ABSTRACT
OBJECTIVES: Fine particulate matter <2.5 microns (PM2.5) is the most studied air pollutant. Both short- and long-term exposure to PM2.5 have been linked to cardiovascular disease (CVD). Studies evaluating air pollution in South America are scarce. Therefore, the impact of exposure to PM2.5, household air pollution (HAP), and ambient air pollution (AAP) on CVD mortality and CVD disability-adjusted life years (DALYs) in South American countries from 1990 to 2019 was explored. STUDY DESIGN AND METHODS: The Global Burden of Disease initiative exposure-response function was used to analyze the total PM2.5, ambient PM2.5, and household PM2.5-related CVD deaths and DALYs rates, per 100,000 individuals, in 12 South American countries between 1990 and 2019. The relative change in burden was also assessed by comparing the 1990-1994 to 2015-2019 periods. RESULTS: In 2019, 70,668 deaths and 1,736,414 DALYs due to CVD were attributed to total PM2.5 exposure in South America. Substantial regional heterogeneity was observed concerning the absolute change in PM2.5 concentration levels comparing 1990 to 2019. All South American countries observed a relative decline in CVD deaths and DALYs comparing the 1990-1994 to 2015-2019 periods. No country was able to reach the current World Health Organization 5 µg/m3 recommended limit in 2019. Predominantly, AAP was the greatest contributor to the CVD burden. CONCLUSION: Air pollution substantially impacted CVD in South America; however, this impact was heterogenous, and the relative reduction of HAP and AAP burden was also not uniform. Recognizing PM2.5 importance is key for developing target population and individual-level interventions, which could ultimately alleviate its burden.
ABSTRACT
BACKGROUND: Thoracic aortic surgeries remain with high mortality rates, often associated with postoperative neurological complications. The choice of the right cannulation site is extremely important for suitable blood supply and maintenance of vital functions, especially of the central nervous system. OBJECTIVES: To compare the influence of central versus peripheral arterial cannulation on neurological outcomes in patients undergoing thoracic aortic surgery through systematic review and meta-analysis. METHODS: MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS and reference lists of relevant articles were searched for clinical studies that reported in-hospital neurological outcomes after central or peripheral arterial cannulation during thoracic aortic surgery procedures until December 2013. The principal summary measures were Odds Ratio (OR) for central compared to peripheral arterial cannulation with 95% confidence interval (CI) and p-values considered statistically significant when <0.05. The ORs were combined across studies, using the DerSimonian-Laird random effects model and fixed effects model using the Mantel-Haenszel model--both models were weighted. The meta-analysis was completed using the software Comprehensive Meta-Analysis version 2 (Biostat Inc., Englewood, NJ). RESULTS: Six studies were identified and included a total of 4459 patients (1180 for central and 3279 for peripheral cannulation). There was no significant difference between the central and peripheral groups regarding neurological outcomes. The meta-regression evidenced no relationship between neurological outcomes and the variables age, sex, previous coronary event, previous neurological event, urgency surgery, cardiopulmonary bypass time, activated clotting time and esophageal temperature with p > 0,05. CONCLUSION: When it comes to neurological outcomes in patients undergoing thoracic aortic surgery, there was no evidence that argues in favor of any choice of arterial cannulation site, which makes us reject any superiority of one approach over the other in this regard.
Subject(s)
Aorta, Thoracic/surgery , Cardiac Surgical Procedures , Catheterization , Nervous System Diseases , Postoperative Complications , Age Factors , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/methods , Catheterization/adverse effects , Catheterization/methods , Data Mining , Female , Humans , Male , Nervous System Diseases/etiology , Nervous System Diseases/mortality , Postoperative Complications/etiology , Postoperative Complications/mortality , Sex Factors , SoftwareABSTRACT
The efficacy of pulmonary artery balloon counterpulsation (PABC) has been previously demonstrated. Clinically this is usually achieved by suturing a Dacron graft to the side of the pulmonary artery with an intra-aortic balloon pulsating inside the graft. PABC via the percutaneous route has not been previously reported, although it has been demonstrated experimentally that an intrapulmonary artery balloon inserted via the outflow of the right ventricle provides effective counterpulsation. The morphologic effects of PABC on the heart and lungs have not been previously demonstrated. This study evaluates the feasibility of PABC via the percutaneous route and assesses the morphologic changes of PABC on the heart and lungs of pigs. Results indicate that PABC via the percutaneous route is technically feasible. However, after 24 h of PABC morphologic changes occurred in the heart and lungs, consisting of valvular and mural thrombi and hemorrhage. Histopathologic evaluation of the lungs revealed interstitial and intra-alveolar hemorrhage and pulmonary emboli. The etiology of these pathologic changes are likely multifactorial. Further studies are necessary to fully delineate the short and long term effects of PABC prior to initiation of clinical trials with this new percutaneous assist device.
