Roles of the CHADS2 and CHA2DS2-VASc scores in post-myocardial infarction patients: Risk of new occurrence of atrial fibrillation and ischemic stroke

Background: Patients with myocardial infarction (MI) are at risk of the development of atrial fibrillation (AF) and ischemic stroke. We sought to evaluate the prognostic performance of the CHADS2 and CHA2DS2-VASc scores in predicting new AF and/or ischemic stroke in post-ST segment elevation MI (STEMI) patients. Six hundred and seven consecutive post-STEMI patients with no previously documented AF were studied.Methods and Results: After a follow-up of 63 months (3,184 patient-years), 83 (13.7%) patients developed new AF (2.8% per year). Patients with a high CHADS2 and/or CHA2DS2-VASc score were more likely to develop new AF. The annual incidence of new AF was 1.18%, 2.10%, 4.52%, and 7.03% in patients with CHADS2 of 0, 1, 2, and ≥ 3; and 0.39%, 1.72%, 1.83%, and 5.83% in patients with a CHA2DS2-VASc score of 1, 2, 3 and ≥ 4. The CHA2DS2-VASc score (C-statistic = 0.676) was superior to the CHADS2 (C-statistic = 0.632) for discriminating new AF. Ischemic stroke occurred in 29 patients (0.9% per year), the incidence increasing in line with the CHADS2 (0.41%, 1.02%, 1.11%, and 1.95% with score of 0, 1, 2, and ≥ 3) and CHA2DS2-VASc scores (0.39%, 0.49%, 1.02%, and 1.48% with score of 1, 2, 3 and ≥ 4). The C-statistic of the CHA2DS2-VASc score as a predictor of ischemic stroke was 0.601, superior to that of CHADS2 score (0.573). CHADS2 and CHA2DS2-VASc scores can identify post-STEMI patients at high risk of AF and stroke.Conclusions: The CHADS2 and CHA2DS2-VASc scores can identify post-STEMI patients at high risk of AF and ischemic stroke. This enables close surveillance and prompt anticoagulation for stroke prevention

Fios e desafios da atenção à saúde da criança no estado do Espírito Santo: análise da mortalidade de zero a cinco anos com gestores do Programa Estadual de Saúde da Mulher e da Criança

Trata-se de um estudo de abordagem qualitativa que objetivou discutir a mortalidade de zero a cinco anos, no estado do Espírito Santo, no lapso de agosto de 2011 a agosto de 2012, a partir de matérias veiculadas por um jornal diário da mídia impressa de grande circulação, a saber A Gazeta. As referidas matérias constituíram uma hemeroteca que subsidiou a criação de um painel reprográfico. Os sujeitos da investigação foram os técnicos que compõem a equipe da Coordenação do Programa Estadual de Saúde da Mulher e da Criança, e a produção do material de estudo se deu a partir da análise de um grupo focal, com roteiro semiestruturado, tendo como partida a análise de uma cópia do painel contendo todas as máterias. Todo o material foi gravado e filmado. A Análise Institutucional foi a baliza norteadora de toda a elaboração e descrição do estudo. Conforme preconiza este quadro teórico proposto por Lourau, a etapa final do projeto constituiu-se em uma restituição concreta parte do procedimento científico, tratando-se da discussão das produções na pesquisa com os interessados, de modo a possibilitar a sua interferência direta neste processo. O estudo demonstrou que os sujeitos, a partir do dispositivo analisador natural, a morte de crianças menores de cinco anos, conseguiram fazer uma reflexão sobre o quanto é necessário buscar uma interlocução com os demais setores e perceber que a análise institucional, com sua potência de provocar a autoanálise e a autogestão, proporcionou-lhes uma possibilidade de repensar seus processos de trabalho na atenção à saúde da criança

Prospective, multicentre study of screening, investigation and management of hyponatraemia after subarachnoid haemorrhage in the UK and Ireland

Background: Hyponatraemia often occurs after subarachnoid haemorrhage (SAH). However, its clinical significance and optimal management are uncertain. We audited the screening, investigation and management of hyponatraemia after SAH. Methods: We prospectively identified consecutive patients with spontaneous SAH admitted to neurosurgical units in the United Kingdom or Ireland. We reviewed medical records daily from admission to discharge, 21 days or death and extracted all measurements of serum sodium to identify hyponatraemia (<135 mmol/L). Main outcomes were death/dependency at discharge or 21 days and admission duration >10 days. Associations of hyponatraemia with outcome were assessed using logistic regression with adjustment for predictors of outcome after SAH and admission duration. We assessed hyponatraemia-free survival using multivariable Cox regression. Results: 175/407 (43%) patients admitted to 24 neurosurgical units developed hyponatraemia. 5976 serum sodium measurements were made. Serum osmolality, urine osmolality and urine sodium were measured in 30/166 (18%) hyponatraemic patients with complete data. The most frequently target daily fluid intake was >3 L and this did not differ during hyponatraemic or non-hyponatraemic episodes. 26% (n/N=42/164) patients with hyponatraemia received sodium supplementation. 133 (35%) patients were dead or dependent within the study period and 240 (68%) patients had hospital admission for over 10 days. In the multivariable analyses, hyponatraemia was associated with less dependency (adjusted OR (aOR)=0.35 (95% CI 0.17 to 0.69)) but longer admissions (aOR=3.2 (1.8 to 5.7)). World Federation of Neurosurgical Societies grade I–III, modified Fisher 2–4 and posterior circulation aneurysms were associated with greater hazards of hyponatraemia. Conclusions: In this comprehensive multicentre prospective-adjusted analysis of patients with SAH, hyponatraemia was investigated inconsistently and, for most patients, was not associated with changes in management or clinical outcome. This work establishes a basis for the development of evidence-based SAH-specific guidance for targeted screening, investigation and management of high-risk patients to minimise the impact of hyponatraemia on admission duration and to improve consistency of patient care

[In Press] The influence of running shoes on familiarization time for treadmill running biomechanics evaluation

This study investigated treadmill familiarisation time in different shoe conditions by comparing lower limb consecutive kinematics waveforms using a trend symmetry method to calculate trend symmetry index, range amplitude ratio and range offset. Eighteen young adults (26.6 ± 3.3 years, 7 females) completed three 10-minute running trials at their preferred running speed (2.30 ± 0.17 m/s) on a treadmill with three shoe conditions (i.e., usual, minimalist and maximalist shoes) in a random order. Sagittal lower limb kinematic data were recorded using inertial measurement units. The results showed that sagittal-plane kinematic waveforms in the hip, knee and ankle remained consistent (trend symmetry > 0.95) without extreme excursions (range amplitude ratio ≈ 1) over 10 minutes within each testing shoe condition. Significant time × shoe interaction effect was observed in range offset (i.e., absolute differences in the average degree of kinematic waveforms between consecutive minutes) at ankle (p = 0.029, ŋp2 = 0.096) and knee (p = 0.002, ŋp2 = 0.126). Post-hoc analysis suggested that running with novel shoes required a shorter time to achieve stable lower limb kinematics (2 to 3 minutes) compared with usual shoes (7 minutes). In conclusion, young healthy adults need up to 3 and 7 minutes to familiarise to the treadmill when running at their preferred speed with their novel and usual running shoes

Tulsa Daily World

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Influence of surface water availability on mammal distributions in Nonggang National Nature Reserve, Guangxi, China

Surface water is a major limiting factor affecting animal activities in karst ecosystems. From March, 2006 to June, 2007 and from October, 2010 to May, 2011, infra-red camera traps were installed along animal trails and temporary rain pools in Nonggang National Nature Reserve, Guangxi, China, to monitor mammal diversity and relative abundance. In total, 19 species from 17 genera, 12 families, and 5 orders were recorded, including two State Key Protection Class I species, the François’ langur ( Trachypithecus francoisi ) and Assam macaque ( Macaca assamensis ). Although 42% of species only occurred in one of the microhabitats, differences in species assemblages between trails and pools were not significant. The results of our observation indicated that camera trapping was effective in monitoring medium to large sized mammals, and for recording illegal hunting. In addition, our results suggest that authorities should reinforce patrolling, especially at water pools during the dry season, and eradicate unsustainable extraction of underground water. Moreover, based on the advantages of large inhibited environments to animal species, especially to large predators, we also recommend connecting the three isolated sections of the reserve to promote species recovery and dispersal

Impact of Antithrombotic Therapy in Atrial Fibrillation on the Presentation of Coronary Artery Disease.

Little is known about whether atrial fibrillation is a presentation of coronary disease. There is a paucity of knowledge about their causal relationship and also the impact of different antithrombotic strategies on the subsequent presentation of symptomatic coronary disease.We studied 7,526 Chinese patients diagnosed with non-valvular atrial fibrillation and no documented history of coronary artery disease. The primary endpoint was the new occurrence of coronary artery disease--either stable coronary artery disease or acute coronary syndrome. After a mean follow-up of 3.2±3.5 years (24,071 patient-years), a primary endpoint occurred in 987 patients (13.1%). The overall annual incidence of coronary artery disease was 4.10%/year. No significant differences in age, sex, and mean CHA2DS2-VASc score were observed between patients with and without the primary endpoint. When stratified according to the antithrombotic strategies applied for stroke prevention, the annual incidence of coronary artery disease was 5.49%/year, 4.45%/year and 2.16%/year respectively in those prescribed no antithrombotic therapy, aspirin, and warfarin. Similar trends were observed in patients with acute coronary syndromes. Diabetes mellitus, smoking history and renal failure requiring dialysis were predictors for primary endpoint in all antithrombotic therapies.In patients with non-valvular atrial fibrillation, there is a modest association with coronary artery disease. Patients prescribed warfarin had the lowest risk of new onset coronary artery disease