METHODS: This retrospective, observational, population-based study involved all children with KD registered in Johor Kawasaki Clinical Registry over 10 years (January 2010 and December 2019). The prevalence of delayed diagnosis and its trend over time was calculated. Multivariable binary logistic regression was used to identify the independent risk factors for delayed diagnosis.
RESULTS: There were 556 cases of KD, with 28% having incomplete criteria, 11% atypical presentation, while 10% developed a coronary aneurysm. The overall prevalence of delayed diagnosis was 9.9% (95% confidence interval (CI): 7.6-12.7%). There was a statistically significant decrease in delayed diagnosis over time (P = 0.008), with the latest rate of 4.6%. The majority of delayed diagnoses were due to failure to diagnose the disease during the initial consultation. Independent risk factors for delayed diagnosis were children older than 1 year, diagnosis before 2015, atypical presentation, and incomplete KD, with adjusted odds ratios (ORs) of 2.7, 2.3, 4.3, and 3.6, respectively. Compared to early diagnosis of KD, delayed diagnosis was significantly associated with coronary aneurysms (27.3% vs. 8.2%, P < 0.001, OR 4.2, [95% CI: 2.1-8.3]).
CONCLUSIONS: One-tenth of cases of KD were diagnosed late, but it has improved over time. Children > 1 year, presenting with atypical presentation, and incomplete criteria are associated with late diagnosis.
METHODS: A cross-sectional study was conducted on all primary care doctors working in government health clinics in Kuala Lumpur, Malaysia, from October 2016 to November 2016. A self-reported questionnaire was used, which included questions on demographic information, knowledge of in-flight medicine, and the attitude and confidence of primary care doctors in managing in-flight medical emergencies.
RESULTS: 182 doctors completed the questionnaire (92.9% response rate). The mean knowledge score was 8.9 out of a maximum score of 20. Only 11.5% of doctors felt confident managing in-flight medical emergencies. The majority (69.2%) would assist in an in-flight medical emergency, but the readiness to assist was reduced if someone else was already helping or if they were not familiar with the emergency. Total knowledge score was positively associated with confidence in managing in-flight medical emergencies (p = 0.03).
CONCLUSION: Only one in ten primary care doctors in this study felt confident managing in-flight medical emergencies. A higher total knowledge score of in-flight medical emergencies was positively associated with greater confidence in managing them. Educational programmes to address this gap in knowledge may be useful to improve doctors' confidence in managing in-flight medical emergencies.
METHOD: Literature search was performed within the PubMed, ScienceDirect.com and Google Scholar.
RESULTS: The presence of proline at the C-terminal tripeptide of ACE inhibitor can competitively inhibit the ACE activity. The effects of other amino acids are less studied leading to difficulties in predicting potent peptide sequences. The broad specificity of the enzyme may be due to the dual active sites observed on the somatic ACE. The inhibitors may not necessarily competitively inhibit the enzyme which explains why some reported inhibitors do not have the common ACE inhibitor characteristics. Finally, the in vivo assay has to be carried out before the peptides as the antihypertensive agents can be claimed. The peptides must be absorbed into circulation without being degraded, which will affect their bioavailability and potency. Thus, peptides with strong in vitro IC50 values do not necessarily have the same effect in vivo and vice versa.
CONCLUSION: The relationship between peptide amino acid sequence and inhibitory activity, in vivo studies of the active peptides and bioavailability must be studied before the peptides as antihypertensive agents can be claimed.