Variation in COVID-19 Mortality Across 117 US Hospitals in High- and Low-Burden Settings

Some hospitals have faced a surge of patients with COVID-19, while others have not. We assessed whether COVID-19 burden (number of patients with COVID-19 admitted during April 2020 divided by hospital certified bed count) was associated with mortality in a large sample of US hospitals. Our study population included 14,226 patients with COVID-19 (median age 66 years, 45.2% women) at 117 hospitals, of whom 20.9% had died at 5 weeks of follow-up. At the hospital level, the observed mortality ranged from 0% to 44.4%. After adjustment for age, sex, and comorbidities, the adjusted odds ratio for in-hospital death in the highest quintile of burden was 1.46 (95% CI, 1.07-2.00) compared to all other quintiles. Still, there was large variability in outcomes, even among hospitals with a similar level of COVID-19 burden and after adjusting for age, sex, and comorbidities.

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Sex modulates the association of radial artery augmentation index with renal function decline in individuals without chronic kidney disease

International Urology and Nephrology ◽

10.1007/s11255-020-02776-5 ◽

2021 ◽

Author(s):

Qiao Qin ◽

Fangfang Fan ◽

Jia Jia ◽

Yan Zhang ◽

Bo Zheng

Keyword(s):

Chronic Kidney Disease ◽

Renal Function ◽

Kidney Disease ◽

Arterial Stiffness ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Augmentation Index ◽

Renal Function Decline

Abstract Purpose An increase in arterial stiffness is associated with rapid renal function decline (RFD) in patients with chronic kidney disease (CKD). The aim of this study was to investigate whether the radial augmentation index (rAI), a surrogate marker of arterial stiffness, affects RFD in individuals without CKD. Methods A total of 3165 Chinese participants from an atherosclerosis cohort with estimated glomerular filtration rates (eGFR) of ≥ 60 mL/min/1.73 m2 were included in this study. The baseline rAI normalized to a heart rate of 75 beats/min (rAIp75) was obtained using an arterial applanation tonometry probe. The eGFRs at both baseline and follow-up were calculated using the equation derived from the Chronic Kidney Disease Epidemiology Collaboration. The association of the rAIp75 with RFD (defined as a drop in the eGFR category accompanied by a ≥ 25% drop in eGFR from baseline or a sustained decline in eGFR of > 5 mL/min/1.73 m2/year) was evaluated using the multivariate regression model. Results During the 2.35-year follow-up, the incidence of RFD was 7.30%. The rAIp75 had no statistically independent association with RFD after adjustment for possible confounders (adjusted odds ratio = 1.12, 95% confidence interval: 0.99–1.27, p = 0.074). When stratified according to sex, the rAIp75 was significantly associated with RFD in women, but not in men (adjusted odds ratio and 95% confidence interval: 1.23[1.06–1.43], p = 0.007 for women, 0.94[0.76–1.16], p = 0.542 for men; p for interaction = 0.038). Conclusion The rAI might help screen for those at high risk of early rapid RFD in women without CKD.

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Translational delivery of Cool Little Kids to prevent child internalising problems: Randomised controlled trial

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867417726582 ◽

2017 ◽

Vol 52 (2) ◽

pp. 181-191 ◽

Cited By ~ 14

Author(s):

Jordana K Bayer ◽

Ruth Beatson ◽

Lesley Bretherton ◽

Harriet Hiscock ◽

Melissa Wake ◽

...

Keyword(s):

Standard Deviation ◽

Confidence Interval ◽

Anxiety Disorders ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Controlled Trial ◽

Secondary Outcomes ◽

Randomised Controlled ◽

Internalising Problems

Objective: To determine whether a population-delivered parenting programme assists in preventing internalising problems at school entry for preschool children at-risk with temperamental inhibition. Methods: Design: a randomised controlled trial was used. Setting: the setting was 307 preschool services across eight socioeconomically diverse government areas in Melbourne, Australia. Participants: a total of 545 parents of inhibited 4-year-old children: 498 retained at 1-year follow up. Early intervention: Cool Little Kids parenting group programme was implemented. Primary outcomes: the primary outcomes were child DSM-IV anxiety disorders (assessor blind) and internalising problems. Secondary outcomes: the secondary outcomes were parenting practices and parent mental health. Results: At 1-year follow up (mean (standard deviation) age = 5.8 (0.4) years), there was little difference in anxiety disorders between the intervention and control arms (44.2% vs 50.2%; adjusted odds ratio = 0.86, 95% confidence interval = [0.60, 1.25], p = 0.427). Internalising problems were reduced in the intervention arm (Strengths and Difficulties Questionnaire: abnormal – 24.2% vs 33.0%; adjusted odds ratio = 0.56, 95% confidence interval = [0.35, 0.89], p = 0.014; symptoms – mean (standard deviation) = 2.5 (2.0) vs 2.9 (2.2); adjusted mean difference = –0.47, 95% confidence interval = [–0.81, –0.13], p = 0.006). Parents’ participation in the intervention was modest (29.4% attended most groups, 20.5% used skills most of the time during the year). A priori interaction tests suggested that for children with anxious parents, the intervention reduced anxiety disorders and internalising symptoms after 1 year. Conclusion: Offering Cool Little Kids across the population for inhibited preschoolers does not impact population outcomes after 1 year. Effects may be emerging for inhibited children at highest risk with parent anxiety. Trial outcomes will continue into mid-childhood.

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Interfacility transfers for US ischemic stroke and TIA, 2006–2014

Neurology ◽

10.1212/wnl.0000000000005419 ◽

2018 ◽

Vol 90 (18) ◽

pp. e1561-e1569 ◽

Cited By ~ 13

Author(s):

Benjamin P. George ◽

Sara J. Doyle ◽

George P. Albert ◽

Ania Busza ◽

Robert G. Holloway ◽

...

Keyword(s):

Emergency Department ◽

Ischemic Stroke ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Stroke Care ◽

Hospital Level ◽

Transfer Rates ◽

The Us ◽

Ed Visits ◽

Low Volume

ObjectiveTo investigate changes in emergency department (ED) transfers for ischemic stroke (IS) and TIA.MethodsWe performed a retrospective observational study using the US Nationwide Emergency Department Sample to identify changes in interfacility ED transfers for IS and TIA from the perspective of the transferring ED (2006–2014). We calculated nationwide transfer rates and individual ED transfer rates for IS/TIA by diagnosis and hospital characteristics. Hospital-level fractional logistic regression examined changes in transfer rates over time.ResultsThe population-estimated number of transfers for IS/TIA increased from 22,576 patient visits in 2006 to 54,485 patient visits in 2014 (p trend < 0.001). The rate of IS/TIA transfer increased from 3.4 (95% confidence interval [CI] 3.0–3.8) in 2006 to 7.6 (95% CI 7.2–7.9) in 2014 per 100 ED visits. Among individual EDs, mean transfer rates for IS/TIA increased from 8.2 per 100 ED visits (median 2.0, interquartile range [IQR] 0–10.2) to 19.4 per 100 ED visits (median 8.1, IQR 1.1–33.3) (2006–2014) (p trend < 0.001). Transfers were more common among IS. Transfer rates were greatest among rural (adjusted odds ratio [AOR] 3.05, 95% CI 2.56–3.64) vs urban/teaching and low-volume EDs (AOR 7.49, 95% CI 6.58–8.53, 1st vs 4th quartile). The adjusted odds of transfer for IS/TIA increased threefold (2006–2014).ConclusionsInterfacility ED transfers for IS/TIA more than doubled from 2006 to 2014. Further work should determine the necessity of IS/TIA transfers and seek to optimize the US stroke care system.

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Morbidity After Symptomatic Hemorrhage of Cerebral Cavernous Malformation

Stroke ◽

10.1161/strokeaha.120.029942 ◽

2020 ◽

Vol 51 (10) ◽

pp. 2997-3006

Author(s):

Li Ma ◽

Shuo Zhang ◽

Zongze Li ◽

Chun-Xue Wu ◽

Zhaozhao Wang ◽

...

Keyword(s):

Calibration Curve ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Cavernous Malformation ◽

Cerebral Cavernous Malformation ◽

Developmental Venous Anomaly ◽

Venous Anomaly ◽

Discriminative Ability ◽

Increased Risk

Background and Purpose: Symptomatic hemorrhage contributes to an increased risk of repeated bleeding and morbidity in cerebral cavernous malformation (CCM). A better understanding of morbidity after CCM hemorrhage would be helpful to identify patients of higher risk for unfavorable outcome and tailor individualized management. Methods: We identified 282 consecutive patients who referred to our institute from 2014 to 2018 for CCM with symptomatic hemorrhage and had an untreated follow-up period over 6 months after the first hemorrhage. The morbidity after hemorrhage was described in CCM of different features. Nomogram to predict morbidity was formulated based on the multivariable model of risk factors. The predictive accuracy and discriminative ability of nomogram were determined with concordance index (C-index) and calibration curve, and further validated in an independent CCM cohort of a prospective multicenter study from 2019 to 2020. Results: The overall morbidity of CCM was 26.2% after a mean follow-up of 1.9 years (range 0.5–3.5 years) since the first hemorrhage. The morbidity during untreated follow-up was associated with hemorrhage ictus (adjusted odds ratio per ictus increase, 4.17 [95% CI, 1.86–9.33]), modified Rankin Scale score at initial hemorrhage (adjusted odds ratio per point increase, 2.57 [95% CI, 1.82–3.63]), brainstem location (adjusted odds ratio, 2.93 [95% CI, 1.28–6.68]), and associated developmental venous anomaly (adjusted odds ratio, 2.21 [95% CI, 1.01–4.83]). Subgroup analysis revealed similar findings in brainstem and non-brainstem CCM. Nomogram was contracted based on these features. The calibration curve showed good agreement between nomogram prediction and actual observation. The C-index of nomogram predicting morbidity was 0.83 (95% CI, 0.77–0.88). In validation cohort, the nomogram maintained the discriminative ability (C-index, 0.87 [95% CI, 0.78–0.96]). Conclusions: Multiple symptomatic hemorrhages, initial neurological function after hemorrhage, brainstem location, and associated developmental venous anomaly were associated with morbidity of CCM hemorrhage. The nomogram represented a practical approach to provide individualized risk assessment for CCM patients. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT04076449.

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Levels of inflammatory markers and the development of the post-thrombotic syndrome

Thrombosis and Haemostasis ◽

10.1160/th08-08-0511 ◽

2009 ◽

Vol 101 (03) ◽

pp. 505-512 ◽

Cited By ~ 69

Author(s):

Hadia Shbaklo ◽

Christina A. Holcroft ◽

Susan R. Kahn

Keyword(s):

Odds Ratio ◽

Inflammatory Markers ◽

Subsequent Development ◽

Regression Analyses ◽

Post Thrombotic Syndrome ◽

Venous Valves ◽

Markers Of Inflammation ◽

Close Relationship ◽

Study Population

SummaryThe post-thrombotic syndrome (PTS) occurs frequently after deep venous thrombosis (DVT) despite appropriate anticoagulant therapy. A close relationship between inflammation and thrombosis exists. While the inflammatory process at the time of DVT appears to improve thrombus resolution, it may promote destruction of venous valves, valvular reflux and subsequent development of PTS. We prospectively evaluated the association between levels of four cytokines (IL-6, IL-8, IL-10 and MCP-1), two adhesion molecules (ICAM-1 and VCAM-1) and the development of PTS in a well-defined cohort of patients with DVT. The study population consisted of 387 patients with objectively diagnosed symptomatic DVT who were followed for two years to determine the incidence of PTS. At the end of follow-up, plasma samples frozen at the four-month visit in 307 study patients were thawed and analyzed for the above inflammatory markers using the Luminex beads technology. Mean levels of IL-6 were significantly higher in patients with PTS compared to patients without PTS (7.35 pg/ml ± 14.26 [SD] vs. 4.60 pg/ml ± 4.90;p=0.03). Logistic regression analyses showed significant associations between PTS and levels above vs. below the median of IL-6 [odds ratio (OR) 1.66; 95% confidence interval (CI) 1.05, 2.62 (p=0.03)] and ICAM-1 [OR 1.63; 95% CI 1.03, 2.58 (p=0.04)]. None of the other markers showed any association with PTS. Our study suggests the presence of significant associations between markers of inflammation such as IL-6 and ICAM-1 and the development of PTS. Further work is needed to evaluate this relationship and to analyse other candidate markers that could be implicated etiologically in the association between DVT and PTS. If confirmed, this could lead to identification of new therapeutic targets for preventing PTS after DVT.

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Thrombus Migration and Fragmentation After Intravenous Alteplase Treatment

Stroke ◽

10.1161/strokeaha.120.029292 ◽

2021 ◽

Vol 52 (1) ◽

pp. 203-212

Author(s):

Tomoyuki Ohara ◽

Bijoy K. Menon ◽

Fahad S. Al-Ajlan ◽

MacKenzie Horn ◽

Mohamed Najm ◽

...

Keyword(s):

Computed Tomography ◽

Carotid Artery ◽

Clinical Outcome ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Internal Carotid ◽

Artery Occlusion ◽

Intravenous Alteplase ◽

Over Time

Background and Purpose: There is interest in what happens over time to the thrombus after intravenous alteplase. We study the effect of alteplase on thrombus structure and its impact on clinical outcome in patients with acute stroke. Methods: Intravenous alteplase treated stroke patients with intracranial internal carotid artery or middle cerebral artery occlusion identified on baseline computed tomography angiography and with follow-up vascular imaging (computed tomography angiography or first run of angiography before endovascular therapy) were enrolled from INTERRSeCT study (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography). Thrombus movement after intravenous alteplase was classified into complete recanalization, thrombus migration, thrombus fragmentation, and no change. Thrombus migration was diagnosed when occlusion site moved distally and graded according to degrees of thrombus movement (grade 0–3). Thrombus fragmentation was diagnosed when a new distal occlusion in addition to the primary occlusion was identified on follow-up imaging. The association between thrombus movement and clinical outcome was also evaluated. Results: Among 427 patients in this study, thrombus movement was seen in 54% with a median time of 123 minutes from alteplase administration to follow-up imaging, and sub-classified as marked (thrombus migration grade 2–3 + complete recanalization; 27%) and mild to moderate thrombus movement (thrombus fragmentation + thrombus migration grade 0–1; 27%). In patients with proximal M1/internal carotid artery occlusion, marked thrombus movement was associated with a higher rate of good outcome (90-day modified Rankin Scale, 0–2) compared with mild to moderate movement (52% versus 27%; adjusted odds ratio, 5.64 [95% CI, 1.72–20.10]). No difference was seen in outcomes between mild to moderate thrombus movement and no change. In M1 distal/M2 occlusion, marked thrombus movement was associated with improved 90-day good outcome compared with no change (70% versus 56%; adjusted odds ratio, 2.54 [95% CI, 1.21–5.51]). Conclusions: Early thrombus movement is common after intravenous alteplase. Marked thrombus migration leads to good clinical outcomes. Thrombus dynamics over time should be further evaluated in clinical trials of acute reperfusion therapy.

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Pancreatic and gut hormones as predictors of new-onset prediabetes after non-necrotising acute pancreatitis: a prospective longitudinal cohort study

Endocrine Connections ◽

10.1530/ec-21-0229 ◽

2021 ◽

Author(s):

Sakina H Bharmal ◽

Wandia Kimita ◽

Juyeon Ko ◽

Maxim S Petrov

Keyword(s):

Acute Pancreatitis ◽

Cohort Study ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Gut Hormones ◽

Study Groups ◽

Prospective Longitudinal ◽

Prospective Longitudinal Cohort ◽

New Onset

Objective: Early identification of individuals at a high risk for metabolic derangements after an attack of acute pancreatitis (AP) is critical with a view to tertiary preventing of this disease. The aim was to investigate whether fasting pancreatic and gut hormones at baseline were predictive of future risk of new-onset prediabetes after acute pancreatitis (NOPAP) in individuals with non-necrotising AP. Methods: This was a prospective longitudinal cohort study that included 69 consecutive non-diabetic participants with AP, of whom 55% (n=38) had normoglycaemia both at baseline and during follow-up, 25% (n=17) had prediabetes both at baseline and during follow-up, and 20% (n=14) were normoglycaemic at baseline but developed NOPAP during follow-up. The associations between the study groups and circulating fasting levels of pancreatic and gut hormones (insulin, C-peptide, glucose-dependent insulinotropic peptide, glucagon-like peptide-1, pancreatic polypeptide, and peptide YY) were studied using multinomial regression in both unadjusted and adjusted analyses. Results: Elevated plasma insulin and glucagon at baseline were significantly associated with NOPAP (adjusted odds ratio 1.99, 95% confidence interval 1.01 to 3.92; and adjusted odds ratio 3.44, 95% confidence interval 1.06 to 11.19, respectively). The same hormones had no significant association with antecedent prediabetes in AP. The other studied hormones were not significantly associated with the study groups. Conclusions: Normoglycaemic AP individuals with elevated fasting levels of insulin and glucagon at baseline constitute a high-risk group for future NOPAP.

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One opioid user saving another: the first study of an opioid overdose-reversal and naloxone distribution program addressing hard-to-reach drug scenes in Denmark

Harm Reduction Journal ◽

10.1186/s12954-019-0328-0 ◽

2019 ◽

Vol 16 (1) ◽

Author(s):

Birgitte Thylstrup ◽

Morten Hesse ◽

Marian Jørgensen ◽

Henrik Thiesen

Keyword(s):

Police Officers ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Prevention Programs ◽

Opioid Overdose ◽

Protection Agency ◽

User Groups ◽

Low Threshold ◽

Overdose Deaths

Abstract Background Overdose education and naloxone distribution programs decrease opioid overdose deaths. However, no studies of such programs have been carried out in Denmark. The aim of this study was to evaluate the feasibility and the effect of a broader “training-the-trainers” model in low-threshold settings after participation in the “Danish Save Lives” [SL] program. Methods Between May 2013 and November 2015, 552 participants from four municipalities took part in the SL program. The program is built on the train-the-trainers model where a central trainer trains others (trainers), who in turn train others (helpers). Participants were 30 police officers (5%), 188 people who use opioids (34%), 23 significant others (4%), and 217 social workers (39%). Ninety-four participants could not be classified (17%). At follow-up, participants were interviewed to determine the number and outcomes of opioid overdoses. Logistic regression was used to assess predictors of treating an overdose. Results In all, 37 (7%) participants had intervened in 45 opioid overdose events (two trainers and 35 helpers). Detailed descriptions of the overdose event were available from 32 follow-up interviews (70%). In 16 cases, the person who intervened was already present at the site when the overdose occurred, and in 17 cases, the overdose victim recovered without complications. All overdose victims survived except one. People who used opioids were more likely to have treated an overdose than other participants (adjusted odds ratio [AOR] = 8.50, p = 0.001), and the likelihood of treating and overdose declined over time AOR = 0.37 (0.13, 0.93), p = 0.034). Conclusions Prevention programs that target people who use opioids are more likely to be effective than programs that target professionals, especially in high-risk settings that can be hard for paramedics to reach. A future goal is to explore how prevention programs can be adapted to new user groups. Trial registration The Danish Data Protection Agency, 2015-57-0002, Aarhus University, 2016-051-000001, 184, retrospectively registered

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Abstract 15142: Left Bundle Branch Pacing, Procedure Characteristics, Feasibility and Long-term Safety: Insights From a Large Sample Single Center Study

Circulation ◽

10.1161/circ.142.suppl_3.15142 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Weijian Huang ◽

Lan Su ◽

Songjie Wang ◽

Shengjie Wu ◽

Lei Xu ◽

...

Keyword(s):

Left Ventricular ◽

Left Ventricular Ejection ◽

Large Sample Size ◽

Ventricular Ejection Fraction ◽

Large Sample ◽

Number Of Patients ◽

Operative Revision ◽

Long Term Follow Up

Introduction: Left bundle branch pacing (LBBP) is a novel pacing method and has been proven to have low and stable pacing thresholds. However, data on large numbers of patients with long-term follow-up is still needed to evaluate its feasibility and safety. Hypothesis: To evaluate the feasibility and safety of LBBP in a large sample with long-term follow up. Methods: This study prospectively enrolled 632 consecutive patients with left bundle branch block, AV block or sick sinus syndrome with attempted LBBP from April 2017 to July 2019. Pacing parameters, ECG, echocardiographic measurements, complications were assessed at implant, and during follow-up of 1, 6, 12 and 24 months. Results: LBBP was successful in 618/632 (97.8%) patients according to the strict criteria for LBB capture. Mean follow-up time was 17.8±6.9 months. LBB capture threshold at implant was 0.65±0.27 [email protected] and 0.71±0.35 [email protected] at 2-year follow-up (n=166). Left ventricular ejection fraction were improved in QRS≥120ms and <120ms groups (60.62±14.22% vs. 63.95±11.29 %, p<0.001; 49.77±17.58 % vs. 58.58±12.79 %, p<0.001; respectively). The number of patients with moderate and sever tricuspid regurgitation decreased at 1-year (120 to 66;28 to 16; respectively). Permanent right bundle branch injury occurred in 55 (8.9%) patients. LBB capture threshold increased greater than 2 V in 6 patients, loss of capture in 2 patients, two lead dislodgements requiring operative revision within 1 month after implantation during 2-years follow-up. Conclusions: Feasibility and safety of LBBP were confirmed by this large sample size and long-term follow-up study. It is a reliable physiologic method for standards pacing indications.

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Importance of Additional Mutation Analysis in Chorionic Villous Sample for Prenatal Diagnosis of Thalassemia

Blood ◽

10.1182/blood.v126.23.4572.4572 ◽

2015 ◽

Vol 126 (23) ◽

pp. 4572-4572

Author(s):

Soumita Choudhuri ◽

Maitreyee Bhattacharyya ◽

Aditi Sen ◽

Debmalya Bhattacharyya ◽

Siddhartha Sankar Ray

Keyword(s):

Prenatal Diagnosis ◽

West Bengal ◽

Conflicts Of Interest ◽

Genetic Disorder ◽

Globin Gene ◽

Carrier Status ◽

Medical College ◽

Number Of Patients ◽

Study Population

Abstract Introduction: β thalassaemia is a genetic disorder of β globiin gene synthesis. Its presentation ranges from transfusion dependent to non transfusion dependent thalassaemia. Non transfusion dependent thalassaemia can have normal life with proper care whereas only curative option for transfusion dependent thalassaemia is bone marrow transplantation which is costly as well as requiring technical expertise. Carrier screening before marriage/conception, antenatal screening and prenatal diagnosis are the only way to prevent birth of a child with thalassaemia. Objective of prenatal diagnosis is to identify homozygous or double heterozygous baby by mutation study. However clinical course after birth may get altered depending on associated other mutation. Till date these associated mutations are not considered in cases of prenatal diagnosis. However, this approach may avoid termination of the baby. This study was carried out retrospectively in the prenatal samples to detect presence of phenotype-modifying mutations. Method and Material: The study was conducted at the Institute of Haematology and Transfusion Medicine, Medical College, Kolkata. Study population consisted of 145 CVS samples and samples of carrier mother and father. Carrier status was detected by HPLC and confirmed by ARMS- PCR for β thalassaemia mutation. Co- inheritance of α- thalassaemia was assessed by GAP- PCR and polymorphism with haplotype assessment was done by RFLP-PCR. 36 parent samples were analyzed for mutation for the carrier status and also for presence of α and Xmn 1 polymorphism. Result: Out of 145 CVS, 8.96% (13 samples) were found to be homozygous, 12.41% (18 samples) double heterozygous, 51.72% (75 samples) heterozygous, 23.44% (34 samples) normal and 3.44% (5 samples) with uncharacterized for β mutation. Our results designated that IVS 1-5 was the most common beta mutation in the state of West Bengal population (Table 1). Co-inheritance of α 3.7 deletion was found in only three affected CVS. Xmn1 polymorphism was detected in 9 CVS samples. Out of these, 3 were homozygous and 6 were heterozygous. Both co-inheritance of α mutation and xmn1 polymorphism were detected in 22 parents sample and 18 affected CVS sample ( Table: 2). Out of 31 affected sample, 18 samples showed presence of Xmn 1 and 4 for α deletion. Additional disease modifying mutations were detected in 6 samples (19.35%). In cases where the 18 parents' sample were positive for Xmn1 polymorphism and 3 for α deletion in CVS sample, either homozygous or double heterozygous for parents' mutation. Table 1. Common β globin gene mutation of CVS samples Beta genotype Homozygote Heterozygote Compound Heterozygote Normal Uncommon IVS 1-5 (G→ C) 7 48 - -- -- CD26(G→A) HbE 1 13 5 -- -- CD15(G→A) 8 9 - -- -- CD30 (G→ C) 5 -- -- -- -- CD41/42(-CTTT) 2 3 -- -- CD8/9(+G) 3 -- -- -- -- CD6 (A → T) 2 2 -- -- Total 13 75 5 34 18 Table 2. Affected CVS with additional mutations: Additional mutations Homozygous CVS Double heterozygous CVS Parents α deletion 1 -- 7 Homozygous Xmn1 +/+ 1 1 3 Heterozygous Xmn 1 -/+ 9 3 12 α deletion + Homozygous Xmn1 +/+ -- 1 -- α deletion + Homozygous Xmn1 -/+ -- 2 -- Discussion: Common thalassaemia subtypes prevalent in West Bengal are HbE beta and Beta thalassaemia . In cases where both the parents are carrier, beta mutation or mutation for HbE was first analyzed and subsequent decision for termination of baby was taken on the presence of both these mutations in the CVS sample. But phenotype is determined by presence of additional mutations like co-inheritance of α mutation and Xmn 1 polymorphism. From our study it became evident that around 19.35% cases the baby was expected to have intermedia or NTDT phenotype. Complete genotype analysis of CVS samples in prenatal diagnosis can save a life and that give a baby to the parents. However, further exploration with larger number of patients and post natal follow up is necessary to reach a definite conclusion. Conclusion: Alpha deletion and Polymorphism detection should be employed for prenatal diagnosis. While developing such program in the population, we save of multiple neonates. Disclosures No relevant conflicts of interest to declare.

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