Analysis of intracranial aneurysms treated at a University Hospital in Curitiba

Abstract Objective: The aim of this paper is analyze the population and the types of intracranial aneurysms treated in the neurosurgery service of the Hospital Universitário Evangélico of Curitiba (HUEC), checking possible relations of this pathology with some risk factors and analyzing also the result of the treatment of this patients. Method: We reviewed the hospital files, surgical and out-patient notes of all patients operated on for the treatment of intracranial aneurysms from January 2006 to December 2010, composing a sample of 93 patients. The variables analyzed were gender, age, history of hypertension, smoking habit, diabetes mellitus, site of aneurysm, score scales Hunt-Hess and Fisher at hospital admission and treatment outcome of aneurysms using the Glasgow Outcome Scale (GOS). Results: The patients studied were predominantly women (73%), ranging in age from 51 to 60 years (38%), with a history of hypertension (61%). At admission, the grade 1 in a Hunt-Hess scale was most frequent (31%), while grade 4 on a scale of Fisher was more prevalent (26%). Aneurysms were more frequent in the anterior circulation, mainly affecting the middle cerebral artery. The most frequent score in GOS was 5 (40%). Conclusion: Subarachnoid hemorrhage is an event that may worsen the outcome of treatment of patients with intracranial aneurysms, so there is a correlation between the amount of bleeding identified on CT and prognostic evolution.

Download Full-text

Small (< 10-mm) incidentally found intracranial aneurysms, Part 1: reasons for detection, demographics, location, and risk factors in 212 consecutive patients

Neurosurgical FOCUS ◽

10.3171/2011.9.focus11234 ◽

2011 ◽

Vol 31 (6) ◽

pp. E3 ◽

Cited By ~ 18

Author(s):

Ioannis Loumiotis ◽

Anne Wagenbach ◽

Robert D. Brown ◽

Giuseppe Lanzino

Keyword(s):

Risk Factors ◽

Subarachnoid Hemorrhage ◽

Intracranial Aneurysms ◽

Imaging Techniques ◽

Imaging Study ◽

Consecutive Series ◽

Common Location ◽

Unruptured Intracranial Aneurysms ◽

Paraclinoid Aneurysms ◽

History Of

Object The widespread use of imaging techniques for evaluating nonspecific symptoms (vertigo, dizziness, memory concerns, unsteadiness, and the like) and focal neurological symptoms related to cerebrovascular disease has led to increased identification of asymptomatic incidentally discovered unruptured intracranial aneurysms (UIAs). The management of these incidental aneurysms is controversial and many factors need to be considered. The authors describe reasons leading to diagnosis, demographics, and risk factors in a large consecutive series of patients with small incidentally found UIAs. Methods The authors prospectively evaluated 335 patients harboring 478 small (< 10-mm) UIAs between January 2008 and May 2011. Patients with known aneurysms, possibly symptomatic aneurysms, arteriovenous malformation–related aneurysms, patients with a history of subarachnoid hemorrhage from another aneurysm, and patients harboring extradural aneurysms were excluded from the analysis. Only truly incidental small aneurysms (272 aneurysms in 212 patients) were considered for the present analysis. Data regarding the reason for detection, demographics, location, and presence of potential risk factors for aneurysm formation were prospectively collected. Results There were 158 female (74.5%) and 54 male (25.5%) patients whose mean age was 60.6 years (median 62 years). The most common reason for undergoing the imaging study that led to a diagnosis of the aneurysms was evaluation for nonspecific spells and symptoms related to focal cerebrovascular ischemia (43.4%), known/possible intracranial or neck pathology (24%), and headache (16%). The most common location (27%) of the aneurysm was the middle cerebral artery; the second most common (22%) was the paraclinoid internal carotid artery (excluding cavernous sinus aneurysms). Sixty-nine percent of patients were current or prior smokers, 60% had a diagnosis of hypertension, and 23% had one or more relatives with a history of intracranial aneurysms with or without subarachnoid hemorrhage. Conclusions Small incidental UIAs are more commonly diagnosed in elderly individuals during imaging performed to investigate ill-defined spells or focal cerebrovascular ischemic symptoms, or during the evaluation of known or probable unrelated intracranial/neck pathology. Hypertension, smoking, and family history of aneurysms are common in this patient population, and the presence of these risk factors has important implications for treatment recommendations. Although paraclinoid aneurysms (excluding intracavernous aneurysms) are uncommon in patients with ruptured intracranial aneurysms, this location is very common in patients with small incidental UIAs.

Download Full-text

The case for family screening for intracranial aneurysms

Neurosurgical FOCUS ◽

10.3171/2011.9.focus11210 ◽

2011 ◽

Vol 31 (6) ◽

pp. E8 ◽

Cited By ~ 7

Author(s):

Nohra Chalouhi ◽

Rohan Chitale ◽

Pascal Jabbour ◽

Stavropoula Tjoumakaris ◽

Aaron S. Dumont ◽

...

Keyword(s):

Risk Factors ◽

Subarachnoid Hemorrhage ◽

Natural History ◽

Intracranial Aneurysms ◽

Family Screening ◽

Multiple Factors ◽

History Of ◽

The Cost ◽

Familial Aneurysms ◽

Risk Of Treatment

Given that relatives of patients with intracranial aneurysms (IAs) or subarachnoid hemorrhage have a greater risk of harboring an aneurysm, family screening has become a common practice in neurosurgery. Unclear data exist regarding who should be screened and at what age and interval screening should occur. Multiple factors including the natural history of IAs, the risk of treatment, the cost of screening, and the psychosocial impact of finding an aneurysm should be taken into account when family screening is considered. In this paper, the authors review the current literature regarding risk factors and natural history of sporadic and familial aneurysms. Based on these data the authors assess current recommendations for screening and propose their own recommendations.

Download Full-text

Prevalence and Associated Risk Factors of Gestational Diabetes Mellitus at a University Hospital in Saudi Arabia

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.2.498 ◽

2019 ◽

Vol 35 (2) ◽

Author(s):

Shahad Abualhamael ◽

Hala Mosli ◽

Mukhtiar Baig ◽

Abdulelah M. Noor ◽

Fahd M. Alshehri

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Saudi Arabia ◽

Family History ◽

Gestational Diabetes ◽

Antenatal Clinic ◽

University Hospital ◽

History Of ◽

Working Status ◽

Associated Risk Factors

Objectives: We aimed to find out the prevalence and associated risk factors of GDM among females who attended antenatal clinic at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia (SA). Methods: This retrospective study was carried out from 25th September 2016 till 20th December 2016, at the Endocrine Clinic, Faculty of Medicine, KAUH, Jeddah, SA. A total of 5000 women attended antenatal clinic and 637 women were referred to the endocrine clinic for GDM. The data of only 103 GDM was included in the study because only these patients’ complete data was available. The electronic record of 93 pregnant age and BMI matched females, not having GDM were selected as a control group. Results: The prevalence of GDM was 12.75% (637/5000). Parity was associated with GDM (X2=16.82, P=.001) and GDM was significantly higher in multigravida while no association of GDM was found with working status, place of living, hypertension, family history of DM and BMI. Logistic regression analysis revealed that grand multigravida female had the lower risk of GDM as compared to multi, primi and nulligravida while age, working status, place of living, hypertension, family history of DM and BMI were not found significant risk factors for GDM. In GDM group, according to nationality, 68(66%) women were Saudi while 35(34%) were expatriates’ (Yemeni 11.2%, Egyptians 3.9%, Indians 3.9%, Pakistanis 2.9%, Sudanese 2.9%, Syrians 2.9% and others). Conclusions: The prevalence of GDM was 12.75% and it was not associated with working status, place of living, hypertension, family history of diabetes and BMI. How to cite this:Abualhamael S, Mosli H, Baig M, Noor AM, Alshehri FM. Prevalence and Associated Risk Factors of Gestational Diabetes Mellitus at a University Hospital in Saudi Arabia. Pak J Med Sci. 2019;35(2):---------. doi: https://doi.org/10.12669/pjms.35.2.498 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Download Full-text

Characteristics of prevalence in peripheral arterial disease and correlative risk factors and comorbidities among female natural population in China

VASA ◽

10.1024/0301-1526/a000054 ◽

2010 ◽

Vol 39 (4) ◽

pp. 305-311 ◽

Cited By ~ 11

Author(s):

Wang ◽

Xu ◽

Li ◽

Wei ◽

Zhao ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Coronary Heart Disease ◽

Heart Disease ◽

Natural Population ◽

Smoking Habit ◽

Arterial Disease ◽

Lipid Disorders ◽

History Of ◽

Peripheral Arterial

Background: To investigate the prevalence of peripheral arterial disease (PAD) and correlating risk factors and comorbidities in a natural female population in China, and to study the characteristics of atherosclerotic disease in females. Patients and methods: Natural population from communities in several cities and districts including Beijing, Shanghai, Changsha, Guangdong, Inner Mongolia, and Xinjiang in China were investigated as study subjects through cluster multistage and random sampling. Ankle-brachial index (ABI) was measured among participants in the communities by trained investigators and correlative information and clinical data were collected. PAD was defined as an ABI ≤ 0.9 in either leg. Results: 21 152 eligible participants were included in the survey. The prevalence in males and females was 2.52 % and 3.66 %, the standardized prevalence was 1.84 % and 4.31 % respectively, and the prevalence in females was higher than that in males (p < 0.01). The prevalence in females obviously increased (p < 0.01) with increasing age. More female participants with PAD were over 69 years old compared with those without PAD (18.8 % vs. 10.0 %, p = 0.000) and more frequently have a smoking habit (11.1 % vs. 2.5 %, p = 0.000), lipid disorders (34.8 % vs. 29.2 %, p = 0.047), diabetes mellitus (14.8 % vs. 8.6 %, p = 0.000), coronary heart disease (16.9 % vs. 10.0 %, p = 0.000) and a history of stroke (6.8 % vs. 2.3 %, p = 0.000). Using multiple logistic regression analysis, older age (> 69 years old, OR: 1.60, 95 % CI: 1.11 - 2.29), a smoking habit (OR: 5.98, 95 % CI: 3.88 - 9.21), comorbidities of lipid disorders (OR: 1.45, 95 % CI: 1.10 - 1.91), diabetes mellitus (OR: 1.46, 95 % CI: 1.02 - 2.11), coronary heart disease (OR: 1.50, 95 % CI: 1.02 - 2.19)and a history of stroke (OR: 1.71, 95 % CI: 1.01 - 2.91) were correlated with the prevalence of PAD in females in China. Only 0.8 % of female patients with PAD had been diagnosed previously. Conclusions: The data suggest that the prevalence of PAD in a female natural population in China is higher than that in males. Many conventional risk factors and comorbidities were correlated with the high prevalence of PAD in females. But only very few female patients with PAD were diagnosed. Thus, more measures should be taken to diagnose, prevent and control PAD in females in China.

Download Full-text

Risk factors and outcome in 100 patients with aneurysmal subarachnoid hemorrhage

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2001000500004 ◽

2001 ◽

Vol 59 (3B) ◽

pp. 676-680 ◽

Cited By ~ 19

Author(s):

Leonardo Bonilha ◽

Edilson L. Marques ◽

Edmur F. Carelli ◽

Yvens B. Fernandes ◽

Arquimedes C. Cardoso ◽

...

Keyword(s):

Risk Factors ◽

Subarachnoid Hemorrhage ◽

Medical History ◽

Glasgow Outcome Scale ◽

Surgical Procedure ◽

Smoking Habit ◽

Previous History ◽

History Of ◽

The Moment ◽

Previous Medical History

OBJECTIVE: Clinical and surgical outcome of patients with subarachnoid hemorrhage (SAH) due to ruptured aneurysm were assessed in comparison to pre-operative data and risk factors such as previous medical history, clinical presenting condition, CT findings and site of bleeding. METHODS: We evaluated 100 consecutive patients with aneurysmal SAH. Gender, color, history of hypertension, smoking habit, site and size of aneurysm, admittance and before surgery Hunt Hess scale, need for cerebro-spinal fluid shunt, presence of complications during the surgical procedure, Glasgow Outcome Scale, presence of vasospasm and of rebleeding were assessed and these data matched to outcome. For statistical analysis, we applied the chi-squared test or Fisher's test using the pondered kappa coeficient. Kruskal-Wallis test was used for comparison of continue variables. Tendency of proportion was analyzed through Cochran-Armitage test. Significance level adopted was 5%. RESULTS: Patients studied were mainly white, female, without previous history of hypertension and non-smokers. Upon hospital admittance, grade 2 of Hunt-Hess scale was most frequently observed (34%), while grade 3 of Fisher scale was the most prevalent. Single aneurysms were most frequent at anterior circulation, between 12 and 24 mm. The most frequent Glasgow Outcome Scale observed was 5 (60%). Hunt Hess upon the moment of surgery and presence of complications during surgical procedure showed positive correlation with clinical outcome (p=0.00002 and p=0.001, respectively). Other variables were not significantly correlated to prognosis. Tendency of proportion was observed between Hunt-Hess scale and Fisher scale. CONCLUSION: Among variables such as epidemiological data, previous medical history and presenting conditions of patients with ruptured aneurysms, the Hunt-Hess scale upon the moment of surgery and the presence of surgical adversities are statistically related to degree of disability.

Download Full-text

Incidence of diabetes mellitus and associated risk factors in the adult population of the Basque country, Spain

Scientific Reports ◽

10.1038/s41598-021-82548-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Inés Urrutia ◽

◽

Alicia Martín-Nieto ◽

Rosa Martínez ◽

J Oriol Casanovas-Marsal ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Family History ◽

Basque Country ◽

Adult Population ◽

Tolerance Test ◽

Oral Glucose ◽

Family History Of Diabetes ◽

History Of ◽

Incident Cases

AbstractThe aim of this study was to estimate the incidence of diabetes mellitus in the Basque Country and the risk factors involved in the disease by reassessing an adult population after 7 years of follow-up. In the previous prevalence study, 847 people older than 18 years were randomly selected from all over the Basque Country and were invited to answer a medical questionnaire, followed by a physical examination and an oral glucose tolerance test. In the reassessment, the same variables were collected and the resulting cohort comprised 517 individuals of whom 43 had diabetes at baseline. The cumulative incidence of diabetes was 4.64% in 7 years and the raw incidence rate was 6.56 cases/1000 person-years (95%CI: 4.11–9.93). Among the incident cases, 59% were undiagnosed. The most strongly associated markers by univariate analyses were age > 60 years, dyslipidaemia, prediabetes and insulin resistance. We also found association with hypertension, obesity, family history of diabetes and low education level. Multivariate analysis adjusted for age and sex showed that a set of risk factors assessed together (dyslipidaemia, waist-to-hip-ratio and family history of diabetes) had great predictive value (AUC-ROC = 0.899, 95%CI: 0.846–0.953, p = 0.942), which suggests the need for early intervention before the onset of prediabetes.

Download Full-text

The physiopathology of spontaneous hemorrhagic stroke: a systematic review

Reviews in the Neurosciences ◽

10.1515/revneuro-2020-0131 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Alcivan Batista de Morais Filho ◽

Thiago Luis de Holanda Rego ◽

Letícia de Lima Mendonça ◽

Sulyanne Saraiva de Almeida ◽

Mariana Lima da Nóbrega ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Ischemic Stroke ◽

Subarachnoid Hemorrhage ◽

Natural History ◽

Hemorrhagic Stroke ◽

Recent Literature ◽

Clinical Manifestations ◽

The Road ◽

History Of

Abstract Hemorrhagic stroke (HS) is a major cause of death and disability worldwide, despite being less common, it presents more aggressively and leads to more severe sequelae than ischemic stroke. There are two types of HS: Intracerebral Hemorrhage (ICH) and Subarachnoid Hemorrhage (SAH), differing not only in the site of bleeding, but also in the mechanisms responsible for acute and subacute symptoms. This is a systematic review of databases in search of works of the last five years relating to the comprehension of both kinds of HS. Sixty two articles composed the direct findings of the recent literature and were further characterized to construct the pathophysiology in the order of events. The road to the understanding of the spontaneous HS pathophysiology is far from complete. Our findings show specific and individual results relating to the natural history of the disease of ICH and SAH, presenting common and different risk factors, distinct and similar clinical manifestations at onset or later days to weeks, and possible complications for both.

Download Full-text

POS0727 INSULIN RESISTANCE AND LEPTIN LEVELS IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS WITHOUT DIABETES MELLITUS OR FASTING HYPERGLYCEMIA

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1307 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 613.2-614

Author(s):

L. Kondrateva ◽

T. Panafidina ◽

T. Popkova ◽

M. Cherkasova ◽

A. Lila ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Insulin Resistance ◽

Fasting Glucose ◽

Family History Of Diabetes ◽

History Of ◽

Traditional Risk Factors ◽

Risk Categories ◽

Group 1

Background:Insulin resistance (IR) is considered as initial stage of diseases continuum from development of prediabetes to eventual progression to type 2 diabetes mellitus (T2DM). Individuals with prediabetes have also elevated leptin levels, so this adipocytokine along with IR can be considered as predictive laboratory markers of higher risk of T2DM. It is not yet clear whether presence of individual or multiple SLE-related and/or known traditional risk factors of T2DM (such as unhealthy diet, physical inactivity, family history of diabetes, or being overweight) can precipitate the development of IR.Objectives:To analyze the relationship between IR and increasing leptin levels rates. To identify the presence and evaluate the potential role of traditional and disease-related risk factors for IR in SLE patients without T2DM or hyperglycemia.Methods:A total of 49 SLE pts (46 women, 3 men, 40 [33;48] years old) without established DM and with normal fasting glucose levels (<6,1 mmol/l) were enrolled in the study. Median disease duration was 3,0[0,7;8,0] years, SLEDAI-2K was 5[2;8]. SLE pts were treated with glucocorticoids (GC) (84%), hydroxychloroquine (78%), immunosuppressive drugs (20%) and biological agents (10%). Insulin levels were measured using electrochemiluminescence assay Elecsys (Roche Diagnostics), serum leptin concentrations were estimated using ELISA (DBS-Diagnostics Biochem Canada Inc.). IR was defined as Homeostasis Model Assessment of Insulin Resistance index (HOMA-IR) ≥2,77. Leptin levels were considered elevated at values ≥11,1 ng/ml for women, ≥5.6 ng/ml for men. Eight traditional T2DM risk factors from the FINDRISK (Finnish Type 2 Diabetes Risk Assessment Form) questionnaire (older age, being overweight, abdominal obesity, family history of diabetes, sedentary lifestyle, lack of regular dietary fiber intake, taking antihypertensive medications as a surrogate marker of high blood pressure, documented episodes of hyperglycemia) were evaluated. This study used 5 risk categories for developing T2DM proposed by FINDRISK questionnaire: low, slightly elevated, moderate, high or very high.Results:Median HOMA-IR levels were 1,7 [1,2;2,5]. HOMA-IR correlated with leptin levels (r=0,7, p<0,001), body mass index (BMI) (r=0,6, p<0,001), waist circumference (WC) (r=0,5, p<0,001), T2DM risk categories by FINDRISK (r=0,3, p=0,03), SLEDAI-2K (r= -0,4, p<0,01), and duration of GCs therapy (r=0,3, p=0,03). Current GC use had no influence on HOMA-IR in SLE. IR was detected in 10 (20%) SLE pts. The traditional T2DM risk factors profiles were similar in pts with (Group 1) or without IR (Group 2) except for higher anthropometric parameters in group 1 (for BMI 27,2[24,8;32,2]kg/m2 vs 23,7[20,6;26,7]kg/m2, p<0,01; for WC: 93[86;102]cm vs 83[76;93]cm, p=0,02). Leptin levels were also higher in SLE pts with IR compared to pts without IR (74,2[30,4;112,7]ng/ml vs 25,0[6,7;42,4]ng/ml, p<0,01). Increased leptin levels were found in 35 (71%) pts, more often in pts with IR (100 vs 64%, p=0,04).Conclusion:IR was found in 20% of SLE pts without T2DM having normal serum fasting glucose concentration. Emergence of IR was commonly preceded by increased leptin levels. IR values were closely associated with accumulation of adipose tissue facilitated by long-term GCs use and disease activity decrease. Contribution of other traditional risk factors of T2DM seemed insignificant.Disclosure of Interests:None declared

Download Full-text

Clinical Study of Postoperative Bleeding after Tonsillectomy in 497 Cases

International Journal of Practical Otolaryngology ◽

10.1055/s-0041-1723787 ◽

2021 ◽

Vol 4 (01) ◽

pp. e17-e20

Author(s):

Takeshi Tanaka ◽

Kenji Ishii ◽

Kyoko Matsumoto ◽

Koushirou Miura ◽

Ayako Kihara ◽

...

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Clinical Study ◽

General Anesthesia ◽

Retrospective Analysis ◽

Body Mass ◽

Smoking Habit ◽

Postoperative Bleeding ◽

Operation Time ◽

History Of

AbstractWe conducted a retrospective analysis of 497 patients who underwent tonsillectomy at Kamio Memorial Hospital from September 2015 to August 2018. A total of 35 cases (7.0%) developed postoperative bleeding and three cases (0.6%) needed a second operation under general anesthesia to stop the bleeding. Postoperative bleeding most frequently occurred between 24 hours and 6 days after the operation. The incidence of postoperative bleeding was significantly higher in males and in patients aged 20 to 39 years old. The operation time, body mass index, smoking habit, and history of hypertension were not identified as clinical risk factors for bleeding after tonsillectomy in this study.

Download Full-text