scholarly journals Predictors of post-spinal hypotension in elderly patients; a prospective observational study in the Durban Metropole

2019 ◽  
pp. 13-17
Author(s):  
ZA Malima ◽  
A Torborg ◽  
L Cronjé ◽  
BM Biccard
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Observational Study ◽  
Systolic Blood Pressure ◽  
Spinal Anaesthesia ◽  
Prospective Observational Study ◽  
Primary Outcome ◽  
Baseline Heart Rate ◽  
Female Sex ◽  
Spinal Hypotension

Aims and objective: To evaluate the pre-spinal risk factors for hypotension associated with spinal anaesthesia in elderly surgical patients. Summary of background data: Hypotension is associated with morbidity and mortality following noncardiac surgery. Reducing the incidence of hypotension associated with spinal anaesthesia may be associated with improved postoperative outcomes. Methods: This was a prospective, observational study, using convenience sampling. All patients over 55 years of age scheduled to receive spinal anaesthesia for lower limb surgery were eligible. Exclusion criteria included the need for resuscitation and/or the need for vasopressors prior to anaesthesia and surgery, and patients who declined spinal anaesthesia. The dosage of spinal anaesthesia and the use of intraoperative sedation were left to the attending anaesthesiologist. The primary outcome was hypotension, which was defined as a decrease in the systolic blood pressure by 25% from the baseline, or a systolic blood pressure below 100 mmHg. The following pre-spinal risk factors were assessed in a multivariable logistic regression for their association with spinal hypotension: age, American Society of Anaesthesiologists-Physical September 2019 Status, sex, dose of local anaesthetic, isobaric bupivacaine or bupivacaine with dextrose, baseline blood pressure, baseline heart rate and fluid preloading prior to spinal anaesthesia. Results: Three hundred and eighty-nine patients were recruited. The primary outcome of spinal hypotension was independently associated with female sex (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.19–3.28), increasing dosage of bupivacaine (OR 1.14, CI 1.01–1.29), and the use of isobaric bupivacaine (OR 1.50, CI 0.95–2.36). Conclusion: Spinal hypotension was associated with female sex, increasing dosage of bupivacaine, and the use of isobaric bupivacaine.

Abstract P333: Carotid Intima Media Echolucency is Related to Age, Female Sex, Systolic Blood Pressure, BMI and Smoking in Patients with Familial Hypercholesterolemia

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Karlijn A Groenewegen ◽  
Sanne A Peters ◽  
Hester M den Ruijter ◽  
Michiel L Bots
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Systolic Blood Pressure ◽  
Cardiovascular Risk Factors ◽  
Familial Hypercholesterolemia ◽  
Controlled Trial ◽  
Multivariable Model ◽  
Female Sex ◽  
The Common

Background: Atherosclerotic vascular disease can be assessed non-invasively with B-mode ultrasound. Echolucency is an ultrasound characteristic which is measured as the Gray Scale Median (GSM). Echolucent structures appear dark on ultrasound images; echogenic structures appear light. Echolucency of the carotid intima-media is thought to be a marker of the content of the vascular wall, where low values of GSM might reflect inflammation and/or high lipid content and high values of GSM reflect increased collagen and/or calcifications. In previous studies in asymptomatic individuals, echolucency of the carotid intima-media was associated with cardiovascular risk factors. Studies in high-risk populations are lacking. Aim: To assess the relation between cardiovascular risk factors and carotid intima media echolucency in patients with familial hypercholesterolemia. Methods: Baseline data were used from the RADIANCE 1 trial, a randomized controlled trial on the effects of atorvastatin and torcetrapib (a CETP-inhibitor) compared to atorvastatin alone in familial hypercholesterolemia. Echolucency of the common carotid artery intima media was measured as the mean GSM of the first baseline visit. Linear mixed effects models were used to assess the relation between each cardiovascular risk factor and mean GSM (adjusted for age, sex and carotid intima media thickness (CIMT), and in a multivariable model containing all risk factors). We studied systolic blood pressure (SBP), body mass index (BMI), high and low density lipoprotein (HDL and LDL), triglycerides (TGs), smoking, diabetes mellitus and C - reactive protein (CRP). Results: 875 patients were included in the current analysis. Mean age was 46 years (sd 13) and 50% was female. Mean GSM was 67 (sd 18). In age, sex and CIMT adjusted analyses, higher age (ß/sd: -5.71 (95% CI-6.82;-4.61)), female sex (β:-3.53 (95% CI -5.32;-1.73)), higher SBP (β/sd:-1.86 (95% CI -2.81;-0.91)), higher BMI (β/sd:-2.37 (95% CI -2.26;-1.29)) and higher levels of TGs (β/sd:-1.34 (95% CI -2.21;-0.47 were related to a lower GSM (i.e, more echolucency) and smoking (ß 2.91 (95% CI 0.52-5.29)) was related to a higher GSM. In the multivariable model, age (β/sd: -4.92 (95% CI -6.18;-3.65)), female sex (β: -4.35 (-6.41;-2.29), systolic blood pressure (β/sd: -1.32 (-2.38;-0.25) and BMI (β/sd: -1.82 (-2.90;-0.73)) were related to a lower GSM and smoking (β: 2.78 (0.39;5.18)) was related to a higher GSM. Conclusion: Several established risk factors were related to the echolucency of the common carotid intima media in patients with familial hypercholesterolemia.

Risk factors for shivering during caesarean section under spinal anaesthesia. A prospective observational study

2019 ◽  
Vol 64 (1) ◽  
pp. 112-116 ◽  
Author(s):  
Bartłomiej Wódarski ◽  
Radosław Chutkowski ◽  
Jolanta Banasiewicz ◽  
Katarzyna Moorthi ◽  
Stanisław Wójtowicz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Observational Study ◽  
Spinal Anaesthesia ◽  
Prospective Observational Study

scholarly journals POS0441 DEVELOPMENT OF RHEUMATOID ARTHRITIS AMONG ANTI-CITRULLINATED PROTEIN ANTIBODIES POSITIVE ASYMPTOMATIC INDIVIDUALS: A PROSPECTIVE OBSERVATIONAL STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 449.1-449
Author(s):  
S. Mizuki ◽  
K. Horie ◽  
K. Imabayashi ◽  
K. Mishima ◽  
K. Oryoji
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Observational Study ◽  
Rheumatoid Factor ◽  
Prospective Observational Study ◽  
Enzyme Linked Immunosorbent Assay ◽  
P Value ◽  
Healthy Population ◽  
Asymptomatic Individuals ◽  
Citrullinated Protein

Background:In the idividuals with genetic and enviromental risk factors, immune events at mucosal surfaces occur and may precede systemic autoimmunity. Anti-citrullinated protein antibodies (ACPA) are present in the serum for an average of 3-5 years prior to the onset of rheumatoid arthritis (RA) during an asymptomatic period. In ACPA-positivite individuals, the additional presence of RA-related risk factors appears to add significant power for the development of RA. To date, there have been few reports in which clinical courses of ACPA-positive asymptomatic individuals were investigated prospectively.Objectives:To observe the clinical time course of ACPA-positive healthy population for the development of RA.Methods:Healthy volunteers without joint pain or stiffness, who attended the comprehensive health screening of our hospital, were enrolled in this prospective observational study. The serum ACPA levels were quantified by Ig-G anti-cyclic citrullinated peptide enzyme-linked immunosorbent assay with levels > 4.4 U/mL considered positive. ACPA-positive subjects were followed by rheumatologists of our department clinically or a questionnaire sent by mail for screening to detect arthritis.Results:5,971 healthy individuals without joint symptons were included. Ninty-two (1.5%) were positive for ACPA. Of these, 19 (20.7%) developed RA and two were suspected as RA by mail questionnaire. Their average age were 58-years, and women were 68%. The average duration between the date of serum sampling and diagnosis was 10.7 months. ACPA-positive individuals who developed to RA had higher serum ACPA and Ig-M rheumatoid factor levels than ACPA-positive individuals who did not (P value by Mann-Whitney U test: 0.002, 0.005, respectively).Conclusion:Among ACPA-positive asymptomatic individuals, 20% developed RA. The higher titer of ACPA and Ig-M rheumatoid factor levels are risk factors for devoloping RA.Disclosure of Interests:None declared

Long-term effects (>24 months) of multiple lifestyle intervention on major cardiovascular risk factors among high risk subjects: a meta-analysis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
H Bergum ◽  
I Sandven ◽  
TO Klemsdal
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Systolic Blood Pressure ◽  
Total Cholesterol ◽  
Cardiovascular Risk Factors ◽  
Lifestyle Intervention ◽  
Small Study ◽  
Long Term Effects

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Norwegian health department Background The evidence of the long-term effects of multiple lifestyle intervention on cardiovascular risk is uncertain. We aimed to summarize the evidence from randomized clinical trials examining the efficacy of lifestyle intervention on major cardiovascular risk factors in subjects at high cardiovascular risk. Methods  Eligible trials investigated the impact of lifestyle intervention versus usual care with minimum 24 months follow-up, reporting more than one major cardiovascular risk factor. A literature search updated April 15, 2020 identified 12 eligible studies. The results from individual trials were combined using fixed and random effect models, using the standardized mean difference (SMD) to estimate effect sizes. Small-study effect was evaluated, and heterogeneity between studies examined by subgroup and meta-regression analyses considering patient- and study-level variables. Results  Small-study effect was not identified. Lifestyle intervention reduced systolic blood pressure modestly with an estimated SMD of -0.13, 95% confidence interval (CI): -0.21 to -0.04, with moderate heterogeneity (I² = 59%), corresponding to a mean difference of approximately 2 mmHg (MD = -1.86, 95% CI: -3.14 to -0.57, p = 0.0046). This effect disappeared in the subgroup of trials judged at low risk of bias (SMD = 0.02, 95% CI: -0.08 to 0.11). For the outcome total cholesterol SMD was -0.06, 95% CI: -0.13 to 0.00, with no heterogeneity (I² = 0%), indicating no effect of the intervention. Conclusion  Lifestyle intervention resulted in only a modest effect on systolic blood pressure and no effect on total cholesterol after 24 months. Further lifestyle trials should consider the challenge of maintaining larger long-term benefits to ensure impact on cardiovascular outcomes.

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