DSpace Collection: Faculty of Medicine, B.Sc. (Med) Projects

Cigarette smoking and socioeconomic status in disease outcomes of systemic lupus erythematosus: results from the 1000 Faces of Lupus cohort

2013-05-13T13:57:49Z

Title: Cigarette smoking and socioeconomic status in disease outcomes of systemic lupus erythematosus: results from the 1000 Faces of Lupus cohort Authors: Nguyen, Mai Abstract: Part 1: The effect of smoking on the disease characteristics of systemic lupus erythematosus (SLE) has not been extensively researched in large cohorts to date. Through this study, we aim to examine the relationship between current smoking status, sociodemographic variables, disease activity and organ damage in a large cohort of SLE patients. Methods: 1380 adult SLE patients from the 1000 Faces of Lupus cohort were tested for differences in sociodemographic variables, disease activity and organ damage between current smokers and non-smokers. Significant variables from univariate analyses were included in linear regression models examining for predictors of disease outcomes. Results: More Caucasians (19%) and Aboriginals (44%) smoked compared to Asians (6%), and Africans (9%) (p<0.001). More smokers had low income compared to non-smokers (27% vs. 11%, p<0.001). Less smokers completed high school (76% vs. 87% of non-smokers, p<0.001). No difference in organ damage was found. Disease activity, measured by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score, trended higher in current smokers (5.5 ± 0.3 vs. 5.0 ± 0.1 in non-smokers). In linear regression, smoking status was the only significant predictor of SLEDAI (p=0.024), other than current treatment with prednisone when controlled for income, education, ethnicity, number of diagnostic criteria met, and age at diagnosis of SLE. Conclusion: Current smoking is a predictor of increased disease activity in SLE, and may account for the differences in disease activity seen between ethnic and socioeconomic groups. Part 2: The relationship between socioeconomic status (SES) and disease outcome is well studied in SLE. Inflammation and immune dysfunction have been proposed as possible mediators. We aim to examine the relationship between SES, autoantibody frequency, and inflammation in SLE patients. Methods: A cohort of 273 Winnipeg SLE patients was tested for associations between education, income, autoantibody frequency and inflammation as measured by erythrocyte sedimentation rate (ESR). Linear regression models were developed for predictors of total autoantibody frequency, elevated ESR, and organ damage. Results: No associations were found between SES and autoantibody frequency. Less education and low income were associated with increased maximum ESR scores (p<0.001, p=0.035 respectively). Both income and education were predictors of increased mean ESR scores in linear regression (p=0.025 and p=0.047). When total ACR score, age, and income were included in the regression model, mean ESR score and high school completion were predictors of organ damage (p=0.032 and p=0.04). Conclusion: Low SES is associated with elevated inflammation, and inflamation.

Understanding the impact of HIV among a vulnerable population in south India

2013-01-29T18:32:31Z

Title: Understanding the impact of HIV among a vulnerable population in south India Authors: Zylberman, Melina Abstract: India has approximately 5.7 million people living with HIV/AIDS (PLWHA). Karnataka, a southern state in India containing the capital city of Bangalore, is a prime example of an area demonstrating high HIV prevalence. Snehadaan, a care and support centre for PLWHA in the outskirts of Bangalore, has requested assistance from partners at the Karnataka Health Promotion Trust and the University of Manitoba to understand better the needs of their patients to plan the expansion of their services. A retospective chart review of 210 charts from an adult population of HIV infected inpatients who died at Snehadaan between 2010 and 2011 was conducted to describe causes of mortality. Last admission details such as clinical presentation and tuberculosis (TB) and HIV diagnosis and treatment details were also explored. It was found that almost all the patients presented as WHO HIV stage III or IV (96.9%) and 76.4% had CD4 counts less than 200 cells/mm3, but only 56.7% were on antiretoviral therapy (ART) at time of admission. Furthermore, almost halt (49.6%) died within one year from their date of HIV diagnosis and 70.3% were diagnosed during their last admission with TB, a disease that accounted for 39.6% of the total deaths. These findings show that these patients presented late and at advanced stages in their disease and emphasize the importance of continuing to increase awareness of HIV for earlier testing and treatnent and of opportunistic infections such as TB, as they further compromise the health of an already immunocompromised population.

Accurate bedside clinical assessment of hypertensive and 'symptomatic' hypotensive patient's intravascular volume status with hand-carried ultrasound devices in hemodialysis clinic

2013-01-29T18:36:00Z

Title: Accurate bedside clinical assessment of hypertensive and 'symptomatic' hypotensive patient's intravascular volume status with hand-carried ultrasound devices in hemodialysis clinic Authors: Zhang, Yiyang Abstract: The number of people diagnosed and living with kidney failure requiring dialysis in Canada has tripled in the last two decades. In center hemodialysis is a thrice-weekly treatment that attempts to remove fluid and toxins rapidly and in a short time. One of the major difficulties is determining how much fluid to remove from a patient in a given treatment as the bedside physical exam is often inaccurate. Therefore the aim of this study is to assess volume status in chronic dialysis patients by measuring the IVC diameter employing a hand-carried ultrasound. Patients with kidney failure were recruited to the study and each was scanned three times on three different dialysis sessions. Measurements of the inferior vena cava were taken pre, mid, and post dialysis sessions. Measurements of the inferior vena cava were compared to clinical surrogates of volume, which include blood pressure, symptoms, and ultrafiltration removed. The student learnt ultrasound techniques to scan for the inferior vena cava, as well, he learnt basic research and statistical skills in order to assess the reliability and feasibility of using hand-carried ultrasound in clinical practice.

Evaluation of a novel head and neck immobilization device for external beam radiation therapy

2013-01-29T18:36:05Z

Title: Evaluation of a novel head and neck immobilization device for external beam radiation therapy Authors: Willcock, Michael Abstract: The purpose of this study was to compare the novel CDR Systems MayoMold to the Civco Medical Solutions standard neck roll in order to determine if the MayoMold should become widely used for head and neck cancer radiation therapy immobilization at CancerCare Manitoba. Fifteen patients were enrolled in the standard neck roll cohort and ten patients were enrolled in the MayoMold cohort. Bony landmarks of clinical interest were selected and daily imaging was used to quantify daily changes in patient set up and deformations with respect to the digitally reconstructed radiograph created from each patient’s planning CT. Bayesian statistics were employed with support from Epidemiology at CancerCare Manitoba in order to compare the patients to themselves across all of their treatment fractions, to different patients in the same cohort, and to the other cohort. Subjective end points concerning the MayoMold were solicited from patients and staff. Several measures of patient immobilization, especially concerning the mandible, were found to be inferior in the MayoMold cohort. These results were statistically significant but not clinically significant, allowing the conclusion to be made that the MayoMold was not superior to the standard neck roll with regards to patient immobilization. Adverse subjective feedback and the increased cost of using the MayoMold skewed the subjective end points towards the negative. In all, it was not recommended that CancerCare Manitoba adopt the MayoMold.