[Inflammatory state in patients with atrial fibrillation before and after electrical cardioversion]. / Estado inflamatorio de los pacientes con fibrilación auricular antes y después de la cardioversión eléctrica.

OBJECTIVE: To assess the inflammatory state in patients with persistent atrial fibrillation and to determine the predictive value in the success of cardioversion and recurrence at 30 days. DESIGN: Prospective observational case-control study. PATIENTS: We included consecutively 49 patients with atrial fibrillation previously to scheduled electrical cardioversion in Coronary Care Unit. Clinical and echocardiographic variables were registered and High-sensivity C-reactive protein, interleukin-1beta, interleukin-6 and Tumour Necrosis Factor-alpha were measured. At 30-days follow-up, rhythm and biomarkers were reassessed. As control groups, we recruited 27 healthy volunteers and 16 patients matched for age, gender and cardiovascular risk factors. RESULTS: Median age was 66 +/- 10 years and 38% were women. All the markers were higher in patients than in both control groups (p < 0.05). FNT-alpha and Interleukin-6 levels were higher in non-cardiovertors but only an enlarged atria was related to unsuccessful cardioversion (p = 0.036). High-sensivity C-reactive protein values in the higher cuartile tended to be related to recurrence of persistent atrial fibrillation (p = 0.06). CONCLUSIONS: There is an increased inflammatory state in patients with atrial fibrillation. FNT-alpha and Interleukin-6 levels were increased in non-cardiovertors, but no biomarker was associated with success of cardioversion or rhythm state at 30-days. However, higher levels of hs-CRP showed a trend to be related to recurrence of atrial fibrillation.

Estado inflamatorio de los pacientes con fibrilación auricular antes y después de la cardioversión eléctrica / Inflammatory condition of patients with atrial fibrillation before and after electrical cardioversion

Objetivo. Evaluar el estado inflamatorio en pacientes con fibrilación auricular persistente, y analizar su influencia en el éxito de la cardioversión y la recurrencia a los 30 días. Diseño. Estudio prospectivo, observacional, de casos y controles. Pacientes. Se incluyeron 49 pacientes consecutivos con fibrilación auricular persistente remitidos a la Unidad Coronaria para cardioversión eléctrica programada. Se registraron las variables clínicas y ecocardiográficas y se determinaron PCR-ultrasensible, IL-1ß, IL-6 y FNTα. A los 30 días se reevaluaron ritmo y biomarcadores. Como grupos control se incluyeron 27 individuos sanos y 16 pacientes emparejados en edad, sexo y antecedentes de riesgo cardiovascular. Resultados. La edad media fue de 66 ± 10 años y el 38% eran mujeres. Todos los biomarcadores analizados fueron más altos en los pacientes con fibrilación auricular que en ambos grupos de control (p < 0,05). Los niveles de IL-6 y FNT-α estaban más elevados en los pacientes que no respondieron a la cardioversión, pero el éxito de la misma sólo se asoció al tamaño de la aurícula izquierda (p = 0,036). Los niveles de PCR-ultrasensible situados en el cuartil superior mostraban una tendencia a asociarse con la recurrencia de la arritmia (p = 0,06). Conclusiones. Existe un estado inflamatorio incrementado en los pacientes con fibrilación auricular persistente. Ningún biomarcador se relacionó significativamente con el éxito de la cardioversión ni con ritmo a los 30 días. Sin embargo, los niveles más elevados de PCR-ultrasensible tendían a relacionarse con la recurrencia de la arritmia

Objective. To assess the inflammatory state in patients with persistent atrial fibrillation and to determine the predictive value in the success of cardioversion and recurrence at 30 days. Design. Prospective observational case-control study. Patients. We included consecutively 49 patients with atrial fibrillation previously to scheduled electrical cardioversion in Coronary Care Unit. Clinical and echocardiographic variables were registered and High-sensivity C-reactive protein, interleukin-1beta, interleukin-6 and Tumour Necrosis Factor-alpha were measured. At 30-days follow-up, rhythm and biomarkers were reassessed. As control groups, we recruited 27 healthy volunteers and 16 patients matched for age, gender and cardiovascular risk factors. Results. Median age was 66 ± 10 years and 38% were women. All the markers were higher in patients than in both control groups (p < 0.05). FNT-alpha and Interleukin-6 levels were higher in non-cardiovertors but only an enlarged atria was related to unsuccessful cardioversion (p = 0.036). High-sensivity C-reactive protein values in the higher cuartile tended to be related to recurrence of persistent atrial fibrillation (p = 0.06). Conclusions. There is an increased inflammatory state in patients with atrial fibrillation. FNT-alpha and Interleukin-6 levels were increased in non-cardiovertors, but no biomarker was associated with success of cardioversion or rhythm state at 30-days. However, higher levels of hs-CRP showed a trend to be related to recurrence of atrial fibrillation

Levels of C3 in patients with severe, morbid and extreme obesity: its relationship to insulin resistance and different cardiovascular risk factors.

OBJECTIVE: Increased C3 has been related to body mass index (BMI) and insulin resistance, although there are not sufficient studies in subjects with morbid obesity. The purpose of this study was to evaluate the levels of C3 as a function of the BMI in subjects of both sexes, with severe, morbid and extreme obesity, and their possible relationship to insulin resistance or associated diseases such as diabetes, hypertension and dyslipidemia. SUBJECTS: The study included a total of 316 patients (110 men and 206 women) with severe obesity (17.1%), morbid obesity (54.4%) and extreme obesity (28.4%), with an average BMI of 46.70+/-7.37 kg/m2. MEASUREMENTS: The glucose and insulin levels were determined baseline, and 2 h after a 75 g of oral glucose load. The homeostasis model of assessment for insulin resistance (HOMA-IR) was calculated. A lipid profile (total cholesterol, triglycerides, high-density lipoprotein cholesterol, apolipoprotein AI and apolipoprotein B100) was obtained and C3 levels determined by nephelometry. RESULTS: When distributing the patients by quartiles of BMI, we found a progressive increase in the levels of C3, and no significant differences in the rest of analytical variables studied were found; the mean values of C3 were 127.78+/-29.7 mg/dl.A significant correlation was found between C3 and the BMI (r=0.263, P<0.001), baseline insulin (r=0.237, P=0.001) and HOMA-IR (r=0.237, P=0.001). High blood pressure was found in 111 patients, type 2 diabetes in 74 patients and dyslipidemia in 139 cases. When distributing the levels of C3 according to the number of associated risk factors (hypertension, diabetes and dyslipidemia), we found significant differences between these patients and those who presented no associated diseases (P<0.01). CONCLUSION: A relationship between C3 and the progressive increase of BMI in subjects with severe, morbid or extreme obesity was established. This increase in C3 was closely related to insulin levels and the values for HOMA-IR. Furthermore, we also found an increase in C3 as more diseases related to insulin resistance, such as diabetes, hypertension and dyslipidemia, were associated with the obesity.

Understanding variances in hospital stay.

Systems for tracking, analyzing, and reporting variances in the length of hospital stay enable nurse case managers, nurse managers, and nurse executives to ensure desirable clinical outcomes in a cost-effective manner.

Analysis of motor vehicle crash data in an urban trauma center: implications for nursing practice and research.

OBJECTIVE: To examine the incidence of risk behaviors (safety restraint use and alcohol use) and demographic characteristics of motor vehicle crash victims. DESIGN: Retrospective, descriptive, correlational. SETTING: One major, urban, Level 1 trauma center. SUBJECTS: The medical records of 864 motor vehicle crash victims (drivers, passengers, pedestrians, bicycle riders, and motorcycle riders) admitted to the trauma center between July 1, 1989, and June 30, 1990, were reviewed. RESULTS: Eighty-two percent of motor vehicle occupants (403 drivers and passengers) were not wearing safety restraints at the time of the crash. Thirty-six percent of drivers (92) and 42% (47) of pedestrians were intoxicated on admission to the trauma center. Failure to use safety restraints was associated with alcohol use in this population. Subjects who engaged in risk behaviors were predominantly adolescent and young adult males. CONCLUSIONS: These data suggest the need for further research into correlates of risk behaviors and interventions to prevent future injury related to these behaviors.