This study analyzed the association between daily levels of air pollution (PM10 and other pollutants) and hospital admissions for ischemic and hemorrhagic stroke among Medicare recipients aged 65 and older in 9 U.S. cities. The results showed a small increased risk of ischemic stroke admissions on high pollution days but no association with hemorrhagic stroke admissions. Specifically, an interquartile range increase in PM10 was associated with a 1.03% increase in ischemic stroke admissions on the same day, but no increased risk 1-2 days prior. No association was found between air pollution and hemorrhagic stroke admissions.
The document reviews literature on Growth Differentiation Factor 15 (GDF-15) and its ability to predict risk in cardiovascular disease. It summarizes data from 17 clinical trials involving over 44,000 patients with stable coronary artery disease or acute coronary syndrome. The studies consistently showed that elevated levels of GDF-15 were associated with higher risks of all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, and heart failure during follow-up periods ranging from 6 months to 10 years. GDF-15 appears to be a promising new biomarker for assessing prognosis in patients with ischemic heart disease.
Three famous individuals struggled with chronic kidney disease: former rugby player Jonah Lomu who had a transplant, film director Alfred Hitchcock who died of renal failure, and the fictional Tiny Tim from A Christmas Carol who appeared to have chronic kidney disease alongside rickets. Chronic kidney disease can have various causes such as genetics, obesity, diabetes or environmental factors as represented by these three examples. Chronic kidney disease is defined as long term kidney damage and is associated with increased mortality, often progressing to end stage renal disease. It affects millions worldwide and prevalence is expected to increase significantly in coming decades due to aging populations and risk factors like diabetes and hypertension.
This case report describes a 76-year-old male patient diagnosed with Marine-Lenhart syndrome. The patient had a history of Graves' disease treated with antithyroid drugs. Tests showed suppressed TSH levels and the patient was referred to an endocrinology department. Exams including ultrasound and scintigraphy revealed the patient had Graves' disease along with a hyperactive nodule in the thyroid, consistent with Marine-Lenhart syndrome. The patient was treated with antithyroid drugs followed by radioactive iodine therapy. Follow up showed improvement of hyperthyroidism symptoms. Marine-Lenhart syndrome is a rare cause of hyperthyroidism where a patient has Graves' disease concurrently with a hyperfunctional thyroid nodule.
Predictors of gastrointestinal bleeding in acute intracerebral haemorrhagesulastio
This study evaluated predictors of gastrointestinal bleeding in 51 patients with acute intracerebral hemorrhage. The researchers found that 30% of patients experienced GI bleeding. Multivariate analysis identified three key predictors: larger hematoma size, presence of sepsis, and lower Glasgow Coma Scale scores. Patients with these factors were more likely to experience GI bleeding. The study highlights sepsis as an important and modifiable risk factor for GI bleeding in ICH patients.
Cardiovascular disease is very common in patients with chronic kidney disease.
- CVD is the leading cause of death in patients with CKD, even in early stages of kidney disease and those with low levels of albuminuria. Reduced kidney function and increased albuminuria are associated with higher risk of CVD events and mortality.
- The prevalence of CVD is extremely high in patients on dialysis, with over 70% of dialysis patients having CVD. CVD is responsible for about 40% of all deaths in dialysis patients.
- Both traditional CVD risk factors like hypertension and diabetes as well as nontraditional risk factors related to CKD contribute to the elevated CVD risk in this population. Targeting modifiable
Global Medical Cures™ | Kidney Disease Statistics for USA
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
The document summarizes a study on severe sepsis and septic shock patients admitted to a medical ICU in Turkey between 2007-2014. The key findings are:
1) 33.1% of ICU patients were admitted with severe sepsis or septic shock, with an overall mortality rate of 48.3%.
2) The most common infection source was respiratory (45.5%) and the most frequent isolated organism was E. coli (23%).
3) While the frequency of sepsis varied over the 8-year period, mortality rates in the ICU and hospital did not significantly change over time.
The document reviews literature on Growth Differentiation Factor 15 (GDF-15) and its ability to predict risk in cardiovascular disease. It summarizes data from 17 clinical trials involving over 44,000 patients with stable coronary artery disease or acute coronary syndrome. The studies consistently showed that elevated levels of GDF-15 were associated with higher risks of all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, and heart failure during follow-up periods ranging from 6 months to 10 years. GDF-15 appears to be a promising new biomarker for assessing prognosis in patients with ischemic heart disease.
Three famous individuals struggled with chronic kidney disease: former rugby player Jonah Lomu who had a transplant, film director Alfred Hitchcock who died of renal failure, and the fictional Tiny Tim from A Christmas Carol who appeared to have chronic kidney disease alongside rickets. Chronic kidney disease can have various causes such as genetics, obesity, diabetes or environmental factors as represented by these three examples. Chronic kidney disease is defined as long term kidney damage and is associated with increased mortality, often progressing to end stage renal disease. It affects millions worldwide and prevalence is expected to increase significantly in coming decades due to aging populations and risk factors like diabetes and hypertension.
This case report describes a 76-year-old male patient diagnosed with Marine-Lenhart syndrome. The patient had a history of Graves' disease treated with antithyroid drugs. Tests showed suppressed TSH levels and the patient was referred to an endocrinology department. Exams including ultrasound and scintigraphy revealed the patient had Graves' disease along with a hyperactive nodule in the thyroid, consistent with Marine-Lenhart syndrome. The patient was treated with antithyroid drugs followed by radioactive iodine therapy. Follow up showed improvement of hyperthyroidism symptoms. Marine-Lenhart syndrome is a rare cause of hyperthyroidism where a patient has Graves' disease concurrently with a hyperfunctional thyroid nodule.
Predictors of gastrointestinal bleeding in acute intracerebral haemorrhagesulastio
This study evaluated predictors of gastrointestinal bleeding in 51 patients with acute intracerebral hemorrhage. The researchers found that 30% of patients experienced GI bleeding. Multivariate analysis identified three key predictors: larger hematoma size, presence of sepsis, and lower Glasgow Coma Scale scores. Patients with these factors were more likely to experience GI bleeding. The study highlights sepsis as an important and modifiable risk factor for GI bleeding in ICH patients.
Cardiovascular disease is very common in patients with chronic kidney disease.
- CVD is the leading cause of death in patients with CKD, even in early stages of kidney disease and those with low levels of albuminuria. Reduced kidney function and increased albuminuria are associated with higher risk of CVD events and mortality.
- The prevalence of CVD is extremely high in patients on dialysis, with over 70% of dialysis patients having CVD. CVD is responsible for about 40% of all deaths in dialysis patients.
- Both traditional CVD risk factors like hypertension and diabetes as well as nontraditional risk factors related to CKD contribute to the elevated CVD risk in this population. Targeting modifiable
Global Medical Cures™ | Kidney Disease Statistics for USA
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
The document summarizes a study on severe sepsis and septic shock patients admitted to a medical ICU in Turkey between 2007-2014. The key findings are:
1) 33.1% of ICU patients were admitted with severe sepsis or septic shock, with an overall mortality rate of 48.3%.
2) The most common infection source was respiratory (45.5%) and the most frequent isolated organism was E. coli (23%).
3) While the frequency of sepsis varied over the 8-year period, mortality rates in the ICU and hospital did not significantly change over time.
The document discusses an indoor positioning and mapping project being conducted by the IMES Consortium and LBS Working Group. The project aims to create an indoor mapping and positioning sub-community within OpenStreetMap. It also discusses the Indoor Messaging System (IMES), which was developed in Japan as a solution for indoor positioning using existing GPS receivers and signals from low-cost indoor transmitters that broadcast their 3D position data.
ProService indoor air quality for Hospitals & HealthcareMohamed Ramadan
Indoor Air Quality Management:
Air duct cleaning.
Air duct disinfection.
Air coils cleaning.
Air coils disinfection.
Air handling systems cleaning.
Air handling systems disinfection .
Indoor air quality is important in hospitals where patients spend significant time. Poor indoor air quality can be caused by several factors like the building layout and HVAC system. Common indoor pollutants in hospitals include sensitizing agents, irritants, toxins, and infectious aerosols from patients. Exposure limits exist for various compounds to protect health, such as limits for formaldehyde, glutaraldehyde, and anesthetic gases.
The document discusses indoor environmental quality (IEQ) and factors that affect it, including lighting, air quality, and damp conditions. IEQ encompasses indoor air quality, which focuses on airborne contaminants as well as comfort issues. Maintaining good IEQ is important for occupant health and well-being. The document outlines various strategies for ensuring good indoor air quality during construction and occupancy, such as implementing an indoor air quality management plan during construction, conducting flush-outs or air testing before occupancy, using low-emitting materials, and monitoring outdoor air delivery.
Indoor and outdoor air quality in hospital environmentAlexander Decker
This study measured indoor and outdoor particulate matter concentrations at five locations in a Nigerian hospital between December 2010 and February 2011. The indoor particulate matter ranged from 243.05-451.39 micrograms per cubic meter, while outdoor particulate matter ranged from 451.39-625 micrograms per cubic meter. There was a positive correlation between indoor and outdoor particulate levels. Both indoor and outdoor particulate matter showed significant spatial variation between locations. Indoor particulate levels exceeded WHO and Nigerian standards in most locations, likely due to sources such as burning waste, cooking fires, photocopiers, vehicles, carpets and printers.
1) Hospital ventilation systems are important to prevent the spread of diseases by controlling air quality, temperature, humidity and airflow.
2) Older conventional ventilation systems had limitations, while new mechanical systems require more space, energy and maintenance.
3) A properly designed system can clean air and create clean zones, while a poorly designed one can spread infections via airborne contaminants from various sources within the HVAC system.
Indoor air quality (IAQ) is a term which refers to the air quality within and around buildings and structures, especially as it relates to the health and comfort of building occupants.
This document summarizes indoor air quality (IAQ), including potential health effects, common causative agents and their sources, and control methodologies. It discusses sick building syndrome and some of its common symptoms. Asthma is highlighted as afflicting 20 million Americans and being exacerbated by indoor environmental factors. Molds are described as growing indoors when moisture is present. IAQ issues in schools are also covered, noting many schools have unsatisfactory air quality. The EPA Building Air Quality guidance document is provided as a resource.
A green hospital aims to enhance patient well-being and recovery while efficiently conserving natural resources. Key benefits include 20-40% energy savings, 35-40% water savings, improved indoor air quality, and faster patient recovery compared to conventional hospitals. Design aspects focus on maximizing daylight, indoor plant life, green materials, and connecting patients to outdoor views and nature.
Indoor air pollution refers to pollutants found inside homes, schools, and other buildings that can negatively impact health. Common sources of indoor air pollution include tobacco smoke, combustion appliances, building materials and furnishings, chemicals from consumer products, and outdoor air pollution entering through open windows or other means. Exposure to indoor air pollutants is an important environmental problem since people spend most of their time indoors where pollutant levels are often higher than outside. Indoor air pollution has been linked to various respiratory and other health issues.
The document discusses indoor air quality (IAQ) and some of the factors that affect it. It defines IAQ as the total attributes of indoor air that impact health and well-being, including pollutant levels, temperature, humidity, and odors. Poor IAQ can cause building-related illnesses like sick building syndrome, with symptoms like headaches and fatigue. Common indoor pollutants come from sources like building materials, dust, tobacco smoke, and lack of proper ventilation. Maintaining good IAQ requires identifying pollutant sources and regulating ventilation, temperature, and humidity.
Indoor air quality refers to the air quality within homes and buildings and how it affects occupant health and comfort. Recent findings show indoor air is often more polluted than outdoor air as people spend up to 90% of their time indoors. Sources release gases and particles indoors, while inadequate ventilation increases indoor pollutants to dangerous levels. Common indoor pollutants include asbestos, biological pollutants, carbon monoxide, formaldehyde, lead, nitrogen dioxide, radon, respirable particles, and secondhand smoke, which can have various negative health effects. Proper ventilation, maintenance, and reducing sources can improve indoor air quality.
Indoor air quality is important for health and comfort. This document discusses indoor air quality standards and guidelines from organizations like ASHRAE. It outlines maximum recommended levels of contaminants like carbon dioxide and particulate matter. Maintaining good indoor air quality involves controlling sources of contamination, proper ventilation, humidity management, and adequate filtration of indoor air. Key aspects of a good ventilation system include cleanable components, accessibility for maintenance, and managing both indoor and outdoor air quality.
This document discusses indoor air quality and indoor air quality management. It defines indoor air quality and notes that it can be affected by gases, particulates, and microbial contaminants. The primary methods for improving indoor air quality are identified as source control, filtration, and ventilation. Common indoor air pollutants such as second-hand smoke, radon, molds, and carbon monoxide are also discussed. Health effects of poor indoor air quality and sick building syndrome are summarized.
A green hospital utilizes sustainable practices to enhance patient well-being while efficiently conserving natural resources. It focuses on green design, construction, and operations like using renewable energy, recycling waste, and promoting natural lighting and indoor air quality. Studies show green hospitals experience lower costs through energy and water savings while providing health benefits like faster recovery times for patients.
Air condition requirement in hospitalsHeena Kousar
Air conditioning in hospitals is essential for three main reasons:
1) It provides a comfortable environment that allows for faster patient recovery and allows doctors to work more effectively.
2) It helps control the spread of airborne bacteria and viruses by diluting contaminants and removing them via filtration. Specialized HEPA filters are used to filter out 99.97% of particles.
3) Different hospital areas have specific temperature and humidity requirements that air conditioning can precisely regulate, such as operating rooms and burn units. Proper air conditioning is vital for infection control and indoor air quality in healthcare facilities.
Kohinoor Hospital the Sustainable HospitalRajat Katarne
The document describes Kohinoor Hospital, a 227,000 square foot, 150-bed multi-specialty hospital in Mumbai. It has implemented numerous sustainable and energy efficient practices, such as using natural light, recycled materials in construction, an on-site water treatment plant for reuse, and solar panels. As a result of these initiatives, Kohinoor Hospital is the first and only LEED Platinum certified hospital in India, demonstrating industry-leading sustainability standards.
This document discusses indoor environmental quality (IEQ) in office and healthcare settings. IEQ refers to the state of the air and environment inside buildings that contribute to occupant health and comfort. It is determined by factors like thermal comfort, lighting, indoor air quality, and acoustics. Poor IEQ can result from inadequate ventilation, indoor pollutants, thermal discomfort, and more. Sick building syndrome describes health issues linked to time spent in a building, like headaches, fatigue, and respiratory problems. The document recommends IEQ management plans, installing proper HVAC systems, and conducting surveys to evaluate IEQ issues. It analyzes IEQ in a university office and hospital in Malaysia through occupant surveys and recommends upgrades to address
The document discusses hospital acquired infections, also known as nosocomial infections. It defines nosocomial infections as infections acquired during or after hospitalization. It discusses the epidemiological interaction between host factors, infectious agents, and the hospital environment. It also summarizes common bacterial, viral, and fungal agents that cause nosocomial infections and how they are transmitted. Prevention and control methods like isolation precautions, hand hygiene, and surveillance programs are also outlined.
This document summarizes key information from a medical report on prescribing dabigatran for a patient with renal impairment. It finds that for patients with a creatinine clearance of 15-30 mL/min, the recommended dose of dabigatran is 75 mg taken twice daily. Dabigatran is primarily cleared renally and its effects can be greater when renal impairment and P-gp inhibitors are combined. For patients on hemodialysis or with bleeding, dialysis can help reverse the effects of dabigatran. Clinical trials found dabigatran 110 mg and 150 mg doses were non-inferior to warfarin for stroke prevention in atrial fibrillation. The doctor
The document discusses an indoor positioning and mapping project being conducted by the IMES Consortium and LBS Working Group. The project aims to create an indoor mapping and positioning sub-community within OpenStreetMap. It also discusses the Indoor Messaging System (IMES), which was developed in Japan as a solution for indoor positioning using existing GPS receivers and signals from low-cost indoor transmitters that broadcast their 3D position data.
ProService indoor air quality for Hospitals & HealthcareMohamed Ramadan
Indoor Air Quality Management:
Air duct cleaning.
Air duct disinfection.
Air coils cleaning.
Air coils disinfection.
Air handling systems cleaning.
Air handling systems disinfection .
Indoor air quality is important in hospitals where patients spend significant time. Poor indoor air quality can be caused by several factors like the building layout and HVAC system. Common indoor pollutants in hospitals include sensitizing agents, irritants, toxins, and infectious aerosols from patients. Exposure limits exist for various compounds to protect health, such as limits for formaldehyde, glutaraldehyde, and anesthetic gases.
The document discusses indoor environmental quality (IEQ) and factors that affect it, including lighting, air quality, and damp conditions. IEQ encompasses indoor air quality, which focuses on airborne contaminants as well as comfort issues. Maintaining good IEQ is important for occupant health and well-being. The document outlines various strategies for ensuring good indoor air quality during construction and occupancy, such as implementing an indoor air quality management plan during construction, conducting flush-outs or air testing before occupancy, using low-emitting materials, and monitoring outdoor air delivery.
Indoor and outdoor air quality in hospital environmentAlexander Decker
This study measured indoor and outdoor particulate matter concentrations at five locations in a Nigerian hospital between December 2010 and February 2011. The indoor particulate matter ranged from 243.05-451.39 micrograms per cubic meter, while outdoor particulate matter ranged from 451.39-625 micrograms per cubic meter. There was a positive correlation between indoor and outdoor particulate levels. Both indoor and outdoor particulate matter showed significant spatial variation between locations. Indoor particulate levels exceeded WHO and Nigerian standards in most locations, likely due to sources such as burning waste, cooking fires, photocopiers, vehicles, carpets and printers.
1) Hospital ventilation systems are important to prevent the spread of diseases by controlling air quality, temperature, humidity and airflow.
2) Older conventional ventilation systems had limitations, while new mechanical systems require more space, energy and maintenance.
3) A properly designed system can clean air and create clean zones, while a poorly designed one can spread infections via airborne contaminants from various sources within the HVAC system.
Indoor air quality (IAQ) is a term which refers to the air quality within and around buildings and structures, especially as it relates to the health and comfort of building occupants.
This document summarizes indoor air quality (IAQ), including potential health effects, common causative agents and their sources, and control methodologies. It discusses sick building syndrome and some of its common symptoms. Asthma is highlighted as afflicting 20 million Americans and being exacerbated by indoor environmental factors. Molds are described as growing indoors when moisture is present. IAQ issues in schools are also covered, noting many schools have unsatisfactory air quality. The EPA Building Air Quality guidance document is provided as a resource.
A green hospital aims to enhance patient well-being and recovery while efficiently conserving natural resources. Key benefits include 20-40% energy savings, 35-40% water savings, improved indoor air quality, and faster patient recovery compared to conventional hospitals. Design aspects focus on maximizing daylight, indoor plant life, green materials, and connecting patients to outdoor views and nature.
Indoor air pollution refers to pollutants found inside homes, schools, and other buildings that can negatively impact health. Common sources of indoor air pollution include tobacco smoke, combustion appliances, building materials and furnishings, chemicals from consumer products, and outdoor air pollution entering through open windows or other means. Exposure to indoor air pollutants is an important environmental problem since people spend most of their time indoors where pollutant levels are often higher than outside. Indoor air pollution has been linked to various respiratory and other health issues.
The document discusses indoor air quality (IAQ) and some of the factors that affect it. It defines IAQ as the total attributes of indoor air that impact health and well-being, including pollutant levels, temperature, humidity, and odors. Poor IAQ can cause building-related illnesses like sick building syndrome, with symptoms like headaches and fatigue. Common indoor pollutants come from sources like building materials, dust, tobacco smoke, and lack of proper ventilation. Maintaining good IAQ requires identifying pollutant sources and regulating ventilation, temperature, and humidity.
Indoor air quality refers to the air quality within homes and buildings and how it affects occupant health and comfort. Recent findings show indoor air is often more polluted than outdoor air as people spend up to 90% of their time indoors. Sources release gases and particles indoors, while inadequate ventilation increases indoor pollutants to dangerous levels. Common indoor pollutants include asbestos, biological pollutants, carbon monoxide, formaldehyde, lead, nitrogen dioxide, radon, respirable particles, and secondhand smoke, which can have various negative health effects. Proper ventilation, maintenance, and reducing sources can improve indoor air quality.
Indoor air quality is important for health and comfort. This document discusses indoor air quality standards and guidelines from organizations like ASHRAE. It outlines maximum recommended levels of contaminants like carbon dioxide and particulate matter. Maintaining good indoor air quality involves controlling sources of contamination, proper ventilation, humidity management, and adequate filtration of indoor air. Key aspects of a good ventilation system include cleanable components, accessibility for maintenance, and managing both indoor and outdoor air quality.
This document discusses indoor air quality and indoor air quality management. It defines indoor air quality and notes that it can be affected by gases, particulates, and microbial contaminants. The primary methods for improving indoor air quality are identified as source control, filtration, and ventilation. Common indoor air pollutants such as second-hand smoke, radon, molds, and carbon monoxide are also discussed. Health effects of poor indoor air quality and sick building syndrome are summarized.
A green hospital utilizes sustainable practices to enhance patient well-being while efficiently conserving natural resources. It focuses on green design, construction, and operations like using renewable energy, recycling waste, and promoting natural lighting and indoor air quality. Studies show green hospitals experience lower costs through energy and water savings while providing health benefits like faster recovery times for patients.
Air condition requirement in hospitalsHeena Kousar
Air conditioning in hospitals is essential for three main reasons:
1) It provides a comfortable environment that allows for faster patient recovery and allows doctors to work more effectively.
2) It helps control the spread of airborne bacteria and viruses by diluting contaminants and removing them via filtration. Specialized HEPA filters are used to filter out 99.97% of particles.
3) Different hospital areas have specific temperature and humidity requirements that air conditioning can precisely regulate, such as operating rooms and burn units. Proper air conditioning is vital for infection control and indoor air quality in healthcare facilities.
Kohinoor Hospital the Sustainable HospitalRajat Katarne
The document describes Kohinoor Hospital, a 227,000 square foot, 150-bed multi-specialty hospital in Mumbai. It has implemented numerous sustainable and energy efficient practices, such as using natural light, recycled materials in construction, an on-site water treatment plant for reuse, and solar panels. As a result of these initiatives, Kohinoor Hospital is the first and only LEED Platinum certified hospital in India, demonstrating industry-leading sustainability standards.
This document discusses indoor environmental quality (IEQ) in office and healthcare settings. IEQ refers to the state of the air and environment inside buildings that contribute to occupant health and comfort. It is determined by factors like thermal comfort, lighting, indoor air quality, and acoustics. Poor IEQ can result from inadequate ventilation, indoor pollutants, thermal discomfort, and more. Sick building syndrome describes health issues linked to time spent in a building, like headaches, fatigue, and respiratory problems. The document recommends IEQ management plans, installing proper HVAC systems, and conducting surveys to evaluate IEQ issues. It analyzes IEQ in a university office and hospital in Malaysia through occupant surveys and recommends upgrades to address
The document discusses hospital acquired infections, also known as nosocomial infections. It defines nosocomial infections as infections acquired during or after hospitalization. It discusses the epidemiological interaction between host factors, infectious agents, and the hospital environment. It also summarizes common bacterial, viral, and fungal agents that cause nosocomial infections and how they are transmitted. Prevention and control methods like isolation precautions, hand hygiene, and surveillance programs are also outlined.
This document summarizes key information from a medical report on prescribing dabigatran for a patient with renal impairment. It finds that for patients with a creatinine clearance of 15-30 mL/min, the recommended dose of dabigatran is 75 mg taken twice daily. Dabigatran is primarily cleared renally and its effects can be greater when renal impairment and P-gp inhibitors are combined. For patients on hemodialysis or with bleeding, dialysis can help reverse the effects of dabigatran. Clinical trials found dabigatran 110 mg and 150 mg doses were non-inferior to warfarin for stroke prevention in atrial fibrillation. The doctor
The differenece betweeen central and peripheral Blood pressure and its clinic...JAFAR ALSAID
Central blood pressure provides a more accurate assessment of the pressure load on target organs like the heart, brain and kidneys compared to brachial blood pressure. Three key points:
1. Central systolic pressure is usually higher than brachial pressure due to amplification of the pressure wave in the arteries. Central pressure correlates better with organ damage and predicts cardiovascular outcomes more strongly.
2. Increased arterial stiffness, measured by a higher pulse wave velocity, is a strong predictor of cardiovascular events and mortality. Pulse wave velocity increases with age and cardiovascular risk factors.
3. Augmentation index, a measure of wave reflections and arterial stiffness, is associated with increased risk of mortality and cardiovascular disease when elevated. It predicts
This document summarizes a study reporting on patients experiencing cardiogenic shock following acute myocardial infarction. The study analyzed 1,190 patients registered in the SHOCK Trial Registry between 1993-1997. It found that predominant left ventricular failure was the most common cause of shock (78.5%), while mechanical complications like ventricular septal rupture or tamponade caused shock in about 12% of cases. In-hospital mortality was 60% overall but higher at 87.3% for patients with ventricular septal rupture. Outcomes were better for patients receiving treatments like thrombolysis, intra-aortic balloon counterpulsation, coronary angiography, angioplasty or bypass surgery. After adjusting for treatments, early revascularization was found to
Carotid intima-media thickness (IMT) is predictive of cardiovascular risk. A study of 222 patients who suffered their first myocardial infarction found that 88% were in the low to intermediate risk category according to Framingham risk scores, but would have been considered high risk and treated aggressively if carotid IMT was also considered. Prospective population studies show carotid IMT is associated with future cardiovascular events independently of traditional risk factors. Higher IMT levels correlate with greater risks of myocardial infarction, stroke, and cardiovascular death. Measuring carotid IMT could help identify patients at higher risk who may benefit from more intensive prevention efforts.
Clinical Profile of Acute Coronary Syndrome among Young AdultsPremier Publishers
Acute Coronary Syndrome accounts for 30% of hospital admissions with cardiovascular diseases. The risk of this syndrome is increasing among the younger adults, and a deep insight into the clinical profile among these patients will help in devising a preventive strategy, in order to alleviate the morbidity and mortality due to the syndrome. A cross sectional study was done among 125 subjects admitted to our tertiary care hospital with Acute Coronary Syndrome. Their risk factors were assessed and a 12 Lead electrocardiogram and 2D Echocardiogram were taken. Cardio III panel which consists of Troponin I, CK MB, BNP by COBAS meter machine was also measured. STEMI was present in 73.6% of the patients, while unstable angina was present in 16%. About 90% of STEMI patients were males and 62% of them were hypertensives. LV Ejection Fraction <30% was found in 9% of STEMI patients. This study elucidates the need for a preventive strategy for primordial prevention of cardiovascular events among young adults. The study envisaged the male, urban preponderance towards these events.
Vascular repair after firearm injury is associated with increased morbidity a...anomwiradana
This study analyzed data from 648,662 patients with firearm injuries between 1993-2014 using the National Inpatient Sample database. The key findings were:
1) 9.9% (63,973) of firearm injuries involved a concurrent vascular repair, with these patients more likely to be younger, male, black, on Medicaid, and have lower income.
2) Patients undergoing vascular repair had higher injury severity scores and were more likely to have abdomen/pelvis or extremity injuries from assault.
3) Patients undergoing vascular repair had higher rates of in-hospital mortality (5.51% vs 1.98%), acute renal failure, venous thromboembolic events, pulmonary complications, cardiac complications, sepsis
This study analyzed health care resource utilization for 76 neonates with Trisomy 13 in California between 2006-2010. The key findings were:
1) The mortality rate for these patients was 27.6%. Non-survivors had significantly higher use of mechanical ventilation compared to survivors.
2) After adjusting for various factors, the use of mechanical ventilation was associated with increased length of stay (18 days longer on average) and total hospital charges (over $399,000 higher on average) for Trisomy 13 patients.
3) Patients with private insurance had a longer length of stay (10.8 days longer on average) than those with Medicaid.
Examination of the incidence of heart disease in the US. A multivariate logis...AJHSSR Journal
ABSTRACT:Heart disease is a condition that affects the human heart and blood vessels. Heart disease affects
about half of American adults, and it also played a role in the high death rate in the rest of the world. The data
extracted from National Center for Health Statistics (NCHS) span from December 2019 to December 2021. The
only goal of this study is to look at the risk factors that affect the incidence of heart disease. After that, it will
estimate a Youden index to find the best cut-off point and measure how well the multivariate logistic regression
model's diagnostic test performed, adding to the body of knowledge. The application of logistic regression
yielded the finding that socioeconomic and health risk variables strongly influence the incidence of heart
disease. According to the Youden index, the ideal cutoff value is around 52%. Consequently, it is crucial for
American adults to monitor their lifestyle, have their BMI, blood pressure, diabetes, and other risk factors for
heart disease diagnosed, and then make sure they are receiving adequate treatment to prevent the tendency to
develop heart disease, which in turn will lower the death rate brought on by heart disease.
KEYWORDS: Heart disease, Multivariate logistic regression, Youden index, Health risk factors,
socioeconomic factors.
2020 state of the art—high-sensitivity troponins in acute coronary syndromesBryanMielesM
This document discusses the evolution of biomarkers for diagnosing acute myocardial infarction (AMI), focusing on high-sensitivity troponin assays. It notes that while biomarkers like liver enzymes, CK, and LDH were initially used, troponin is now considered the gold standard due to its high cardiac specificity. The development of high-sensitivity troponin assays allows for earlier rule-in and rule-out of AMI. However, these assays are also detecting myocardial injury from non-ischemic causes, challenging clinicians. The document reviews new consensus definitions distinguishing acute myocardial injury, ischemia, and infarction to help clinicians interpret troponin results.
Cardiovascular disease is a major global health burden. Large epidemiological studies and genetic studies have shown a causal relationship between LDL-C levels and cardiovascular risk. People with lifelong low LDL-C due to genetic mutations, such as loss-of-function mutations in PCSK9, have a significantly reduced risk of cardiovascular events. However, there remains unmet need as cardiovascular risk persists in many patients despite standard therapies due to difficulties achieving LDL-C treatment goals.
Lewis Washkansky was the recipient of the first successful human heart transplant in 1967 in South Africa. While he survived over two weeks, he ultimately succumbed to pneumonia. Now approximately 2,000 heart transplants are performed annually in the US, allowing patients to live longer, healthier lives. The most common causes of death after transplant are graft failure early on, opportunistic infections between 6 months to a year post-transplant, and acute rejection within the first three years. Cardiac allograft vasculopathy (CAV), where the transplanted coronary arteries develop atherosclerosis, increases risk of death beyond the first year. Screening for CAV involves annual coronary angiography. Treatment focuses on controlling hypertension and
This study followed up patients from the previous ENIGMA trial to evaluate long-term cardiovascular risks associated with nitrous oxide anesthesia. The researchers reviewed patient records and interviewed surviving patients with a median follow-up time of 3.5 years. They found that nitrous oxide was associated with a 59% increased odds of myocardial infarction but did not significantly increase the risk of death or stroke. The exact relationship between nitrous oxide and serious long-term outcomes requires confirmation in a larger randomized controlled trial.
Definitions of acute coronary syndromes.pdfralizcano
The document discusses definitions of acute coronary syndromes (ACS) and myocardial infarction (MI). It notes that while elevated troponin levels indicate MI, the underlying cause may not be ACS. The document outlines five types of MI based on pathological causes, with Type 1 being the most common ACS-related MI due to atherosclerotic plaque rupture. It emphasizes that determining the specific cause of MI is important for guiding treatment strategies.
Association between Galectin-3 and oxidative stress parameters with coronary ...komalicarol
Galectin-3 (Gal-3), as a mediator of inflammation and fibrosis, has been reported to be a biomarker of severity in
coronary artery disease (CAD). The study aimed to assess the relationships between coronary artery disease (CAD) and risk factors,
including parameters of oxidative stress in Tunisian patients CAD.
Association Between Galectin-3 and Oxidative Stress Parameters with Coronary ...semualkaira
Galectin-3 (Gal-3), as a mediator of inflammation and fibrosis, has been reported to be a biomarker of severity in
coronary artery disease (CAD). The study aimed to assess the relationships between coronary artery disease (CAD) and risk factors,
including parameters of oxidative stress in Tunisian patients CAD
The document discusses the toxic effects of heavy metals like lead, cadmium, mercury, and arsenic on cardiovascular health. It summarizes evidence that exposure to these metals is linked to increased risk of cardiovascular diseases like heart disease and atherosclerosis. The metals may increase risk through oxidative stress and free radical production, depleting antioxidants and damaging lipids and DNA. Chelation with EDTA or curcumin can help reduce metal toxicity by binding and removing the metals from the body. More research is still needed to fully understand the genetic and pathophysiological mechanisms by which metal exposure increases cardiovascular risk.
Toxic Effects of Environmental Heavy Metals on Cardiovascular Pathophysiology...Al Baha University
The mobilization of heavy metals by man through extraction from ores and processing for different applications has led to the release of these elements into the environment. Since heavy metals are non-biodegradable, they accumulate in the environment and subsequently contaminate the food chain. This contamination poses a risk to environmental and human health. Heavy metals are strongly implicated in atherosclerotic heart disease. There is many evidence supporting toxic xenobiotic heavy metals as an emerging cardiovascular risk factor. In this review, we will summarize the evidence for the four toxic xenobiotic heavy metals such as lead, cadmium, mercury and arsenic that are chelated most effectively by edentate (EDTA) disodium and that have convincing published reports documenting their cardiovascular toxicity ranked priority, as environmental chemicals of concern by the Agency for Toxic Substances and Disease Registry. The metabolic
effects of heavy metals and hypothetical mechanisms of metal toxicity are discussed. Standard therapies involving treatment with EDTA and curcumin as chelating agent for heavy metals are given. EDTA normalizes the distribution of most metallic elements in the body. There is a relationship between heavy metals to the blood pressure and cholesterol level as a risk factor of myocardial infraction, coronary or cardiovascular disease. Xenobiotic heavy metals (Pb, As, Hg and Cd deplete glutathione and protein-bound sulfhydryl groups, resulting in the production of reactive oxygen species as superoxide ion, hydrogen peroxide and hydroxyl radical (O2.-, H2O2, .OH, OH-), consequence, enhanced lipid peroxidation and DNA damage. Curcumin reduces the toxicity induced by xenobiotic heavy metals due to its scavenging and chelating properties. The genetic mechanisms through which heavy metals act to increase cardiovascular disease CVD may act still remains unknown. However, additional research is needed in order to proposethe exact mechanism of CVD induced by heavy metals.
DR. MAICOL AUGUSTO CORTEZ SANDOVAL/Fibrilacion auricular subclinica MAICOL AUGUSTO
1) The document discusses subclinical atrial fibrillation (AF) which are episodes of high atrial rate (>6 minutes) detected by implanted cardiac devices in patients without a previous diagnosis of AF.
2) Studies have found the prevalence of subclinical AF detected by devices ranges from 30-60% in patients with devices.
3) Subclinical AF appears to evolve into clinically apparent AF over time and is associated with increased risks of stroke and other thromboembolic events, particularly for longer episodes lasting over 24 hours.
4) Further research is still needed to understand the relationship between subclinical AF detected by devices and cardiovascular outcomes like stroke risk.
בשנים האחרונות ישנה עלייה גוברת במספר החולים בלימפומה שאינה הודג'קין (NHL). מחקרים עדכניים מרמזים על קשר בין תחלואה בסרטן זה בנשים לבין חשיפה למזהמים סביבתיים. פרק מתוך הדו"ח מה דיוע על זיהום סביבתי ותחלואת נשים?
מחקרים רבים מצביעים על קשר מובהק בין חשיפה של נשים למזהמים סביבתיים ובין סיכון מוגבר לחלות בסרטן הריאה ובפרט באדנוקרצינומה (סרטן ריאה בלוטי) הקשור יותר לחשיפות סביבתיות.
בסקירת המחקרים בפרק מתוך הדו"ח "מה ידוע על זיהום סביבתי ותחלואת נשים?", נמצא שנשים מושפעות יותר מזיהום סביבתי ועלולות לחלות במחלות לב, בעיקר לאחר גיל הבלות.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
3. 2550 Stroke December 2005
TABLE 1. No. of Hospital Admissions for Ischemic and Hemorrhagic Stroke Among Medicare
Beneficiaries (age >65) in 9 US Cities During the Study Period
Stroke Cases
Person-Years
City County Time Period (Thousands)* Ischemic Hemorrhagic
Birmingham Jefferson, Shelby 1/1/1986–12/31/1993 792 6642 770
Chicago Cook 5/1/1986–11/30/1999 8603 54 797 7182
Cleveland Cuyahoga 10/1/1988–11/30/1999 2468 20 142 2298
Detroit Wayne 4/1/1986–11/30/1999 3606 26 585 2854
Minneapolis Hennepin, Ramsey 1/1/1987–12/31/1997 1940 6903 1119
New Haven New Haven 4/1/1988–11/30/1999 1373 7546 1043
Pittsburgh Allegheny 1/1/1987–11/30/1999 2995 23 139 2590
Salt Lake City Salt Lake 1/1/1986–11/30/1999 853 2559 380
Seattle King 1/1/1986–12/31/1995 1671 7190 1078
Total 24 300 155 503 19 314
*Based on estimated no. of residents 65 years of age according to the US Bureau of the Census, 1990 Census
of Population and Housing.
disease or occlusion of cerebral arteries, excluding those without for days preceded and followed by nonmissing days. This time-
cerebral infarction.21 In a sensitivity analysis, we limited the defini- series, referred to as “PM10 with imputed values,” had missing values
tion of ischemic stroke to patients admitted from the emergency on 1.7% of days.
room with a primary discharge diagnosis of occlusion of cerebral
arteries.21 Hemorrhagic stroke cases were defined as persons admit- Data Analysis
ted from the emergency room with a primary discharge diagnosis of We used a 2-stage hierarchical model to evaluate the association
intracerebral hemorrhage.21 between ambient pollution and the rate of hospital admission, as
described previously.24 In the first stage, we used the time-stratified
Exposure Information case-crossover study design25 to separately estimate the effect of air
We obtained daily measures of PM10 and hourly measures of CO, pollution in each city. In this design, each subject’s exposure before
NO2, and SO2 from the US Environmental Protection Agency and a case-defining event (case period) is compared with his or her own
computed daily mean concentrations in each city.22 To evaluate the exposure experience during 1 control period when the subject did
effect of PM10 within the range of exposure deemed acceptable in the not become a case. Control periods were chosen such that exposures
during the case period were compared with exposures occurring on
United States under current regulations, we excluded from analysis
other days of the same month falling on the same day of the week as
31 days (of 37 203 possible) on which PM10 levels exceeded 150
g/m3, the current 24-hour US Environmental Protection Agency the case period. Exposure during the case period was defined as
pollutant concentrations 0 to 2 days before admission (lags 0 to 2
standard. We considered pollutant data unavailable for a given city if
days). This design has been shown to be effective in controlling for
10% of days in the observation period had missing values. Using
seasonality, time trends, and chronic and slowly varying potential
this criterion, data on CO was missing in New Haven, Conn; NO2 in
confounders.24
Birmingham, Ala, Salt Lake City, Utah, and Seattle, Wash; and SO2
in Birmingham, Ala. We obtained National Weather Service data on We performed conditional logistic regression, stratifying on each
climatologic variables (National Climatic Data Center) and calcu- day, to obtain estimates of odds ratios and 95% CIs. We report effect
lated the apparent temperature (an index of human discomfort that estimates as the percentage of change in the rate of hospitalization
incorporates ambient temperature and relative humidity) as described associated with an interquartile range increase in mean daily pol-
previously.23 lutant levels. For each pollutant, we simultaneously evaluated the
Data on PM10 were missing on 4.0% of the days. In a sensitivity effect at lags of 0 to 2 days using unconstrained distributed lag
analysis, we used city-specific prediction models to impute single models26 and controlled for meteorological covariates. We modeled
missing values. Specifically, we modeled PM10 as smooth functions the mean apparent temperature at lag 0 as a quadratic function and
of PM10 on the previous and following day, available copollutants, mean apparent temperature at lags 1 and 2, mean barometric pressure
and climatologic variables. City-specific model R2 values ranged at lags 0 and 1, and pollutants at lags 0 to 2 as linear functions of
from 0.50 to 0.85 (mean, 0.71). We imputed missing values of PM10 continuous variables.
TABLE 2. Summary of Mean Daily Concentrations of Air Pollutants and Climatologic
Variables in 9 US Cities
Percentiles
Correlation
Variable 10 25 50 75 90 With PM10
PM10, g/m3 12.91 18.88 28.36 41.84 57.89
3
PM10 with imputed values, g/m 12.94 18.95 28.44 41.83 58.00
CO, ppm 0.54 0.73 1.02 1.44 1.98 0.43
NO2, ppb 13.71 18.05 23.54 29.98 36.54 0.53
SO2, ppb 2.17 3.57 6.22 10.26 16.17 0.39
Apparent temperature, °C 3.93 0.95 9.47 19.33 25.42 0.22
Downloaded from stroke.ahajournals.org by on February 16, 2009
4. Wellenius et al Air Pollution and Stroke 2551
g/m3 (SD 19.75; Table 2). Age on admission ranged from
In the second stage, we obtained a combined random-effects
estimate from the city-specific effect estimates using standard 65 to 117 years with a mean of 78.6 7.7 years. Cases were
random-effects meta-analysis methods.27 All of the reported P values mostly white (75.4%) and female (60.7%).
are based on 2-sided tests at the 0.05 level. Analyses were
We simultaneously estimated the effect of PM10 at lags of
performed using SAS V9 and the R statistical package.
0 to 2 days in each city and then obtained summary estimates
using standard random-effects meta-analysis techniques. A
Results
positive association between PM10 and hospital admissions on
Ischemic Stroke Admissions the same day was observed in 7 of the 9 cities examined
There were 155 503 hospital admissions from the emergency (Pheterogeneity 0.71; Figure, A). Overall, an interquartile range
department with a primary discharge diagnosis of ischemic increase in PM10 on the day of admission was associated with
stroke among Medicare beneficiaries 65 years of age in 9 a 1.03% (95% CI, 0.04% to 2.04%) increase in the rate of
US cities (Table 1). The overall mean PM10 level was 32.69 hospital admission for ischemic stroke. PM10 levels 1 or 2
days before admission were not associated with increased
risk. Using the alternate definition of ischemic stroke yielded
a 1.39% (95% CI, 0.26% to 2.52%) increase for an interquar-
tile range increase in PM10 on the admission day and no
significant increase associated with PM10 levels 1 or 2 days
before admission. Using PM10 with imputed values as the
exposure did not materially alter the results.
Ambient measures of CO, NO2, and SO2 were correlated
with ambient PM10 levels (Table 2). An interquartile range
increase in each pollutant was associated with a qualitatively
similar increase in admissions on the same day (Table 3). No
association was observed with any pollutant 1 or 2 days
before the admission date.
Hemorrhagic Stroke Admissions
There were 19 314 hospital admissions with a primary
discharge diagnosis of hemorrhagic stroke (Table 1). Com-
pared with patients admitted for ischemic stroke, these
patients tended to be younger (mean age, 77.9 7.6 years),
more likely to be white (78.2%), and less likely to be female
(58.8%).
PM10 levels on the day of admission were not associated with
hemorrhagic stroke admissions although there was evidence of
statistical heterogeneity between cities (Pheterogeniety 0.013; Fig-
ure, B). PM10 levels 1 to 2 days before admission were also not
associated with increased risk. Likewise, no association was
observed between hemorrhagic stroke admissions and PM10
with imputed values, CO, NO2, or SO2 (Table 3).
Discussion
Previous studies using administrative data from 1 to 3 cities
suggest an association between daily fluctuations in PM10 and
cerebrovascular hospital admissions.13–16 We evaluated the
association between PM10 and hospital admissions for ische-
mic and hemorrhagic stroke among Medicare beneficiaries
65 years of age in 9 US cities and found that a transient
increase in ambient particles was associated with an increased
risk of hospital admission for ischemic but not hemorrhagic
stroke. Specifically, for ischemic stroke, we found that an
interquartile range increase in PM10 was associated with a
1.03% (95% CI, 0.04% to 2.04%) increase in the risk of
admission on the same day. In contrast, for hemorrhagic
stroke, we found no evidence of an association with PM10 or
City-specific (■, height inversely proportional to variance of esti-
mate) and random-effects summary ( , horizontal limits indicate any other pollutant examined.
95% CIs) estimates of the percentage change in rate of hospital Few published studies have examined the effects of am-
admission for ischemic (A) and hemorrhagic (B) stroke associ-
bient particles specifically on ischemic or hemorrhagic
ated with an interquartile range increase in PM10 (22.96 g/m3)
stroke.15,16,20 Using hospital admission records from Taiwan,
on the same day (lag 0).
Downloaded from stroke.ahajournals.org by on February 16, 2009
5. 2552 Stroke December 2005
TABLE 3. Percentage Change in Rate of Hospital Admission for Ischemic
and Hemorrhagic Stroke for an Interquartile Range Increase in Mean Daily
Pollutant Concentrations*
Percent Increase in Hospitalization Rate
Unit Increase
Pollutant (interquartile range) Ischemic Stroke Hemorrhagic Stroke
3
PM10 22.96 g/m 1.03 (0.04, 2.04) 0.58 ( 5.48 to 4.58)
22.96 g/m3
PM10 with imputed values 2.33 (1.22, 3.45) 0.05 ( 5.01 to 5.39)
CO 0.71 ppm 2.83 (1.23, 4.46) 1.61 ( 4.79 to 1.68)
NO2 11.93 ppb 2.94 (1.78, 4.12) 0.38 ( 2.66 to 3.51)
SO2 6.69 ppb 1.35 (0.43, 2.29) 0.68 ( 1.77 to 3.19)
*Random-effects summary estimates for lag 0 from single-pollutant models controlling for
meteorological covariates.
Tsai et al16 found a statistically significant positive associa- The health effects of exposure to air pollution from indoor
sources (eg, from tobacco smoke or cooking) are also of
tion between PM10 and both ischemic and hemorrhagic
interest, but evaluating these effects requires a different study
strokes after excluding days with mean daily temperature
design and indoor, as well as ambient, pollutant monitors.
20°C. Similarly, Hong et al20 analyzed death certificates in
Although ambient particles have been shown to penetrate
Seoul, Korea, with similar statistically significant results for
indoors, there is little correlation between exposure to parti-
ischemic and hemorrhagic stroke. Linn et al15 also found a
cles originating from indoor sources and those from outdoor
significant increase in hospitalization rates for ischemic
sources.33
stroke in metropolitan Los Angeles, but did not consider
This study has several potential limitations. First, misclas-
hemorrhagic strokes. The discrepant results in relation to
sification of the outcome is expected as a result of diagnostic
hemorrhagic stroke may be explained by differences in case
or coding errors. However, these errors are likely unrelated to
definitions, analytic methods, average pollutant levels, or
pollutant levels and are expected to reduce the precision of
population characteristics between the current and previous
our estimates and potentially bias the relative risk toward the
studies.
null. In fact, using the alternate definition of ischemic stroke,
Exposure to ambient particles may plausibly increase the risk
which is likely to be more specific, albeit less sensitive, than
of ischemic stroke by promoting atherosclerotic plaque disrup-
the primary definition,34,35 we found a stronger association
tion and thrombosis. This could be mediated by a combination of
with PM10. Similarly, we expect that the incidence of clini-
3 different mechanisms. First, particulate exposure can induce
cally unrecognized or nonhospitalized stroke is unrelated to
an acute systemic inflammatory response with an increased
pollutant levels after adjusting for meteorological covariates
number of circulating neutrophils28 and increased levels of
and month-of-year and day-of-week effects. Therefore, ex-
C-reactive protein.9 Second, particulate-related changes in he-
clusion of these cases is expected to reduce the precision of
mostatic factors have been reported, including increased levels
our estimates but not otherwise bias our results. Second, the
of fibrinogen7,8 and von Willebrand factor9 and enhanced pe-
use of ambient rather than personal exposure measures is
ripheral arterial thrombosis.29 Third, particulate-related changes
expected to result in exposure misclassification. However,
in autonomic nervous system activity, as assessed by heart rate
this misclassification is expected to lead one to underestimate
variability, are well documented and are consistent with relative
the relative risk.36 Third, the date of symptom onset likely
sympathoexcitation.10,11
preceded the date of admission in a proportion of cases,
The observed association between ischemic stroke and air
leading to nondifferential exposure misclassification and bias
pollution was similar for all of the pollutants considered. of the relative risk toward the null. Fourth, residual confound-
Likewise, we consistently failed to find evidence of an ing by short-term respiratory epidemics remains a possibility.
association between hemorrhagic stroke and any pollutant However, the time-stratified case-crossover design used in
considered. Because ambient measures are correlated, sepa- this study has been shown to effectively control for confound-
rating the effects of individual pollutants is problematic. ing by time trends in both exposure and outcomes.24 In
However, PM10 is relatively spatially homogenous within a particular, this approach provides effective control for time
metropolitan area,30 and ambient measures at a central site are trends that occur over periods longer than 1 calendar month.
well correlated with personal exposure measures.31 In con- Additionally, studies directly examining this possibility sug-
trast, personal exposures to CO, NO2, and SO2 are relatively gest that respiratory epidemics are not important confounders
poorly predicted by ambient measures.32 For example, ambi- of the association between particulate matter and all-cause or
ent measures of NO2 are likely more strongly correlated with cardiovascular mortality.37
personal exposure to particulate matter than to personal NO2
Conclusions
exposure.32 Thus, the present study is consistent with the
interpretation that sources of pollution that lead to concurrent In the current study, we found that a transient increase in
elevation of these pollutants may be responsible for the ambient particles was associated with an increased risk of
observed associations. hospital admission for ischemic but not hemorrhagic stroke.
Downloaded from stroke.ahajournals.org by on February 16, 2009
6. Wellenius et al Air Pollution and Stroke 2553
Although the relative increase in risk was small, given the 17. Burnett RT, Smith-Doiron M, Stieb D, Cakmak S, Brook JR. Effects of
particulate and gaseous air pollution on cardiorespiratory hospitalizations.
large number of people simultaneously at risk for ischemic
Arch Environ Health. 1999;54:130 –139.
stroke and exposed to urban pollution, even a small relative 18. Le Tertre A, Medina S, Samoli E, Forsberg B, Michelozzi P, Boumghar
risk may be of significant public health interest. Additional A, Vonk JM, Bellini A, Atkinson R, Ayres JG, Sunyer J, Schwartz J,
studies with more detailed data on the clinical characteristics Katsouyanni K. Short-term effects of particulate air pollution on cardio-
vascular diseases in eight European cities. J Epidemiol Community
of subjects and more accurate assessment of the timing of
Health. 2002;56:773–779.
symptom onset are needed to confirm or refute these findings. 19. Sunyer J, Ballester F, Tertre AL, Atkinson R, Ayres JG, Forastiere F,
Forsberg B, Vonk JM, Bisanti L, Tenias JM, Medina S, Schwartz J,
Acknowledgments Katsouyanni K. The association of daily sulfur dioxide air pollution levels
with hospital admissions for cardiovascular diseases in europe (the
This study was supported by grants ES013804, HL07374, and
aphea-ii study). Eur Heart J. 2003;24:752–760.
ES09825 from the National Institutes of Health and by US Environ-
20. Hong YC, Lee JT, Kim H, Kwon HJ. Air pollution: a new risk factor in
mental Protection Agency research award R827353 from the US
ischemic stroke mortality. Stroke. 2002;33:2165–2169.
Environmental Protection Agency.
21. Department of Health and Human Services. International Classification
of Diseases, 9th Revision, Clinical Modification: ICD-9-CM. 3rd ed.
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