Factores pronósticos de mortalidad en pacientes graves con enfermedades neurológicas agudas no traumáticas / Prognostic factors of mortality in seriously ill patients with acute non-traumatic neurological diseases

RESUMEN Fundamento: las enfermedades neurológicas son una de las principales causas de muerte e invalidez en todo el mundo. Objetivo: identificar los factores pronósticos relacionados con la mortalidad por enfermedades neurológicas agudas no traumáticas en pacientes graves. Métodos: se realizó un estudio retrospectivo, transversal, del 1ro de enero al 31 de diciembre 2019. El universo estuvo representado por 130 pacientes y la muestra fue de 114. Se empleó el porcentaje, suma, el chi cuadrado y el Odd Radio para identificar los factores de riesgo, con un IC de 95 %. Resultados: predominó el grupo etario de 50-59 años del sexo masculino con enfermedad cerebrovascular isquémica, aunque el mayor porcentaje de fallecidos fue por enfermedad cerebrovascular hemorrágica. Los pacientes con tratamiento quirúrgico tuvieron relación con la mortalidad, con discreto predominio de la cirugía urgente. Alrededor de la mitad de los pacientes requirieron ventilación mecánica y fue un factor pronóstico de mortalidad. Predominó la desnutrición y la obesidad. Las arritmias cardíacas, necesidad de apoyo de aminas vasoactivas, estadía promedio mayor de 14 días y las complicaciones fueron factores de pronóstico de mortalidad. Igual, el índice leucoglicémico mayor de 0,75 y APACHE II inicial mayor de 15 puntos. Predominó la puntuación Glasgow por encima de ocho puntos. Conclusiones: los factores pronósticos relacionados con la mortalidad por enfermedades neurológicas agudas no traumáticas en pacientes graves fueron la presencia de arritmias cardíacas, necesidad de ventilación mecánica y de apoyo de aminas vasoactivas tratamiento quirúrgico, índice leucoglicémico mayor de 0,75 puntos, puntuación APACHE II inicial mayor de 15 puntos y la presencia de complicaciones.

ABSTRACT Background: neurological diseases are one of the main causes of death and disability worldwide. Objective: to identify prognostic factors related to mortality from acute non-traumatic neurological diseases in seriously ill patients. Methods: a retrospective, cross-sectional study was carried out from January 1st to December 31st, 2019. Universe was constituted of 130 patients and the sample was 114. Percentage, sum, chi-square and Odd Radio were used to identify risk factors, with an IC of 95 %. Results: the age group of 50-59 years prevailed, male with ischemic cerebrovascular disease, although the highest percentage of deaths was due to hemorrhagic cerebrovascular disease. Patients with surgical treatment were related to mortality, with a slight predominance of urgent surgery. About half of the patients required mechanical ventilation and it was a prognostic factor for mortality. Malnutrition and obesity predominated. Cardiac arrhythmias, need for vasoactive amine support, average length of stay greater than 14 days and complications were prognostic factors for mortality. Likewise, the leukoglycemic index greater than 0.75 and the initial APACHE II was greater than 15 points. The Glasgow score was above 8 points. Conclusions: the prognostic factors related to mortality from acute non-traumatic neurological diseases in severe patients were the presence of cardiac arrhythmias, need for mechanical ventilation and support for vasoactive amines, surgical treatment, leukoglycemic index greater than 0.75 points, initial APACHE II score greater than 15 points and the presence of complications.

The effects of cigarette smoking on ventricular repolarization in adolescents / O tabagismo altera a repolarização ventricular em adolescentes

ABSTRACT Objective To assess the association between cigarette smoking and ventricular arrhythmias in adolescents. Novel electrocardiographic parameters -Tp-e interval, as well as Tpe/QT and Tpe/QTc ratios - were used to make this assessment. Methods The study population consisted of 87 subjects aged between 16-19 years. Fifty-one adolescent smokers with no risk of arrhythmia comprised the Smoker Group, and 36 adolescents who had never smoked cigarettes comprised the Control Group. Smokers were defined as patients smoking more than three cigarettes per day, for at least 1 year. Body mass index, systolic, diastolic and mean blood pressures were measured, and electrocardiograms were performed on all subjects. Heart rate, PR and Tp-e intervals, and Tpe/QT, Tpe/QTc ratio were digitally measured. Results Adolescents in Smoker Group had smoked cigarettes for 2.9±1.4 years (range 1 to 6 years). The mean age at starting smoking was 13.8±1.4 years. There were no differences between smokers and Control Group as to baseline clinical variables (p>0.05). The PR, QT and QTc intervals were similar in all groups. Tp-e interval (98.4±12.7ms and 78.3±6.9 ms; p<0.001), Tpe/QT (0.28±0.04 and 22±0.03; p<0.01), Tpe/QTc (0.24±0.03 and 0.19±0.01; p<0.001) ratios were significantly higher in Smoker Group. There were no correlations between years of smoking, number of cigarettes per day, Tpe interval, Tpe/QT or Tpe/QTc ratios. Conclusion Cigarette smoking is associated with risk of ventricular arrhytmogenesis with prolonged Tp-e interval and increased Tpe/QT and Tpe/QTc ratios in adolescents.

RESUMO Objetivo Avaliar a associação entre tabagismo e arritmias ventriculares em adolescentes usando novos parâmetros eletrocardiográficos: intervalo Tp-e, e relações Tpe/QT e Tpe/QTc. Métodos A população do estudo incluiu 87 indivíduos de 16 a 19 anos de idade. Cinquenta e um adolescentes fumantes, sem risco de arritmia, formaram o Grupo Fumantes, e 36 adolescentes, que nunca tinham fumado cigarros, formaram o Grupo Controle. Os fumantes foram definidos como pacientes que fumavam mais de três cigarros por dia, há pelo menos 1 ano. O índice de massa corporal, e a pressão arterial sistólica, diastólica e média foram medidos, e foram realizados eletrocardiogramas em todos os participantes. Frequência cardíaca, intervalos PR e Tp-e, e as relações Tpe/QT e Tpe/QTc foram medidas por instrumentos digitais. Resultados Os adolescentes do Grupo Fumante fumavam há 2,9±1,4 anos (variação 1 a 6 anos). A média de idade ao começar a fumar foi 13,8±1,4 anos. Não houve diferença nas variáveis clínicas iniciais entre os Grupos Fumante e controle (p>0,05). Os intervalos PR, QT e QTc foram semelhantes em todos os grupos. O intervalo Tp-e (98,4±12,7ms e 78,3±6,9ms; p<0,001), e as relações Tpe/QT (0,28±0,04 e 22±0,03; p<0,01) e Tpe/QTc (0,24±0,03 e 0,19±0,01; p<0,001) foram significativamente maiores no Grupo Fumantes. Não houve correlação entre anos de tabagismo, número de cigarros por dia, intervalo Tpe e relações Tpe/QT e Tpe/QTc. Conclusão O hábito de fumar está associado ao risco de arritmogênese ventricular, com interval Tp-e prolongado e aumento nas relações Tpe/QT e Tpe/QTc em adolescentes.

Out of hospital cardiac arrest resuscitation outcome in North India — CARO study / 世界急诊医学杂志（英文）

@#BACKGROUND:To evaluate the outcome of cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrests (OHCA) in India and factors influencing the outcome. METHODS:The outcome and related factors like demographics, aspects of the OHCA event, return of spontaneous circulation (ROSC) and survival to discharge, among the 80 adult patients presenting to emergency department experiencing OHCA considered for resuscitation between January 2014 to April 2015, were analyzed, according to the guidelines of the Utstein consensus conference. RESULTS: The survival rate to hospital admission was 32.5％, the survival rate to hospital discharge was 8.8％and with good cerebral performance category (CPC1) neurological status was 3.8％. Majority of OHCA was seen in elderly individuals between 51 to 60 years, predominately in males. Majority of OHCA were witnessed arrests (56.5％) with 1.3％bystander CPR rate, 92.5％arrests occurred at home, 96％presented with initial non-shockable rhythm and 92.5％with presumed cardiac etiology but survival was better in those who experienced OHCA at public place, in witnessed arrests, in patients who had shockable presenting rhythm and in those where CPR duration was≤20 minutes. CONCLUSION: Witnessed arrests, early initiation of CPR by bystanders, CPR duration ≤20 minutes, initial presenting shockable rhythm, OHCA with non-cardiac etiology are associated with a good outcome. To improve the outcome of CPR and the low survival rates after an OHCA event in India, focused strategies should be designed to set up an emergency medical system (EMS), to boost the rates of bystander CPR and education of the lay public in basic CPR.

Fragmented QRS scale and brain natriuretic peptide predict infarction in patients with acute myocardial infarction and heart attacks / 中国医师杂志

Objective To investigate the acute myocardial infarction (AMI) patient's electrocardiogram appearing fragment QRS wave (fQRS) and brain natriuretic peptide (BNP) level and scope of coronary lesions,severe cardiac complications,and the cor relation of cardiac death.Methods For selected patients with AMI,whether based on electrocardiogram (ECG) appeared in fQRS group and non fQRS groups; immunofluorescence technique was used to detect the plasma BNP level in patients with AMI.Two groups of patients with serious cardiac events and coronary artery lesions scope were observed; Coronary artery lesion count and BNP level were recorded.Results The incidence of fragment QRS wave in patients with AMI was 34.0％,fQRS wave group height/three degree atri oventricular block,ventricular tachycardia/ventricular fibrillation,cardiac shock,cardiac death rate was higher than non fQRS wave group (P ＜0.05).fQRS wave group of plasma BNP and left ventricular end-diastolic diameter,the double branch lesion,multivessel lesions were significantly higher than that of non fQRS group (P ＜ 0.01) ; left ventricular ejection fraction,the single lesion was sig nificantly lower than non fQRS wave group (P ＜0.01).The BNP levels in single,double,and multivessel lesions in the group with the increase of the lesion count were increased.Conclusions The AMI patients with fQRS easily complicated with severe arrhythmia,and case fatality rate was high,the prognosis was poor.fQRS on electrocardiogram (ECG) and BNP level had a certain relationship with range and degree of coronary artery lesions,degree of indexes might be used as a prediction of coronary lesions,and multivessel lesions had certain prediction value.

Novel mutations in arrhythmogenic right ventricular cardiomyopathy from Indian population.

BACKGROUND: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a progressive condition with right ventricular myocardium being replaced by fibro-fatty tissue. The spectrum of the expression may range from benign palpitations to the most malignant sudden death. Most of the mutations identified for the condition are localized in desmosomal proteins although three other nondesmosomal genes (cardiac ryanodine receptor-2, TGF-β3, and TMEM43) have also been implicated in ARVC. Both desmosomal and nondesmosomal genes were screened in a set of patients from local population. MATERIALS AND METHODS: A set of 34 patients from local population were included in this study. Diagnosis was based on the criteria proposed by task force of European Society of Cardiology/International Society and Federation of Cardiology. Polymerase chain reaction-based single-strand conformation polymorphism analysis was carried out, and samples with abnormal band pattern were commercially sequenced. RESULTS: Screening of cardiac ryanodine receptor revealed an insertion of a base in the intronic region of exon-28 in a patient, leading to a creation of a cryptic splice site. Screening of plakohilin-2 for mutations revealed an abnormal band pattern in three patients. Two of them had similar abnormal band pattern for exon-3.1. Sequencing revealed a novel 2 base pair deletion (433_434 delCT), which would lead to premature truncation of the protein (L145EfsX8). Another patient showed abnormal band pattern for exon-3.2 and sequencing revealed a missense mutation C792T leading to amino acid change P244L, in N-terminal, and this substitution may cause disturbances in the various protein–protein interactions. CONCLUSION: This study reports novel cardiac ryanodine receptor (RyR-2) mutations and Pkp-2 for the first time from Indian population.

Exercise-induced ventricular arrhythmias: analysis of predictive factors in a population with sleep disorders / Arritmia ventricular esforço-induzida: análise dos fatores preditores em uma população com queixas de sono

Objective: To assess the prevalence of ventricular arrhythmias induced by exercise in a population with sleep disorders and to analyze the triggering factors. Methods: Patients were consecutively selected from the database of the Sleep Clinic of Universidade Federal de São Paulo. All subjects were submitted to basal polysomnography, blood sample collection, physical examination, 12-lead ECG, spirometry, cardiorespiratory exercise study on a treadmill, and echocardiogram. The Control Group was matched for age and gender. Results: A total of 312 patients were analyzed. Exercise-induced ventricular arrhythmia was observed in 7%. The aortic diameter was larger (3.44 ± 0.30, 3.16 ± 0.36, p = 0.04) and the minimal saturation was lower (92.75 ± 3.05, 95.50 ± 1.73, p=0.01) in the ventricular arrhythmia group when compared to controls, respectively. After correction of the aortic root to body surface, there was only a trend to a larger diameter being associated with the emergence of arrhythmia. Conclusions: Exercise-induced ventricular arrhythmia was observed in 7% of sample and it was associated with lower oxygen saturation during exercise.

Objetivo: Avaliar a prevalência de arritmias ventriculares esforço-induzidas em uma população com distúrbios do sono e determinar seus fatores desencadeantes. Métodos: Foram selecionados consecutivamente pacientes do banco de dados da Clínica de Sono que foram submetidos à polissonografia basal por queixas de sono. Foi realizada coleta de sangue, seguida de avaliação clínica, eletrocardiograma de 12 derivações, espirometria, teste cardiopulmonar e ecocardiograma. O Grupo Controle foi formado por pacientes que não desenvolveram arritmias durante o esforço, pareados por sexo e idade. Resultados: Foram selecionados 320 e analisados 312 pacientes. Um total de 7% deles desenvolveram arritmia ventricular durante o teste cardiopulmonar. O diâmetro da aorta foi maior (3.44 ± 0.30, 3.16 ± 0.36, p = 0.04) e a saturação mínima observada durante o esforço foi menor (92.75 ± 3.05, 95.50 ± 1.73, p = 0.01) no grupo com arritmia quando comparado ao controle, respectivamente. Após correção do diâmetro de raiz da aorta para a superfície corpórea, houve apenas tendência de associação entre maior diâmetro e aparecimento de arritmia. Conclusões: O aparecimento de arritmia ventricular induzida pelo esforço foi observado em 7% da amostra e associado à menor saturação de oxigênio durante o exercício. Houve tendência de maior diâmetro da raiz de aorta nesse grupo.