Pre-delivery hypotension after spinal anesthesia during cesarean section and its associated  factors at Jigme Dorji Wangchuck National Referral Hospital, Bhutan

Introduction: The current choice of anesthesia for the cesarean section is spinal anesthesia. However, hypotension is the major complication. If promptly not recognized and treated, it increases the morbidity and mortality of the mother and fetus. This study was conducted to evaluate the rate of pre-delivery hypotension and risk factors following spinal anesthesia for cesarean section at the National Referral Hospital in Bhutan. Methods: A cohort study was conducted from 1st October 2018 to 30th June 2019 on 350 women undergoing cesarean section under spinal anesthesia. Pre-delivery hypotension was defined as systolic blood pressure < 100 mm Hg. The association of factors for hypotension was tested using multivariable binary logistic regression using a forward stepwise model. A p-value < 0.05 was considered significant. Results: The rate of pre-delivery hypotension was 74.6 % (n=261). History of hypertension during pregnancy (Adjusted OR 0.25, [0.11-0.60], p=0.013), prophylaxis use of ephedrine (Adjusted OR 0.45, [0.22-0.92], p= 0.024) and ondansetron (Adjusted OR 0.43, [0.22-0.82], p= 0.010),longer preoperative fasting duration (Adjusted OR 1.12, [1.01-1.21], p=0.024,), sensory block level <= T4 (Adjusted OR 3.4, [1.8-6.4], p=<0.001) and baseline systolic blood pressure less than or equal to 120 mmHg (Adjusted OR 2.8, [1.5-5.1], p=0.001) were significant risk factors. Conclusions: This study conduces that the rate of pre-delivery hypotension following spinal anesthesia in a cesarean section was high among women undergoing cesarean section. It is alarming as around two-third of women and fetus undergoing cesarean section under spinal anesthesia are at risk of consequences of hypotension. Most of the risk factors in the study are modifiable. The study suggests that if the anesthesia provider intervenes in managing the modifiable risk factors and treat hypotension promptly, it can help reduce the risk of women and fetus to spinal hypotension consequences.

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Incidence and Risk Factors of Post-Operative Delirium in Elderly Patients Who Underwent Spinal Anesthesia in Orotta, Halibet and Sembel Hospitals: A Cross Sectional Study in Eritrea

10.47363/jsar/2021(2)116 ◽

2021 ◽

pp. 1-8

Author(s):

Michael Beraki Mengistu ◽

◽

Yonatan Mehari Andemeske ◽

AriamTsegay Emhatsion ◽

HabtomTareke Wrieta ◽

...

Keyword(s):

Risk Factors ◽

Elderly Patients ◽

Spinal Anesthesia ◽

Significant Risk ◽

Multivariate Logistic Regression Analysis ◽

Cross Sectional Study ◽

P Value ◽

Sectional Study ◽

Cross Sectional ◽

History Of

Background: Delirium is a common but often underdiagnosed set of transient symptoms often seen in elderly patients following surgeries under spinal anesthesia. With early recognition and diagnosis based on the established standard criteria delirium can be improved. Early identification of the possible contributingfactors and the magnitude of the burden will help in the management of the fragile elderly patients. The aim of this study is to determine the incidence of postoperative delirium and associated risk factors in elderly patients who have done surgery under spinal anesthesia. Method: This cross sectional study was conducted in the National Referral Hospitals and Sembel PrivateHospital, in Asmara, Eritrea from February to May, 2019. The study participants were elderly patients (age ≥65 years) having no known history of dementia or delirium or no mental disorder, no history of acute cerebrovascular disease. Basic background and clinical characteristics of the patients was collected. To assess the status of cognitive impairment level, the Mini Mental State Examination and Confusion Assessment Method tools were used. Data was collected through an interview method. After the data was entered into SPSS version 22 software, data was analyzed with frequency, percentage, bivariate and multivariate logistic regression analysis method as appropriate. P value <0.05 was considered as statistically significant. Results: The mean age of the participants was 74 ±6.62 and 102 (79.1%) of the participants were males. POD occurred in 14 (10.9%) of the patients. Adjusting all the potential factors, age was identified as arisk factor for developing POD. Conclusion: Age was determined to be a significant risk factor of delirium. Elderly patients require more attention and care and the findings might help to develop preventive strategies to the occurrence of POD

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Anemia and risk factors among children 6 months to 59 months old: a hospital-based prospective study

Bhutan Health Journal ◽

10.47811/bhj.45 ◽

2017 ◽

Vol 3 (2) ◽

pp. 1-5

Author(s):

Kalpana Chhetri ◽

Mimi L. Mynak ◽

Kuenley Pedon

Keyword(s):

Risk Factors ◽

Family Income ◽

Referral Hospital ◽

P Value ◽

Major Public Health Problem ◽

Severe Anemia ◽

Pediatric Ward ◽

Factors Associated ◽

National Referral Hospital ◽

Prevalence Of Anemia

Background: Anemia is a major public health problem and the most common nutritional issue in many parts of the world, especially in developing countries. The objective of the study was to determine the prevalence of anemia and factors associated with anemia among children 6 to 59 months old admitted in Pediatric ward of National Referral Hospital, Thimphu. Methods: A hospital-based descriptive cross-sectional study. All children 6 months to 59 months old admitted in Pediatric ward of National Referral Hospital, Thimphu were included in the study. A total of 353 children were included in the study. Data was analyzed using STATA 12. Results: The prevalence of anemia was 58.4%. Mild, moderate and severe anemia was 65%, 22.8% and 12.2% respectively. Anemia was more common in children less than 2 years old. The majority of the children had microcytic hypochromic anemia with low serum iron. The risk factors associated with moderate to severe anemia were malnutrition [p-value 0.001, OR 32.1, 95% CI (9.10-118.8)], low education level of caregiver [p value 0.0019, OR 5.10, 95% CI (1.66-15.68), monthly family income less than 5000/month [p-value 0.0004, OR 4.6 , 95% CI (1.89-11.54)] and chronic illness [p value 0.030, OR 2.43, 95% CI (1.08-5.47)]. Conclusion: This study found a high prevalence of anemia in under-5 children, with iron deficiency accounting for the majority of the cases. Children under 2 years were affected more.

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Profil Penurunan Tekanan Darah (hipotensi) pada Pasien Sectio Caesarea yang Diberikan Anestesi Spinal dengan Menggunakan Bupivakain

e-CliniC ◽

10.35790/ecl.5.1.2017.15813 ◽

2017 ◽

Vol 5 (1) ◽

Author(s):

Popi Tanambel ◽

Lucky Kumaat ◽

Diana Lalenoh

Keyword(s):

Blood Pressure ◽

Cesarean Section ◽

Systolic Blood Pressure ◽

Spinal Anesthesia ◽

Diastolic Blood Pressure ◽

Emergency Operation ◽

Study Data ◽

Sectio Caesarea ◽

Age Group ◽

Spinal Anesthetic

Abstract: Cesarean section is generally performed on pregnant women and the prevalence is continuously increasing every years. This study was aimed to determine the profile of the occurence of hypotension in patients of sectio caesarea with spinal anesthesia using bupivacaine at Prof. Dr. R. D. Kandou Manado. This was a descriptive retrospective study. Data were obtained from the emergency operation room at Prof. Dr. R. D. Kandou Manado from November through December 2015. The results showed that there were 15 cases of cesarean section with spinal anesthesia using bupivacaine. According to age group, there was 1 patient (6.66%) in age group <20 years; 11 patients (73.33%) in age group 20-35 years; and 3 patients (20%) in age group >35 years. After spinal anaesthesia using bupivacaine, the highest percentage of decrease in systolic blood pressure was 18.18%, meanwhile of diastolic blood pressure was 11.11%. Conclusion: The decreases in systolic blood pressure and diastolic blood pressure after spinal anesthesia using bupivacaine were within normal limits.Keywords: spinal anesthetic, bupivacaine, hypotension Abstrak: Sectio caesarea (SC) merupakan operasi yang umum dan luas dilakukan pada wanita hamil dan prevalensi meningkat setiap tahun. Penelitian ini bertujuan untuk mengetahui profil kejadian hipotensi pada pasien SC yang diberikan anestesi spinal dengan bupivakain di RSUP Prof. Dr. R. D. Kandou Manado. Jenis penelitian ialah deskriptif retrospektif. Data penelitian diambil dari ruang operasi darurat periode November 2015 sampai Desember 2015. Hasil penelitian mendapatkan 15 kasus bedah SC dengan menggunakan teknik anestesi spinal. Berdasarkan golongan usia, ditemukan kelompok usia <20 tahun sebanyak 1 pasien (6,66%); usia 20-35 tahun sebanyak 11 pasien (73,33%); dan usia >35 tahun sebanyak 3 pasien (20%). Persentase penurunan tekan darah sistolik yang paling tinggi sesudah dilakukan anestesi spinal ialah sebesar 18,18% sedangkan untuk tekanan darah diastolik paling tinggi mencapai 11,11%. Simpulan: Penurunan tekan darah sistolik dan tekanan darah diastolik sesudah dilakukan anestesi spinal masih berada dalam batas normal.Kata kunci: anestesi spinal, bupivakain, hipotensi

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Prevalence of hypertension and its significant correlates among Bangladeshi adults: a quantitative analysis from City Corporation Rangpur, Bangladesh

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20193964 ◽

2019 ◽

Vol 6 (9) ◽

pp. 3748

Author(s):

Sukanta Das ◽

B. K. Chakravorti ◽

Sahebul Islam

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Systolic Blood Pressure ◽

Smoking Habit ◽

Significant Risk ◽

Medical Problem ◽

Blood Pressure Reading ◽

Categorical Variables ◽

Chi Square ◽

Pressure Reading

Background: Hypertension (HTN) is a common medical problem and the premier risk factor for cardiovascular disease. Hypertension is growing at a faster rate among all aged population. Therefore, this study aimed to investigate the prevalence of hypertension and to identify the significant risk factors of hypertension among the respondents.Methods: The sample of 1302 randomly selected respondents of various government offices at Rangpur City Corporation, Bangladesh are taken for this study. Hypertension was defined by the systolic blood pressure reading above 140 or the diastolic reading above 90 mmHg. Pre-hypertension was defined by the systolic blood pressure reading 120-139 or the diastolic reading 80-89 mmHg. Prevalence and risk factors of hypertension are presented as percentages. The significant association between the categorical variables is measured using Chi-square test.Results: It is found that the prevalence of hypertension and pre-hypertension (stage-1 HTN) among the respondents are 25% and 54%, respectively. Most of the respondents are in the pre-HTN stage, and at any time they may fall under hypertension. Respondent’s age, gender, residence, smoking habit, and physical activity are found as significant factors of hypertension.Conclusions: Reliable information about the prevalence of hypertension and its associated risk factors is very essential for growing awareness, treatment, and control of hypertension. Prevalence of hypertension is high among the study subjects. The male respondents who are at the higher age group, residing in the urban area, not taking regular physical exercise, and having smoking habit are found more prevalent cases of hypertension than the other counterparts.

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Risk Factors of Hypercholesterolemia on Obese Pre-elderly Population in Rejosari Sub-village Gunung Kidul Yogyakarta

Journal of Health ◽

10.30590/vol3-no2-p92-97 ◽

2016 ◽

Vol 3 (2) ◽

pp. 92

Author(s):

Desto Arisandi ◽

Yesi Apriliasari ◽

Subrata Tri Widada

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Systolic Blood Pressure ◽

Total Cholesterol ◽

Diastolic Blood Pressure ◽

Cholesterol Level ◽

Total Cholesterol Level ◽

P Value ◽

Spearman Correlation ◽

Cell Recovery

Background: Obesity is one of the most epidemiological burden which is being a dangerous threat for global health. It also contributes for leading cause of hypercholesterolemia. Prevalence of stroke, diabetes mellitus, coronary heart disease, and hypertension in Indonesia has reached out 23.7% in 2007. Rejosari sub-village, Kemadang village, Tanjungsari sub-district locate in coastal area which is fisher taking mostly part of the citizen's occupation. Hence they have tendency to intake sea products such as shrimps, squids, crabs, anchovies, and bivalves that contain amino acid required to growth and cell recovery nevertheless it also has much cholesterol contained which cause of total cholesterol level rising. The aims of this study to determine risk factors of hypercholesterolemia on obese pre-eldery population in Rejosari sub-village, Kemadang village, Tanjungsari sub-district, Gunung Kidul district, Yogyakarta. Method: This was an analytic observational study with cross sectional that conducted on February 2015 on obese pre-eldery population in Rejosari sub-village, Kemadang village, Tanjungsari sub-district, Gunung Kidul district, Yogyakarta. Data collected such age, sex, blood pressure, seafood intake frequencies, and total cholesterol. Data were analyzed by STATA version 12 software for windows with spearman correlation statistical test. Result: This study findings that 30 pre-elderly people came as respondents. Data performed the average value of age was 49 years old, systolic blood pressure was 142 mmHg, diastolic blood pressure was 87 mmHg, seafood intake frequencies was 3 times per week, and total cholesterol level was 241 mg/dl. Spearman correlation shown age (p value=0.0477), systolic blood pressure (p value=0.0012), diasolic blood pressure (p value= 0.0435) and seafood intake frequencies (p value= 0.0018) have stattistical correlation with hypercholesterolemia. Conclusion:Age, systolic blood pressure, diastolic blood pressure, and seafood intake frequencies are correlated with total cholesterol raising within blood.

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Incidence of Post Dural Puncture Headache and Associated Factors Following Spinal Anaesthesia for Caesarean Delivery in Mulago National Referral Hospital

10.21203/rs.2.9491/v1 ◽

2019 ◽

Author(s):

Philo Nambooze ◽

Kizito Samuel ◽

John Baptist Kiggundu ◽

Andrew Kintu ◽

Mary T. Nabukenya

Keyword(s):

Caesarean Section ◽

Spinal Anesthesia ◽

Spinal Anaesthesia ◽

Associated Factors ◽

Dural Puncture ◽

Cost Effective ◽

Referral Hospital ◽

P Value ◽

Mulago National Referral Hospital ◽

National Referral Hospital

Abstract Background Spinal anaesthesia is a cost effective anaesthesia technique commonly used for abdominal procedures like caesarean sections. The incidence of post dural puncture headaches (PDPH) which is one of the most reported complications) remains unknown in Uganda. We set out to study the incidence of PDPH and associated factors following spinal anaesthesia in mothers delivering by caesarean section in Mulago National Referral Hospital. Methods Prospective cohort study among 1294 women that received spinal anaesthesia for emergency caesarean section delivery from July 2015 to February 2016. Consecutive sampling was applied to recruit participants. Pre-tested interviewer administered questionnaires were used to collect information on demographics and associated factors. Both bivariate and multivariate logistic regressions were used with a P value of 0.05 and confidence interval of 95% being considered statistically significant. Results The incidence of PDPH was found to be 48.8% (n=239/1294) (95%CI: 46.0-51.6). Significant factors associated with PDPH were history of spinal anaesthesia OR 1.3 95% CI (1.0-1.6) p=0.04 and loss more than 500mls of blood during surgery OR 2.2, 95% CI (1.1-4.2) P=0.02. Conclusion Results from our study indicate high incidence of PDPH women undergoing spinal anesthesia for Caesarean section. Prior exposure to spinal anesthesia and blood loss of more than 500mls are the major associated factors. There is need to objectively screen women at risk for PDPH prior to caesarean section and institute appropriate interventions.

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Incidence Of Post Dural Puncture Headache And Associated Factors Following Spinal Anaesthesia For Caesarean Delivery In Mulago National Referral Hospital

10.21203/rs.2.9491/v2 ◽

2019 ◽

Author(s):

Philo Nambooze ◽

Kizito Samuel ◽

John Baptist Kiggundu ◽

Andrew Kintu ◽

Mary T. Nabukenya

Keyword(s):

Caesarean Section ◽

Spinal Anesthesia ◽

Spinal Anaesthesia ◽

Associated Factors ◽

Dural Puncture ◽

Cost Effective ◽

Referral Hospital ◽

P Value ◽

Mulago National Referral Hospital ◽

National Referral Hospital

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

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.253 ◽

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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Effects of Cranberry Juice Supplementation on Cardiovascular Disease Risk Factors in Adults with Elevated Blood Pressure: A Randomized Controlled Trial

Nutrients ◽

10.3390/nu13082618 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2618

Author(s):

Chesney K. Richter ◽

Ann C. Skulas-Ray ◽

Trent L. Gaugler ◽

Stacey Meily ◽

Kristina S. Petersen ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Systolic Blood Pressure ◽

Vascular Function ◽

Elevated Blood Pressure ◽

Elevated Blood ◽

Lipoprotein Profile ◽

Cranberry Juice ◽

Central Systolic Blood Pressure

Emerging cardiovascular disease (CVD) risk factors, including central vascular function and HDL efflux, may be modifiable with food-based interventions such as cranberry juice. A randomized, placebo-controlled, crossover trial was conducted in middle-aged adults with overweight/obesity (n = 40; mean BMI: 28.7 ± 0.8 kg/m2; mean age: 47 ± 2 years) and elevated brachial blood pressure (mean systolic/diastolic BP: 124 ± 2/81 ± 1 mm Hg). Study participants consumed 500 mL/d of cranberry juice (~16 fl oz; 27% cranberry juice) or a matched placebo juice in a randomized order (8-week supplementation periods; 8-week compliance break), with blood samples and vascular measurements obtained at study entry and following each supplementation period. There was no significant treatment effect of cranberry juice supplementation on the primary endpoint of central systolic blood pressure or central or brachial diastolic pressure. Cranberry juice significantly reduced 24-h diastolic ambulatory BP by ~2 mm Hg compared to the placebo (p = 0.05) during daytime hours. Cranberry juice supplementation did not alter LDL-C but significantly changed the composition of the lipoprotein profile compared to the placebo, increasing the concentration of large LDL-C particles (+29.5 vs. −6.7 nmol/L; p = 0.02) and LDL size (+0.073 vs. −0.068 nm; p = 0.001). There was no effect of treatment on ex vivo HDL efflux in the total population, but exploratory subgroup analyses identified an interaction between BMI and global HDL efflux (p = 0.02), with greater effect of cranberry juice in participants who were overweight. Exploratory analyses indicate that baseline C-reactive protein (CRP) values may moderate treatment effects. In this population of adults with elevated blood pressure, cranberry juice supplementation had no significant effect on central systolic blood pressure but did have modest effects on 24-hr diastolic ambulatory BP and the lipoprotein profile. Future studies are needed to verify these findings and the results of our exploratory analyses related to baseline health moderators.

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Abstract P052: Circulating Natural Killer Cells and Subclinical Cardiovascular Disease in the Multi-Ethnic Study of Atherosclerosis (MESA)

Circulation ◽

10.1161/circ.137.suppl_1.p052 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Nancy S Jenny ◽

Nels C Olson ◽

Alicia M Ellis ◽

Margaret F Doyle ◽

Sally A Huber ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Confidence Interval ◽

Systolic Blood Pressure ◽

Nk Cells ◽

Nk Cell ◽

Agatston Score ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Race Ethnicity

Introduction: Clinically, natural killer (NK) cells are important in inflammatory and autoimmune diseases. As part of innate immunity, NK cells produce chemokines and inflammatory cytokines, potentially linking them to cardiovascular disease (CVD) development and progression as well. However, their role in human CVD is not clear. Hypothesis: NK cells are proatherogenic in humans and are associated with CVD risk factors and subclinical CVD measures. Methods: We examined cross-sectional associations of circulating NK cell levels with CVD risk factors, subclinical CVD measures and coronary artery calcium (CAC) in 891 White, Black, Chinese and Hispanic men and women (mean age 66 y) in the Multi-Ethnic Study of Atherosclerosis (MESA) at Exam 4 (2005-07). NK cell percent, percent of circulating lymphocytes that were CD3 - CD56 + CD16 + , was measured in whole blood by flow cytometry. CAC presence was defined as Agatston score > 0. Results: Mean (standard deviation) NK percent differed by race/ethnicity; 8.2% (4.7) in Whites, 11.3% (7.5) in Chinese (p<0.001 compared to Whites), 7.1 (4.2) in Blacks (p=0.007) and 8.4 (5.2) in Hispanics (p=0.6). NK cell percent was positively associated with age (p<0.001) and systolic blood pressure (P=0.003) in the full group. However, NK cell percent was lower in current smokers than in never smokers (p=0.002). Adjusting for age, sex, race/ethnicity, smoking, body mass index, systolic blood pressure, diabetes and dyslipidemia, NK cell percent was negatively associated with common carotid intima media thickness (IMT; β coefficient -0.01; 95% confidence interval -0.03, -0.003) but was not associated with internal carotid IMT (-0.002; -0.037, 0.033). Likewise, NK cell percent was not associated with the presence of CAC (compared those with no detectable CAC; relative risk 1.02; 95% confidence interval 0.96, 1.08) or continuous Agatston score in those with a positive score (β coefficient 0.16, 95% confidence interval -0.003, 0.32) in the full group (models adjusted as above). Results were similar across race/ethnic groups. Conclusions: Of clinical interest, CD3 - CD56 + CD16 + NK cell percent varied significantly by race/ethnicity in these men and women from MESA. However, NK cell percent was inconsistently associated with CVD risk factors; positively with age and systolic blood pressure, and negatively with smoking. NK cell percent was also negatively associated with common carotid IMT. Larger sample sizes and longitudinal analyses will be required to clarify the potential relationship between NK cells and atherosclerosis in humans.

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