[Time series analysis for the evaluation of risk of death associated with environmental air pollution].
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Air Pollutants↗
Biomedical subjects
Daniel Rabczenko
Publications and source records attributed to Daniel Rabczenko.
[Identification of delayed health effects of short-term changes of air pollution].
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Air Pollution↗
Factors determining long-term maintenance of sinus rhythm after cardioversion of persistent atrial fibrillation.
BACKGROUND: Long-term maintenance of sinus rhythm (SR) after successful cardioversion (CV) of persistent atrial fibrillation (AF) carries a low risk of stroke and may avoid the risks associated with anticoagulation. AIM: To determine the clinical and echocardiographic predictors of maintaining SR during one-year follow-up. METHODS: The initial study group consisted of 205 patients with persistent AF of whom 104 (33 females, 71 males, mean age 60.4+/-7.4 years) were randomised to SR restoration and maintenance. The results of transthoracic echocardiography, obtained before CV, were compared between patients who remained in SR and those in whom AF recurred during a one-year follow-up period, using the linear and logistic regression analysis. RESULTS: SR was present in 63.5% of patients at the end of the follow-up period. Of several analysed echocardiographic parameters, an increased left atrial area (<28 cm(2)) (p<0.02; RR 1.72, OR 1.09-2.71) and an increase in the fractional shortening of the left ventricle (range 25-40%, p<0.05, RR 1.2, OR 1.01-1.44) were significantly associated with SR maintenance during a 12-month follow-up period. CONCLUSIONS: Left atrial area and left ventricular fractional shortening are the independent predictors of the maintenance of SR after successful CV in patients with persistent AF.
Aged↗
Rhythm control versus rate control in patients with persistent atrial fibrillation. Results of the HOT CAFE Polish Study.
BACKGROUND: Patients with atrial fibrillation (AF) can be managed either by maintaining sinus rhythm using antiarrhythmic drugs and/or electrical cardioversion, or by leaving patients in AF and controlling ventricular rate without attempts to restore sinus rhythm. Which of these two strategies is superior, has not yet been definitively established. AIM: HOT CAFE Polish Study (How To Treat Chronic Atrial Fibrillation) was designed to evaluate in a randomised, multicentre and prospective manner the risks and advantages of two therapeutical strategies - rate control or rhythm control, in patients with persistent AF. METHODS: The study group consisted of 205 patients (71 females and 134 males; mean age 60.8+/-11.2 years) with a mean time of AF duration of 273.7+/-112.4 days; 101 patients were randomly assigned to rate control (Group I) whereas 104 patients were randomised to sinus rhythm (SR) restoration by DC cardioversion (CV) and subsequent antiarrhythmic drug treatment (Group II). At the end of follow-up (12 months) SR was present in 75% of patients. RESULTS: The incidence of hospital admissions was higher in group II in comparison to group I (12% vs 74%; p<0.001). Mortality was similar in both groups (1.0% versus 2.9%, NS). In both groups a significant improvement of heart failure symptoms was observed during the first 2 months (p<0.02 and p<0.001). In group II exercise tolerability measured by maximal workload during treadmill test significantly improved compared with baseline (5.2+/-5.1 vs 7.6+/-3.3 MET; p<0.0001). In patients in whom SR was restored, the left ventricular function improved and an increase in the shortening fraction was observed (29+/-7% vs 31+/-7%; p<0.01). No thromboembolic complications were observed in patients left with AF. Three patients from group II suffered ischaemic stroke; in two cases stroke was associated with CV whereas in the third patient - with late AF recurrence. CONCLUSIONS: The HOT CAFE Polish Study did not reveal significant differences in mortality between the two treatment strategies in patients with persistent AF. Although patients with SR had better improvement in some haemodynamical parameters, the hospitalisation rate was higher and the incidence of stroke was not reduced compared with the rate control group.
Aged↗
[Myoglobin and troponin I as markers of myocardial damage during cardioversion of atrial fibrillation].
UNLABELLED: We performed direct comparison of safety and efficacy of monophasic and biphasic shock cardioversion (CV) of atrial fibrillation (AF). Troponin I (cTnl) and myoglobin (My) were used as markers of potential myocardial and skeletal muscle damage during the procedure. METHODS: 63 patients (p.t.s.) with persistent, nonvalvular AF (F/M 18/45; mean age 61.6 +/- 11.4 years) were randomized to CV either with monophasic (F/M 10/24, Group I) or biphasic (F/M 8/21, Group II) shock. Plasma levels of cTnl and My were measured before CV, 6 hours and 24 hours after CV. RESULTS: The efficacy of CV was significantly higher in Group II (93% vs 85%, p < 0.04). Sinus rhythm restoration required lower total energy used during procedure with biphasic shock (379.8 +/- 301.5 vs 192.8 +/- 100.6 J; p 0.001). There was no significant difference in mean values of cTnl before CV in both groups (0.3 +/- 0.2 vs 0.2 +/- 0.1 ng/mL, p > 0.15). In 14 pts (41%) from Group I and 3 pts (10%) from Group II plasma cTnl concentration above discriminatory level (0.9 ng/mL) were noted. There was a significant increase in mean plasma cTnl level (0.3 +/- 0.2 vs 1.9 +/- 0.9 ng/mL, p < 0.04) 24 hours after the procedure in Group I. We did not observed significant differences in cTnl plasma concentration 6 and 24 hours after CV in Group II (0.2 +/- 0.1 vs 0.4 +/- 0.2 ng/mL, p > 0.15). Both study groups did not significantly differ in mean serum My level at baseline (39.1 +/- 14.2 vs 43.1 +/- 20.9 ng/mL). In Group I mean My serum concentration increased during the first 6 hours after CV (43.1 +/- 20.9 vs 247.9 +/- 53.3 ng/mL, p < 0.02) and there was a significant decreasing in My serum level during the further observation (247.9 +/- 53.3 vs 104.5 +/- 46.1 ng/mL, p < 0.03). Mean serum My concentration remained within normal ranges during the 24 hour follow-up after the biphasic shock CV (43.1 +/- 20.9 vs 43.6 +/- 29.1 ng/mL). Increased of cTnl and My in Group I may be due to myocardial and skeletal muscle damage and correlate closely with cumulative energy delivered (Spearmann correlation index (r) = 0.55, p < 0.01 for My and r = 0.66, p < 0.01 for cTnl). In Group I positive correlation between cumulative energy used during CV and increase of studied markers indexed with left ventricular mass (r = 0.6, p < 0.05 for My and r = 0.74, p < 0.04 for cTnl) was observed. There was no significant correlation between delivered energy and increase of heart markers in Group II noted. CONCLUSIONS: We observed the significant increase in mean serum cTnl and My level 24 hours after CV with monophasic shock and its positive correlation with total energy used during the procedure. There is a conclusion that biphasic shock used during CV of AF is more efficient and may cause less myocardial and skeletal muscle damage due to lower energy delivered.
Adolescent↗
[Characteristics of bacteria isolated from body surface of German cockroaches caught in hospitals].
The objective of the study was to identify bacterial flora from external parts of German cockroaches caught in hospitals. The susceptibility of the bacteria to the most important groups of antimicrobial agents was also examined. 80 strains of bacteria were isolated, among them 34 strains of Gram-positive cocci and 31 strains of Gram-negative rods. One of isolated strains of Citrobacter freundii and two strains of Serratia liquefaciens showed ESBL mechanism of resistance and extended level of AmpC--type beta-lactamases. Two Staphylococcus strains (S. epidermidis and S. equorum) were resistant to erythromycin and clindamycin (MLSB mechanism of resistance). Such strains, resistant to antibiotics and chemiotherapeutics may be reservoirs of resistance genes which can be transmitted into other bacteria. Presence of such pathogens on the body surface of German cockroaches, very mobile insects, might create conditions for easy dissemination of them in hospital environment.
Animals↗
The temporal pattern of mortality responses to air pollution: a multicity assessment of mortality displacement.
Although the association between particulate matter and mortality or morbidity is generally accepted, controversy remains about the importance of the association. If it is due solely to the deaths of frail individuals, which are brought forward by only a brief period of time, the public health implications of the association are fewer than if there is an increase in the number of deaths. Recently, other research has addressed the mortality displacement issue in single-city analysis. We analyzed this issue with a distributed lag model in a multicity hierarchic modeling approach, within the Air Pollution and Health: A European Approach (APHEA-2) study. We fit a Poisson regression model and a polynomial distributed lag model with up to 40 days of delay in each city. In the second stage we combined the city-specific results. We found that the overall effect of particulate matter less than 10 microM in aerodynamic diameter (PM10) per 10 microg/m3 for the fourth-degree distributed lag model is a 1.61% increase in daily deaths (95% CI = 1.02-2.20), whereas the mean of PM10 on the same day and the previous day is associated with only a 0.70% increase in deaths (95% CI = 0.43-0.97). This result is unchanged using an unconstrained distributed lag model. Our study confirms that the effects observed in daily time-series studies are not due primarily to short-term mortality displacement. The effect size estimate for airborne particles more than doubles when we consider longer-term effects, which has important implications for risk assessment.
Air Pollutants↗
[Role amiodarone in sinus rhythm maintenance after successful cardioversion in patients with chronic non-valvular atrial fibrillation].
UNLABELLED: Antiarrhythmic drugs prophylaxis may improve late outcome of electrical cardioversion (CV) in persistent atrial fibrillation (AF). We conducted a prospective study of the efficacy of sequential antiarrhythmic drug therapy in sinus rhythm (SR) maintenance after a successful elective CV in patients (pts) with persistent nonvalvular AF. Investigated group and methods. 104 pts (60.4 +/- 7.9 years old) with persistent AF underwent CV. Following SR restoration pts received one of these antiarrhythmic drugs (Drug I): propafenone, sotalol, disopyramide. In case of arrhythmia recurrence we performed a second CV and pts received another drug from the mentioned before (Drug II). If treatment proved to be unsuccessful pts received amiodarone (Drug III) and a third CV was attempted. Following an unsuccessful first CV pts received loading dose amiodarone and another CV was attempted. In case of SR restoration amiodarone was administered continuously. RESULTS: First CV was successful in 53.8% pts. Following 1 year 27 pts (48.2%) presented with SR treated with Drug I (median not exist); Drug II proved to be effective in 2 pts (7.0%) (median 14 days). Amiodarone as the third antiarrhythmic agent (Drug III), administered in pts who had previously AF recurrence during the first two antiarrhythmic agents, occurred effective in additional 13 pts (median 307 days) who remained free from AF for one year from the initiation of sequential antiarrhythmic therapy. 48 pts in whom the first CV was ineffective, received amiodarone. During the loading period SR was restored in 10 pts (20.8%). The remaining 38 pts underwent repeated CV and SR was restored in 24 (62.3%) of them. Long-term amiodarone treatment maintained SR during the follow-up period in 24 (70.6%) pts. In total, amiodarone helped to maintain SR in 56.0% of pts. CONCLUSIONS: Sequential antiarrhythmic drug therapy improve arrhythmia prognosis in AF within a 12 months observation period. Amiodarone seems to be the most effective antiarrhythmic drug also in pts who required a second CV proceeded by amiodarone treatment to restore SR.
Aged↗
[Assessment of the determinants of accidents and injuries among elderly people].
According to the GUS data in Poland every tenth person over the 60 years were physically handicapped due to accidents and injuries (1996). The aim of the present study was to assess the causes and risk factors of accidents in the elderly and types of action taken. Health status was estimated on the basis of information about diseases, complaints, stage of disability. Study covered 1910 subjects from Poland. In the investigated group 35% subjects had an accident in the previous 10 years. Accidents happened most frequently out of home (64%). 56% of victims of accidents needed medical care (29% were admitted to hospital). Place of inhabitancy, educational status, marital status, BMI had no influence on the risk of accidents. Only living alone (without family) was a significant risk factor. The risk of accidents increased proportionally to the age in the study group (1% per year). The lowest rate of accidents was observed in the group of moderate physical activity.
Accident Prevention↗