Anaplastic Large Cell Lymphoma of the Spine: Report of a Rare Case.

This abstract discusses a rare case of anaplastic large cell lymphoma (ALCL) involving the cervical and dorsal spine in a 17-year-old female. ALCL is a distinct subtype of lymphoma characterized by abnormal proliferation of lymphocytes and is divided into ALK-positive and ALK-negative subtypes. Spinal involvement in ALCL is uncommon, particularly in the cervical and dorsal regions. The patient presented with persistent fever, weakness, and delayed onset of severe neck pain. Diagnosis involved imaging, bone marrow biopsy, and lymph node biopsy. Treatment strategies for ALCL typically involve a multimodal approach, including chemotherapy, radiotherapy, and targeted therapy. However, due to the rarity of spinal involvement, treatment decisions are based on extrapolation from other ALCL cases. Prognosis is influenced by disease stage and ALK status, but specific outcomes for spinal involvement remain poorly established. This case emphasizes the need for considering lymphoma in patients with unexplained symptoms and abnormal imaging findings. It highlights the importance of further research to improve the understanding and management of ALCL with spinal involvement.

Multidrug-Resistant Salmonella Endocarditis of a Native Valve: A Rare Case Presentation.

Salmonella species is a rare cause of infective endocarditis that commonly involves a prosthetic or a previously damaged heart valve. We present a case of a 25-year-old young man with a one and a half month history of cough, fever, shortness of breath, and hemoptysis. Clinical examination revealed bilateral mid-zone crackles, palpable tip of the spleen, and an early diastolic murmur in the aortic (A2) area. Initial laboratory results indicated anemia with leukocytosis, raised inflammatory markers, and low serum albumin. Blood cultures showed the growth of multidrug-resistant Salmonella typhi. A radiological workup showed multiple aortic valve vegetation. Salmonella endocarditis was diagnosed based on Duke's criteria. The patient was treated with culture-sensitive antibiotics and subsequently showed significant clinical recovery. This case highlights a rare multidrug-resistant Salmonella endocarditis of a native valve. It also emphasizes the difficulties in making a diagnosis and the benefit of using a multidisciplinary strategy to manage challenging clinical manifestations.

A Symphony of Challenges: Multi-Drug Resistant Tuberculosis, Pleurocutaneous Fistula, and Empyema Necessitans in Concert.

This case report details the clinical course of a 37-year-old male with multi-drug-resistant tuberculosis (MDR-TB) who initially presented with respiratory symptoms. Following a month of anti-TB therapy, the patient developed a painful chest swelling, diagnosed as empyema necessitans, with a subsequent spontaneous rupture leading to a pleurocutaneous fistula. Despite recommendations for surgery, the patient opted for active surveillance. The follow-up revealed symptom improvement. This case underscores the unique challenges of managing rare complications of MDR-TB, particularly when patients decline surgical interventions. The observed symptom improvement, despite the absence of surgery, illuminates the intricate decision-making process and alternative management strategies involved in addressing such complications, highlighting the complexities inherent in MDR-TB care.

Efficient Thorax Disease Classification and Localization Using DCNN and Chest X-ray Images.

Thorax disease is a life-threatening disease caused by bacterial infections that occur in the lungs. It could be deadly if not treated at the right time, so early diagnosis of thoracic diseases is vital. The suggested study can assist radiologists in more swiftly diagnosing thorax disorders and in the rapid airport screening of patients with a thorax disease, such as pneumonia. This paper focuses on automatically detecting and localizing thorax disease using chest X-ray images. It provides accurate detection and localization using DenseNet-121 which is foundation of our proposed framework, called Z-Net. The proposed framework utilizes the weighted cross-entropy loss function (W-CEL) that manages class imbalance issue in the ChestX-ray14 dataset, which helped in achieving the highest performance as compared to the previous models. The 112,120 images contained in the ChestX-ray14 dataset (60,412 images are normal, and the rest contain thorax diseases) were preprocessed and then trained for classification and localization. This work uses computer-aided diagnosis (CAD) system that supports development of highly accurate and precise computer-aided systems. We aim to develop a CAD system using a deep learning approach. Our quantitative results show high AUC scores in comparison with the latest research works. The proposed approach achieved the highest mean AUC score of 85.8%. This is the highest accuracy documented in the literature for any related model.

A Rare Presentation of Acute Kidney Injury in Diffuse Large B-Cell Lymphoma: A Case Report.

Acute kidney injury from bilateral renal infiltration is rare in diffuse large B-cell lymphoma (DLBCL). We present the case of a 45-year-old woman with a three-month history of night sweats, weight loss, fever, and fatigue. Clinical evaluation revealed anemia, edema, cervical lymphadenopathy, and elevated blood pressure. Initial lab results indicated severe kidney injury, initially suspected to be chronic kidney disease, later ruled out. Radiological assessments confirmed mediastinal lymphadenopathy. A cervical lymph node biopsy led to a diagnosis of DLBCL. Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy improved renal function and hematological parameters. Subsequent staging CT confirmed lymphadenopathy. Close monitoring revealed a complete return to normal renal function after one month. Further follow-up was missed. This case emphasizes diagnostic complexities and the value of a multidisciplinary approach in managing complex clinical presentations.

A Survey on COVID-19 Data Analysis Using AI, IoT, and Social Media.

Coronaviruses are a well-established and deadly group of viruses that cause illness in both humans and animals. The novel type of this virus group, named COVID-19, was firstly reported in December 2019, and, with the passage of time, coronavirus has spread to almost all parts of the world. Coronavirus has been the cause of millions of deaths around the world. Furthermore, many countries are struggling with COVID-19 and have experimented with various kinds of vaccines to eliminate the deadly virus and its variants. This survey deals with COVID-19 data analysis and its impact on human social life. Data analysis and information related to coronavirus can greatly help scientists and governments in controlling the spread and symptoms of the deadly coronavirus. In this survey, we cover many areas of discussion related to COVID-19 data analysis, such as how artificial intelligence, along with machine learning, deep learning, and IoT, have worked together to fight against COVID-19. We also discuss artificial intelligence and IoT techniques used to forecast, detect, and diagnose patients of the novel coronavirus. Moreover, this survey also describes how fake news, doctored results, and conspiracy theories were spread over social media sites, such as Twitter, by applying various social network analysis and sentimental analysis techniques. A comprehensive comparative analysis of existing techniques has also been conducted. In the end, the Discussion section presents different data analysis techniques, provides future directions for research, and suggests general guidelines for handling coronavirus, as well as changing work and life conditions.

A Race Against Time: Early-Onset Differentiation Syndrome Following All-Trans-Retinoic-Acid (ATRA) Therapy in Acute Promyelocytic Leukemia (AML-M3).

This study reports a case of differentiation syndrome, a rare complication of ATRA (all-trans-retinoic-acid) therapy, observed in a 20-year-old male with acute promyelocytic leukemia (APML). Following the initiation of ATRA therapy for APML, the patient presented with fever, bleeding gums, bloody stool, and mouth ulcers. After 36 hours, he developed respiratory distress, hypotension, tachycardia, and hypoxemia, leading to the diagnosis of differentiation syndrome. ATRA therapy was promptly discontinued, and the patient, exhibiting type 1 respiratory failure, necessitated intubation. The management included hydroxyurea, dexamethasone, vasopressors, intravenous fluids, and furosemide. After seven days, significant improvement was observed, underscoring the importance of recognizing and promptly addressing differentiation syndrome in APML patients undergoing ATRA therapy. This case emphasizes the necessity of ATRA discontinuation, coupled with the judicious use of steroids and hydroxyurea, in the effective management of differentiation syndrome.

Deliver Cardiac Virtual Care: A Primer for Cardiovascular Professionals in Canada.

The COVID-19 pandemic, with its need for distancing, has necessitated the use of virtual care in never-before-seen volumes. This review article aims to provide a primer on virtual care for cardiovascular professionals in Canada. The technology to facilitate remote patient interactions is already available, but barriers exist. Adequate and effective cardiac virtual care must be further developed given the need for rapid evaluation and close ongoing follow-up of patients, as seen in the areas of management of heart failure, cardiac rehabilitation, electrophysiology, and hypertension. Many Canadian organizations have published resources to assist health care providers and patients navigate the unfamiliar virtual care landscape. Although there are concerns surrounding issues such as patient privacy, access to technology, language discrepancies, and billing, these deficits provide opportunities for growth by health care organizations and technology companies. The integration of virtual care, home-based devices, and disruptive technologies emphasize the trend toward virtualization of health care, with the potential for greater personalization of health care interactions and continuity of care. Funding models were rapidly developed at the beginning of the COVID-19 pandemic, and although some provinces have deemed these changes as permanent, the status from other provinces remains unknown. The foundations to support virtual care as a key modality for health care delivery in Canada have been built, and further developments may strengthen its viability as a long-term option.

Dans le contexte de la pandémie de COVID-19 et de la distanciation sociale qu'elle impose, le recours aux soins de santé virtuels a atteint des sommets historiques. Le présent article de synthèse est une introduction aux soins de santé virtuels destinée aux professionnels de la santé cardiovasculaire du Canada. La technologie permettant de faciliter les interactions à distance avec les patients existe déjà, mais il y a des obstacles à sa mise en œuvre. Des soins de santé virtuels adéquats et efficaces doivent être développés davantage en cardiologie compte tenu de la nécessité d'une évaluation rapide et d'un suivi étroit et continu des patients, notamment quand il est question de prise en charge de l'insuffisance cardiaque, de réadaptation cardiaque, d'électrophysiologie ou d'hypertension. De nombreux organismes canadiens ont publié des ressources pour aider les fournisseurs de soins et les patients à trouver leurs repères dans l'univers peu connu des soins de santé virtuels. Les questions telles que la protection des renseignements personnels des patients, l'accès à la technologie, les différences linguistiques et la facturation soulèvent des préoccupations. Néanmoins, les lacunes constituent des possibilités de croissance pour les organismes de soins de santé et les entreprises technologiques. L'intégration des soins de santé virtuels, des dispositifs à domicile et des technologies perturbatrices met en lumière la tendance à la virtualisation des soins de santé, allant de pair avec la possibilité d'accroître la personnalisation des interactions et la continuité des soins. Des modèles de financement ont été rapidement élaborés au début de la pandémie de COVID-19. Bien que certaines provinces aient reconnu le caractère permanent des changements; la position des autres provinces demeure inconnue. Les conditions de base sont réunies pour que les soins de santé virtuels soient reconnus en tant que modalités clés de la prestation des soins de santé au Canada, et d'autres développements pourraient en renforcer la viabilité en tant qu'option à long terme.

Myocardial strain assessment using cardiovascular magnetic resonance imaging in recipients of implantable cardioverter defibrillators.

BACKGROUND: Cardiovascular magnetic resonance (CMR) is increasingly used in the evaluation of patients who are potential candidates for implantable cardioverter-defibrillator (ICD) therapy to assess left ventricular (LV) ejection fraction (LVEF), myocardial fibrosis, and etiology of cardiomyopathy. It is unclear whether CMR-derived strain measurements are predictive of appropriate shocks and death among patients who receive an ICD. We evaluated the prognostic value of LV strain parameters on feature-tracking (FT) CMR in patients who underwent subsequent ICD implant for primary or secondary prevention of sudden cardiac death. METHODS: Consecutive patients from 2 Canadian tertiary care hospitals who underwent ICD implant and had a pre-implant CMR scan were included. Using FT-CMR, a single, blinded, reader measured LV global longitudinal (GLS), circumferential (GCS), and radial (GRS) strain. Cox proportional hazards regression was performed to assess the associations between strain measurements and the primary composite endpoint of all-cause death or appropriate ICD shock that was independently ascertained. RESULTS: Of 364 patients (mean 61 years, mean LVEF 32%), 64(17.6%) died and 118(32.4%) reached the primary endpoint over a median follow-up of 62 months. Univariate analyses showed significant associations between GLS, GCS, and GRS and appropriate ICD shocks or death (all p < 0.01). In multivariable Cox models incorporating LVEF, GLS remained an independent predictor of both the primary endpoint (HR 1.05 per 1% higher GLS, 95% CI 1.01-1.09, p = 0.010) and death alone (HR 1.06 per 1% higher GLS, 95% CI 1.02-1.11, p = 0.003). There was no significant interaction between GLS and indication for ICD implant, presence of ischemic heart disease or late gadolinium enhancement (all p > 0.30). CONCLUSIONS: GLS by FT-CMR is an independent predictor of appropriate shocks or mortality in ICD patients, beyond conventional prognosticators including LVEF. Further study is needed to elucidate the role of LV strain analysis to refine risk stratification in routine assessment of ICD treatment benefit.

Agent-Based Semantic Role Mining for Intelligent Access Control in Multi-Domain Collaborative Applications of Smart Cities.

Significance and popularity of Role-Based Access Control (RBAC) is inevitable; however, its application is highly challenging in multi-domain collaborative smart city environments. The reason is its limitations in adapting the dynamically changing information of users, tasks, access policies and resources in such applications. It also does not incorporate semantically meaningful business roles, which could have a diverse impact upon access decisions in such multi-domain collaborative business environments. We propose an Intelligent Role-based Access Control (I-RBAC) model that uses intelligent software agents for achieving intelligent access control in such highly dynamic multi-domain environments. The novelty of this model lies in using a core I-RBAC ontology that is developed using real-world semantic business roles as occupational roles provided by Standard Occupational Classification (SOC), USA. It contains around 1400 business roles, from nearly all domains, along with their detailed task descriptions as well as hierarchical relationships among them. The semantic role mining process is performed through intelligent agents that use word embedding and a bidirectional LSTM deep neural network for automated population of organizational ontology from its unstructured text policy and, subsequently, matching this ontology with core I-RBAC ontology to extract unified business roles. The experimentation was performed on a large number of collaboration case scenarios of five multi-domain organizations and promising results were obtained regarding the accuracy of automatically derived RDF triples (Subject, Predicate, Object) from organizational text policies as well as the accuracy of extracted semantically meaningful roles.

Miniaturised Low-Cost Gamma Scanning Platform for Contamination Identification, Localisation and Characterisation: A New Instrument in the Decommissioning Toolkit.

Formerly clandestine, abandoned and legacy nuclear facilities, whether associated with civil or military applications, represent a significant decommissioning challenge owing to the lack of knowledge surrounding the existence, location and types of radioactive material(s) that may be present. Consequently, mobile and highly deployable systems that are able to identify, spatially locate and compositionally assay contamination ahead of remedial actions are of vital importance. Deployment imposes constraints to dimensions resulting from small diameter access ports or pipes. Herein, we describe a prototype low-cost, miniaturised and rapidly deployable 'cell characterisation' gamma-ray scanning system to allow for the examination of enclosed (internal) or outdoor (external) spaces for radioactive 'hot-spots'. The readout from the miniaturised and lead-collimated gamma-ray spectrometer, that is progressively rastered through a stepped snake motion, is combined with distance measurements derived from a single-point laser range-finder to obtain an array of measurements in order to yield a 3-dimensional point-cloud, based on a polar coordinate system-scaled for radiation intensity. Existing as a smaller and more cost-effective platform than presently available, we are able to produce a millimetre-accurate 3D volumetric rendering of a space-whether internal or external, onto which fully spectroscopic radiation intensity data can be overlain to pinpoint the exact positions at which (even low abundance) gamma-emitting materials exist.

Post-operative pain following cardiac implantable electronic device implantation: insights from the BRUISE CONTROL trials.

AIMS: Post-operative pain following cardiac implantable electronic device (CIED) insertion is associated with patient dissatisfaction, emotional distress, and emergency department visits. We sought to identify factors associated with post-operative pain and develop a prediction score for post-operative pain. METHODS AND RESULTS: All patients from the BRUISE CONTROL-1 and 2 trials were included in this analysis. A validated Visual Analogue Scale (VAS) was used to assess the severity of pain related to CIED implant procedures. Patients were asked to grade the most severe post-operative pain, average post-operative pain, and pain on the day of the first post-operative clinic. Multivariable regression analyses were performed to identify predictors of significant post-operative pain and to develop a pain-prediction score. A total of 1308 patients were included. Multivariable regression analysis found that the presence of post-operative clinically significant haematoma {CSH; P value < 0.001; odds ratio (OR) 3.82 [95% confidence interval (CI): 2.37-6.16]}, de novo CIED implantation [P value < 0.001; OR 1.90 (95% CI: 1.47-2.46)], female sex [P value < 0.001; OR 1.61 (95% CI: 1.22-2.12)], younger age [<65 years; P value < 0.001; OR 1.54 (95% CI: 1.14-2.10)], and lower body mass index [<20 kg/m2; P value < 0.05; OR 2.05 (95% CI: 0.98-4.28)] demonstrated strong and independent associations with increased post-operative pain. An 11-point post-operative pain prediction score was developed using the data. CONCLUSION: Our study has identified multiple predictors of post-operative pain after CIED insertion. We have developed a prediction score for post-operative pain that can be used to identify individuals at risk of experiencing significant post-operative pain.

Differences in Healthcare Use Between Patients With Persistent and Paroxysmal Atrial Fibrillation Undergoing Catheter-Based Atrial Fibrillation Ablation: A Population-Based Cohort Study From Ontario, Canada.

Background Patients with persistent atrial fibrillation (AF) undergoing catheter-based AF ablation have lower success rates than those with paroxysmal AF. We compared healthcare use and clinical outcomes between patients according to their AF subtypes. Methods and Results Consecutive patients undergoing AF ablation were prospectively identified from a population-based registry in Ontario, Canada. Via linkage with administrative databases, we performed a retrospective analysis comparing the following outcomes between patients with persistent and paroxysmal AF: healthcare use (defined as AF-related hospitalizations/emergency room visits), periprocedural complications, and mortality. Multivariable Poisson modeling was performed to compare the rates of AF-related and all-cause hospitalizations/emergency room visits in the year before versus after ablation. Between April 2012 and March 2016, there were 3768 consecutive patients who underwent first-time AF ablation, of whom 1040 (27.6%) had persistent AF. The mean follow-up was 1329 days. Patients with persistent AF had higher risk of AF-related hospitalization/emergency room visits (hazard ratio [HR], 1.21; 95% CI, 1.09-1.34), mortality (HR, 1.74; 95% CI, 1.15-2.63), and periprocedural complications (odds ratio, 1.36; 95% CI, 1.02-1.75) than those with paroxysmal AF. In the overall cohort, there was a 48% reduction in the rate of AF-related hospitalization/emergency room visits in the year after versus before ablation (rate ratio [RR], 0.52; 95% CI, 0.48-0.56). This reduction was observed for patients with paroxysmal (RR, 0.45; 95% CI, 0.41-0.50) and persistent (RR, 0.74; 95% CI, 0.63-0.87) AF. Conclusions Although patients with persistent AF had higher risk of adverse outcomes than those with paroxysmal AF, ablation was associated with a favorable reduction in downstream AF-related healthcare use, irrespective of AF type.

Approach to optimize 3-dimensional brain functional activation image with high resolution: a study on functional near-infrared spectroscopy.

In this study, 3-dimensional (3-D) enhanced brain-function-map generation and estimation methodology is presented. Optical signals were modelled in the form of numerical optimization problem to infer the best existing waveform of canonical hemodynamic response function. Inter-channel activity patterns were also estimated. The estimation of activation of inter-channel gap depends on the minimization of generalized cross-validation. 3-D brain activation maps were produced through inverse discrete cosine transform. The proposed algorithm acquired significant results for 3-D functional maps with high resolution, in comparison with that of 2-D functional t-maps. A comprehensive analysis by exhibiting images corresponding to several layers has also been appended.

Effect of Direct Oral Anticoagulants, Warfarin, and Antiplatelet Agents on Risk of Device Pocket Hematoma: Combined Analysis of BRUISE CONTROL 1 and 2.

BACKGROUND: Oral anticoagulant use is common among patients undergoing pacemaker or defibrillator surgery. BRUISE CONTROL (Bridge or Continue Coumadin for Device Surgery Randomized Controlled Trial; NCT00800137) demonstrated that perioperative warfarin continuation reduced clinically significant hematomas (CSH) by 80% compared with heparin bridging (3.5% versus 16%). BRUISE-CONTROL-2 (NCT01675076) observed a similarly low risk of CSH when comparing continued versus interrupted direct oral anticoagulant (2.1% in both groups). Using patient level data from both trials, the current study aims to: (1) evaluate the effect of concomitant antiplatelet therapy on CSH, and (2) understand the relative risk of CSH in patients treated with direct oral anticoagulant versus continued warfarin. METHODS: We analyzed 1343 patients included in BRUISE-CONTROL-1 and BRUISE-CONTROL-2. The primary outcome for both trials was CSH. There were 408 patients identified as having continued either a single or dual antiplatelet agent at the time of device surgery. RESULTS: Antiplatelet use (versus nonuse) was associated with CSH in 9.8% versus 4.3% of patients (P<0.001), and remained a strong independent predictor after multivariable adjustment (odds ratio, 1.965; 95% CI, 1.202-3.213; P=0.0071). In multivariable analysis, adjusting for antiplatelet use, there was no significant difference in CSH observed between direct oral anticoagulant use compared with continued warfarin (odds ratio, 0.858; 95% CI, 0.375-1.963; P=0.717). CONCLUSIONS: Concomitant antiplatelet therapy doubled the risk of CSH during device surgery. No difference in CSH was found between direct oral anticoagulant versus continued warfarin. In anticoagulated patients undergoing elective or semi-urgent device surgery, the patient specific benefit/risk of holding an antiplatelet should be carefully considered. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT00800137, NCT01675076.

Concomitant anti-platelet therapy in warfarin-treated patients undergoing cardiac rhythm device implantation: A secondary analysis of the BRUISE CONTROL trial.

BACKGROUND: Anti-platelet therapy is commonly used in patients receiving oral anticoagulation and may increase bleeding risk among patients undergoing cardiac implantable electronic device (CIED) surgery. We sought to determine the proportion of anticoagulated patients who are concomitantly receiving anti-platelet therapy, the associated risk of clinically significant hematoma (CSH), and the proportion of patients in whom anti-platelet usage is guideline-indicated. METHODS: A secondary analysis of the Bridge or Continue Coumadin for Device Surgery Randomized Controlled Trial (BRUISE CONTROL). Patients who were receiving warfarin, had an annual predicted risk of thromboembolism of ≥5% and were scheduled to undergo non-emergent CIED surgery were randomized to continued warfarin versus heparin bridging. In the current analysis, patients were divided into those receiving anti-platelet therapy and those not receiving anti-platelet therapy. The incidence of CSH was compared in both groups. The proportion of patients on potentially inappropriate and potentially interruptible antiplatelet therapy was estimated. RESULTS: All 681 patients enrolled in BRUISE CONTROL were included, of whom 280 received and 401 did not receive anti-platelet therapy. Anti-platelet therapy increased the risk of CSH (relative risk, 1.72; 95% confidence interval (CI), 1.09 to 2.72; P = 0.02). Of the 280 patients receiving anti-platelet therapy, 97 (34.6%) had no guideline indication for concomitant anti-platelet therapy and an additional 146 (52.1%) were on anti-platelet therapy that could potentially have been interrupted around CIED surgery. CONCLUSIONS: Concomitant anti-platelet therapy in patients receiving anticoagulation is associated with a significant risk of CSH. The majority of concomitant anti-platelet therapy is potentially inappropriate or interruptible. TRIAL REGISTRATION: clinicaltrials.gov Identifier: (NCT00800137).

Acute Myeloid Leukemia with t(8;21)(q22;q22) and Trisomy 4: A Rare Occurrence in a Female Child.

Acute myeloid leukemia (AML) with balanced translocation t (8;21) is one of the most frequent chromosomal abnormalities and carries a favorable clinical outcome. However, according to a literature review, additional chromosomal aberrations can affect the overall disease prognosis. Trisomy 4 is a rare numerical abnormality in AML patients with t (8;21), which can be associated with c-KIT gene involvement. In adults, c-KIT mutation carries an unfavorable clinical outcome; however, its incidence and clinical importance in the pediatric population are still under scrutiny. Here, we report a case of AML with t(8;21) and trisomy 4 in an eight-year-old female child and the clinical course of the disease.

Factors influencing contraceptive use among women in Afghanistan: secondary analysis of Afghanistan Health Survey 2012.

The increase in contraceptive use in Afghanistan has been frustratingly slow from 7.0% in 2003 to 11.3% in 2012. Data on contraceptive use and influencing factors were obtained from Afghanistan Health Survey (AHS) 2012, which had been collected through interview-led questionnaire from 13,654 current married women aged 12-49 years. Odds ratio (OR) and 95% confidence interval (CI) of contraceptive use were estimated by logistic regression analysis. When adjusted for age, residence, region, education, media, and wealth index, significant OR was obtained for parity (OR of 6 or more children relative to 1 child was 3.45, and the 95%CI 2.54-4.69), number of living sons (OR of 5 or more sons relative to no son was 2.48, and the 95%CI 1.86-3.29), wealth index (OR of the richest households relative to the poorest households was 2.14, and the 95%CI 1.72-2.67), antenatal care attendance (OR relative to no attendance was 2.13, and the 95%CI 1.74-2.62), education (OR of secondary education or above relative to no education was 1.62, and the 95%CI 1.26-2.08), media exposure (OR of at least some exposure to electronic media relative to no exposure was 1.15, and the 95%CI 1.01-1.30), and child mortality experience (OR was 0.88, and the 95%CI 0.77-0.99), as well as age, residence (rural/urban), and region. This secondary analysis based on AHS 2012 showed the findings similar to those from the previous studies in other developing countries. Although the unique situation in Afghanistan should be considered to promote contraceptive use, the background may be common among the areas with low contraceptive use.

Evaluation of genes encoding for the transient outward current (Ito) identifies the KCND2 gene as a cause of J-wave syndrome associated with sudden cardiac death.

BACKGROUND: J-wave ECG patterns are associated with an increased risk of sudden arrhythmic death, and experimental evidence supports a transient outward current (I(to))-mediated mechanism of J-wave formation. This study aimed to determine the frequency of genetic mutations in genes encoding the I(to) in patients with J waves on ECG. METHODS AND RESULTS: Comprehensive mutational analysis was performed on I(to)-encoding KCNA4, KCND2, and KCND3 genes, as well as the previously described J-wave-associated KCNJ8 gene, in 51 unrelated patients with ECG evidence defining a J-wave syndrome. Only patients with a resuscitated cardiac arrest or type 1 Brugada ECG pattern were included for analysis. A rare genetic mutation of the KCND2 gene, p.D612N, was identified in a single patient. Co-expression of mutant and wild-type KCND2 with KChIP2 in HEK293 cells demonstrated a gain-of-function phenotype, including an increase in peak I(to) density of 48% (P<0.05) in the heterozygous state. Using computer modeling, this increase in Ito resulted in loss of the epicardial action potential dome, predicting an increased ventricular transmural Ito gradient. The previously described KCNJ8-S422L mutation was not identified in this cohort of patients with ECG evidence of J-wave syndrome. CONCLUSIONS: These findings are the first to implicate the KCND2 gene as a novel cause of J-wave syndrome associated with sudden cardiac arrest. However, genetic defects in I(to)-encoding genes seem to be an uncommon cause of sudden cardiac arrest in patients with apparent J-wave syndromes.