scholarly journals Comparison of Surgical Outcomes with Time Interval of Operation among extradural haematoma (EDH) Patients

2018 ◽  
Vol 4 (1) ◽  
pp. 33-39
Author(s):  
MM Ehsanul Haque ◽  
Shamima Sultana ◽  
Md Saiful Alam ◽  
Wahida Begum ◽  
Syeda Asfiya Ara
Keyword(s):  
Surgical Intervention ◽  
Group Iv ◽  
Time Interval ◽  
Extradural Haematoma ◽  
Group Iii ◽  
Medical College ◽  
Group I ◽  
Study Population ◽  
Death Cases

Background: Post-operative outcome of extradural haematoma (EDH) patients depends on the time interval of operation.Objectives: The purpose of the present study was to evaluate the role of time interval and surgical intervention in EDH.Methodology: This interventional study was carried out in the Department of Neurosurgery at Dhaka Medical College and Hospital, Dhaka, Bangladesh from July 2001 to July 2003 for a period of two (02) years. Patients with the history of head trauma admitted in Neurosurgery unit of Dhaka Medical College and Hospital which were being diagnosed as EDH both clinically and radiologically were included as study population. All patients were treated surgically and haematoma was evacuated. Outcome regarding neurological status, functional recovery, associated morbidity and mortality were assessed in each case as per Glasgow Outcome Scale and was compared between the two groups of patients who were treated surgically within 3rd day and 4th to 7th day after infliction of injury. The study population was devided into 4 groups on the basis of the consciousness level on admission of the patients. The EDH patietns who had GCS <5, 5 to 8, 9 to 12 and 13 to 15 were categorized as group I, II, III and IV respectively. On the basis of pre operative time interval, surgical intervention was done within 3 days of injury and from 4th to 7th day of injury. Craniotomy and craniectomy were done depending on patient’s condition and situation of haematoma.Result: A total 63 patients were included. During admission out of 63 patients majority of the patients were in the group III which was 29(46%) cases. During pre-operqative period out of 63 patients majority of the patients were in the group III which was 30(47.6%) cases. Out of 63 cases a total number of 40 cases were performed the surgery within 72 hours and the rest 23 patients were from 4th day to 7th day of injury. In group I at 8th POD, 3 death cases were recorded at 3rd day operation group and 2 cases at 4th to 7th cases. In group IV at 8th POD follow up good recovery was reported in 6 cases at 3rd day and 3 cases at 4th to 7th day. In group I after 1 month, 3 death cases were recorded at 3rd day operation group and 2 cases at 4th to 7th cases. In group IV after 1 month follow up good recovery was reported in 6 cases at 3rd day and 3 cases at 4th to 7th day; however, moderate disability was reported in 2 cases at 4th to 7th day.Conclusion: In conclusion mortality rate is reduced in patients with EDH who are treated in the earliest possible time after head injuryJournal of National Institute of Neurosciences Bangladesh, 2018;4(1): 33-39

scholarly journals Impact on outcome of different etiologies, baseline degree and improvement of mitral regurgitation in patients with aortic stenosis who underwent transcatheter aortic valve replacement

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
F Melillo ◽  
F Putorti ◽  
F Ancona ◽  
S Stella ◽  
C Capogrosso ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Group Iv ◽  
Prognostic Impact ◽  
Group Iii ◽  
Funding Sources ◽  
Transcatheter Aortic Valve ◽  
Group I ◽  
Negative Prognostic Factor ◽  
Study Population

Abstract Funding Acknowledgements Type of funding sources: None. Background -  Mitral regurgitation (MR) is a frequent finding in patients with aortic stenosis (AS). Moderate or severe MR is present in up to one-third of pts undergoing TAVR and it is a negative prognostic factor as well as the presence of residual MR after TAVR. However, whether different etiologies/mechanisms of MR have different effects on outcome and MR degree changes after TAVR is yet unknown. Aim – The aim of the study is to evaluate the prognostic impact of baseline MR degree and its changes after TAVR procedures according to different etiologies of MR in patients who underwent TAVR. Methods - We performed a retrospective observational study on a cohort of patients who underwent TAVR between January 2015 and December 2019. During the index period 947 pts underwent TAVR. To better characterize the mechanism of MR only pts with pre-procedural 3D transesophageal echocardiographic and at least one follow-up available study were included. The final study population consisted of 224 pts. MR severity was evaluated by multiparametric approach and classified in 4 degrees. The study population was further divided in 4 groups: Group I: fibro-calcific degeneration of the leaflets (78.6% pts); 2. Group II: prolapse or flail (4.4% pts); Group III: functional MR (FMR) due to leaflets tethering (5.6% pts); Group IV: FMR due to annular dysfunction or dilatation (11.3% pts). Primary outcome was all-cause of death. Results and Discussion – MR was absent in 15 pts (6.7%), mild in 79 pts (35.7%), mild-to-moderate in 109 in pts (49.3%), moderate-to-severe in 7 pts (3.1%) and severe in 11 pts (4.9%). Patients with &gt; moderate MR degree at baseline had a worse outcome than patients with &lt; moderate MR degree (p log rank = 0.029). FMR (groups III and IV) was associated with better outcome than organic MR (groups I and II) (p log rank = 0.035). Moreover, group IV showed a better outcome compared groups I (p log rank = 0.047) and II (p log rank = 0.038). Patients who showed improvement of MR of at least 1 degree post TAVR showed better outcome compared to patients without improvement (p log rank = 0.04). At multivariate analysis, including pre procedural MR &gt; 2+, pre procedural TR &gt; 2+, organic vs functional etiology and MR improvement after TAVR as covariates, only baseline MR &gt; moderate was an independent predictor of mortality (HR 6.3; 95% CI 1.4 -27.0; p &lt; 0.001). Conclusion - This study confirms the prognostic role of the baseline degree of MR in patients with AS undergoing TAVR. Moreover, this is the first study demonstrating that FMR due to annular dilatation but not due to leaflet tethering is associated with better outcome compared to organic etiologies.

SPECIMENS OF URINE OBTAINED FROM YOUNG GIRLS BY CATHETER VERSUS VOIDING

PEDIATRICS ◽  
1959 ◽  
Vol 23 (3) ◽  
pp. 441-452
Author(s):  
Charles V. Pryles ◽  
Nina L. Steg
Keyword(s):  
Urinary Tract ◽  
Epithelial Cells ◽  
Time Interval ◽  
Pertinent Literature ◽  
Diagnostic Significance ◽  
Group Iii ◽  
Group I ◽  
Female Children ◽  
Follow Up Studies

The pertinent literature on bacteriologic study of the urine has been reviewed in brief. Bacteriologic studies, including cultures, Gram stains and colony counts, of catheterized and voided specimens of urine from girls aged 2 to 12 years, were carried out in three groups: Group I: paired specimens (catheter and clean voided). Group II: clean voided specimens. Group III: random non-clean voided specimens. There was a 96.5% positive correlation between catheter and clean voided specimens obtained by a standardized technique from the same patients; the time interval between the two types of examinations was less than 1 hour. Colony counts provide a valid means of differentiating infection from contamination in both clean voided and catheter specimens from female children. The data suggest that urines containing less than 1,000 colonies/ml are indicative of contamination; urines containing between 1,000 and 100,000 colonies/ml are to be suspected of infection, and urines containing more than 100,000 colonies/ml of urine are indicative of infection. Clean voided specimens are valid only if the patient is prepared before collection of the specimen as carefully as for catheterization. Where doubtful results are obtained, the study of more than one specimen of urine is absolutely necessary. In our experience, follow-up studies resolved doubtful findings in every instance. Under certain circumstances, catheterization must remain a necessary procedure in the diagnosis and management of infection of the urinary tract, with the full realization that the use of this instrumentation may involve the risk of introducing infection. Our results confirm previous findings that the presence of organisms in Gram stains in the absence of epithelial cells from catheter or clean voided specimens of urine is of diagnostic significance.

scholarly journals Signal-averaged electrocardiogram in chronic Chagas' heart disease

1995 ◽  
Vol 113 (2) ◽  
pp. 851-857 ◽  
Author(s):  
Aguinaldo Pereira de Moraes ◽  
Paulo Jorge Moffa ◽  
Eduardo A. Sosa ◽  
Giovanni M. V. Bellotti ◽  
Carlos A. Pastore ◽  
...  
Keyword(s):  
Heart Disease ◽  
Time Domain Analysis ◽  
Group Iv ◽  
Root Mean Square Amplitude ◽  
Group Iii ◽  
Group I ◽  
Chagas Heart Disease ◽  
Group Ii ◽  
The Relationship

The aim of the study was to register the prevalence of late potentials (LP) in patients with chronic Chagas' heart disease (CCD) and the relationship with sustained ventricular tachycardia (SVT). 192 patients (96 males), mean age 42.9 years, with CCD were studied through a Signal Averaged ECG using time domain analysis. According to presence or absence of bundle branch block (BBB) and SVT, four groups of patients were created: Group I (n = 72): without SVT (VT-) and without BBB (BBB-): Group II (n = 27): with SVT (VT+) and BBB-; Group III (n = 63): VT- and with BBB (BBB+); and Group IV (N = 30): VT+ and BBB+. The LP was admitted, with 40 Hz filter, in the groups without BBB using standard criteria of the method. In the group with BBB, the root-mean-square amplitude of the last 40 ms (RMS) < =14µV was considered as an indicator of LP. RESULTS: In groups I and II, LP was present in 21 (78%) of the patients with SVT and in 22 (31%) of the patients without SVT (p < 0.001), with Sensitivity (S) 78%; Specificity (SP) 70% and Accuracy (Ac) 72%. LP was present in 30 (48%) of the patients without and 20 (67%) of the patients with SVT, in groups III and IV. p = 0.066, with S = 66%; SP = 52%; and Ac = 57%. In the follow-up, there were 4 deaths unrelated to arrhythmic events, all of them did not have LP. Eight (29,6%) of the patients from group II and 4 (13%) from group IV presented recurrence of SVT and 91,6% of these patients had LP. CONCLUSIONS: LP occurred in 77.7% of the patients with SVT and without BBB. In the groups with BBB, there was association of LP with SVT in 66,6% of the cases. The recurrence of SVT was present in 21% of the cases from which 91,6% had LP.

scholarly journals Analysis of the length of fixation during hemivertebra resection. A monocentric cohort

2020 ◽  
Author(s):  
Sergey O Ryabykh ◽  
Egor Yu Filatov ◽  
Joseph Olorunsogo Mejabi ◽  
Dmitry M Savin ◽  
Alexander B Gubin
Keyword(s):  
Blood Loss ◽  
Cobb Angle ◽  
Spinal Deformity ◽  
Operating Time ◽  
Group Iv ◽  
Group Iii ◽  
Fixation Group ◽  
Group I ◽  
Segmental Fixation

Abstract Background: We aimed at reviewing results of surgical correction of spinal deformity due to hemivertebra with regard to length of instrumentation. Methods: Study comprised 117 patients with congenital spinal deformity treated between 2010 and 2018. Patients’ aged 1 to 18 years. Mean follow-up was 3 years (1 to 8). Posterior approach was used in all cases. Patients were subdivided into 4 groups. Result: Unilateral monosegmental fixation (Group I) for 15 children with mean age of 48.3 months. Cobb angle for scoliosis and kyphosis were 31.1 0 + 6.4 0 and 29.3° + 11.9 0 corrected to 7.8 0 + 6.8 0 and 4.7 0 + 4.0 0 respectively. Blood loss was 213.6 mL. Operating time was 165 minutes. Bilateral monosegmental fixation (Group II) for 24 patients with mean age of 53.1 months. Cobb angle for scoliosis and kyphosis were 32.5° + 8.6 0 and 30.9° + 4.3 0 corrected to 5.3 0 + 2.8 0 and 0.2 0 + 11.6 0 respectively. Blood loss was 215.4 mL. Operating time was 160.5 minutes. Bilateral three-segmental fixation (Group III) for 29 patients with mean age of 78.2 months. Cobb angle for scoliosis and kyphosis were 36.6° + 10.6 0 and 37.6° + 14.6 0 corrected to 6.2 0 + 6.1 0 and 5.0 0 + 5.2 0 respectively. Blood loss was 342.7 mL. Operating time was 197.0 minutes. Bilateral polysegmental fixation (Group IV) for 49 children with mean age of 112.7 months. Cobb angle for scoliosis and kyphosis were 40.2° + 14.8 0 and 58.2° + 35.6 0 corrected to 10.7 0 + 9.6 0 and 10.7 0 + 10.3 0 respectively. Blood loss was 549.3 mL. Operating time was 288.8 minutes. Conclusion: Choice of spinal fixation technique and the length of fixation were determined on the basis of patient’s age, magnitude of the deformity and concomitant vertebral abnormalities.

scholarly journals Analysis of the length of fixation during hemivertebra resection. A monocentric retrospective cohort

2020 ◽  
Author(s):  
Sergey O Ryabykh ◽  
Egor Yu Filatov ◽  
Joseph Olorunsogo Mejabi ◽  
Dmitry M Savin ◽  
Alexander B Gubin
Keyword(s):  
Blood Loss ◽  
Cobb Angle ◽  
Spinal Deformity ◽  
Operating Time ◽  
Group Iv ◽  
Group Iii ◽  
Fixation Group ◽  
Group I ◽  
Segmental Fixation

Abstract Background: We aimed at reviewing results of surgical correction of spinal deformity due to hemivertebra with regard to the age, severity of deformity and length of instrumentation.Methods. Study comprised 117 patients with congenital spinal deformity treated between 2010 and 2018. Patients’ aged 1 to 18 years. Mean follow-up was 3 years (1 to 8). Posterior approach was used in all cases. Patients were subdivided into 4 groups.Result:Unilateral mono-segmental fixation (Group I) for 15 children with mean age of 48.3 months. Cobb angle for scoliosis and kyphosis were 31.10 + 6.40 and 29.3° + 11.90 corrected to 7.80 + 6.80 and 4.70 + 4.00 respectively. Blood loss was 213.6 mL. Operating time was 165 minutes.Bilateral mono-segmental fixation (Group II) for 24 patients with mean age of 53.1 months. Cobb angle for scoliosis and kyphosis were 32.5° + 8.60 and 30.9° + 4.30 corrected to 5.30 + 2.80 and 0.20 + 11.60 respectively. Blood loss was 215.4 mL. Operating time was 160.5 minutes.Bilateral three-segmental fixation (Group III) for 29 patients with mean age of 78.2 months. Cobb angle for scoliosis and kyphosis were 36.6° + 10.60 and 37.6° + 14.60 corrected to 6.20 + 6.10 and 5.00 + 5.20 respectively. Blood loss was 342.7 mL. Operating time was 197.0 minutes.Bilateral poly-segmental fixation (Group IV) for 49 children with mean age of 112.7 months. Cobb angle for scoliosis and kyphosis were 40.2° + 14.80 and 58.2° + 35.60 corrected to 10.70 + 9.60 and 10.70 + 10.30 respectively. Blood loss was 549.3 mL. Operating time was 288.8 minutes.Conclusion: Choice of spinal fixation technique and the length of fixation were determined on the basis of patient’s age, magnitude of the deformity and concomitant vertebral abnormalities.

Clinical Follow-up of a Fissure Sealant Placed Using Different Adhesive Protocols: A 24-month Split-mouth Study

2018 ◽  
Vol 43 (4) ◽  
pp. 362-371 ◽  
Author(s):  
AR Yazici ◽  
E Ozturk Bayazit ◽  
ZB Kutuk ◽  
G Ozgunaltay ◽  
E Ergin ◽  
...  
Keyword(s):  
Retention Rate ◽  
Group Iv ◽  
Retention Rates ◽  
Fissure Sealant ◽  
Group Iii ◽  
Group I ◽  
Etch And Rinse ◽  
Acid Etch ◽  
Self Etch

SUMMARY The purpose of this study was to evaluate the retention rates of a fissure sealant placed using different adhesive protocols over 24 months. Twenty-four subjects with no restorations or caries received fissure sealants (Clinpro Sealant, 3M ESPE) placed using different adhesive protocols. A total of 292 sealants were placed as follows by two previously calibrated dentists using a table of random numbers (n=73): group I, acid-etch/without adhesive; group II, with a self-etch adhesive (Adper Easy Bond, 3M ESPE); group III, with an etch-and-rinse adhesive (Adper Single Bond 2, 3M ESPE); group IV, with acid + self-etch adhesive (Adper Easy Bond). Two other calibrated examiners independently evaluated the sealants at baseline and at six-, 12-, 18-, and 24-month recalls. Each sealant was evaluated in terms of caries formation being present or absent and retention using the following criteria: 1 = total retention, 2 = partial loss, and 3 = total loss. Pearson's χ2 test was used to evaluate differences in retention rates among the sealants for each evaluation period. At the end of 24 months, total retention rates were 57.5%, 27.4%, 84.9%, and 76.7% in the acid-etch, self-etch adhesive, etch-and-rinse adhesive, and acid + self-etch adhesive groups, respectively. Although there were no statistically significant differences between the retention rates among the adhesive protocols at 6 months (p=0.684), significant differences were observed at the 12-, 18-, and 24-month evaluations. At 24 months, the lowest retention rates were observed in the self-etch group (p&lt;0.05). No caries development was observed in any of the groups. The retention rate of sealants placed using self-etch adhesive was poor compared with the other groups.

THE PHYSIOLOGICAL CONSEQUENCES OF BRONCHOSCOPY : A STUDY OF THE HAEMODYNAMIC CHANGES DURING BRONCHOSCOPY

2003 ◽  
Vol 41 (142) ◽  
pp. 299-305
Author(s):  
Anjan K Das ◽  
S Dutta
Keyword(s):  
Heart Rate ◽  
Rigid Bronchoscopy ◽  
Group Iv ◽  
Adult Patients ◽  
Ecg Changes ◽  
Group Iii ◽  
Medical College ◽  
Group I ◽  
Haemodynamic Changes ◽  
Electrocardiogram Ecg

Physiological consequences are inherent to the procedure of bronchoscopy. Sixtypatients who underwent bronchoscopy at the Medical College Hospitals, Calcutta,India, were studied to determine the changes that occur during bronchoscopy. Ofthese twenty were consecutive adult patients who underwent rigid bronchoscopy undergeneral anaesthesia (Group I). Twenty were consecutive adult patients who had flexiblebronchoscopy under local anaesthesia (Group II). Ten consecutive paediatric patientsunderwent rigid bronchoscopy with spontaneous ventilation under General Anaesthesia(Group III) and ten were operated with controlled ventilation (Group IV). Heart Rate,Blood Pressure SpO2and ECG were monitored during and upto 60 minutes after theprocedure.Heart Rate changes were minimal in Group I but maximum in Groups II and III.Procedures like suctioning & Bronchoalveolar Lavage (Bal) were associated with fallof SpO2, SpO2was best maintained in the fourth group. Three patients out of fortyadults patients had Electrocardiogram (ECG) changes. Significant Mean ArterialPressure (MAP) rise was seen in adults, but this was not significant in children. GeneralAnaesthesia failed to modify the rise of MAP observed in adults.Key Words: Bronchoscopy : Physiological consequences : SpO2, ECG changes,heart rate, Mean arterial pressure

Diagnosis and management of pediatric brain-stem gliomas

1986 ◽  
Vol 65 (6) ◽  
pp. 745-750 ◽  
Author(s):  
Ann R. Stroink ◽  
Harold J. Hoffman ◽  
E. Bruce Hendrick ◽  
Robin P. Humphreys
Keyword(s):  
Brain Stem ◽  
Survival Time ◽  
Group Iv ◽  
Content Type ◽  
Group Iii ◽  
Mean Survival Time ◽  
Group I ◽  
Group Ii ◽  
The Brain

✓ The authors reviewed the cases of 49 children, ranging in age from 9 months to 15 years, who were diagnosed by computerized tomography (CT) as having brain-stem glioma. Four distinct groups of brain-stem gliomas were identified based on CT scan characteristics: Group I included isodense contrast-enhancing tumors that were dorsally exophytic into the fourth ventricle; Group II(a) included hypodense nonenhancing intrinsic tumors of the brain stem; Group II(b) included intrinsic tumors of the brain stem with hyperdense exophytic components extending ventrally and laterally into the cerebellopontine and prepontine cisterns; Group III included intrinsic cystic tumors with contrast-enhancing capsules; and Group IV included focally intrinsic tumors of the brain stem that were isodense and enhanced brightly on administration of contrast medium. The clinical presentation, efficacy of surgical intervention, pathology, and prognosis of these tumors were correlated within these groupings. Eleven patients had Group I tumors, all of which were surgically resected; 10 of the 11 lesions were proven to be low-grade gliomas. These patients had an excellent prognosis; 10 of the 11 survived, with a mean follow-up period of 4.5 years. There were 18 patients with Group II(a) tumors; although tumor biopsy was attempted on eight of these, pathological diagnosis at the time of surgery was made in only one case. These patients did poorly; the mean survival time was 6.2 months. The seven Group II(b) tumor patients demonstrated a similarly poor prognosis: all of them died within 23 months of diagnosis, with a mean survival time of 12 months. Only two of six patients undergoing biopsy had sufficient tissue for histological verification. Three of the four patients with Group III tumors died; their mean survival time was 11.5 months. Successful histological examination was carried out in all four cases. The nine Group IV tumor patients did reasonably well; seven of these patients remain alive, with a mean follow-up period of 2.3 years. Histological diagnosis was obtained in three of the seven patients who were explored in this group. This classification system has proven to be of value in determining prognosis and efficacy of surgical intervention.

scholarly journals Surgical outcome of repair of aortic valve prolapse and regurgitation associated with ventricular septal defect

2021 ◽  
Vol 37 (3) ◽  
Author(s):  
Tariq Waqar ◽  
Muhammad Farhan Ali Rizvi ◽  
Jamal Abdul Nasir ◽  
Kamran Khan
Keyword(s):  
Aortic Valve ◽  
Ventricular Septal Defect ◽  
Aortic Valve Disease ◽  
Septal Defect ◽  
Group Iv ◽  
Single Patient ◽  
Valve Repair ◽  
Group Iii ◽  
Group I

Objective: To analyze the outcome of repair of aortic valve disease associated with various types of ventricular septal defect. Methods: In a retrospective observational study design, data of seventy-two patients of ventricular septal defect (VSD) associated with aortic valve prolapse (AVP) and aortic regurgitation (AR) who was operated in Punjab Institute of cardiology from May 2016 to April 2020 was collected. Depending on presence of AR, all patients were divided in four groups. Group-I (VSD and AVP but no AR) had fifteen patients. Only VSD was closed in this group. Group-II (VSD and Mild AR) had forty patients, only VSD was closed in this group as well. Group-III (VSD and Moderate AR) had ten patients, VSD closure and aortic valve repair was done. Group-IV (VSD and severe AR) had seven patients. Aortic valve was repaired in five patients and replaced (AVR) in two patients along with VSD closure. Associated anomalies were addressed as well. Results: Group-I: Twelve out of fifteen patients (80%) showed no post-operative AR. While two patients (13.3%) showed Trace AR. Single patient (6.6%) showed mild AR. There results were unchanged after mean follow up of 36 months. Group-II: Eight out of forty patients (20%) had no AR, while eight (20%) had trace AR. Twenty-three (57.5%) patients had mild AR. Single (2.5%) patient had moderate AR. After follow up of 24 months the patient with moderate AR progressed to severe AR. We are planning to do Aortic Valve Replacement (AVR) in this case. Rest of cases showed no progression of disease. Group-III: Two out of ten patients (20%) had no AR, four (40%) had trace AR, while four (40%) had mild AR. Mean follow up was 42 months (2.5 years). Neither trace nor mild AR progressed to severe or moderate AR. Group-IV: Among seven patients, five underwent repair while two had AVR. Out of five patients who underwent aortic valve repair, four patients (57.1%) were declared mild AR, while severe AR was converted to moderate AR in single patient (14.28%). Mean follow up was 18 months. The moderate AR patient has progressed to severe AR for last six months and we are planning to do AVR in this patient. Postoperative echo of patients with AVR showed adequately functioning aortic valve with AVPG mean 10 mmHg and 15 mm Hg respectively, with no residual AR. Conclusions: Aortic regurgitation associated with VSD is a congenital lesion with continuously active aortic valve disease resulting in significant morbidity and mortality. Early diagnosis, effective treatment and meticulous follow up decelerate and in most cases arrest the disease process. doi: https://doi.org/10.12669/pjms.37.3.3067 How to cite this:Waqar T, Rizvi MFA, Nasir JA, Khan K. Surgical outcome of repair of aortic valve prolapse and regurgitation associated with ventricular septal defect. Pak J Med Sci. 2021;37(3):---------. doi: https://doi.org/10.12669/pjms.37.3.3067 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.

Association between secondhand smoke exposure and new-onset hypertension in 65169 self-reported never smokers verified by cotinine

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B.J Kim ◽  
D.C Seo ◽  
B.S Kim
Keyword(s):  
Group Iv ◽  
Exposure Group ◽  
Group Iii ◽  
Group I ◽  
Shs Exposure ◽  
Group Ii ◽  
Never Smokers ◽  
The Relationship ◽  
New Onset

Abstract Background No study has reported the relationship between secondhand smoke (SHS) exposure and new-onset hypertension (NOHT) in self-reported never-smokers verified by cotinine. Purpose This longitudinal study was conducted to evaluate whether the change of SHS exposure status at baseline and at follow-up affects NOHT in self-reported and cotinine-verified never-smokers. Methods Out of individuals enrolled in the Kangbuk Samsung Cohort study (KSCS) between 2012 and 2016, 65,169 self-reported and cotinine-verified never-smokers without hypertension at baseline visit (20,046 men; age 36±5.7 years) were included. The mean follow-up period in this study was 32 months (6–58 months). SHS exposure was defined as having experienced passive smoking indoors at home or the workplace. Individuals were divided into 4 groups on the basis of their SHS exposure status at baseline and at follow-up: no SHS exposure group (Group I) as individuals without SHS exposure both at baseline and at follow-up; new SHS exposure group (Group II) as those without SHS exposure at baseline and with SHS exposure at follow-up; ex-SHS exposure group (Group III) as those with SHS exposure at baseline and without SHS exposure at follow-up; continuous SHS exposure group (Group IV) as those with SHS exposure both at baseline and at follow-up. New-onset hypertension was defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, or current use of antihypertensive medication(s) at follow-up. Results The incidence of NOHT in the overall population was 2.5%; the incidence in group I, II, III, and IV was 2.3%, 3.2%, 2.9%, and 3.1%, respectively (p&lt;0.001). The results in a multivariate Cox-hazard model adjusted for the baseline variables including age, sex, body mass index, waist circumference, vigorous exercise, alcohol consumption and presence of diabetes showed that Group II and IV increased relative risks (RRs) for NOHT compared to Group I (RR[95% CI], 1.44 [1.17, 1.77] for Group II and 1.21 [1.01, 1.45] for Group IV) However, Group III did not increase the risk of NOHT (0.95 [0.83, 1.08]). In another model adjusted for the variables in the above model and creatinine, uric acid, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides and high-sensitivity C reactive protein showed that only Group II increased the risk for NOHT (1.43 [1.16, 1.77] in Group II, 0.94 [0.82, 1.07] in Group III, 1.18 [0.98, 1.41] in Group IV). Conclusions This study showed that the new and continuous SHS exposure, but not ex-SHS exposure, increased the risk for NOHT in self-reported never-smokers verified as nonsmokers by urinary cotinine. In particular, the relationship to increased risk for NOHT was more obvious in individuals with new SHS exposure than in those with continuous SHS exposure. These findings suggest that it is important to continuously minimize SHS exposure and prohibit smoking at home and at workplace to reduce the risk of developing hypertension. Funding Acknowledgement Type of funding source: None

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