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Evidence is emerging that rates of adverse events in patients taking warfarin may vary with ethnicity. This study investigated the rates of bleeds and thromboembolic events, the international normalised ratio (INR) status and the relationship between INR and bleeding events in Malaysia. Patients attending INR clinic at the Heart Centre, Sarawak General Hospital were enrolled on an ad hoc basis from May 2010 and followed up for 1 year. At each routine visit, INR was recorded and screening for bleeding or thromboembolism occurred. Variables relating to INR control were used as predictors of bleeds in logistic regression models. 125 patients contributed to 140 person-years of follow-up. The rates of major bleed, thromboembolic event and minor bleed per 100 person-years of follow-up were 1.4, 0.75 and 34.3. The median time at target range calculated using the Rosendaal method was 61.6 % (IQR 44.6–74.1 %). Of the out-of-range readings, 30.0 % were below range and 15.4 % were above. INR variability, (standard deviation of individuals’ mean INR), was the best predictor of bleeding events, with an odds ratio of 3.21 (95 % CI 1.10–9.38). Low rates of both major bleeds and thromboembolic events were recorded, in addition to a substantial number of INR readings under the recommended target range. This may suggest that the recommended INR ranges may not represent the optimal warfarin intensity for this population and that a lower intensity of therapy, as observed in this cohort, could be beneficial in preventing adverse events.

A most distinctive feature of the settlement pattern of the Brasov area is the extreme dispersal of mixed farming encountered in the western extreme of the county to the north and south of Zarnesti: the Bran and Poiana Marului areas. Here a system of peasant subsistence farming developed in a political borderland between the Habsburg and Ottoman Empires. Despite feudal pressures, the peasantry took all available opportunities to extend their independence including elaborate transhumance systems. And after seeing transfrontier commerce as a source of plunder, in the tradition of Balkan highway robbery within relatively unregulated spaces, the peasantry has profited through employment in factories, particularly during the communist period. However, the current recession in manufacturing is throwing the rural population back on limited land resources. Although farming assumes an important subsistence role which contributes to stability, the long-term survival of these communities will depend on new sources of income. Rural tourism has considerable potential and a promising start has been made in Bran. There are, however, constraints on the further development of the business and great attention will have to be given to the conservation of the environment in both the Bucegi Mountains and the Piatra Craiului where national park status is proposed.

Serum sialic acid and C reactive protein are the markers for inflammation. The main objective of this study was to determine the sialic acid level in Caribbean type 2 diabetic patients with and without microvascular complications and its relationship with metabolic and anthropometric variables. The Caribbean subjects aged 15–60 years with type 2 diabetes were recruited for the study. Fasting venous blood samples were collected from 162 subjects of which 44 were healthy individuals, 44 were of type 2 diabetes, 44 were of type 2 diabetes with nephropathy and 30 were of diabetes with retinopathy. Simultaneously urine samples were also collected from each of the subjects. All the blood samples were processed for lipid profile, glucose, HbA1C, C-reactive protein and sialic acid. The urine samples were analysed for sialic acid and microalbumin. Serum sialic acid concentrations were significantly higher among diabetic subjects (66.0 ± 11.7 mg %) as compared to controls (55.2 ± 8.3 mg %). There was a significantly increasing trend of serum sialic acid with severity of nephropathy (71.6 ± 23.6 mg %) and degree of urinary albumin excretion (794.3 ± 805.9). The diabetic retinopathy patients also demonstrated significantly higher values of serum sialic acid (77.9 ± 29.0) and urine microalbumin (351.1 ± 559.9). Elevated serum sialic acid microalbumin concentrations were associated with cardiovascular risk factors such as hypertension, increased waist to hip ratios. (P < 0.05). Sialic acid had no correlation with CRP or any component of the lipid profile. The increased serum sialic acid and microalbumin were strongly related to the presence of microvascular complications like diabetic nephropathy and diabetic retinopathy and cardiovascular risk factors like hypertension and waist to hip ratios in Caribbean type-2 diabetic patients. The serum sialic acid may be used as an inflammatory marker and possible indicator of microvascular complications in type-2 diabetic patients.