Over the past years, prevention and control of risk factors has begun to play an important role in the management of patients prone to develop atrial fibrillation (AF). A considerable number of risk factors that contribute to the creation of a predisposing substrate for AF has been identified over the years. Although certain AF risk factors such as age, gender, genetic predisposition, or race are unmodifiable, controlling modifiable risk factors may represent an invaluable tool in the management of AF patients. In the recent decades, numerous studies have evaluated the mechanisms linking different risk factors to AF, but the exact degree of atrial remodeling induced by each factor remains unknown. Elucidating these mechanisms is essential for initiating personalized therapies in patients prone to develop AF. The present review aims to provide an overview of the most relevant modifiable risk factors involved in AF occurrence, with a focus on the mechanisms by which these factors lead to AF initiation and perpetuation.
Tag Archives: risk factors
Diet, Smoking and Family History as Potential Risk Factors in Acne Vulgaris – a Community-Based Study
Objective. This study aimed to evaluate the effects of practices and attitudes towards lifestyle in adolescence as risk or protective factors, for both the acne occurrence and lesions’ severity.
Methods. A cross-sectional study based on a self-reported questionnaire was conducted during 4 months on 148 high school students, aged 16-20 years, in a high school community of Tîrgu Mureș. Acne prevalence and severity, demographic and anthropometric characteristics, the family history of acne vulgaris, smoking behavior and the weekly intake of certain food categories supposed to increase the risk of acne vulgaris were evaluated. Statistical analysis was performed in terms of Odds ratio, Confidence Interval and Chi-square (p<0.05) methods.
Results. In the investigated community, acne prevalence was found of 47.30%, while 78 subjects (control group) had no facial acne lesions. In acne group: 57.1% had family history of acne, 62.9% were smokers, 22.9% were overweight or obese and 84.3% did not receive any dietary information from specialists. 41.4% were not fish consumers, while 74.3% rarely or never were eating fruits and vegetables. Statistically significant differences between the two analyzed groups were found in terms of sweets, carbonated drinks, dietary fat, white bread, fish, fruits and vegetables weekly intake.
Conclusions. Family history, smoking behavior, excessive dietary fat, sweets, carbonated drinks and white bread could be considered as risk factors in acne vulgaris. An increased weekly intake of fish, vegetables and fruits, may have a protective effect in acne development or severity.
Helicobacter Pylori and its Determinations on Gastric Biopsies
Background and Aims. Gastric cancer, because of its aggressive evolution and the high mortality associated with it, remains one of the most debated subjects in medical literature with Helicobacter pylori (HP) as a major risk factor. Chronic inflammation caused by HP infection represents the initial site of the predisposing and afterwards premalignant lesions for gastric carcinoma. The purpose of this study was to evaluate the prevalence of HP infection, of predisposing and premalignant lesions on gastric biopsies, as well as to identify the correlations between them.
Material and method. A retrospective cross-sectional study was performed on gastric biopsies collected endoscopically from a single region, antrum or corpus, and from different regions, between January 2012 and July 2014. Incidence of HP infection, of predisposing and premalignant gastric lesions, the correlation of HP infection and these lesions, were evaluated.
Results. HP infection was diagnosed in 32.81%. Predisposing and premalignant lesions were present in 53.64% of biopsies with most of them in the antrum. HP infection stands out for the under 50 yo group (p=0.001). No correlation between frequency of HP infection and predisposing and premalignant lesions was observed.
Conclusions. Prevalence of HP infection in our study suggests that besides HP infection, other factors are also involved in gastric cancer development. Biopsies from different regions of the gastric mucosa do not offer extra information regarding HP infection prevalence but may be helpful in evaluating incidence and extension of predisposing and premalignant lesions.
Assessment of the Risk Factors for Deceased Patients in Pediatric Clinic I
Purpose: The evaluation of the risk factors in patients deceased in Pediatric Intensive Care Unit (PICU) during January 1 to December 31, 2009.
Material and method: This is a retrospective study in which we evaluated the risk factors of the 29 deceased patients admitted in PICU. We followed the age groups, gender, environment, prior treatments, number of hospitalization days, the patient flow, the associated comorbidities, the mothers’ age and the anatomico-pathological concordances.
Results: From all 29 deceased patients, 34.48% were between 3–12 months, the average age being 27.3 months. 79.31% came from rural areas. The number of deaths was almost equally distributed between sexes. Etiological, nosological, location-related and complication-related consistencies were found. The main cause of death was the respiratory disease. In the cold season, the number of deaths was increased. Most children were admitted in Pediatric Clinic I from other clinics, were hospitalized for more than 72 hours and presented at least one comorbidity.
Conclusions: The main risk factors that concluded in children’s death were: association with at least one comorbidity, the age group of less than 1 year, as well as the patient’s flow through multiple sections. The main cause of death was respiratory infection. Etiological, nosological, location-related and complication-related consistencies were present.
Evaluation of Diastolic Function in Patients with Aortic Stenosis
Introduction: Diastolic dysfunction is characterized by an increased resistance to filling with increased diastolic filling pressures. Aortic stenosis has become the most frequent type of valvular heart disease. Aortic stenosis increases diastolic filling pressures due left ventricular hypertrophy.
Material and methods: Our study is a retrospective one, and includes the IV. th Medical Clinic patients discharged in years 2009–2010. Thirty-four patients with severe aortic stenosis (group A), and 21 patients with moderate aortic stenosis (group B) underwent complete paraclinical evaluation.
Results: The mean age in the group A was 70 years, versus 67 years in group B. The left atrium anteroposterior diameter was 46 mm in grop A, and 43 mm in group B. In group A, the mean left ventricular thickness index was 0.51, versus 0.46 in group B. Severe diastolic dysfunction was present in 35% in group A , and in 19% in group B. The most frequent associated pathology was hypertension (35% in group A, 47% in group B).The most common complications were mitral insufficiency (31 patients in group A, 16 patients in group B), pulmonary hypertension (16 patients versus 9 patients).
Conclusions: The severe aortic stenosis was more frequent in advanced ages. The left atrium enlargement, the severe diastolic dysfunction, and a greater left ventricular wall thickness index were more common in patients with severe aortic stenosis. The most common associated risk factors in both groups were hypertension. The mitral regurgitation was more frequent in the severe aortic stenosis group.
The Impact of Modifiable Risk Factors on the Short-term Outcome of Stroke
Objective: The high stroke morbidity and related mortality in Central-Eastern European countries might be related to several factors. In this study we used a large, database from Tîrgu Mureș (Romania) to investigate the impact of risk factors on the short-term outcome of stroke. We opted for this method as hospital databases usually provide more detailed information on risk factors, stroke severity and correlated outcome than population based registries.
Methods: We analyzed the data of 1478 consecutively hospitalized stroke patients during a period of one year, regardless of the ward they were admitted to. We recorded risk factors, stroke severity and correlated with the short-term outcome (i.e. in-hospital outcome, assessed by Glasgow Outcome Scale) of stroke.
Results: Significantly more men and patients with a lower age than the European average were admitted. 26% of admitted patients had a previous cerebrovascular disease in their history. The prevalence of modifiable risk factors such as hypertension, diabetes, hyperlipidaemia, smoking, etc was higher than in other European countries. Overall case fatality was 10.4% and 75% of discharged patients had some degree of disability. Outcome at discharge was worse with higher systolic and diastolic blood pressure, increased heart rate, higher serum glucose, higher white blood cell count as well as decreased consciousness and increased age.
Conclusions: In this large hospital based database we found an alarming number of untreated and frequently aggregated risk factors. Our findings emphasize the role of modifiable risk factors as well as indicate major opportunities for more efficient stroke prevention.
Traditional Risk Factors in Hypertensive Women and Men with Ischemic Heart Disease
Background: Ischemic heart disease is the main cause of morbidity and mortality in Europe. It occurs often in women, and its prevalence increases with age. Hypertensive patients with coronary heart disease are at highest risk and thus are the most important target of secondary prevention strategies. The purpose of this study was the identification of traditional cardiovascular risk factors in group of patients with known cardiovascular disease.
Material and methods: One hundred seventy-six patients took part in this cross -sectional study, which included 72 women and 104 men. Statistical analysis was performed with Microsoft Excel and SPSS 17 Programs.
Results: The average age of the patients was 66 for women and 68 for men. Obesity (BMI >30) was found more among women. We haven’t found statistically significant differences between the sexes regarding lipid profile, this being a common risk factor for both men and women. New cases of diabetes have been discovered in 19%.
Conclusions: Traditonal cardiovascular risk factors are present both in women and men with hypertension and ischemic heart disease.The target levels for lipids suggested by secondary prevention guides are not achieved by a large number of patients.
Frequency of Risk Factors in Retinopathy of Prematurity In a Sample of Infants from Mureș County
Objective: To analyze the risk factors involved in retinopathy of prematurity (ROP) and to report the incidence of ROP in premature infants from Mureș county, Romania.
Material and methods: Our study was based on a prospective study of premature infants with risk for developing ROP, based on international protocols, admitted to the Neonatal Intensive Care Unit from Tîrgu Mureș, between March 2008 and March 2010. In the study were included all the premature babies with gestational age ≤32 weeks and birth weight ≤1500 g, and those with gestational age >32 weeks and birth weight >1500 g, but with unstable perinatal evolution. Ophthalmic examinations were started at 4–6 weeks after birth, and followed until complete resolution of ROP or complete maturation of the retina. We used Chi square test and Fisher test to estimated relative risk (RR), associated with the risk factors of ROP.
Results: In our group of 137 premature babies monitored, 22% were in different stages of ROP. The advanced types of illness that needed therapeutic intervention represented 3% of all premature babies monitored and 13% of all babies with ROP. We found a statistically significant association between low birth weight (≤1500 g), low gestational age (≤32 weeks), mechanical ventilation for more than 7 days, intrauterine risk factors (maternal preeclampsia), respiratory distress syndrome, and the development of ROP. We also found a statistically significant association between extremely low birth weight (≤1000 g) and the development of severe forms of ROP. The other followed risk factors (blood transfusion, anemia or sepsis) were not linked significantly to the risk of ROP development.
Conclusions: Despite progress in neonatal intensive care, ROP persists and can be explained by greater prematurity and early screening. Effective screening procedures performed between the 4th and 6th week of life can improve the prognosis of the disease.
Management Algorithm for Surgical Patients Infected with Human Immunodeficiency Virus
Objective: The purpose of this study was to establish the risk factors which influence the postoperative evolution of surgical patients infected with human immunodeficiency virus (HIV), and to conceive a management algorithm based upon these factors.
Methods: We have performed a bidirectional transversal study on a group of 73 HIV-positive patients who had undergone 104 surgical procedures during 2006–2010 in the university medical center of Tîrgu Mureş. We studied risk factors such as the number of CD4 T-cells (LTCD4) < 100/µl, anemia, thrombocytopenia, hypoproteinemia, leukopenia, wasting syndrome, ASA (American Society of Anesthesiologists) score, Altemeier class and NNISS (National Nosocomial Infections Survey Systems) score. We defined any registered postoperative complication, as well as all deaths within the first 30 days from surgery as poor outcome. We used GraphPad statistical program, Fisher test for the statistical analysis of data, we interpreted p <0.05 as statistically significant, for a CI of 95%.
Results: We have registered a total of 15 complications, 5 deaths. Risk factors associated with poor postoperative outcome were LTCD4 <100/µl (p=0.03) wasting syndrome (p=0.0001), ASA score > 1 (p=0.01), Altemeier class > II (p=0.0001), NNISS score 1 (p=0.0001).
Conclusions: HIV-infected patients with emergency surgical pathology will benefit of surgical treatment when the anesthetic risk does not overpass the surgical risk, while patients who require elective interventions will be operated after the correction of risk factors.
New Onset Diabetes Mellitus in Heart Transplant Recipients
Introduction: New onset diabetes mellitus in patients with heart transplant is a known complication with importance in the long term survival.
Material and methods: We have studied the incidence of new onset diabetes in a group of 38 patients with heart transplant that are included database of Emergency Institute of Cardiovascular Diseases and Transplantation, Tîrgu Mureș, between 1999–2011.
Results: The incidence of new onset diabetes was of 24.32% in the 1st month of posttransplant evolution, 22.58% at 1 year of evolution, 18.18% at 3 years of evolution and 10% at 5 years of posttransplant evolution. We have studied these posttransplant complications in relation with the risk factors and the most important complications in the evolution of these patients.
Conclusions: New onset diabetes in heart transplant recipients is a serious complication with high incidence and with serious implications in their evolution, requiring an accurate screening of the recipients in the waiting list and a periodical posttransplant evaluation, an early detection and a prompt and efficient treatment.