29 research outputs found
Atrial Flutter: Diagnosis and Management strategies
Atrial flutter (AFL) is a regular, macro reentrant arrhythmia traditionally defined as a supraventricular tachycardia with an atrial rate of 240–320 beats per minute (bpm). Pathophysiology of atrial flutter and atrial fibrillation (AF) is closely related to the similar risk of stroke and they coexist clinically. Atrial flutter is classified to cavotricuspid isthmus (CTI) dependent (or typical) and non-isthmus dependent (atypical). Isthmus is a distinct structure in the right atrium (RA) through which atrial flutter passes and makes a good target for ablation therapy. Ablation is the primary therapy in atrial flutter, particularly in CTI dependent group, with regard to its safety profile and high success rate of approximately 90%. Three-dimensional electroanatomic mapping is progressively being used to ablate atypical forms of atrial flutter
Comparison of periodic face-to-face visits and use of smartphone application during COVID-19 pandemic in clinical follow-up of range of motion in patients with distal humeral fracture
Objective: As the prevalence of the coronavirus increases, there is now more emphasis on reducing "face-to-face" patient visits. Therefore, the use of smartphones and their special medical applications can play an important role in following up patients. The aim of this study was to evaluate the use of smartphone in evaluating clinical outcomes and range of motion of patients after elbow operation.
Materials and Methods: Forty patients were randomly selected from patients undergoing elbow operation. Patients were divided into two groups, so that in the first group, the patients were visited and then were followed-up for 2,6, and 12 weeks as well as 6 months after first visit by smartphone connection and delivering the pictures and videos of involved organ to the physician as well as having the physical examination him. In the second group, all assessments were performed by clinical visiting at the same time points.
Results: The two groups were similar in baseline characteristics including demographics; the side of involved elbow, type of fracture, surgical approach, operation time, and mean Mepi score. Assessing the postoperative complications and also patients' satisfaction was also similar in both groups. There was no difference in different range of elbow motion degrees between the case and control groups at different times of following-up as well as the progress in motion of elbow after surgery in two groups. Moreover, there was no significant difference between the range of motion evaluated by smartphone and physical examination.
Conclusion: The use of the smartphone has a high degree of accuracy and sensitivity in assessing the status of elbow range of motion after surgical treatment, both in the short and long term after surgery
The effect of preoperative aspirin use on postoperative bleeding and perioperative myocardial infarction in patients undergoing coronary artery bypass surgery
Background: We tried to evaluate the clinical outcomes (mortality, postoperative bleeding
and perioperative myocardial infarction) of patients who underwent first elective coronary
artery bypass grafting and received aspirin during the preoperative period.
Methods: The study was a prospective, randomized and single-blinded clinical trial. Two
hundred patients were included and divided into two groups. One group received aspirin 80-160 mg, while in the other aspirin was stopped at least seven days before surgery. The
primary end-points of the study were in-hospital mortality and hemorrhage-related complications
(postoperative blood loss in the intensive care unit, re-exploration for bleeding and red
blood cell and non-red blood cell requirements). The secondary end-point was perioperative
myocardial infarction.
Results: There were no differences in patient characteristics between the aspirin users and
non-aspirin users. We found a significant difference between postoperative blood loss (608 ± 359.7 ml vs. 483 ± 251.5 ml; p = 0.005) and red blood cell product requirements (1.32 ± 0.97 unit packed cell vs. 0.94 ± 1.02 unit packed cell; p = 0.008). There was no significant
difference between the two groups regarding platelet requirement and the rate of in-hospital
mortality and re-exploration for bleeding. Similarly, we found no significant difference in the
incidence of definite and probable perioperative myocardial infarction (p = 0.24 and p = 0.56
respectively) or in-hospital mortality between the two groups.
Conclusion: Preoperative aspirin administration increased postoperative bleeding and red
blood cell requirements with no effect on mortality, re-exploration rate and perioperative myocardial
infarction. We recommend withdrawal of aspirin seven days prior to surgery. (Cardiol J
2007; 14: 453-457
Early septal activation, successful lateral ablation
The coronary sinus activation pattern is an important clue for the detection of arrhythmia
mechanisms and/or localization of accessory pathways. Any change in this pattern during
radiofrequency ablation should be evaluated carefully to recognize the presence of another
accessory pathway or innocence of the accessory pathway during arrhythmia. Intra-atrial
conduction block can change the coronary sinus activation pattern. Negligence regarding this
phenomenon can cause irreversible complications. Here we describe a case with left lateral
accessory pathway conduction in which intra-atrial conduction block completely reversed the
coronary sinus activation pattern. (Cardiol J 2008; 15: 181-185
A patient with sick sinus syndrome, atrial flutter and bidirectional ventricular tachycardia: Coincident or concomitant presentations?
Channelopathies are among the major causes of syncope or sudden cardiac death in patients
with structurally normal hearts. In these patients, the atrium, ventricle or both could be
affected and reveal different presentations. In this case, we present a patient with an apparently
structurally normal heart and recurrent syncope, presented as sick sinus syndrome with
atrial flutter and bidirectional ventricular tachycardia. (Cardiol J 2007; 14: 585-588)
Relationship between QRS complex notch and ventricular dyssynchrony in patients with heart failure and prolonged QRS duration
Background: Cardiac resynchronization therapy (CRT) has been accepted as an established
therapy for advanced systolic heart failure. Electrical and mechanical dyssynchrony are usually
evaluated to increase the percentage of CRT responders. We postulated that QRS notch can
increase mechanical LV dyssynchrony independently of other known predictors such as left
ventricular ejection fraction and QRS duration.
Methods: A total of 87 consecutive patients with advanced systolic heart failure and QRS
duration more than 120 ms with an LBBB-like pattern in V1 were prospectively evaluated.
Twelve-lead electrocardiogram was used for detection of QRS notch. Complete
echocardiographic examination including tissue Doppler imaging, pulse wave Doppler and
M-mode echocardiography were done for all patients.
Results: Eighty-seven patients, 65 male (75%) and 22 female (25%), with mean (SD) age of
56.7 (12.3) years were enrolled the study. Ischemic cardiomyopathy was the underlying heart
disease in 58% of the subjects, and in the others it was idiopathic. Patients had a mean (SD)
QRS duration of 155.13 (23.34) ms. QRS notch was seen in 49.4% of the patients in any of
two precordial or limb leads. Interventricular mechanical delay was the only mechanical
dyssynchrony index that was significantly longer in the group of patients with QRS notch.
Multivariate analysis revealed that the observed association was actually caused by the effect of
QRS duration, rather than the presence of notch per se.
Conclusions: QRS notch was not an independent predictor of higher mechanical
dyssynchrony indices in patients with wide QRS complex and symptomatic systolic heart
failure; however, there was a borderline association between QRS notch and interventricular
delay
Wpływ przedoperacyjnego stosowania kwasu acetylosalicylowego na występowanie krwawienia pooperacyjnego i okołooperacyjnego zawału serca u osób poddawanych pomostowaniu aortalno-wieńcowemu
Wstęp: Podjęto próbę oceny wyników klinicznych (śmiertelność, występowanie krwawienia
pooperacyjnego i okołooperacyjnego zawału serca) u pacjentów, których poddano pierwszej
operacji pomostowania aortalno-wieńcowego, otrzymujących w okresie przedoperacyjnym kwas
acetylosalicylowy.
Metoda: Do prospektywnego, randomizowanego badania przeprowadzonego metodą ślepej
próby włączono 200 pacjentów, których podzielono na dwie grupy. Osoby z jednej z nich
otrzymywały kwas acetylosalicylowy w dawce 80–160 mg, natomiast chorzy z drugiej grupy
przyjmowanie tego leku zakończyli przynajmniej 7 dni przed operacją. Pierwotnymi punktami
końcowymi badania były: zgon w trakcie hospitalizacji i powikłania związane z krwawieniem
(pooperacyjna utrata krwi na oddziale intensywnej opieki medycznej, reoperacja z powodu
krwawienia oraz konieczność przetoczeń koncentratu krwinek czerwonych lub innych preparatów
krwiopochodnych). Za wtórny punkt końcowy przyjęto występowanie okołooperacyjnego
zawału serca.
Wyniki: Pacjenci leczeni kwasem acetylosalicylowym nie różnili się w zakresie charakterystyki
od osób, u których nie wdrożono tej formy terapii. Stwierdzono natomiast istotną różnicę
w wielkości pooperacyjnej utraty krwi (608 ± 359,7 ml vs. 483 ± 251,5 ml; p = 0,005)
i konieczności przetoczeń masy erytrocytarnej (1,32 ± 0,97 j. vs. 0,94 ± 1,02 j.; p = 0,008).
Grupy nie różniły się w zakresie zapotrzebowania na płytki krwi i liczby zgonów szpitalnych
oraz częstości reoperacji z powodu krwawienia. Nie wykazano również istotnych statystycznie różnic między grupami w występowaniu rzeczywistego i prawdopodobnego zawału serca (odpowiednio
p = 0,24 i p = 0,56) oraz śmiertelności wewnątrzszpitalnej.
Wnioski: Stosowanie kwasu acetylosalicylowego przed operacją zwiększało krwawienie pooperacyjne
i konieczność przetoczeń masy erytrocytarnej, nie wpływając na liczbę zgonów,
częstość reoperacji i występowanie okołooperacyjnego zawału serca. Zaleca się odstawienie
kwasu acetylosalicylowego na 7 dni przed operacją (Folia Cardiologica Excerpta 2008; 3:
35–39
Mortality and disability-adjusted life years in North Africa and Middle East attributed to kidney dysfunction : a systematic analysis for the Global Burden of Disease Study 2019
The authors would like to thank the hard work of the staff of the Institute for Health Metrics and Evaluation (IHME) for providing the best possible epidemiologic estimation of diseases in almost all regions and countries of the world, trying to reduce and eliminate poverty of knowledge and information about the diseases globally. Also, the core team authors sincerely thank all the collaborators of the GBD 2019 study who contributed to this study by providing data or a precise review of the manuscript. Publisher Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of the ERA. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.Peer reviewe
Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021
Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic
Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions