Aims
Several clinical conditions may precipitate acute heart failure (AHF) and influence clinical outcome. In this study we hypothesized that precipitating factors are independently associated with ...90‐day risk of death in AHF.
Methods and results
The study population consisted of 15 828 AHF patients from Europe and Asia. The primary outcome was 90‐day all‐cause mortality according to identified precipitating factors of AHF acute coronary syndrome (ACS), infection, atrial fibrillation (AF), hypertension, and non‐compliance. Mortality at 90 days was 15.8%. AHF precipitated by ACS or by infection showed increased 90‐day risk of death compared with AHF without identified precipitants hazard ratio (HR) 1.69, 95% confidence interval (CI) 1.44–1.97, P < 0.001; and HR 1.51, 95% CI 1.18–1.92, P = 0.001), while AHF precipitated by AF showed lower 90‐day risk of death (HR 0.56, 95% CI 0.42–0.75, P < 0.001), after multivariable adjustment. The risk of death in AHF precipitated by ACS was the highest during the first week after admission, while in AHF precipitated by infection the risk of death had a delayed peak at week 3. In AHF precipitated by AF, a trend toward reduced risk of death during the first weeks was shown. At weeks 5–6, AHF precipitated by ACS, infection, or AF showed similar risk of death to that of AHF without identified precipitants.
Conclusions
Precipitating factors are independently associated with 90‐day mortality in AHF. AHF precipitated by ACS or infection is independently associated with higher, while AHF precipitated by AF is associated with lower 90‐day risk of death.
Background
Stress, sleep deprivation, and infectious diseases are important seizure‐precipitating factors in human epilepsy patients. However, these factors have not been thoroughly studied in ...epileptic dogs.
Objective
Seizure‐precipitating factors are common in dogs with idiopathic epilepsy and the occurrence of these factors associate with the dogs' signalment, personality, and epilepsy‐related factors.
Animals
Fifty dogs with diagnosed idiopathic epilepsy from the hospital populations of University Veterinary Teaching Hospital of University of Helsinki and Referral Animal Hospital Aisti.
Methods
In a retrospective cross‐sectional observational study, owners were interviewed about their dogs' possible seizure‐precipitating factors according to a predefined questionnaire. The dogs were identified and selected by searching the medical records of the participating animal hospitals.
Results
The prevalence of seizure‐precipitating factors in the study population was 74% (37/50). The most frequently reported factors included stress‐related situations, sleep deprivation, weather, and hormonal factors. In dogs with focal onset seizures, the number of precipitating factors was 1.9 (95% CI 1.1‐3.4) times higher compared to dogs with generalized seizures.
Conclusions and Clinical Importance
Seizure‐precipitating factors are common in dogs with idiopathic epilepsy, and the nature of these factors is consistent with those of human patients. Aside from antiepileptic medication, acknowledging and avoiding seizure‐precipitating factors could help veterinarians achieve better treatment outcomes.
Summary
Objective
Most epileptic seizures occur unexpectedly and independently of known risk factors. We aimed to evaluate the clinical significance of patients’ perception that weather is a risk ...factor for epileptic seizures.
Methods
Using a hospital‐based, bidirectional case‐crossover study, 604 adult patients admitted to a large university hospital in Central Germany for an unprovoked epileptic seizure between 2003 and 2010 were recruited. The effect of atmospheric pressure, relative air humidity, and ambient temperature on the onset of epileptic seizures under temperate climate conditions was estimated.
Results
We found a close‐to‐linear negative correlation between atmospheric pressure and seizure risk. For every 10.7 hPa lower atmospheric pressure, seizure risk increased in the entire study population by 14% (odds ratio OR 1.14, 95% confidence interval CI 1.01–1.28). In patients with less severe epilepsy treated with one antiepileptic medication, seizure risk increased by 36% (1.36, 1.09–1.67). A high relative air humidity of >80% increased seizure risk in the entire study population by up to 48% (OR 1.48, 95% CI 1.11–1.96) 3 days after exposure in a J‐shaped association. High ambient temperatures of >20°C decreased seizure risk by 46% in the overall study population (OR 0.54, 95% CI 0.32–0.90) and in subgroups, with the greatest effects observed in male patients (OR 0.33, 95% CI 0.14–0.74).
Significance
Low atmospheric pressure and high relative air humidity are associated with an increased risk for epileptic seizures, whereas high ambient temperatures seem to decrease seizure risk. Weather‐dependent seizure risk may be accentuated in patients with less severe epilepsy. Our results require further replication across different climate regions and cohorts before reliable clinical recommendations can be made.
Introduction
Moyamoya angiopathy (MMA) has been known to manifest with myriad of neurological manifestations, often in association with various precipitating factors. This is the first study to ...systematically analyze the precipitating triggers to neurological symptoms done on the largest cohort of MMA in India.
Methods
A single-centered, cross-sectional observational study, recruiting 160 patients with consecutive angiographically proven MMA over a period of 5 years (2016–2021), was undertaken to evaluate the profile of immediate precipitating factors in temporal association to the neurological symptoms, along with their clinical and radiological characteristics. SPSS 25 was used for statistical analysis.
Results
Among the 160 patients (Adult-85, children-75), precipitating factors were seen in 41.3%, significantly higher in children (52%) than adults (31.8%) (
p
value: 0.011). The commonest triggers included fever (18.8%), emotional stress (8.1%), heavy exercise and diarrhea (6.3% each). Cold bath triggered MMA symptoms in 1.3%. Fever (
p
value: 0.008) and persistent crying (
p
value: 0.010) triggered neurological symptoms more commonly in children than in adults. Amongst MMA patients with precipitating factors, the commonest MMA presentation included cerebral infarction type (37.9%) and TIA (31.8%). The majority of precipitating factors that preceded an ischemic event were BP-lowing ones (54.7%).
Conclusion
Neurological symptoms of MMA are commonly associated with several precipitating factors, including the lesser known triggers like cold bath. The frequency and profile precipitating factors varies with the age of presentation and type of MMA. It can serve as an early clue to the diagnosis of MMA and its careful avoidance can be largely beneficial in limiting the distressing transient neurological symptoms.
Over the last decade there has been increased attention to the association between bullying involvement (as a victim, perpetrator, or bully-victim) and suicidal ideation/behaviors. We conducted a ...meta-analysis to estimate the association between bullying involvement and suicidal ideation and behaviors.
We searched multiple online databases and reviewed reference sections of articles derived from searches to identify cross-sectional studies published through July 2013. Using search terms associated with bullying, suicide, and youth, 47 studies (38.3% from the United States, 61.7% in non-US samples) met inclusion criteria. Seven observers independently coded studies and met in pairs to reach consensus.
Six different meta-analyses were conducted by using 3 predictors (bullying victimization, bullying perpetration, and bully/victim status) and 2 outcomes (suicidal ideation and suicidal behaviors). A total of 280 effect sizes were extracted and multilevel, random effects meta-analyses were performed. Results indicated that each of the predictors were associated with risk for suicidal ideation and behavior (range, 2.12 95% confidence interval (CI), 1.67-2.69 to 4.02 95% CI, 2.39-6.76). Significant heterogeneity remained across each analysis. The bullying perpetration and suicidal behavior effect sizes were moderated by the study's country of origin; the bully/victim status and suicidal ideation results were moderated by bullying assessment method.
Findings demonstrated that involvement in bullying in any capacity is associated with suicidal ideation and behavior. Future research should address mental health implications of bullying involvement to prevent suicidal ideation/behavior.
Acute decompensation (AD) of cirrhosis may present without acute-on-chronic liver failure (ACLF) (AD-No ACLF), or with ACLF (AD-ACLF), defined by organ failure(s). Herein, we aimed to analyze and ...characterize the precipitants leading to both of these AD phenotypes.
The multicenter, prospective, observational PREDICT study (NCT03056612) included 1,273 non-electively hospitalized patients with AD (No ACLF = 1,071; ACLF = 202). Medical history, clinical data and laboratory data were collected at enrolment and during 90-day follow-up, with particular attention given to the following characteristics of precipitants: induction of organ dysfunction or failure, systemic inflammation, chronology, intensity, and relationship to outcome.
Among various clinical events, 4 distinct events were precipitants consistently related to AD: proven bacterial infections, severe alcoholic hepatitis, gastrointestinal bleeding with shock and toxic encephalopathy. Among patients with precipitants in the AD-No ACLF cohort and the AD-ACLF cohort (38% and 71%, respectively), almost all (96% and 97%, respectively) showed proven bacterial infection and severe alcoholic hepatitis, either alone or in combination with other events. Survival was similar in patients with proven bacterial infections or severe alcoholic hepatitis in both AD phenotypes. The number of precipitants was associated with significantly increased 90-day mortality and was paralleled by increasing levels of surrogates for systemic inflammation. Importantly, adequate first-line antibiotic treatment of proven bacterial infections was associated with a lower ACLF development rate and lower 90-day mortality.
This study identified precipitants that are significantly associated with a distinct clinical course and prognosis in patients with AD. Specific preventive and therapeutic strategies targeting these events may improve outcomes in patients with decompensated cirrhosis.
Acute decompensation (AD) of cirrhosis is characterized by a rapid deterioration in patient health. Herein, we aimed to analyze the precipitating events that cause AD in patients with cirrhosis. Proven bacterial infections and severe alcoholic hepatitis, either alone or in combination, accounted for almost all (96-97%) cases of AD and acute-on-chronic liver failure. Whilst the type of precipitant was not associated with mortality, the number of precipitant(s) was. This study identified precipitants that are significantly associated with a distinct clinical course and prognosis of patients with AD. Specific preventive and therapeutic strategies targeting these events may improve patient outcomes.
Display omitted
•Bacterial infections and/or severe alcoholic hepatitis are the major precipitants of acute decompensation and ACLF.•The type of precipitating event had no association with survival.•The number of identifiable events was significantly associated with surrogates of systemic inflammation and increased 90-day mortality.•Adequate first-line antibiotic treatment of proven bacterial infections reduced ACLF development and improved 90-day survival.•Strategies to prevent or treat precipitating events may improve outcome in decompensated cirrhosis.
•We analyze autonomous technology disengagements experienced by autonomous vehicles.•Disengagements are safety-critical failures and prompt the response of a human driver.•The data is obtained from ...the archive of the California Department of Motor Vehicle.•Contributory factors and trends for frequency of occurrence are presented.•Limitations and shortcomings in the current DMV regulations are also highlighted.
Autonomous Vehicle (AV) technology is quickly becoming a reality on US roads. Testing on public roads is currently undergoing, with many AV makers located and testing in Silicon Valley, California. The California Department of Motor Vehicles (CA DMV) currently mandates that any vehicle tested on California public roads be retrofitted to account for a back-up human driver, and that data related to disengagements of the AV technology be publicly available. Disengagements data is analyzed in this work, given the safety-critical role of AV disengagements, which require the control of the vehicle to be handed back to the human driver in a safe and timely manner. This study provides a comprehensive overview of the fragmented data obtained from AV manufacturers testing on California public roads from 2014 to 2017. Trends of disengagement reporting, associated frequencies, average mileage driven before failure, and an analysis of triggers and contributory factors are here presented. The analysis of the disengagements data also highlights several shortcomings of the current regulations. The results presented thus constitute an important starting point for improvements on the current drafts of the testing and deployment regulations for autonomous vehicles on public roads.
RETRACTED: Migraine headache in Sudan Ibrahim, Etedal Ahmed A.; Badri, Ghada A. Mutaal; Ahmed, Khabab Abbasher Hussien Mohamed ...
Brain and behavior,
12/2021, Letnik:
11, Številka:
12
Journal Article
Recenzirano
Odprti dostop
Abstract
Background
Migraine is a main form of headache, it is also a chronic and complex neuroinflammatory disease; it is characterized by recurrent severe headaches, usually affecting one side of ...the head, and often accompanied by nausea and blurred vision. In susceptible individuals, irritants can trigger migraine attacks, which can be considered as triggers or accelerators.
Objective
To describe the precipitating factors, clinical presentation, and treatment of migraine headache in Sudanese patients.
Methods
This is a descriptive hospital‐based prospective study covering 130 patients during the study period from January 2016 to December 2018. At the National Centre for Neurological Science, Khartoum, participants were Sudanese patients with migraine headache after exclusion of other causes of headache. Data was collected using structured questionnaire entered and analyzed using SPSS version 22.0, p value < .05 is considered significant.
Results
The study covered 130 study participants most of them were females (80%), within 26–35 years of age (56.9%) and a considerable proportion of them were housewives (40%). The majority of the study participants had headache without aura in 81.5% and headache with aura in 18.5% (mainly visual type 87.5%). Photophobia and nausea were the main associated symptoms in 51.5% and 50%, respectively. Acetaminophen was the main prescribed treatment in 46.1%, beta blockers was the main prophylaxis in 29.2%. Environmental triggers were the prevalent predisposing factors (43.8%) followed by fasting, lack of sleep, and exertion (24.6% for each).
Conclusion
Environmental conditions were the commonest triggering factors of migraine headache, while Acetaminophen was the most common drug used for relieving migraine in this population.
This is a descriptive hospital‐based prospective study covering 130 patients during the study period from January 2016 to December 2018. At the National Centre for Neurological Science, Khartoum, participants were Sudanese patients with migraine headache after exclusion of other causes of headache.
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