scholarly journals S-reflex score: a predictor score of vaso-vagal reflex syncope

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
H Costa ◽  
R Fernandes ◽  
T Mota ◽  
J Bispo ◽  
P Azevedo ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Reflex syncope is one of the most common causes of syncope, usually associated with unspecified triggers and prodromes. The probability of occurrence is higher when  concomitant factors coexist whether inherent to individual or related to environment, and changes in conventional tests may prove useful in their diagnosis. Objective Identify predictive factors in the initial investigation in order to establish a predictor score of vasovagal reflex syncope (VVS). Methods Observational and retrospective study, with descriptive analysis and correlation of patients followed in syncope appointment at a Cardiology Center from 1 January 2015 to 31 Novembe 2019. Descriptive analysis on patient characteristics and complementary exams were carried out. The correlation test used between categorical variables was Chi-square and among continuous variables the T-Student test with a significance level of 95%. Independent predictors of VVS were identified through binary logistic regression considering a p = 0.05, with subsequent application of a discriminatory function using the lambda Wilks test to determine the discriminant score of variables under analysis. SPSS 24.0 was used for statistical analysis. Results Identified N694 patients, 52% male, mean age of 63 years. 15.7% of patients with suspected VVS in a first impression. At the end, 22.9% diagnosed with VVS and of these 66% had syncope recurrence. 42% had long prodromes (p = 0.013), 17% with heat prodromes (p = 0.012), in 11.3% the trigger was the meal (p = 0.031), 12.2% suffered trauma (p = 0.07) and 59.7% had ECG with pathological q wave (p = 0.00), thus showing to be independet predictors of  VVS. A predictor score of VVS was determined using the formula = -0.761 + (0.529.Long_Prodromes) + (0.721.Heat_Prodromes) + (0.313.Trigger_Meal) + (2,431.ECG_q) - (0.542.Trauma), with a cutoff value of 0.258, specificity of 90.5% with discriminative power of 87%. Conclusion The final diagnosis of VVS was higher than suspicions during initial clinical investigation and 66% of these patients had recurrence. The independent predictors factors of VVS are long prodromes, heat prodromes, meal as a trigger, ECG with q waves and trauma. The S-Reflex score was determined with a good discriminative power with high specificity. Considering clinical variables and conventional exams, this score could be useful to guide the strategy for syncope patients after the first evaluation to a more cost-effective strategy.

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Faria Da Mota ◽  
P Azevedo ◽  
R Fernandes ◽  
J S ◽  
J Guedes ◽  
...  

Abstract Introduction A significant number of patients admitted for Non-ST Elevation Myocardial Infarction (NSTEMI) have multivessel complex coronary artery disease (CAD) and benefit from Coronary Artery Bypass Graft surgery (CABG). These patients frequently present high-risk surgical profiles, constituting a challenging group when it comes to balancing ischemic and haemorrhagic risk. Objective To develop a simple predictive risk model of referral to CABG in patients admitted for NSTEMI. Methods The authors present a retrospective, descriptive and correlational study including all patients admitted for NSTEMI in a Cardiology department between the 1st of October 2010 and the 1st of October 2018. Demographic profile, clinical characteristics, risk factors and hospitalization data of NSTEMI patients referred to CABG were studied, and a correlational analysis was performed with Chi-square test for categorical variables and t-Student test for continuous variables (confidence level of 95%). Independent predictors of CABG in patients with NSTEMI were identified through Binary logistic regression analysis, using a significance level of 0,05. A discriminatory function was subsequently applied, and the Wilks lambda test was used to determine the discriminant score for the studied groups. The authors used SPSS 24,0 for statistical analysis. Results A total of 2476 patients were included, 668 (27%) of which were female, with a mean age of 68,5±13,4 years. In the studied sample, 273 patients (11%) were proposed to CABG. The authors found a significant association between CABG and multiple clinical, laboratorial and therapeutical variables, but after multivariate analysis only male sex, previous Diabetes Mellitus, previous angina, previous Percutaneous coronary intervention, absence of a normal EKG, ST segment depression at admission, sinus rythm and brain natriuretic peptide (BNP) >100pg/mL proved to be independent predictors of referral. Using these variables, the authors developed a risk model to predict CABG referral in NSTEMI patients: −0,614 − (0,756 x female sex) + (0,305 x diabetes) + (0,631 x angina) − (1,513 x previous PCI) + (1,216 x sinus rythm) + (0,672 x ST depression) − (0,806 x normal EKG) + (0,562 x BNP>100). In this function, variables should be substituted by 1 or 0, depending on wheter the condition they specify is present or absent. The optimal discrimination cutoff was 0,23, with a 64% sensibility and 59% specificity, and a discriminant power of 60%. Conclusion Being able to predict referral to surgical revascularization in NSTEMI may help physicians to optimize a specific approach in each patient, in particular with regard to anti-thrombotic strategies. The authors developed a risk predicting model for CABG in NSTEMI patients based on simple clinical and laboratory variables, which will require validation in a larger cohort, before it can be applied in a clinical context.


2014 ◽  
Vol 17 (3) ◽  
pp. 485-495 ◽  
Author(s):  
Karla Geovanna Moraes Crispim ◽  
Aldo Pacheco Ferreira ◽  
Terezinha Lima Silva ◽  
Euler Esteves Ribeiro

OBJECTIVES: Characterize self-reported communication disorders highlighting the association between variables of health conditions, socio-demographic factors, lifestyle, hearing loss and diseases in an elderly group. METHODS: Cross-sectional study conducted from August to December 2012, with 159 women aged 60 or more, recruited at UnATI/UEA (University of the Third Age, University of the State of Amazonas), Manaus, Amazonas State, Brazil. The subjects were interviewed and asked for self-reported communications disorders. Descriptive analysis was performed using central tendency and dispersion measures for continuous variables and frequency distributions for categorical variables and the prevalence of self-reported language disorders was estimated. To verify the presence of statistically significant differences it was used χ2, considering the significance level of 5% (p≤0.05). RESULTS: Communication disorders were reported by 8.18% of elderly women. The following deficits were reported: intelligibility (6.92%), oral comprehension (10.69%), lexical access (10.69%), and recent memory (38.36%). Reading and writing difficulties were informed by 5.66% and 6.92%, respectively. Among the illiterate group, 20% declared communication disorders, while the literate group, 8.44%. Statistical association was verified between communication disorders and self-reported hearing loss (p=0.03). Association was not detected between communication disorders and diseases. CONCLUSIONS: Considering the diversity of communication disorders within this population, further studies are needed to assess if changes occur at the aging process and how they work so that possibilities for prevention can be discussed.


2021 ◽  
Vol 9 (1) ◽  
pp. 15
Author(s):  
Sheenam Gazala ◽  
Mohmad Saleem Chesti ◽  
Syed Mushfiq

Background: Current study aimed at s to delineate the etiology and clinical parameters associated with AUFI presenting to emergency department in a tertiary care hospital.Methods: This was a prospective hospital based study carried out at emergency medicine, SKIMS hospital, Soura Kashmir, India July 2017 to august 2018. Patients with acute undifferentiated fever were enrolled. Descriptive statistics were calculated in terms of mean±SD for continuous variables like age of the patients and duration of fever, Frequency and percentage were used to analyse categorical variables such as causes of fever and gender, while as descriptive analysis was calculated in terms of mean±SD for continuous variables like age of the patients and duration of fever.Results: Total numbers of patients included were 174, among these 112 (64.3%) were males and 62 (35.6%) were females. Most patients were diagnosed enteric fever (N=59, 33.9%) followed by UTI (N=25, 14.3%) dengue (N=12, 6.8%) and malaria (N=8, 4.5%) while rest of cases were associated with other viral illnesses (N=70, 40.5%) based on clinical basis and inconclusive laboratory results.Conclusions: Enteric fever was found to be the most common cause of acute undifferentiated fever followed by dengue and other viral illnesses, although causes and clinic spectrum of AUFI is varied.


2019 ◽  
Vol 91 (3) ◽  
Author(s):  
Mauro Pacella ◽  
Nicolo' Testino ◽  
Guglielmo Mantica ◽  
Matteo Valcalda ◽  
Rafaela Malinaric ◽  
...  

Objective: To present the results of the largest series of patients with bladder diverticula > 4 cm managed with an endoscopic approach and give tips about the execution of the procedure. Materials and methods: Data of male patients undergone the endoscopic approach for an acquired bladder diverticula > 4 cm from December 2004 to August 2018 were prospectively collected and retrospectively analyzed. The description of the monopolar and bipolar techniques are provided. The success of the procedure was defined as the reduction of the diverticula for more of the 80% of its initial diameter documented at the 3- months follow-up imaging. Continuous variables with nonparametric distribution were compared using the Mann-Whitney test, while frequencies of categorical variables were compared between groups by Fisher’s exact test with significance level set at 0.05. Results: Thirty-nine patients with a mean (+/- SD) age at surgery of 69.4 ± 8.8 years were enrolled, for an equal number of diverticula managed. The mean diverticular size was 75.1 ± 24.5 millimeters. The mean operative time was 65 ± 21.9 minutes including the prostate surgery. Twelve patients (30.8%) were managed with bipolar energy, the others with monopolar. The success of the procedure was achieved in 30 patients (76.9% - 7 bipolar and 23 monopolar - p = 0.66). Conclusions: The endoscopic approach might be considered as a useful option for patients with a large bladder diverticulum who are at risk for major or laparoscopic procedure.


2019 ◽  
Vol 3 (4) ◽  
pp. 154-158
Author(s):  
Simran Kaur ◽  
Aseem Singh ◽  
Rahul Singh

INTRODUCTION: The presence of Oral Mucosal Lesions (OMLs) in one’s oral mucosa can lead to unwanted consequences and mostly are due to tobacco use. AIM: To  document the prevalence of OMLs among patients of Delhi NCR and provide health education counselling to those under the grip of this evil practice.  MATERIAL AND METHODS: We retrospectively analyzed the data of a total of 402 subjects visiting various screening camps in Delhi NCR and recalled a total of 174 patients, out of which 161 reported back to us for further diagnosis and screening of OMLs. The examination of patients in the camp were an ADA type III examination. All patients we given a health education while tobacco users were also given a specialized one-on-one health education regarding the tobacco and its ill effects as well as techniques for cessation. A descriptive analysis of the sample was first performed using means (±standard deviation (SD)) for continuous variables  and frequencies (proportions) for categorical variables. The chi-square test was used for statistical analysis and to find significant difference, if any. RESULTS: Among the 402 subjects screened, the mean age was 33.24±6.74 Years and most of the study population belonged to the age group of 25-60 Years [178(44.3%)]. 301(74.8%) of the study population were males. The main chief complaint was periodontal problem [187(46.5%)], while 15 patients (3.73%) came for regular check-up. The prevalence of leukoplakia was found to be 8.70% and OSMF was found to be 6.21%. A significant difference was seen among gingivitis with respect to age and gender (p<.05), leukoplakia and frictional keratosis was seen significant in relation to gender. In all significant cases, Males were more prone to get these OMLs as compared to females CONCLUSION: It is advised that regular Oral Health Drives and counselling sessions be arranged for the people of elhi NCR to reduce the burden of the OMLs.


2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 1577-1577
Author(s):  
Veda N. Giri ◽  
Nicholas Bowler ◽  
Sarah Hegarty ◽  
Laura Gross ◽  
Colette Hyatt ◽  
...  

1577 Background: Germline testing (GT) for prostate cancer (PCA) is rapidly increasing with higher demand for genetic counseling (GC). Alternate GC strategies need to be studied to address pretest informed consent. Here we conducted a patient-choice study of pretest video-based genetic education (VBGE) or in-person GC (IPGC) and assessed men’s preference and patient-reported outcomes from the first cohort of the Evaluation and Management for Prostate Oncology, Wellness, and Risk (EMPOWER) study. Methods: Eligibility for EMPOWER includes any male with PCA or at-risk for PCA based on family history or African American race. Men may choose pretest IPGC or VBGE. All receive results by a genetic professional. Demographics and PCA features were collected at baseline. The following outcomes and scales were assessed: baseline anxiety (GAD-7 scale), change in cancer genetics knowledge from baseline (Giri 2019), decisional conflict for GT (O’Connor 1993), and satisfaction (DeMarco 2004). Understanding of personal GT results was assessed after disclosure (Giri 2019). Descriptive statistics summarized results with counts and percentages for categorical variables and mean and standard deviation for continuous variables. Data were compared with Fisher’s exact, Chi-squared, or Wilcoxon two-sample tests, as appropriate. Mean change in cancer genetics knowledge was compared with t-tests. Significance level was set a priori at 0.05. All analyses were performed with SAS 9.4 (Cary, NC). Results: At the time of this analysis, 94 men were enrolled. Characteristics of the cohort were: White (88.3%), bachelor’s degree (67%), PCA diagnosis (93%), mean age of consent 59 years (IPGC) and 61 years (VBGE), Gleason > = 8 (32%), and > = T3 (31%). The majority preferred VBGE (77%) vs. IPGC (23%). Men who opted for IPGC had lower educational levels ( < = high school/GED) (18% IPGC vs 7% VBGE) and reported higher baseline anxiety (45% IPGC vs. 24% VBGE). Cancer genetics knowledge improved significantly with IPGC vs. VBGE (+2.5 vs +0.8; p < 0.01). No differences were observed in decisional conflict, satisfaction, or understanding of personal GT results between IPGC vs. VBGE. Both groups had high rates of GT uptake (IPGC 91%, VBGE 93%). Pathogenic mutations were identified in 15% in IPGC group and 10.4% in VBGE group. Conclusions: A substantial proportion of men opted for VBGE, and results suggest that VBGE is comparable to IPGC for men considering PCA GT. IPGC may be more suitable for men with lower knowledge of cancer genetics and greater levels or anxiety. Further study is warranted.


Author(s):  
Priscila de Jesus dos Santos Alves ◽  
Ana Ciléia P.T. Henriques ◽  
Livia R.M. Pinto ◽  
Rosa Maria S. Mota ◽  
Carlos Henrique M. Alencar ◽  
...  

AbstractLow birth weight (LBW) seems to be a determining factor for many cardiovascular diseases in adult life.The objectives of this study were to investigate the occurrence of metabolic syndrome (MetS) and endothelial dysfunction in adolescents with LBW and compare them with subjects with normal birth weights (NBW).This retrospective cohort study evaluated 172 adolescents (86 in each group) aged 10–20 years, who were born in a reference maternity hospital. The following criteria were adopted: International Diabetes Federation parameters for the diagnosis of MetS and flow-mediated brachial artery dilatation for endothelial dysfunction. Student’s t-test or Mann-Whitney tests were used for continuous variables (depending on the normality of distribution evaluated by the Shapiro-Wilk test), and the Fisher exact test was used for categorical variables. The significance level was determined at 0.05.MetS was present in three cases of LBW and in four cases of NBW (p=0.70). The number of components of the syndrome was, on average, 0.6 and 0.5 in LBW and NBW, respectively (p=0.77). Endothelial dysfunction occurred in 25 (29.1%) cases of LBW and in 31 (36.1%) cases of NBW (p=0.33).LBW did not represent a risk factor in the occurrence of MetS or endothelial dysfunction in adolescence.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Menezes Fernandes ◽  
T.F Mota ◽  
J.S Bispo ◽  
H Costa ◽  
P Azevedo ◽  
...  

Abstract Introduction The importance of education is well recognized in patients presenting with syncope, in order to reduce the recurrence rate. Purpose To determine a predictive score of recurrent syncopal episodes after the first medical assessment. Methods We conducted a retrospective study enrolling patients followed in our Syncope Consultation from January 2015 to November 2019. Clinical and episodes characteristics, as well as diagnostic studies were analysed. Correlation between variables was performed by the Chi-square and T-Student tests, with a significance level of 95%. Independent predictors of recurrent syncope were identified through a binary logistic regression analysis, considering p=0.05. Then, a discriminatory function was applied using the Wilks lambda test to determine the discriminant score of the analysed groups. SPSS 24.0 was used for statistical analysis. Results A total of 694 patients were included, and 420 (60.5%) had recurrent syncope at the first evaluation. After educational approach, 97 (14%) maintained recurrent episodes. In this subgroup, the mean age was 63.7±22.8 years-old and 88.7% already had previous recurrent syncope (vs 56.1%; p&lt;0.001). The prodrome of malaise was common (40.2% vs 26.8%; p=0.008), but 32% of these patients had syncope without prodromes (vs 21.8%; p=0.032). They also had frequently first-degree atrioventricular (AV) block (22.5% vs 6.8%; p&lt;0.001) and 51.7% had a final diagnosis of reflex syncope. No previous medication with calcium channel blockers (CCB) (p&lt;0.001), malaise (p=0.011), not having Q-waves in the electrocardiogram (p=0.022) and the presence of first-degree AV block (p&lt;0.001) were independent predictors of recurrent syncope. A predictive score of recurrence was determined using the formula: 0.108 − 1.556 x (medication with CCB) + 0.989 x (malaise) − 1.031 x (Q-waves) + 2.406 x (first degree AV block). Variables should be replaced by 1 or 0, depending on whether the condition is present or not. A cut-off of 0.283 was obtained with a specificity of 96.1% and a discriminative power of 81.2%. Conclusion In our patients presenting with syncope, recurrence rate reduced from 60,5% to 14% just with educational measures. To help identify patients who maintain recurrence, we determined a predictive score using clinical data from the first visit, with a good discriminative power and excellent specificity. It could be used to strengthen education, to direct diagnostic studies and to shorten follow-up visits, but it still needs validation to be used in clinical practice. Funding Acknowledgement Type of funding source: None


2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Rachel E. Soeiro ◽  
Leila Rocha ◽  
Fernanda G. Surita ◽  
Luis Bahamondes ◽  
Maria L. Costa

Abstract Background Adolescent and young women (10–24 years old) are habitually a neglected group in humanitarian settings. Menstrual hygiene management (MHM) is an unmet aspect of sexual and reproductive health (SRH) and an additional challenge if lack of hygiene products, inadequate access to safe, clean, and private toilets identified as period poverty. Our objective was to provide an overview of the main MHM issues affecting Venezuelan migrant adolescents and young women in the north-western border of Venezuela-Brazil. Method A cross-sectional study was conducted, early in 2021, with the use of a self-responded questionnaire, in Spanish, adapted from the Menstrual Practice Needs Scale (MPNS-36). All identified adolescents and young women aged between 12 and 24 years old were invited to participate (convenience sample-167 women). Women with complete questionnaires and who menstruate were included. Information on access to and quality of hygiene kits and toilets were retrieved, and a descriptive analysis performed, with an evaluation of frequencies for categorical variables (n, %) and mean (± SD-standard deviation) for continuous variables. In addition to the open-ended questions, we included one open question about their personal experience with menstruation. Results According to official reports, at the moment of the interviews, there were 1.603 Venezuelans living on the streets in Boa Vista. A total of 167 young women were invited, and 142 further included, mean age was 17.7 years, almost half of the participants who menstruate (46.4%) did not receive any hygiene kits, 61% were not able to wash their hands whenever they wanted, and the majority (75.9%) did not feel safe to use the toilets. Further, menstruation was often described with negative words. Conclusions Migrant Venezuelan adolescents and young women have their MHM needs overlooked, with evident period poverty, and require urgent attention. It is necessary to assure appropriate menstrual materials, education, and sanitation facilities, working in partnership among governmental and non-governmental organizations to guarantee menstrual dignity to these young women.


Author(s):  
Ekta Sharma ◽  
Gurmeet Katoch ◽  
Rajesh Guleri ◽  
Jalam Bhardwaj

Background: COVID-19 is the third corona virus that has emerged among the human population in the last two decades. The main aim of this study was to describe the epidemiologic features, clinical presentation of first 52 patients diagnosed with polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection admitted at COVID health facilities.Methods: A retrospective descriptive study was conducted over a period of three months from 1st April 2020 to 30th June 2020. We obtained demographic, epidemiological, clinical, laboratory data from the medical records of patients infected with SARS-Cov-2. The categorical variables were expressed in terms of frequency and percentages and the continuous variables were expressed as mean and standard deviation. In addition to descriptive analysis, Pearson’s chi- square test was applied to ascertain the associations between certain variables.Results: The mean age of participants was 29±11.67 years with a male preponderance. Forty three (83%) patients had travel history within India in the previous 30 days i.e. from Delhi (35%), Haryana (15%), Tamilnadu (11%), Himachal Pradesh (8%), Maharashtra (1.9%), Punjab (8%), and Uttar Pradesh (4%). Majority of the patients (90%) were asymptomatic. The age group of 21-30 years was the most affected group (44%) as comparison to the other age groups. No mortality was reported and 100% recovery rate was found.Conclusions: In conclusion, COVID-19 affects a wide-range of patients, from youth to the elderly.  In this study, all the COVID-19 infected patients were classified as mild as most were asymptomatic. Close monitoring and large-scale control strategies will be needed to prevent widespread transmission within the community.


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