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1.
Milagrosa Santana Hernández Ione Ahedey Aguiar-Santana Fernando Artiles Campelo Elena Colino Gil 《Enfermedades infecciosas y microbiología clínica》2018,36(10):607-611
Objectives
To calculate the incidence of invasive pneumococcal disease (IPD) in the paediatric population of Gran Canaria (Spain), its clinical and epidemiological characteristics, serotype distribution, antibiotic resistance, and variations in these variables before and after the introduction of the PCV13 vaccine.Methods
Prospective hospital-based study including all patients (190) aged 0–14 years admitted with confirmed IPD between January 2001–May 2010 (152 cases) and June 2010–December 2016 (38 cases). Patients were divided into 3 age groups (<2 years; 2–5 years; and >5 years). Clinical symptoms were mutually-exclusively classified as meningitis, bacteraemic pneumonia, pleural effusion (PE), empyema or bacteraemia without a focus.Results
Most cases occurred in boys (59.47%), during autumn-winter (65.79%), in children aged <2 years (55.79%) and with mean age increasing from the pre-PCV13 to the post-PCV13 period (2.5 vs 3.1 years). Incidence between periods reduced by 66.4% (p < 0.001): from 13.1/100,000 to 4.4/100,000. PEs (3.9% vs 18.4%, p < 0.005) and empyemas (1.5% vs 16.7%, p = NS) increased in the post-PCV13 period whereas all other symptoms decreased, although this was not statistically significant. Vaccine serotypes (77% vs 40.6%, p = 0.000), particularly serotypes 19A (23.9% vs 12.5%) and 14 (14.2% vs 9.4%), as well as erythromycin resistance (57.2% vs 7.9%, p = 0.000) decreased in the post-PCV13 period.Conclusion
IPD incidence, vaccine serotypes and erythromycin resistance decreased in the post-PCV13 period whereas PEs increased. 相似文献2.
Cirugía cardiaca en pacientes con lupus eritematoso sistémico: características clínicas y desenlaces
Javier Tejeda-Maldonado Lauro Quintanilla-González Jaime Galindo-Uribe Andrea Hinojosa-Azaola 《Reumatología clinica》2018,14(5):269-277
Objectives
To study the clinical characteristics and outcomes in systemic lupus erythematosus (SLE) patients who underwent cardiac surgery.Methods
Retrospective analysis of 30 SLE patients who underwent cardiac surgery at a single center. Demographics, comorbidities, clinical and serologic characteristics, cardiovascular risk scores and treatment were recorded. Type of surgery, postoperative complications, mortality and histology were analyzed.Results
Disease duration at surgery was 2 years. Valve replacement was the procedure most frequently performed (53%), followed by pericardial window (37%). At least one postoperative complication developed in 63% (mainly infections). An aortic cross-clamp time ≥ 76 minutes was associated with at least one postoperative complication (OR 6.4, 95% CI 1.1-35.4, p = .03). Early death occurred in 5 patients (17%) and late in 3 (10%); main causes were sepsis and heart failure. Disease activity was associated with pericardial window (OR 12.6, 95% CI 1.9-79, p = .007); lymphopenia ≤ 1.200 (OR 10.1, 95% CI 1.05-97, p = .04); age ≤ 30 years (OR 7.7, 95% CI 1.2-46.3, p = .02); and New York Heart Association class III (OR 7.0, 95% CI 1.1-42, p = .03). Postoperative infection was associated with length of hospital stay ≥ 2 weeks (OR 54.9, 95% CI 5.0-602.1, p = .001); intensive care unit stay ≥ 10 days (OR 20, 95% CI 1.6-171.7, p = .01); duration of mechanical ventilation ≥ 5 days (OR 16.9, 95% CI 1.5-171.7, p = .01); and pulmonary artery systolic pressure ≥ 50 mmHg (OR 7.8, 95% CI 1.4-41.2, p = .01).Conclusions
Cardiac surgery in SLE confers high morbidity and mortality. SLE-specific preoperative risk scores should be designed to identify prognostic factors. 相似文献3.
Khal Salem Dania Fallata Maha ElSebaie Ahmad Montasser Khaled ElGedamy Osama ElKhateeb 《Journal of the Saudi Heart Association》2017,29(2):90-95
Aims
We aimed to evaluate congestive heart failure (CHF) multidisciplinary disease management program (DMProg) impact on mortality, readmission rates, length of stay (LOS), and gender health characteristics.Methods and results
This was a quasi-observational, pre- and post-trial with a parallel nonequivalent group. We enrolled 174 inpatients having CHF with reduced ejection fraction and New York Heart Association (NYHA) Class II–IV, and a total of 197 hospital admissions. A comparative follow-up was performed from 15 December 2014 to 15 December 2015. Among 197 consecutive hospital admissions, 76 (39%) were included in the preintervention or usual care group and 121 (61%) were assigned to the postintervention group. After 1 year, in comparison with the preintervention group, the postintervention group had shorter average LOS in days (7.6 days vs. 11.1 days, p < 0.002), lower 1-year readmission rate (36% vs. 57%, p < 0.003), and lower in-house mortality (1.6% vs. 7.8%, p = 0.03), but similar baseline mortality scores (38.2 vs. 38.6, p = 0.7), 30-day and 90-day readmission rates (15% vs. 18.3%, p = 0.62 and 27.6% vs. 30%, p = 0.65), and 30-day readmission risk score (24.9% vs. 26.2%, p = 0.09). By regression analysis, the DMProg intervention was an independent factor for 1-year readmission reduction (p = 0.001). Kaplan–Meier survival analysis favored the postintervention group (log-rank, p < 0.001).Conclusion
DMProg significantly decreased 1-year readmission rates, LOS, and in-house mortality. 相似文献4.
Amr Abdel Aziz ElFaramawy Irini Samuel Hanna Reham Mohamed Darweesh Ahmed Shehata Ismail Hossam Ibrahim Kandil 《The Egyptian Heart Journal》2018,70(1):15-19
Background
Cardiovascular disease is a leading cause of death worldwide. Aging is an unavoidable coronary risk factor and is associated with dermatological signs that could be a marker for increased coronary risk. We tested the hypothesis that hair graying as a visible marker of aging is associated with risk of coronary artery disease (CAD) independent of chronological age.Methods
This cross-sectional study included 545 males who underwent a computed tomography coronary angiography (CTCA) for suspicious of CAD, patients were divided into subgroups according to the percentage of gray/white hairs (Hair Whitening Score, HWS: 1–5) and to the absence or presence of CAD.Results
CAD was prevalent in 80% of our studied population, 255 (46.8%) had 3 vessels disease with mean age of 53.2 ± 10.7 yrs. Hypertension, diabetes and dyslipidemia were more prevalent in CAD group (P = 0.001, P = 0.001, and P = 0.003, respectively). Patients with CAD had statistically significant higher HWS (32.1% vs 60.1%, p < 0.001) and significant coronary artery calcification (<0.001). Multivariate regression analysis showed that age (odds ratio (OR): 2.40, 95% confidence interval (CI): [1.31–4.39], p = 0.004), HWS (OR: 1.31, 95% CI: [1.09–1.57], p = 0.004), hypertension (OR: 1.63, 95% CI: [1.03–2.58], p = 0.036), and dyslipidemia (OR: 1.61, 95% CI: [1.02–2.54], p = 0.038) were independent predictors of the presence of atherosclerotic CAD, and only age (p < 0.001) was significantly associated with HWS.Conclusions
Higher HWS was associated with increased coronary artery calcification and risk of CAD independent of chronological age and other established cardiovascular risk factors. 相似文献5.
Objective
To study differences in demographic, clinical and immunologic characteristics, activity and cumulative organ damage according to age of onset in systemic lupus erythematosus (SLE).Methods
Cross-sectional study was performed including 204 SLE patients. Characteristics were compared between juvenile and adult-onset SLE patients using parametric and nonparametric tests (SPSS 23.0).Results
Juvenile-SLE patients had malar rash more often (78.9% vs 53%; p = 0.001), oral ulcers (45.5% vs 17.5%; p = 0.001), neurological involvement (13.1% vs 3.6%; p = 0.02) nephritis (50% vs 33.9%), p = 0.04) and haematological manifestations such as hemolytic anaemia (23.6% vs 5.4%; p = 0.002) and leukopenia (46.1% vs 4.2%; p < 0.001). Arthritis was more prevalent in adult-onset patients (70.9% vs 90%; p < 0.04). Overall, 20% of juvenile patients had chronic damage (Systemic Lupus International Collaborating Clinics/Damage Index [SLICC/DI] ≥ 1), However, the percentage of patients with irreversible damage was higher in the adult SLE patient group (24%, p = 0.04). No statistically significant differences were found in other characteristics studied.Conclusion
In summary, our study confirms the existence of differences in clinical manifestations, according to age at diagnosis of SLE. Juvenile-SLE patients showed a more aggressive clinical presentation. 相似文献6.
N. Behniafard A.A. Amirzargar M. Gharagozlou F. Delavari S. Hosseinverdi S. Sotoudeh E. Farhadi M. Mahmoudi M. Khaledi Z.G. Moghaddam A. Aghamohammadi N. Rezaei 《Allergologia et immunopathologia》2018,46(2):155-159
Background
Atopic dermatitis is an inflammatory skin disease in which both genetic and environmental factors interact to determine the susceptibility and severity of the disease.Objective
The aim of this study was to determine the association between atopic dermatitis and IL-10 and TGF-β1 gene polymorphisms.Methods
The allele and genotype frequencies of genes encoding for IL-10 and TGF-β1 were investigated in 89 patients with atopic dermatitis in comparison with 138 in the control group using the PCR-SSP method.Results
A significant increase was found in the frequency of the TGF-β1 codon 10/C allele among patients (p < 0.001, OR = 6.77), whereas a significant decrease was observed in the frequency of the T allele at the same position (p < 0.001, OR = 0.14). The frequency of the TGF-β1 codon 25/G allele in the control group was significantly higher than among patients (p < 0.001, OR = 0.08). A significant positive correlation was seen between CC (p < 0.001, OR = 15.10) and CG (p < 0.001) genotypes and AD at codons 10 and 25, respectively. The most frequent haplotypes among patients was TGF-β1 CG which was significantly higher than in the control subjects (50% in patients vs. 39.9% in controls, p = 0.042). A significant increase was found in the frequency of TGF-β CC (36% in patients vs. 7.6% in controls, p < 0.001) and TC (14% in patients vs. 0% in controls, p < 0.001) haplotypes among patients compared to controls. By contrast, the TGF-β1 TG haplotype was significantly lower in patients than controls (0% in patients vs. 52.5% in controls, p < 0.001). There were no significant differences in the frequency of alleles, genotypes and haplotypes of the IL-10 gene.Conclusions
We found a strong association between the polymorphisms of the TGF-β1 gene at codon 10 and codon 25 positions and atopic dermatitis. 相似文献7.
Tuba Guler Yesim Garip Fulya Dortbas Yasemin Pekin Dogan 《The Egyptian Rheumatologist》2018,40(2):117-121
Aim of the work: To evaluate the quality of life (QoL) in Familial Mediterranean Fever (FMF) patients, and determine its association with fatigue, depression, disease severity and other clinical parameters. Patients and methods: Sixty FMF patients were included. QoL was assessed by Short Form-36 (SF-36), depression by Hamilton Depression Scale (HDS), and fatigue by Fatigue severity scale (FSS). Disease severity score and Mutations of the Mediterranean fever (MEFV) gene were assessed. Results: The mean age of patients was 33.73 ± 9.81 years and disease duration 14.6 ± 12.1 years. They were 35 females and 25 males. FMF patients scored significantly higher in FSS (29.9 ± 17.6) and HDS (15.1 ± 8.5) compared to the control (10.6 ± 7.1 and 6.3 ± 9.4; p < 0.0001 respectively) while all SF36 sub-items except mental health were significantly lower (p < 0.05). MEFV gene mutation was present in 49 (81.7%) patients. The visual analogue scale of pain significantly negatively correlated with the FSS (p < 0.0001), HDS (p < 0.0001) and all SF36 sub-items except mental health (p < 0.0001). Disease duration, age of onset, and duration of attacks showed no significant correlation with FSS, HDS and SF36. Delay in diagnosis significantly correlated with FSS (p < 0.0001) and negatively with SF36 sub-items physical role (p = 0.02), general health (p = 0.01) and social functioning (p = 0.03). Age of diagnosis significantly correlated with FSS (p = 0.03) and negatively with SF36-vitality (p = 0.047). There was a significant effect of disease severity on QoL, fatigue and depression (p < 0.05). Conclusion: QoL is associated with fatigue, depression and disease severity in FMF patients. It should be used in routine clinical evaluation as an outcome measure in FMF. 相似文献
8.
Objective
To describe the frequencies of fibromyalgia syndrome (FMS) in various rheumatic diseases; rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and Behçets disease (BD) patients and to study the relation to clinical manifestations and quality of life (QoL).Patients and methods
160 patients (50 RA, 50 SLE, 30 SSc and 30 BD) and matched corresponding healthy controls were included. Disease activity was assessed using disease activity score in 28 joints (DAS28) for RA, SLE Disease Activity index (SLEDAI), modified Rodnan skin score for SSc and BD Current Activity Form (BDCAF). The QoL was also recorded. Severity in FMS cases was estimated using the revised Fibromyalgia Impact Questionnaire score.Results
In the RA, SLE, SSc and BD patients, FMS was found in 14%, 18%, 6.67% and 3.33% respectively compared to 2.1%, 3%, 3.3% and 0% in their corresponding controls. In RA patients, DAS28 was significantly higher in those with FMS (p = 0.009) and significantly correlated with both Widespread Pain Index (WPI) (p = 0.011) and Symptom Severity (SS) scale (p = 0.012). The QoL scale in those with FMS was significantly worse (62.3 ± 7.9) compared to those without (71.7 ± 14.4) (p = 0.023). In SLE patients, The WPI and SS both significantly correlated with the presence of thrombosis (r = 0.28, p = 0.049 and r = 0.43, p = 0.002 respectively). The SS scale tended to correlate with the SLEDAI (r = 0.28, p = 0.05). In BD patients, BDCAF and WPI significantly correlated (p = 0.03).Conclusion
Fibromyalgia syndrome is more frequent in rheumatic diseases, could be related to the disease activity in RA and BD patients and to thrombosis in SLE and affected the QoL in RA. 相似文献9.
Lívia D. Akl Ana L.R. Valadares Monica Jacques de Moraes Aarão M. Pinto-Neto Bianca Lagrutta Lúcia Costa-Paiva 《The Brazilian journal of infectious diseases》2017,21(3):263-269
Objectives
To determine the prevalence of metabolic syndrome (MetS) and its associated factors in a group of HIV-infected middle-aged women.Methods
Cross-sectional study including 273 HIV-infected climacteric women of 40–60 years of age under care in two HIV outpatient reference centers in Brazil. Metabolic syndrome diagnosis was based on 2006 International Diabetes Federation criteria. Sociodemographic, clinical and behavioral factors were evaluated as well as HIV infection-related parameters.Results
Mean age was 47.7 years; 59.1% of women were premenopausal, 91% were on antiretroviral therapy. Current CD4 count was >500 cells/mm3 in 61.7%, current viral load undetectable in 76.9% of women, and a quarter had previous diagnosis of aids. The prevalence of metabolic syndrome in the subgroup of menopausal women was 46.9%. Univariate analysis showed an association between metabolic syndrome and age ≥50 years (p = 0.002), schooling <8 years (p = 0.003), post-menopause (p < 0.001), body mass index (BMI) >25 kg/m2 (p < 0.001), and FSH ≥40 mIU/mL (p = 0.002). In the multivariate analysis only increased BMI (PR = 1.09; 95% CI: 1.05–1.13; p < 0.001) and FSH levels ≥40 mIU/mL (PR = 1.66; 95% CI: 1.14–2.40; p = 0.008) maintained statistical significance. There was no association between PI use or any other factor related to HIV-infection and MetS in any of the analyses performed.Conclusion
High BMI and FSH levels compatible with menopause were the only factors associated with MetS in these middle aged HIV-infected women. In the context of well-controlled, early treated HIV infection, traditional rather than HIV-related factors were associated with MetS. 相似文献10.
Marlone Cunha-Silva Fábio R.T. Marinho Paulo F. Oliveira Tirzah M. Lopes Tiago Sevá-Pereira Sonia L.S. Lorena Jazon R.S. Almeida 《The Brazilian journal of infectious diseases》2017,21(4):441-447
Background
Chronic hepatitis B is a major cause of cirrhosis, and the natural history of the disease has several clinical stages that should be thoroughly understood for the implementation of proper treatment. Nonetheless, curing the disease with antiviral treatment remains a challenge.Aims
To describe the clinical course, response to treatment, and poor prognostic factors in 247 hepatitis B virus chronic infection patients treated in a tertiary hospital in Brazil.Methods
This was a retrospective and observational study, by analyzing the medical records of HBV infected patients between January 2000 and January 2015.Results
Most patients were male (67.2%) and 74.1% were HBeAg negative. Approximately 41% had cirrhosis and 8.5% were hepatitis C virus coinfected. The viral load was negative after two years on lamivudine, entecavir and tenofovir in 86%, 90.6%, and 92.9% of the patients, respectively. The five-year resistance rates for lamivudine, adefovir, entecavir, and tenofovir were 57.5%, 51.8%, 1.9%, and 0%, respectively. The overall seroconversion rates were 31.2% for HBeAg and 9.4% for HBsAg. Hepatocellular carcinoma was diagnosed in 9.7% of patients, liver transplantation was performed in 9.7%, and overall mortality was 10.5%. Elevations of serum alanine aminotransferase (p = 0.0059) and viral load (p < 0.0001) were associated with progression to liver cirrhosis. High viral load was associated with progression to hepatocellular carcinoma (p < 0.0001). Significant risk factors associated with death were elevated alanine aminotransferase (p = 0.0039), liver cirrhosis (p < 0.0001), high viral load (p = 0.007), and hepatocellular carcinoma (p = 0.0008). HBeAg positive status was not associated with worse outcomes, and treatment may have been largely responsible.Conclusions
Elevations of viral load and serum alanine aminotransferase may select patients with worse prognosis, especially progression to cirrhosis and hepatocellular carcinoma, which were strongly association with death. 相似文献11.
Ashraf Abd El-Khalik Barakat Fatma Mohammad Nasr Amna Ahmed Metwaly Sherif Morsy Mervat Eldamarawy 《The Egyptian Heart Journal》2017,69(2):139-147
Background
Chronic Hepatitis C virus (HCV) infection and liver cirrhosis may be associated with atherosclerosis and coronary artery disease (CAD). There are two phases to atherosclerosis, Subclinical and Clinical. Assessment of atherosclerosis may be started at its Subclinical phase by the evaluation of Epicardial Fat Thickness (EpFT) and Carotid Intima Thickness (CIMT).Aim of the study
The aim of the study was to evaluate Clinical and Subclinical atherosclerosis in chronic HCV patients with and without liver cirrhosis by evaluating CIMT and EpFT and correlating the results with Child-Pugh functional scoring of cirrhosis as well as with ultrasound and laboratory parameters that define the severity of liver disease.Patients and methods
This study involved 64 chronic HCV patients that were divided into two groups: 24 patients without liver cirrhosis and 40 patients with liver cirrhosis in addition to 20 apparently healthy volunteers serving as control. All of the 84 subjects were subjected to the following: Clinical evaluation; Routine Laboratory Evaluation (CBC, Liver Function Tests, Renal Function Tests, Serum electrolytes, Cholesterol, Triglycerides, HBs antigen and HCV antibody); ECG; Abdominal ultrasound; Echocardiographic evaluation of segmental wall motion abnormalities and EpFT and B-Mode Carotid ultrasonography for evaluation of CIMT.Results
In the cirrhotic HCV group, the CIMT and EpFT were both significantly increased [Compared to control group (p = 0.000), compared to the non-cirrhotic HCV group (p = 0.000)]. In the non-cirrhotic HCV group, the CIMT and EpFT were both significantly increased compared to the control group with a p-value of 0.003 for CIMT and 0.048 for EpFT. The CIMT and EpFT were also positively correlated with each other (r = 0.456, p = 0.001). There was a statistically significant increase in the EpFT and CIMT in Child class B patients compared to Child class A (p = 0.007 for CIMT and p = 0.028 for EpFT) and in Child class C patients compared to Child class B patients (p = 0.001 for CIMT and 0.005 for EpFT). CIMT and EpFT were correlated positively with AST (r = 0.385, p = 0.002 for CIMT, and r = 0.379, p = 0.003 for EpFT), Total Bilirubin (r = 0.378, p = 0.003 for CIMT, and r = 0.384, p = 0.002 for EpFT), INR% (r = 0.456, p = 0.001 for CIMT, and r = 0.384, p = 0.001 for EpFT), CRP (r = 0.378, p = 0.003 for CIMT, and r = 0.386, p = 0.002 for EpFT), spleen span (r = 0.417, p = 0.001 for CIMT, and r = 0.437, p = 0.001 for EpFT) and portal Vein Diameter (r = 0.372, p = 0.003 for CIMT, and r = 0.379, p = 0.003 for EpFT). CIMT and EpFT were correlated negatively with Albumin (r = ?0.379, p = 0.003 for CIMT, and r = ?0.370, p = 0.003 for EpFT), platelets count (r = ?0.382, p = 0.002 for CIMT, and r = ?0.378, p = 0.003 for EpFT) and Liver Span (r = ?0.433, p = 0.001 for CIMT, and r = ?0.424, p = 0.001 for EpFT).Conclusion
EpFT and CIMT significantly increased in chronic hepatitis C virus patients especially in those with cirrhosis and closely correlated with each other. Their thickness also correlated with the Child-Pugh functional scoring of cirrhosis as well as with ultrasound and laboratory parameters that define the severity of liver disease.The echocardiographic assessment of EpFT and the carotid Doppler assessment of CIMT may provide appropriate and simple screening markers for subclinical atherosclerosis and cardiovascular risk in chronic HCV patients with and without cirrhosis. 相似文献12.
Marwa Niazy Wafaa Gaber Abdelkawy Moghazy Hosni Khairy Salem 《The Egyptian Rheumatologist》2017,39(4):213-216
Aim of the work: To assess the urological disorders in rheumatoid arthritis (RA) patients, analyse the risk factors and to find their relation to disease activity and functional status. Patients and methods: 291 RA patients (253 females and 38 males; F:M 6.7:1) and 242 matched controls were included. Urological disorders in the form of urinary tract infections (UTI), urolithiasis and acute urine retention (AUR) were assessed, risk factors were analysed. Disease activity score (DAS-28) and modified health assessment questionnaire (mHAQ) were calculated. Results: RA patients had more frequent urological disorders (38.14%) than controls (20.66%), more UTI (p < 0.001) and this difference persisted in females (p < 0.001). Urolithiasis tended to be more frequent in RA patients (p = 0.3); the difference was significant between the female patients and controls (p = 0.04). Urinary stones were comparable between the male patients and controls (p = 0.2). RA patients had more AUR (4.8%) than the controls (2.1%) (p = 0.07). Asthmatic patients particularly the females had more UTI (p = 0.001 and p < 0.001 respectively). UTIs were observed with higher steroid doses (p = 0.04) and urolithiasis were noticed more in hypertensive female patients (p = 0.03). Patients with higher DAS-28 and mHAQ developed more urological comorbidities (p0.49 and p = 0.82 respectively). UTI and urolithiasis were detected in patients with higher DAS 28 (p = 0.1 and p = 0.4 respectively). Conclusion: RA patients were found to have more urological disorders. Bronchial asthma, hypertension and higher steroid doses may increase risk for urinary comorbidities in RA. Patients with higher DAS28 and mHAQ had more urological comorbidities, however without statistically significant difference. 相似文献
13.
Walid Jomaa Imen Ben Ali Sonia Hamdi Mohamed A. Azaiez Aymen El Hraïech Khaldoun Ben Hamda Faouzi Maatouk 《Journal of the Saudi Heart Association》2017,29(3):153-159
Background
Anemia on admission is a powerful predictor of major cardiovascular events in patients presenting for acute coronary syndromes. We sought to determine the prevalence and prognostic impact of anemia in patients presenting for ST-elevation myocardial infarction (STEMI).Methods
We analyzed data from a Tunisian retrospective single center STEMI registry. Patients were enrolled between January 1998 and October 2014. Anemic and nonanemic patients were compared for clinical and prognostic features and according to four prespecified hemoglobin level subgroups. In patients with severe anemia, factors associated with in-hospital death were studied.Results
A total of 1498 patients were enrolled. Mean age was 60.47 ± 12.7 years and prevalence of anemia was 36.6%. Anemic patients were more likely to be elderly, hypertensive, and diabetic in comparison to nonanemic patients. In-hospital mortality was significantly higher in anemic patients (14.9% vs. 5%, p < 0.001). Lower hemoglobin levels were significantly associated with a higher prevalence of heart failure on admission, cardiogenic shock, and in-hospital mortality (p < 0.001 for all). In univariate analysis, factors associated with in-hospital death in patients with severe anemia were hypertension (p = 0.044), heart failure on admission (p < 0.001), renal failure on admission (p < 0.001), and primary percutaneous coronary intervention (pPCI) use (p = 0.016). The absence of pPCI use was independently associated with in-hospital death in multivariate analysis (odds ratio = 2.22, 95% confidence interval: 1.07–4.76, p = 0.033).Conclusion
According to this study, anemic patients presenting for STEMI have a higher in-hospital mortality rate. The absence of pPCI use was independently associated with in-hospital death. 相似文献14.
Background
A predictive model for Paravalvular aortic regurgitation (PAR) integrating the left ventricular outflow tract-to-ascending aorta angle (LVOT-AO) and depth to the non-coronary cusp (NCC) after TAVI with CoreValve prosthesis (MCP) was retrospectively identified (2 × ∠LVOT-AO + [depth to NCC-10]2; cutoff = 50). However, the validity and clinical utility of this model remain unknown.Methods
A total of 100 patients (79.6 ± 7 years, mean EuroScore 24.9 ± 16.3%, 41 males) constituted a validation cohort for the predictive model. Both angle (LVOT-AO) and depth to NCC were considered during patient selection and device implantation.Results
Significant AR occurred in 16% (group A) vs. 84% (group B). Angle ∠LVOT-AO and depth to NCC were larger in group A compared to group B (16.4 ± 7.2 vs. 11.8 ± 4.1, p < 0.001, and 9.1 ± 4.8 mm vs. 6.6 ± 2.7 mm, p = 0.004). The model showed a sensitivity of 68.7% and a specificity of 88.1% in prediction of PAR. Comparing the derivation cohort (initial experience, n = 50) and validation cohort (later experience, n = 100) it is showed that the ∠LVOT-AO, valve depth and PAR were significantly lower (12.5 ± 4.9 and 6.9 ± 3.2 mm vs. 19.7 ± 7.9 and 10.4 ± 3.7 mm, 40% vs. 16% respectively, all p < 0.001) in the validation cohort.Conclusion
The predictive model for significant PAR after TAVI using MCP is valid with a reassuring specificity and an acceptable sensitivity. A strategy incorporating these anatomical and procedural variables improves PAR after TAVI. 相似文献15.
Hassan El-Toukhy Abdullah Omar Manal Abou Samra 《Journal of the Saudi Heart Association》2017,29(4):252-258
Purpose
To assess the effect of acute coronary syndrome (ACS) patients’ education on their adherence to dual antiplatelet therapy (DAPT) and on lifestyle modifications.Methods
Patients who were prescribed acetyl salicylic acid and clopidogrel DAPT within 15 days of having an ACS event were enrolled in this study. Patients were randomized into two arms: the first arm received the study intervention, which consisted of education on coronary artery disease and the importance of sustained platelet inhibition, whereas the second arm was the control group. Both arms received education on lifestyle modifications. Patients completed six visits over 1 year. At each visit, pill count was used to assess adherence to DAPT, data on lifestyle modifications were collected, and changes in weight and waist circumference were recorded. Cardiovascular risk factors were recorded at baseline and the occurrence of new events was monitored throughout the study.Results
There were 153 patients in Arm 1 and 168 in Arm 2. At Month 6, 99.3% of patients in Arm 1 were adherent compared with 94.4% in Arm 2 (p = 0.016). At Month 12, 303 (94.4%) patients from the overall population were adherent to DAPT and there was no significant difference between the two arms (p = 0.443). In addition, no statistically significant difference was found in mean change in weight (3 kg vs. 2 kg, p = 0.064) or mean change in waist circumference (3.5 cm vs. 2.6 cm, p = 0.071) between the two arms. There was a significant decrease in the percentage of smokers (p < 0.001) and a significant increase in the percentage of physically active patients (p < 0.001) within each arm between baseline and Month 12, but the percent change in smokers (z = 1.72, p = 0.085) and percent change in physically active patients (z = 0.76, p = 0.447) between the two arms were not significantly different. Fourteen myocardial infarctions and two strokes occurred throughout the study period.Conclusion
Patient education on DAPT showed short-term effect on adherence to treatment. More effective education methods should be developed to improve long-term DAPT adherence. 相似文献16.
Anca Drăgănescu Oana Săndulescu Dragoş Florea Ovidiu Vlaicu Anca Streinu-Cercel Dan Oţelea Victoria Aramă Monica Luminiţa Luminos Adrian Streinu-Cercel Maria Niţescu Alina Ivanciuc Rodica Bacruban Daniela Piţigoi 《The Brazilian journal of infectious diseases》2018,22(5):377-386
Background
Influenza continues to drive seasonal morbidity, particularly in settings with low vaccine coverage.Objectives
To describe the influenza cases and viral circulation among hospitalized patients.Methods
A prospective study based on active surveillance of inpatients with influenza-like illness from a tertiary hospital in Bucharest, Romania, in the season 2016/17.Results
A total of 446 patients were tested, with a balanced gender distribution. Overall, 192 (43%) patients tested positive for influenza, with the highest positivity rate in the age groups 3–13 years and >65 years. Peak activity occurred between weeks 1 and 16/2017, with biphasic distribution: A viruses were replaced by B viruses from week 9/2017; B viruses predominated (66.1%). Among the 133 (69.3%) subtyped samples, all influenza A were subtype H3 (n = 57) and all influenza B were B/Victoria (n = 76). Patients who tested positive for influenza presented fewer comorbidities (p = 0.012), except for the elderly, in whom influenza was more common in patients with comorbidities (p = 0.050). Disease evolution was generally favorable under antiviral treatment. The length of hospital stay was slightly longer in patients with influenza-like illness who tested patients negative for influenza (p = 0.031).Conclusions
Distinctive co-circulation of A/H3 and B/Victoria in Bucharest, Romania in the 2016/17 influenza season was found. While the A/H3 subtype was predominant throughout Europe that season, B/Victoria appears to have circulated specifically in Romania and the Eastern European region, predominantly affecting preschoolers and school children. 相似文献17.
Kamel H. Gado Tarek H. Gado Rasha M. Abdel Samie Noha M. Khalil Safa L. Emam Hanan H. Fouad 《The Egyptian Rheumatologist》2017,39(3):159-164
Introduction
The vitamin D receptor (VDR) gene is a candidate for susceptibility to autoimmune disorders.Aim of the work
To study the frequency of vitamin D deficiency in Egyptian systemic lupus erythematosus (SLE) patients and investigate the association of BsmI and FokI VDR gene polymorphisms with disease susceptibility, activity and damage.Patients and methods
Forty-five SLE patients and 40 controls were enrolled. SLE Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics (SLICC) damage index were assessed for the patients. Serum vitamin D levels were measured in all subjects. Genotyping for the VDR BsmI and FokI gene polymorphisms was performed by polymerase chain reaction and restriction fragment length polymorphism for only 34 patients and 16 controls.Results
The mean age of SLE patients was 28.8 ± 7.9 years and disease duration 11.3 ± 9.8 years. Vitamin D level was significantly lower in patients than control (p < 0.001) and significantly correlated with C3 and C4 levels (p < 0.001) and inversely with SLEDAI (p < 0.001), SLICC (p = 0.005), anti-ds DNA (p < 0.001) and ESR (p = 0.011). There were no significant differences in genotype and allelic frequencies of FokI and BsmI polymorphisms between patients and controls. There was a significant relation of FokI polymorphisms with serum vitamin D level (p = 0.002), SLEDAI (p = 0.021) and SLICC (p = 0.002). BsmI polymorphisms showed significant associations with neuropsychiatric damage, low complement, fever and mucosal ulcers.Conclusions
VDR FokI polymorphism in SLE patients is significantly related to low vitamin D level in SLE patients and both are associated with increasing disease activity and damage denoting important implications in this disease. 相似文献18.
Ghada Youssef Ibrahim El Tebi Dina Osama Ahmed Shehahta Essam Baligh Zeinab Ashour Hany Gamal 《The Egyptian Heart Journal》2017,69(1):37-44
Background
Increased arterial stiffness can be used as a prognostic marker of arterial hypertension. The relationship between arterial stiffness and arterial hypertension seems to be reciprocal.Objective
Evaluation of changes of the arterial elastic prosperities in normotensive subjects, with and without parental history of hypertension.Subjects and Methods
One hundred and ten normotensive individuals, aged 20–30 years, were divided into two groups: group-A (n = 57) and group-B (n = 53) subjects with positive and negative parental history of hypertension, respectively. Systolic, diastolic and pulse pressures were measured using mercury sphygmomanometer. The elastic properties of the ascending aorta and the common carotid arteries were assessed using M-mode echo and B-mode imaging, respectively. Stiffness index of the digital volume pulse (SIDVP) was measured in the right index finger using photoplethysmography.Results
Group A subjects showed higher aortic stiffness index (p = 0.002), carotid stiffness index (p = 0.001), carotid pulse wave velocity (p ? 0.001) and stiffness index of digital volume pulse (p = 0.001). Group A subjects showed lower aortic distensibility (p = 0.001), aortic strain (p = 0.004), changes in aortic diameter (p = 0.022), carotid distension (p = 0.026), carotid distensibility coefficient (p ? 0.001) and carotid compliance coefficient (p = 0.002).Conclusion
The aortic and carotid stiffness parameters and SIDVP were higher in normotensive offspring of hypertensive parents. This finding could direct the attention towards the increased cardiovascular risk in this group and thus prompt earlier and tighter prevention of cardiovascular risk factors. 相似文献19.
Zulqarnain Baloch Nafeesa Yasmeen Yuanyue Li Ke Ma Xiaomei Wu Shi-hua Yang Xueshan Xia 《The Brazilian journal of infectious diseases》2017,21(3):325-332
Background
Dai is a major Chinese ethnic minority group residing in rural areas of the southern part of Yunnan. However, no data exist on the Human Papillomavirus (HPV) prevalence and genotype distribution among Dai women.Method
A total of 793 participants (Dai = 324, Han = 251, other ethnic = 218) were included in this study. PCR was performed to detect the HPV-positive samples, and genotyping was performed with an HPV Geno-Array.Result
The overall HPV prevalence was very low among Dai women compared to the others. The prevalence of high-risk-HPV infections was significantly higher (p = 0.001) among other ethnic women (22.0%) than that among Han (13.1%) and Dai women (7.1%). The overall HPV, high-risk-HPV, single and multiple infection prevalence among rural women were 12.9%, 12.1%, 12.3%, and 0.5%, respectively. HPV-16 (5.5%) was shown to be the most prevalent genotype, followed by HPV-52 (2.6%) and HPV-58 (2.4%). Urban women had relatively higher rates of overall HPV (16.0%), high-risk-HPV (14.1%), single genotype (11.9%), and multiple genotype (4.1%) infections. In urban women, HPV-52 (3.6%) was the most prevalent genotype, followed by HPV-39 (2.7%) and HPV-16 (1.2%). In the urban area, HPV prevalence was highest in women aged <29 years, but declined with increasing age. However, in rural women, the highest HPV prevalence was observed among women at older age (>50 years). Education and smoking habit were significantly associated with HPV infection among both rural and urban area women (p < 0.001).Conclusion
The prevalence and genotype distribution of HPV varied among ethnic women in urban and rural area of Yunnan Province. 相似文献20.
Djibril Marie BA Mamadou Saidou Sow Aminata Diack Khadidiatou Dia Mouhamed Cherif Mboup Pape Diadie Fall Moussa Daouda Fall 《The Egyptian Heart Journal》2017,69(4):229-234