RESUMO
Our knowledge of the association between abdominal obesity (AO) and the risk of atrial fibrillation (AF) after adjusting for body mass index (BMI) is limited. We included 11,617 Black and White participants (mean age 63.0 ± 8.4 years) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) national cohort study who were free of AF at baseline. A multivariable logistic regression model was used to estimate the odds ratio (OR) with 95% confidence interval (CI) of incident AF associated with AO. We also evaluated the association between waist circumference (WC) and incident AF. Over a median follow-up of 9.4 years, 999 participants developed AF. AO was associated with an increased risk of AF in a multivariable model adjusted for sociodemographic, lifestyle, and cardiovascular risk factors (OR 1.43, 95% CI 1.24 to 1.65, p <0.001). The association was attenuated after adjusting for BMI (OR 1.13, 95% CI 0.95 to 1.35, p = 0.16). There was no evidence of interaction between AO and incident AF by age category (age >65 vs age ≤65), gender, race, obesity, or BMI category. Conversely, a 10cm increase in WC was associated with a higher incidence of AF after controlling for BMI (OR 1.18 95% CI 1.09 to 1.29, p <0.001), in both nonobese (OR 1.14, 95% CI 1.03 to 1.28, p = 0.02) and obese (OR 1.26, 95% CI 1.11 to 1.42, p <0.001) people. In conclusion, there was an association between AO and incident AF, but the association was weakened after adjusting for BMI. There was a significant association between WC and incident AF, after taking other AF risk factors and BMI into account. WC is a potentially modifiable risk factor for AF, and further research is warranted to explore the effect of decreasing WC on the population AF burden.
Assuntos
Fibrilação Atrial/epidemiologia , Negro ou Afro-Americano/estatística & dados numéricos , Obesidade Abdominal/complicações , Obesidade Abdominal/etnologia , Acidente Vascular Cerebral/epidemiologia , População Branca/estatística & dados numéricos , Idoso , Índice de Massa Corporal , Estudos de Coortes , Feminino , Humanos , Incidência , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Circunferência da CinturaRESUMO
Prompt recognition and treatment for thrombotic thrombocytopenic purpura (TTP) are critical to prevent the irreversible manifestations of this rare and quickly fatal hematologic disorder. Untreated TTP is typically a rapid-onset disease with mortality exceeding 90% within days in the absence of appropriate treatment. In the current report, we describe a case of immune-mediated TTP (iTTP) in a 62-year-old man manifesting as longstanding thrombocytopenia, recurrent cardioembolic strokes, and valvular thrombogenesis over a period of 3 years. We provide correlative evidence to support the potential contribution of adalimumab, a TNFα inhibitor, to the development of iTTP. We offer several educational insights regarding the identification of atypical presentations of iTTP owing to the longstanding disease course and numerous clinical comorbidities seen in this patient.
RESUMO
The developed countries of the world were ill-prepared for the pandemic that they have suffered. When we compare developed to developing countries, the sophisticated parameters we use do not necessarily address the weaknesses in the healthcare systems of developed countries that make them susceptible to crises like the present pandemic. We strongly suggest that better preparation for such events is necessary for a country to be considered developed.
Assuntos
Infecções por Coronavirus/epidemiologia , Atenção à Saúde , Países Desenvolvidos/classificação , Regulamento Sanitário Internacional , Pandemias , Pneumonia Viral/epidemiologia , Saúde Pública , Betacoronavirus/isolamento & purificação , COVID-19 , Defesa Civil/organização & administração , Defesa Civil/normas , Atenção à Saúde/organização & administração , Atenção à Saúde/normas , Humanos , Regulamento Sanitário Internacional/organização & administração , Regulamento Sanitário Internacional/normas , Saúde Pública/normas , SARS-CoV-2Assuntos
Prolapso Uterino , Feminino , Humanos , Prolapso Uterino/diagnóstico , Prolapso Uterino/cirurgiaRESUMO
The complications related to the retropubic placement of polypropylene mesh (TVT) for stress urinary incontinence have been extensively described in the literature. The occurrence of an inflammatory myofibroblastic tumor, however, has not been previously reported as a complication of placement of a mesh sling. We report such a case in a patient with neurofibromatosis who had undergone a TVT for stress urinary incontinence and present a brief review of the literature.