Analysis of risk factors and diseases associated with atherosclerosis in the progression of carotid artery stenosis

Vascular ◽  
2015 ◽  
Vol 24 (1) ◽  
pp. 59-63 ◽  
Author(s):  
Nayara Cioffi Batagini ◽  
Erasmo Simão da Silva ◽  
Carlos AV Pinto ◽  
Pedro Puech-Leão ◽  
Nelson de Luccia

Objective The objective of this study was to analyze the roles of demographic, clinical, and laboratory factors on the progression of atherosclerotic stenosis in carotid bifurcation. It was based on prospective information from records entered on a specific application form for follow-up outpatients at a tertiary university service. Methods Consecutive symptomatic and asymptomatic patients ( n = 210) who had undergone more than one carotid duplex scan but no surgical intervention were selected for the analysis. The patients were divided into two groups: patients whose duplex scans did not show bilateral progression of carotid stenosis and patients with carotid stenosis progression of <50%, 50%–69%, or >70%. Clinical and demographic parameters were compared between groups. Results Group II levels of plasma urea (51.6 ± 27.8 mg/dl) and fibrinogen (493.2 ± 113.3 mg/dl) were higher than the Group I levels (43.0 ± 14.9 mg/dl and 441.3 ± 106.7 mg/dl, respectively) with statistical significance (p urea = 0.013 and p fibrinogen = 0.018). Paradoxically, the mean body mass index was higher in Group I (26.4 ± 4.6 kg/m2) than in Group II (24.6 ± 3.9 kg/m2; p = 0.02). Conclusions Traditional risk factors for the development of atherosclerosis in a carotid bifurcation are important but not unique. Metabolic and inflammatory factors can contribute to disease progression.

2013 ◽  
Vol 70 (11) ◽  
pp. 993-998 ◽  
Author(s):  
Djordje Milosevic ◽  
Janko Pasternak ◽  
Vladan Popovic ◽  
Dragan Nikolic ◽  
Pavle Milosevic ◽  
...  

Background/Aim. A certain percentage of patients with asymptomatic carotid stenosis have an unstable carotid plaque. For these patients it is possible to register by modern imaging methods the existence of lesions of the brain parenchyma - the silent brain infarction. These patients have a greater risk of ischemic stroke. The aim of this study was to analyze the connection between the morphology of atherosclerotic carotid plaque in patients with asymptomatic carotid stenosis and the manifestation of silent brain infarction, and to analyze the influence of risk factors for cardiovascular diseases on the occurrence of silent brain infarction and the morphology of carotid plaque. Methods. This retrospective study included patients who had been operated for high grade (> 70%) extracranial atherosclerotic carotid stenosis at the Clinic for Vascular and Transplantation Surgery of the Clinical Center of Vojvodina over a period of 5 years. The patients analyzed had no clinical manifestation of cerebrovascular insufficiency of the carotid artery territory up to the time of operation. The classification of carotid plaque morphology was carried out according to the Gray-Weale classification, after which all the types were subcategorized into two groups: stable and unstable. Brain lesions were verified using preoperative imaging of the brain parenchyma by magnetic resonance. We analyzed ipsilateral lesions of the size > or = 3 mm. Results. Out of a 201 patients 78% had stable plaque and 22% unstable one. Unstable plaque was prevalent in the male patients (male/female ratio = 24.8% : 17.8%), but without a statistically significant difference (p > 0.05). The risk factors (hypertension, nicotinism, hyperlipoproteinemia, and diabetes mellitus) showed no statistically significant impact on carotid plaque morphology and the occurrence of silent brain infarction. Silent brain infarction was detected in 30.8% of the patients. Unstable carotid plaque was found in a larger percentage of patients with silent brain infarction (36.4% : 29.3%) but without a significant statistical difference (p > 0.05). Conclusions. Even though silent brain infarction is more frequent in patients with unstable plaque of carotid bifurication, the difference is of no statistical significance. The effects of the number and type of risk factors bear no statistical significance on the incidence of morphological asymptomatic carotid plaque.


2007 ◽  
Vol 342-343 ◽  
pp. 849-852
Author(s):  
Keon Hyeon Jo ◽  
Seok Whan Moon ◽  
Young Du Kim ◽  
Young Jo Sa ◽  
Si Young Choi ◽  
...  

To prevent prolonged air leakage after lung surgery, we developed a biodegradable polyglycolic acid (PGA) sheet and compared it with an expanded polytetrafluoethylene (ePTFE). Eighteen adult mongrel dogs were used in this experiment. The airway pressures at which air first leaked at the stapled resection margins were measured immediately after surgery in group I (N=5), 2 days after surgery in group II (N=5), and 7 days after surgery in group IIII (N=5), Based on the presence of SLR, there were 3 subgroups in each group: there was no SLR in subgroup a; ePTFE in subgroup b; PGA sheet in subgroup c. The histologic examination was performed 2 months after surgery (N=3). In group I, there was a significant difference in air leakage pressures (mm Hg) between no reinforcement and SLR. We observed the same results in group II and III with statistical significance. However, there was no significant difference between the reinforcement groups. The histologic findings demonstrated more severe adhesions and biodegradation in the dogs in which the PGA sheet was used. Our PGA sheet was considered a useful reinforcement material, because it had a similar threshold for air leakage with the ePTFE with excellent biodegradation.


2018 ◽  
Vol 61 (7) ◽  
pp. 1784-1793
Author(s):  
Lilian Cássia Bórnia Jacob-Corteletti ◽  
Eliene Silva Araújo ◽  
Josilene Luciene Duarte ◽  
Fernanda Zucki ◽  
Kátia de Freitas Alvarenga

Purpose The aims of the study were to examine the acoustic reflex screening and threshold in healthy neonates and those at risk of hearing loss and to determine the effect of birth weight and gestational age on acoustic stapedial reflex (ASR). Method We assessed 18 healthy neonates (Group I) and 16 with at least 1 risk factor for hearing loss (Group II); all of them passed the transient evoked otoacoustic emission test that assessed neonatal hearing. The test battery included an acoustic reflex screening with activators of 0.5, 1, 2, and 4 kHz and broadband noise and an acoustic reflex threshold test with all of them, except for the broadband noise activator. Results In the evaluated neonates, the main risk factors were the gestational age at birth and a low birth weight; hence, these were further analyzed. The lower the gestational age at birth and birth weight, the less likely that an acoustic reflex would be elicited by pure-tone activators. This effect was significant at the frequencies of 0.5, 1, and 2 kHz for gestational age at birth and at the frequencies of 1 and 2 kHz for birth weight. When the broadband noise stimulus was used, a response was elicited in all neonates in both groups. When the pure-tone stimulus was used, the Group II showed the highest acoustic reflex thresholds and the highest percentage of cases with an absent ASR. The ASR threshold varied from 50 to 100 dB HL in both groups. Group II presented higher mean ASR thresholds than Group I, this difference being significant at frequencies of 1, 2, and 4 kHz. Conclusions Birth weight and gestational age at birth were related to the elicitation of the acoustic reflex. Neonates with these risk factors for hearing impairment were less likely to exhibit the acoustic reflex and had higher thresholds.


Author(s):  
Aditi Sangwan ◽  
Vani Malhotra

Background: Assessment of surgical site infection is an important factor to determine the functioning of the health care system. Objectives of this study was to estimate the incidence of surgical site infection among caesarean section cases and to determine the risk factors associated with surgical site infection and comparison with patients having healthy wounds.Methods: One thousand pregnant women who underwent caesarean section were divided into two groups: Group 1 (cases): Those who had SSI within 30 days of caesarean section and Group 2 (controls): Those who didn’t have SSI.Results: Mean age of group I was 25.35±4.40 and 21.12±3.60 years in group II (p >0.05). Mean gestational age of group I cases was 38.07±1.88 weeks and in group II, it was 38.17±2.06 weeks (p >0.05). A total of 37 (82.5%) women in group I and 931 (96.98%) women in group II underwent emergency caesarean section (p <0.05). In group I, mean duration of surgery was 1.0±0.13 hours and 1.02±0.21 hours in group II (p <0.05). Maximum number of patients i.e. 22 (55%) had wound discharge between 4-7 days followed by 11 (27.5%) between 8-10 days. Mean wound discharge was 7.32±3.45 days in group I. Majority of women, i.e. 27 (67%) found to be sterile in the present study followed by 7 (17.5%) women were found to have staphylococcus aureus.      Mean duration of resuturing was 17.42±6.98 days.  Mean baby weight in group I was 2.72±0.53 kg and in group II it was 2.95±0.53 kg (p <0.001).Conclusions: Risk of developing SSI after caesarean section is multi-factorial and found to be influenced by emergency surgery, PROM, pre-operative anaemia, multiple vaginal examinations, interrupted skin suturing, raised BMI, nulliparity, emergency caesarean, duration of surgery.


Folia Medica ◽  
2017 ◽  
Vol 59 (1) ◽  
pp. 78-83 ◽  
Author(s):  
Vasil G. Marinov ◽  
Desislava N. Koleva-Georgieva ◽  
Nelly P. Sivkova ◽  
Maya B. Krasteva

Abstract Background: A low Apgar score at 5 minutes has been shown to be a risk factor for development of retinopathy of prematurity (ROP). Aim: To examine the prognostic value of Apgar score at 5 minutes for development and progression of ROP. Materials and methods: The study included 132 preterm infants who were screened from 4th week of life onward. Of these, 118 newborns were given Apgar score at 5 minutes. The prognostic significance of this index was studied as an absolute value and as a value ≤ 6. The patients were divided into two groups: group I had no evidence of ROP (n=82) and group II had some signs of ROP (n = 36). Group II was further divided into group IIA - spontaneously regressed cases (n=22), and group IIB with cases which progressed to treatment stages (n=14). We investigated 15 maternal and 20 newborn presumable risk factors for development and progression of ROP. Mann-Whitney U test, χ2 or Fisher’s exact test were used in the statistical analysis. Logistic regression was performed to find significant and independent risk factors for manifestation and progression of ROP. Results: A low 5-minute Apgar score and an Apgar score of 6 or less at 5 minutes were not statistically significant risk factors of ROP (р=0.191, р=0.191, respectively), but were significant risk factors for the manifested ROP to progress to stages requiring treatment (p=0.046, р=0.036, respectively). Conclusion: An Apgar score at 5 minutes of 6 or less was a significant and independent risk factor for progression of ROP to stages requiring treatment.


1993 ◽  
Vol 74 (4) ◽  
pp. 1591-1596 ◽  
Author(s):  
M. Benameur ◽  
M. D. Goldman ◽  
C. Ecoffey ◽  
C. Gaultier

To evaluate the ventilatory consequences of high chest wall compliance during anesthesia in infants, we assessed the effects of halothane at different fractions of minimal alveolar concentration (0.75, 1.0, and 1.5 MAC) on ventilation and movements of the rib cage and abdomen in infants < or = 12 mo of age (group I) and children (group II) > or = 12 mo of age. Minute ventilation decreased in group I, (20.6%, 0.75 to 1.5 MAC), but the change in group II did not reach the level of statistical significance. Tidal volume decreased with halothane level between 0.75 and 1.5 MAC, and its fall was greater in group I (32.7 +/- 11.2 vs. 22.6 +/- 9.3% in group II, P < 0.05). Duty cycle, or ratio of inspiratory to total time (TI/TT), increased in group II with halothane level but did not change in group I, resulting in a decreased TI in group I at higher halothane levels. Thoracic paradox increased with halothane level in group I but not group II. The increase in thoracic paradox in association with the fall in tidal volume between 0.75 and 1.5 MAC was greater in group I than group II (P < 0.05). We conclude that smaller infants depend more on inspiratory intercostal muscle activity to stabilize the thorax, leading to a greater degree of depression of ventilation during halothane depression of inspiratory intercostal activity.


2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Yousseria Elsayed Yousef ◽  
Essam A. Abo El-Magd ◽  
Osama M. El-Asheer ◽  
Safaa Kotb

Background. Chronic suppurative otitis media (CSOM) remains one of the most common childhood chronic infectious diseases worldwide, affecting diverse racial and cultural groups in both developing and industrialized countries.Aim of the Study. This study aimed to assess the impact of educational program on the management of children with CSOM.Subjects and Methods. An experimental study design was used. This study included 100 children of both sexes of 2 years and less of age with CSOM. Those children were divided into 3 groups: group I: it involved 50 children with CSOM (naive) who received the designed educational program; control group: it involved 50 children who were under the traditional treatment and failed to respond; group II: those children in the control group were given the educational program and followed up in the same way as group I and considered as group II.Tools of the Study. Tool I is a structured questionnaire interview sheet for mothers. It consists of four parts: (1) personal and sociodemographic characteristics of child and (2) data about risk factors of otitis media (3) assessment of maternal practice about care of children with suppurative otitis medi (4) diagnostic criteria for suppurative otitis media. Tool II is the educational program: an educational program was developed by the researchers based on the knowledge and practices needs. This study was carried out through a period of 9 months starting from September 2013 to May 2014. The educational program was implemented for mothers of children with CSOM in the form of 5 scheduled sessions at the time of diagnosis, after one week, 1, 3, and 6 months.Results. There were significant differences between children who received the educational program and control group regarding the response to treatment after one and 3 months. The percentages of complete cure increased progressively 32%, 60%, and 84% after 1, 3, and 6 months in group I while they were 24%, 44%, and 64% in group II, respectively. Cure (dry perforation) was 64%, 36%, and 12% among children of group I after 1, 3, and 6 months while it was 64%, 44%, and 24% in group II, respectively. The percentages of compliance to the educational program improved with time in both groups: 44%, 64%, and 80% in group I and 32%, 48%, and 56% in group II after 1, 3, and 6 months, respectively. The percentages of cure were statistically significantly higher among children with complete compliance with the educational program in both groups in comparison to those with incomplete compliance (P= 0.000 for both).Conclusions. From this study we can conclude that the majority of children with CSOM had one or more risk factors for occurrence of the disease; the educational program is effective for management of CSOM (whether cure or complete cure); the higher the compliance of mothers with the program the higher the response rate; regular followup and explanation of the importance of the program played an important role in the compliance with the program.


2014 ◽  
Vol 47 (01) ◽  
pp. 109-115 ◽  
Author(s):  
Nishant Khare ◽  
Vinita Puri

ABSTRACT Introduction: Plastic surgery in India is in an era of transition. The speciality faces many challenges as it grows. The present study attempts to identify these challenges and the prevalent mood among the teachers and the trainees. Materials and Methods: The study was conducted from September 2011 to June 2012. In an E-mail based survey a questionnaire was mailed to professionals actively involved in teaching and training of residents in plastic surgery in many institutes running MCh courses in plastic surgery (Group I) [Appendix 1]. Another questionnaire was mailed to residents undergoing training in plastic surgery and those who had completed their training within past 2 years (Group II) [Appendix 2]. Chi-square test was applied to test for statistical significance. Observations: 29 Group I and 33 Group II subjects responded to the questionnaire. While 72.4% teachers believed that the current system is producing plastic surgeons with enough skill level, only 9.1% of the respondents in Group II thought the same (Chi-square = 28.1; df = 2; P < 0.001). Whereas 58.6% Group I respondents thought that their student is sufficiently equipped to compete in today’s scenario [Figure 1], only 18.2% Group II respondents thought that their training is enough [Figure 2]. (Chi-square = 16.4; df = 2; P < 0.001). Nearly 28% respondents in Group I and only 3% in Group II thought that scientific research and publications should be made mandatory for successful completion of plastic surgery training (Chi-square = 9.4; df = 2; P = 0.009). Adequate exposure was thought to be available in general plastic surgery (Group I: 92% Group II: 81%), maxillofacial surgery (Group I: 72% Group II: 68%) and hand surgery (Group I: 84% Group II: 69%). Both groups agreed that exposure is lacking in craniofacial surgery, aesthetic surgery and microvascular surgery. Aesthetic surgery (38.7%) and microvascular surgery (32.6%) were the most frequent response when the Group II respondents were enquired about the subspeciality they would like to focus on in their practice. Inter-departmental exchange of students for limited period of time was favoured by 86.2% of Group I respondents and 93.9% Group II respondents (Chi-square = 1.3; df = 2; P = 0.49). Conclusion: The current training programme is differently perceived by teachers and the trainees. We recommend that constant deliberations at national and regional forums should take place regarding our education and training programmes.


2021 ◽  
Vol 11 (4) ◽  
pp. 264-270
Author(s):  
O. V. Arsenicheva

The aim. To study the risk factors for hospital mortality in patients with acute coronary syndrome with ST-segment elevation (STEACS) complicated by cardiogenic shock (CS).Materials and methods. A total of 104 patients with STEACS complicated by CS were studied. The follow-up group (group I) included 58 (55,8%) patients who died in hospital (mean age 71,8±7,31 years), the comparison group (group II) – 46 patients, who have been treated and discharged (mean age 59,5±6,18 years). All patients underwent general clinical studies, the level of troponins, lipids, glucose, creatinine in plasma was determined, electrocardiography and echocardiography were performed. Coronary angiography and percutaneous coronary intervention (PCI) were urgently performed. The method of binary logistic regression with the determination of the odds ratio and its 95% confidence interval for each reliable variable was used to identify risk factors for hospital mortality.Results. In group I patients with CS, compared with group II, patients over the age of 70 (32 (55,2%) vs 10 (22,7%), р=0,0004), with concomitant chronic kidney disease (32 (55,2%) vs 9 (19,6%), p=0,0002), postinfarction cardiosclerosis (30 (51,7%) vs 9 (19,6%), р=0,001) and chronic heart failure of III-IV functional class (32 (55,1%) vs 11 (23,9%), p=0,001) were significantly more often observed. Baseline levels of plasma leukocytes, troponin and creatinine were significantly higher in deceased patients with CS. Left ventricular ejection fraction below 40% was observed more often in the follow-up group than in the comparison group (46 (79,3%) vs 27 (58,7%), p=0,022). In group I, compared with group II, there was a higher incidence of three-vessel coronary lesions (36 (75%) vs 12 (26,1%), p=0,0001) and chronic coronary artery occlusion unrelated to STEACS (25 (52,1%) vs 12 (26,1%), р=0,009). The same trend was observed when assessing the average number of stenoses and occlusions of the coronary arteries. PCI was performed in 43 (74,1%) of the deceased and 43 (93,5%) of the surviving STEACS patients with CS (p=0,009). The follow-up group had a higher rate of unsuccessful PCI (30,2%) vs 3 (7%), р=0,001) and performed later than 6 hours after the onset of an angina attack (28 (65,1%) vs 6 (14%), р=0,0001).Summary. Hospital mortality in patients with STEMI complicated by CS was associated with the presence left ventricular ejection fraction less than 40%, three-vessel coronary lesion and performing PCI later than 6 hours from the beginning of the pain attack.


2021 ◽  
pp. 56-63
Author(s):  
Mariana Seliuk ◽  
Marianna Peshkova ◽  
Mykola Kozachok

Cardiovascular diseases are the leading diseases in Ukraine and are the cause of more than half of deaths. They are inextricably linked to lifestyle, diet, bad habits, physical activity, stressors and are the cause of other risk factors. The most common of these are unmodified factors, such as: gender, age, heredity; and modified: dyslipidemia, arterial hypertension, overweight and obesity, diabetes mellitus, smoking, psychosocial factors. According to the results of the published STEPS study in 2019, conducted together with the WHO, which analyzed risk factors among the civilian population of Ukraine aged 18 to 69 years. It was noted that 32,8% of the population had risk factors for CVD. High blood pressure or hypertension was observed in 34,8% of the population. The prevalence of hyperglycemia was 7,1%. Only 39,6% of the population of Ukraine had a normal weight for BMI, 59,1% were overweight, including 24,8% of the population were obese. 33,9% were active smokers, and alcohol consumption was observed in 19,7% of the population. Given the data from the STEPS study, we were interested in the frequency of detection of the main risk factors for cardiovascular events among servicemen. The objective: of the study is to determine the frequency of detection of the main risk factors for cardiovascular events among active servicemen and retirees of the Ministry of Internal Affairs at the stage of inpatient treatment in the conditions of NVMKC «GVKG». Materials and methods. Random sampling was used to analyze 104 case histories of patients in the cardiology department of NVMKC «GVKG» for the period from January 2018 to December 2019. Risk factors and the frequency with which they occur in different categories of patients were studied. The examination group consisted of male patients (100% of cases) aged 33 to 93 years, the average was 66,55±1,47 years. To study the age characteristics of the prevalence of CVD risk factors, patients were divided into two groups: Group I active servicemen, whose average age was 46,41±1,78 years; Group II retirees MOU, whose average age was 71,95±1,26 years. Statistical processing of the results was performed by methods of variation, parametric and non parametric statistics of medical and biological profile using a package of original applied statistical programs «Microsoft Ecxel», «Statistica 7.0». Results. According to the results of the study, the indicators of blood pressure in group I were analyzed: the indicators of mean systolic and diastolic pressure were 129,09±3,86 / 80,45±2,71 mm Hg (n=22). In group II, the average systolic and diastolic pressure were: 138,84±2,41 / 82,99±1,22 mm Hg (n=82). To assess blood pressure, we chose the classification proposed by the WHO in the study (STEPS-2019) for the possibility of compara tive analysis. The percentage of patients in group I with normal blood pressure was 77,27%; high blood pressure was observed in 22,73% of patients, according to the results of their own study, high blood pressure was not detected. In patients of group II normal blood pressure was registered in 63,41%, elevated in 26,83% of patients and high blood pressure was observed in 9,76% of patients. Examining the indicators of laboratory studies, we found that an increase in cholesterol was observed in 45,5% of cases in group I, and in 22,7% of cases the level of cholesterol was not determined. In group II, an increase in cholesterol levels was found in 35,4% of cases, in 13,4% of cases the cholesterol level was not determined. According to the results of the study, an increase in blood glucose levels was observed in 10,6% of cases and 55,8% of cases in group II. Normal blood glucose levels were in 33,7% of patients. The percentage of patients with concomitant type II diabetes was 1,9% of cases of group I, and 14.4% of cases of group II. 72,2% of Group I servicemen and 64.6% of Group II servicemen had an elevated BMI. 50% had a bad habit – smoking in the first group and 18,3% in the second group. Conclusions. We found that the indicators of high blood pressure in groups I and II were 22,73% and 26,83%, which is 12,07% and 6,77% less than among the civilian population of Ukraine where the rate of high blood pressure was 34,8%. The level of total cholesterol is 4,8% higher in patients of group I (45,5%) than among the civilian population of Ukraine (40,7%). In group II by 5,3% less (35,4%), respectively, from the study. The rate of elevated fasting blood glucose in group I (10,6%) is 3,5% higher, and in group II (55,8%), 48,7% higher than the results obtained among the civilian population of Ukraine, where the level of glycemia was 7,1%. The incidence of type II diabetes mellitus in group I (1,9%), which is 1,9% less than the results obtained among the population of Ukraine, where the result was 3,8%, and in group II (14,4%) by 10,6% more, respectively. The increase in BMI in patients of groups I and II was 40,9% and 46,3%, which is 18,2% and 12,8% lower than the data obtained among the civilian population of Ukraine, where the percentage of overweight was 59,1%. The prevalence of smoking among servicemen is 6,68% lower than among the civilian population of Ukraine (33,9%) and amounted to 27,04%.


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