375). There was bleeding that occurred in 7 patients (21.21%); 5 patients in the apixaban monotherapy group and 2 patients in the apixaban with amiodarone group, respectively. CONCLUSIONS: Amiodarone may increase the peaks and troughs of apixaban plasma levels. The co-administration of apixaban with amiodarone is generally well tolerated. However, the careful observation of bleeding symptoms in individual cases is necessary to ensure safety.

Termination Without Global Propagation in Re-Entrant Ventricular Tachycardia: Electrophysiologic Characteristics and 3D-Electroanatomical Mapping Analysis.

BACKGROUND: Termination of ventricular tachycardia (VT) by a pacing stimulus that does not generate a QRS complex (termination without global propagation [TWGP]) can be a marker for a critical re-entry circuit isthmus. However, the electrophysiologic and anatomic features of these sites and their relation to VT substrate defined by 3-dimensional electroanatomical maps (3D-EAM) remain unknown. OBJECTIVES: This retrospective study aimed to characterize TWGP sites and their relation to VT substrate identified by 3D-EAM. METHODS: A total of 632 consecutive cases of catheter ablation for scar-related VT at 2 University medical centers were reviewed to identify TWGP. RESULTS: TWGP was observed 12 times at 11 different sites in 10 patients (5 ischemic cardiomyopathy). The TWGP stimulus fell immediately before or synchronous with the QRS in all cases, and evidence of local capture despite absence of a QRS complex was observed 6 times. In 5 sites, pacing after VT termination produced a QRS different than the VT. Four sites were in dense scar areas (<0.1 mV), and 6 in abnormal low voltage zone (0.1-1.5 mV). Additional mapping or ablation that abolished VT were consistent with the TWGP site being in a VT isthmus. A substrate marker for VT of late potentials, evoked delayed potentials, or slow conduction was present at 6 of 11 TWGP sites. CONCLUSIONS: TWGP may be a marker for detecting a re-entry circuit isthmus that has escaped detection based on electrogram or pace mapping-based substrate mapping.

Data Modeling Using Vital Sign Dynamics for In-hospital Mortality Classification in Patients with Acute Coronary Syndrome.

OBJECTIVES: This study compared feature selection by machine learning or expert recommendation in the performance of classification models for in-hospital mortality among patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). METHODS: A dataset of 1,123 patients with ACS who underwent PCI was analyzed. After assigning 80% of instances to the training set through random splitting, we performed feature scaling and resampling with the synthetic minority over-sampling technique and Tomek link method. We compared two feature selection. METHODS: recursive feature elimination with cross-validation (RFECV) and selection by interventional cardiologists. We used five simple models: support vector machine (SVM), random forest, decision tree, logistic regression, and artificial neural network. The performance metrics were accuracy, recall, and the false-negative rate, measured with 10-fold cross-validation in the training set and validated in the test set. RESULTS: Patients' mean age was 66.22 ± 12.88 years, and 33.63% had ST-elevation ACS. Fifteen of 34 features were selected as important with the RFECV method, while the experts chose 11 features. All models with feature selection by RFECV had higher accuracy than the models with expert-chosen features. In the training set, the random forest model had the highest accuracy (0.96 ± 0.01) and recall (0.97 ± 0.02). After validation in the test set, the SVM model displayed the highest accuracy (0.81) and a recall of 0.61. CONCLUSIONS: Models with feature selection by RFECV had higher accuracy than those with feature selection by experts in identifying patients with ACS at high risk for in-hospital mortality.

The efficacy and safety outcomes of cardiac resynchronization therapy in patients with heart failure in Thailand: Phramongkutklao experience.

BACKGROUND: Cardiac resynchronization therapy (CRT) is one of the crucial treatments in patients with symptomatic heart failure reduced ejection fraction. This study aimed to report the efficacy and safety of CRT implantation in treating patients with heart failure. The responders and related outcomes were also analyzed. METHODS: Medical records of all patients with CRT implantation, because of heart failure treatment indication, in Phramongkutklao Hospital between 2008 and 2019 were reviewed. Free from death and heart failure hospitalization were analyzed as composited efficacy outcomes with survival analysis. Follow-up echocardiography was used to define a responder. The safety outcomes were reported using descriptive data. Cox-proportional hazard model analysis was used for the responder as a predictor of outcomes. RESULTS: A total of 152 patients underwent CRT implantation because of heart failure. 77.63% were male, the mean age of 65.9 ± 13.19 years, 59.85% were diagnosed with ischemic cardiomyopathy, mean LVEF of 22.69 ± 7.51%, and QRS duration of 147 ± 21 ms. Mean Follow-up was 41 months. The composited efficacy outcomes were 91.7%, 54.8%, and 35.4% at 1, 5, and 10 years, respectively. CRT-related complications were found in 12 patients (7.89%). 71.30% of patients who were responders had lower death or heart failure hospitalization when compared to non-responders (HR: 0.43, 95% CI: 0.24-0.78). CONCLUSION: The efficacy and safety in CRT treating patients in our center were consistent with the previous randomized and observational studies. The responder rate remained the same as in previous trials but was a strong predictor for better outcomes.

Do Apixaban Plasma Levels Relate to Bleeding? The Clinical Outcomes and Predictive Factors for Bleeding in Patients with Non-Valvular Atrial Fibrillation.

Apixaban can significantly prevent stroke events in patients with non-valvular atrial fibrillation (NVAF), as can be observed from the large, randomized, controlled trial conducted in the present study. However, the real-world evidence of bleeding events related to the apixaban plasma levels in Asian populations is limited. This study aimed to investigate the apixaban plasma levels and clinical outcomes among NVAF patients receiving apixaban, including determining the risk factors associated with bleeding during routine care. Seventy-one patients were included in the study. The median values were 112.79 (5-95th percentiles: 68.69-207.8) µg/L and 185.62 (5-95th percentiles: 124.06-384.34) µg/L for the apixaban trough (Ctrough) and apixaban peak plasma levels (Cpeak), respectively. Stroke and bleeding were found in 8 (11.27%) and 14 patients (19.72%), respectively. There was no statistical significance for Ctrough and Cpeak in the stroke and non-stroke groups, respectively. The median of Ctrough (139.15 µg/L) in patients with bleeding was higher than that in the non-bleeding group (108.14 µg/L), but there was no statistical significance. However, multivariate analyses showed that bleeding history (odds ratio (OR): 17.62; 95% confidence interval (CI): 3.54-176.64; and p-value = 0.002) and Ctrough (OR: 1.01; 95%: CI 1.00-1.03; and p-value = 0.038) were related to bleeding events. Almost all of the patients presented apixaban plasma levels within the expected range. Interestingly, bleeding events were associated with the troughs of the apixaban plasma levels and bleeding history.