Aortic stenosis (AS) is among the most common valvular heart diseases encountered in the United States. In this review the authors examine differences between racial and ethnic groups in the ...epidemiology and management of severe AS, explore potential explanations for these findings, and discuss the implications for improving the delivery of care to racially and ethnically diverse populations. Underrepresented racial and ethnic groups experience a paradoxically lower prevalence or incidence of AS relative to white subjects, despite having a higher prevalence of traditional risk factors. Historically, UREGs with severe AS have had lower rates of both surgical and transcatheter aortic valve replacement and experienced more post-surgical complications, including, bleeding, worsening heart failure, and rehospitalization. Last, UREGs with severe AS have an increased risk for morbidity and mortality relative to white patients. To date much of the research on AS has examined black-white differences, so there is a need to understand how other racial and ethnic groups with severe AS are diagnosed and treated, with examination of their resulting outcomes. Overall, racial and ethnic disparities in health care access and care delivery are a public health concern given the changing demographics of the U.S. population. These differences in AS management and outcomes highlight the need for additional research into contributing factors and appropriate interventions to address the lower rates of aortic valve replacement and higher morbidity and mortality among UREGs.
Among patients with severe aortic stenosis (AS), there are limited data on aortic valve replacement (AVR), reasons for nonreceipt and mortality by race.
Utilizing the Duke Echocardiography Laboratory ...Database, we analyzed data from 110,711 patients who underwent echocardiography at Duke University Medical Center between 1999 and 2013. We identified 1,111 patients with severe AS who met ≥1 of 3 criteria for AVR: ejection fraction ≤50%, diagnosis of heart failure, or need for coronary artery bypass surgery. Logistic regression models were used to assess the association between race, AVR and 1-year mortality. χ2 testing was used to assess potential racial differences in reasons for AVR nonreceipt.
Among the 1,111 patients (143 AA and 968 CA) eligible for AVR, AA were more often women, had more diabetes, renal insufficiency, aortic regurgitation and left ventricular hypertrophy. CA were more often smokers, had more ischemic heart disease, hyperlipidemia and higher median income levels. There were no racial differences in surgical risk utilizing logistic euroSCORES. Relative to CA, AA had lower rates of AVR (adjusted odds ratio 0.46, 95% CI 0.3-0.71, P < .001) yet similar 1-year mortality (aHR 0.81, 95% CI 0.57-1.17, P = .262). There were no significant differences in reasons for AVR nonreceipt.
We identified 143 African Americans (AA) and 968 Caucasian Americans(CA) with severe AS who met prespecified criteria for AVR.. AA relative to CA were more often women, had more diabetes, renal insufficiency, and left ventricular hypertrophy, however had less tobacco use, ischemic heart disease, hyperlipidemia and lower median income levels. Among patients with severe AS, AA relative to CA had lower rates of AVR (adjusted odds ratio 0.46, 95% CI 0.3-0.71, P < .001) without significant differences in reasons for AVR nonreceipt and similar 1-year mortality.
Mitral annular disjunction is increasingly recognized as an important anatomic feature of mitral valve disease. The presence of mitral annular disjunction, defined as separation between the left ...atrial wall at the point of mitral valve insertion and the left ventricular free wall, has been associated with increased degeneration of the mitral valve and increased incidence of sudden cardiac death. The clinical importance of this entity necessitates standard reporting on cardiovascular imaging reports if patients are to receive adequate risk stratification and management. We provide a narrative review of the literature pertaining to mitral annular disjunction, its clinical implications, and areas needing further research.
Background and Aim
Type 2 diabetes mellitus (DM) has in recent decades become a global pandemic, accounting for over 90% of DM cases. The study evaluated the health‐related quality of life (HrQoL) ...and identified its determinants among type 2 DM patients at the University of Cape Coast Hospital.
Methods
We conducted our study at the University of Cape Coast Hospital from January to March 2022. The EQ‐5D‐5L questionnaire was administered to 68 type 2 DM patients. Data were then inputted into Microsoft Excel and analyzed accordingly using IBM SPSS statistical software version 26 and GraphPad Prism 8.
Results
The mean age of the participants was 60.71 ± 12.18 with 55.9% being females. The average systolic, diastolic blood pressure and fasting blood glucose (FBG) of participants were 140.99 ± 22.27, 85 ± 11.14 and 7.97 ± 2.66 respectively. With the EQ‐5D‐5L scale, participants reported severe to extreme problems mainly in pain/discomfort (19.1%) and mobility (8.8%) dimensions. Approximately 21% (14/68) of patients reported themselves as being in perfect health based on the EQ‐5D index score with no significant difference between males and females (p ≥ 0.05). On a scale of 0 to 100, most (26.5%) of the participants rated their general health state at 80. Age was significantly associated with all five dimensions while patients with comorbidities had higher odds of experiencing pain/discomfort and anxiety/depression.
Conclusion
The study reveals that pain/discomfort and anxiety/depression are the most experienced problems among patients with type 2 DM. The HrQoL of type 2 DM patients was also found to be affected by age, comorbidities, systolic and diastolic blood pressure. Therefore, identifying these factors and developing appropriate interventions is crucial for improving patient outcomes and enhancing treatment outcomes.
Methods Our analysis included adults patients at Duke University Medical Center between 1999-2013, who met criteria for AVR based on echocardiographic indices (aortic valve area <1m/s2 or mean ...gradient >40mmHg) plus one of three additional criteria: ejection fraction<50%, evidence of heart failure, or need for coronary artery bypass surgery. After adjustment for demographics and risk factors, differences in AVR utilization were attenuated (aHR 0.77, 95% CI 0.53-1.12, p-value 0.18) and there were no racial differences in mortality (aHR 0.72, 95% CI 0.48-1.09, p-value 0.12).
Aortic stenosis (AS) is among the most common valvular heart diseases encountered in the United States. In this review the authors examine differences between racial and ethnic groups in the ...epidemiology and management of severe AS, explore potential explanations for these findings, and discuss the implications for improving the delivery of care to racially and ethnically diverse populations. Underrepresented racial and ethnic groups experience a paradoxically lower prevalence or incidence of AS relative to white subjects, despite having a higher prevalence of traditional risk factors. Historically, UREGs with severe AS have had lower rates of both surgical and transcatheter aortic valve replacement and experienced more post-surgical complications, including, bleeding, worsening heart failure, and rehospitalization. Last, UREGs with severe AS have an increased risk for morbidity and mortality relative to white patients. To date much of the research on AS has examined black-white differences, so there is a need to understand how other racial and ethnic groups with severe AS are diagnosed and treated, with examination of their resulting outcomes. Overall, racial and ethnic disparities in health care access and care delivery are a public health concern given the changing demographics of the U.S. population. These differences in AS management and outcomes highlight the need for additional research into contributing factors and appropriate interventions to address the lower rates of aortic valve replacement and higher morbidity and mortality among UREGs.
Display omitted
•Data on the management and outcomes of diverse populations with severe AS are lacking.•Underrepresented racial/ethnic groups have lower rates of AVR and worse outcomes.•Studies assessing reasons for lower AVR and strategies/interventions are needed.
The principal aim of this thesis is to undertake a critical examination of the role of the international patent system in the transfer of technology to West Africa, particularly Ghana and Nigeria. It ...focuses mainly on the patent systans and technology regulatory regimes of the two countries. The study is intended to identify and evaluate the impact of the international patent system on the transfer and development of technology in this area. The first chapter provides a theoretical foundation to some of the more practical issues to be discussed in the subsequent chapters. The Paris Convention and the diplomatic revision exercise thereof, as well as other efforts and policies regarding patents and technology transfer at various levels are discussed in Chapter Two. Chapters Three to Eight consider the two case-studies undertaken in this thesis. Chapter Three begins with the historical development of the patent system in both Ghana and Nigeria, and the remaining chapters continue with a discussion of the present patent and technology regulatory regimes of both countries. Based on facts and figures the two case-studies examine critically the patent law and systems and technology transfer laws of these two countries including other related institutional measures highlighting their strengths and weaknesses. The study argues that if the patent systems of both countries are to play a meaningful role in the transfer and developnent of technology they nust be utilized as a tool of economic policy and also be related to the technology transfer regimes which nust necessarily be integrated into the national technology policy which should, in turn, be made an integral part of the entire national developnent plan. It is concluded that it is only in this way that the patent system can effectively contribute to the transfer of technology and the development of indigenous technological capabilities in the two countries.
The principal aim of this thesis is to undertake a critical examination of the role of the international patent system in the transfer of technology to West Africa, particularly Ghana and Nigeria. It ...focuses mainly on the patent systans and technology regulatory regimes of the two countries. The study is intended to identify and evaluate the impact of the international patent system on the transfer and development of technology in this area. The first chapter provides a theoretical foundation to some of the more practical issues to be discussed in the subsequent chapters. The Paris Convention and the diplomatic revision exercise thereof, as well as other efforts and policies regarding patents and technology transfer at various levels are discussed in Chapter Two. Chapters Three to Eight consider the two case-studies undertaken in this thesis. Chapter Three begins with the historical development of the patent system in both Ghana and Nigeria, and the remaining chapters continue with a discussion of the present patent and technology regulatory regimes of both countries. Based on facts and figures the two case-studies examine critically the patent law and systems and technology transfer laws of these two countries including other related institutional measures highlighting their strengths and weaknesses. The study argues that if the patent systems of both countries are to play a meaningful role in the transfer and developnent of technology they nust be utilized as a tool of economic policy and also be related to the technology transfer regimes which nust necessarily be integrated into the national technology policy which should, in turn, be made an integral part of the entire national developnent plan. It is concluded that it is only in this way that the patent system can effectively contribute to the transfer of technology and the development of indigenous technological capabilities in the two countries.
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