Personal History Of Hypertension Research Articles

ACME: A Classification Model for Explaining the Risk of Preeclampsia Based on Bayesian Network Classifiers and a Non-Redundant Feature Selection Approach

While preeclampsia is the leading cause of maternal death in Guayas province (Ecuador), its causes have not yet been studied in depth. The objective of this research is to build a Bayesian network classifier to diagnose cases of preeclampsia while facilitating the understanding of the causes that generate this disease. Data for the years 2017 through 2023 were gathered retrospectively from medical histories of patients treated at “IESS Los Ceibos” hospital in Guayaquil, Ecuador. Naïve Bayes (NB), The Chow–Liu Tree-Augmented Naïve Bayes (TANcl), and Semi Naïve Bayes (FSSJ) algorithms have been considered for building explainable classification models. A proposed Non-Redundant Feature Selection approach (NoReFS) is proposed to perform the feature selection task. The model trained with the TANcl and NoReFS was the best of them, with an accuracy close to 90%. According to the best model, patients whose age is above 35 years, have a severe vaginal infection, live in a rural area, use tobacco, have a family history of diabetes, and have had a personal history of hypertension are those with a high risk of developing preeclampsia.

Demographic distribution of eclampsia in women attending the University of Calabar teaching hospital (UCTH), Calabar

Eclampsia is a complication of pregnancy characterized by life-threatening acute tonic-clonic seizures. It is the onset of seizures (convulsion) in a woman with pre-eclampsia. It affects 1 in 200 women with pre-eclampsia. The prevalence of eclampsia varies across geographical locations. The incidence of eclampsia lies in the range of 0.3 per 10 deliveries in Calabar (Cross River State). However, there is paucity of information on its prevalence in Calabar; thus this study is aimed at determining the prevalence of eclampsia in University of Calabar Teaching Hospital (UCTH) over a period of five years. Furthermore, data on eclamptic patients from 2015 to 2019 was obtained from Records Department of the hospital. A total of 9,575 deliveries and 153 cases of eclampsia were documented giving an overall prevalence of 1.5%. The prevalence in 2015, 2016, 2017, 2018 and 2019 was 1.2%, 1.0%, 1.5%, 3.4%, 1.2% respectively. One hundred and two (102) case notes were available for analysis (66.6%). The mean age of patients was 29.5±5.4 and majority (39.2%) were in the age group 27-32 years. The mean parity was 1.5 and 42 patients (41.1%) were primiparous. Mean blood pressure at presentation was systolic (158±19.5), diastolic (101.7±16.9) and proteinuria (2.4±0.7). 4 (3.9%) had history of eclampsia, 11 (10.7%) had personal history of pre-eclampsia, 12 (11.7%) had family history of hypertension and 7 (6.8%) had personal history of hypertension. The slight increase in prevalence over the years calls for close monitoring

#2850 EFFICIENCY OF THE GENETIC STUDY IN THE DIAGNOSIS OF AUTOSOMAL DOMINANT TUBULOINTERSTITIAL NEPHROPATHY

Abstract Background and Aims Autosomal dominant tubulointerstitial nephropathy (ADTKD) is a rare underdiagnosed cause of chronic kidney disease (CKD). ADTKD is a renal disease with a non-specific phenotypic expression that cause a slow progression over time. Given the great variability in its inter-familial presentation and among the same family members carrying the same mutation, its diagnosis is a challenge. Five genes have been identified to date such as Uromodulin (UMOD), Renin (REN), Hepatocyte Nuclear Factor 1b (HNF1β), Mucin-1 (MUC1) and, more recently, new genes, SEC61A1(encoding protein transport protein Sec61 subunit α and atypical (DNAJB11). Our main objective is to analyze the diagnostic yield of the genetic study in cases of clinical suspicion of ADTKD in patients with CKD of unknown etiology. We present a case series of patients from our center with CKD of unknown etiology and clinical suspicion of ADTKD. Genetic analysis of the gene SEC61A1 and DNAJB11 was not available at that time. Method This is a descriptive observational retrospective study from 2016 to 2021 at the Virgen del Rocio University Hospital in Seville, Spain. A total of 26 cases had phenotypic presentation of ADTKD. We collected clinical, laboratory, radiologic, and pathologic data. We performed in all the cases genetic testing for UMOD, MUC1, REN and HNF1β mutations. We collected data in a database, including age of presentation of kidney disease, sex, family history of kidney disease, the presence of hypertension at early age (defined as under 40 years of age), hyperuricemia (defined as uric acid >7.5 mg/dl) at early age (<40 years), hemoglobin at the time of diagnosis, age at last follow up with renal function and estimated glomerular filtration rate (eGFR) using the CKD-EPI (CKD Epidemiology Collaboration), urine elemental, renal ultrasound and renal biopsy if it had been performed. Descriptive results of quantitative variables are expressed as median. For categorical data, frequency and percentage are reported. Results Of the 26 cases with suspected ADTKD, 4 cases presented a genetic study that confirmed the diagnosis, that is, 15% of the cases. The median age at the time of the diagnosis was 41 years (IQR 32.7–48). 84% of the cases were male; 34% of cases had a family history of CKD of unknown etiology. 65% percent of the cases had a history of hyperuricemia at early age (<40 years), with a personal history of hypertension <40 years in 30% of the cases; 44% of the cases had renal lithiasis. The median glomerular filtration rate (CKD-EPI) at the time of diagnosis was 70 ml/min/1.73 m2 (46.4–70.7). In most of the patients, the urine elemental was normal. Renal cysts were found on ultrasound in 46% of patients. In 5 of the twenty-six patients a renal biopsy was performed, in which 60% presented data compatible with ADTKD with interstitial fibrosis and tubular atrophy. 4 of the patients with clinical suspicion of ADTKD obtained a genetic study that confirmed the diagnosis. The most frequently identified gene was HNF1β, being present in two of the four patients. The other genes identified were UMOD and MUC. The results are summarized in Table 1. Conclusion Adequate selection of patients based on clinical suspicion is essential to give greater profitability to the genetic study of this entity. The negativity of the study cannot exclude the diagnosis, since at the moment not all the causative genes of this pathology have been identified and it is necessary to use massive sequencing techniques or even the analysis of the complete exome to see the possibility of other variants of the disease.

Demographic distribution of eclampsia in women attending the University of Calabar teaching hospital (UCTH), Calabar

Eclampsia is a complication of pregnancy characterized by life-threatening acute tonic-clonic seizures. It is the onset of seizures (convulsion) in a woman with pre-eclampsia. It affects 1 in 200 women with pre-eclampsia. The prevalence of eclampsia varies across geographical locations. The incidence of eclampsia lies in the range of 0.3 per 10 deliveries in Calabar (Cross River State). However, there is paucity of information on its prevalence in Calabar; thus this study is aimed at determining the prevalence of eclampsia in University of Calabar Teaching Hospital (UCTH) over a period of five years. Furthermore, data on eclamptic patients from 2015 to 2019 was obtained from Records Department of the hospital. A total of 9,575 deliveries and 153 cases of eclampsia were documented giving an overall prevalence of 1.5%. The prevalence in 2015, 2016, 2017, 2018 and 2019 was 1.2%, 1.0%, 1.5%, 3.4%, 1.2% respectively. One hundred and two (102) case notes were available for analysis (66.6%). The mean age of patients was 29.5±5.4 and majority (39.2%) were in the age group 27-32 years. The mean parity was 1.5 and 42 patients (41.1%) were primiparous. Mean blood pressure at presentation was systolic (158±19.5), diastolic (101.7±16.9) and proteinuria (2.4±0.7). 4 (3.9%) had history of eclampsia, 11 (10.7%) had personal history of pre-eclampsia, 12 (11.7%) had family history of hypertension and 7 (6.8%) had personal history of hypertension. The slight increase in prevalence over the years calls for close monitoring

Assessment of Public Knowledge of Hypertension Among the Saudi Population.

Background Hypertension is a major risk factor for cardiovascular illness and premature death and is becoming more prevalent worldwide. To promote better educational strategies regarding hypertension, it is crucial to identify the most significant knowledge gaps among the general public. This study aimed to assess the knowledge of hypertension among the general public in Saudi Arabia. Methodology A cross-sectional, questionnaire-based study was conducted in Saudi Arabia. The target population was the general public aged ≥18 in Saudi Arabia. Statistical analysis was conducted using RStudio (R version 4.1.1). Numerical data were described as mean ± standard deviation or median and interquartile range (IQR) whenever applicable. P-values <0.05 indicated statistical significance. Results A total of 1,404 respondents were collected. After exclusion, 1,399 records were analyzed in this study. More than half of the respondents were females (59.5%) aged 18-39 years (52.7%) and had a university degree (64.8%). Additionally, 46.0% were employed. Approximately one-quarter of the sample had hypertension (26.3%), while 73.3% had a family history of hypertension The median score was 16.0 (IQR = 12.0-18.0) with a minimum and a maximum of 0.0 and 22.0, respectively. Reliability testing revealed that knowledge items had a good internal consistency (Cronbach's alpha = 0.859 based on 22 knowledge items). There was no significant association between knowledge and gender and having a personal history of hypertension. However, the knowledge score differed significantly by age, educational level, employment status, and having a family history of hypertension. On the multivariate analysis, knowledge scores were independently higher among participants in the higher age categories. Moreover, having a university degree, a postgraduate degree, and a family history of hypertension were independently associated with higher knowledge scores. Conclusions This study found that the general public in Saudi Arabia had good levels of knowledge about hypertension. Being knowledgeable about hypertension not only improves adherence to treatment plans among antihypertensive patients but also aids in avoiding its occurrence and consequences among non-hypertensive patients by adopting self-care. Serial and frequent studies on this issue are recommended to gather more evidence on this topic. Ongoing hypertension education is essential to enhance knowledge to minimize the burden of this prevalent issue.

A Survey on Relation of Menopause to Metabolic Syndrome - SAFOMS STUDY (South Asian Federation of Menopause Societies) - Interim Analysis.

Metabolic syndrome (MS) is a spectrum of disorders that includes dysglycemia, dyslipidemia, central obesity, and hypertension. South Asian Indians are more prone to harbor MS at a younger age compared to Caucasians. However, there is a lack of large-scale data correlating menopause to MS in South Asian settings. The study aimed to determine the prevalence of MS and its components in pre- and postmenopausal women. It also assessed the relationship of age, menopausal status, personal and family history, anthropometric parameters, and biochemical markers to MS. It was an interim analysis of a multicountry cross-sectional study in the South Asian Federation of Menopause Society (SAFOMS) countries: India, Pakistan, Bangladesh, Nepal, and Sri Lanka conducted through both online and physical methods. The survey questionnaire consisted of questions about details of personal history, demographics, and family history related to MS. Anthropometric measurements such as height, weight, basal metabolic index (BMI), waist circumference, and blood pressure readings were noted. Relevant history, history of polycystic ovarian syndrome, hypertensive disorders of pregnancy, and vasomotor symptoms were enquired. Biochemical evaluation of markers associated with MS was undertaken. In this interim analysis, 638 women were recruited. Out of them, 406 (63.6%) women were premenopausal and 232 (36.4%) were postmenopausal. 392 (61.4%) women had MS, while 246 (38.6%) women did not have MS. Increasing age, BMI, and visceral adiposity (waist circumference) were significantly correlated with incidence of MS. Raised fasting blood sugar, hemoglobin A1C, total cholesterol, low-density lipoprotein, serum triglyceride, and reduced high-density lipoprotein levels were significantly associated with the incidence of MS in both pre- and postmenopausal women. Peri- and postmenopausal hot flashes, night sweats, and sleep disturbances were also significantly associated with MS. Personal history of hypertension, diabetes, and dyslipidemia were the strongest factors to be associated with MS with a significantly high odds ratio. The study has highlighted the role of BMI and waist circumference as the first warning signs, which will encourage to go for regular biochemical screening through lipid profile and fasting blood glucose measurements. Our study is a stepping stone for all future studies for relation of menopause to MS.

Construct Validity and Reliability of the Arabic Version of Hypertension Knowledge-Level Scale Among Saudi Population.

Background Knowledgeable people are more likely to follow their treatment plan and reduce hypertension morbidity and mortality. This study aimed to construct the validity and reliability of the Arabic version of the Hypertension Knowledge-Level Scale (HK-LS) among Saudis. Methods This cross-sectional questionnaire research targets hypertensives and non-hypertensives. Cronbach's alpha and Spearman's correlation matrix analysis measured the questionnaire's construct validity. Wilcoxon rank sum tests examined HK-LS tools' discriminant validity. A p<0.05 was considered significant. Results A total of 1424 responses were received. However, the 1419 individuals were evaluated after applying exclusion criteria. About 60% of the participants were female, with the most common age groups being 18-29 years (38.5%) and 40-49 years (24.0%). A personal history of hypertension was reported by 26.1%, and a family history of hypertension by73.3% of the subjects. Cronbach's alpha for the whole HK-LS was 0.883, suggesting that the tool was reliable.All the items of the HK-LS questionnaire were significantly correlated with each other, except for a non-significant correlation between statements two and seven (r=0.05, p=0.091). The strongest correlations were apparent between items 19 and 20 (r=0.70, p<0.0001), items one and two (r=0.64, p<0.0001), and items 18 and 19 (r=0.56, p<0.0001). However, the weakest associations were reported among items two and six (r=0.06, p<0.05), items two and nine (r=0.07, p<0.05), and items one and 19 (r=0.07, p<0.05). The discriminant validity showed that a personal history of hypertension was associated with significantly higher scores of two HK-LS subscales, including definitions and complications. In addition, the overall knowledge score was significantly higher among participants with a positive history of hypertension among family and/or friends. Conclusions The Arabic version of the HK-LS was found to be a reliable and valid tool for measuring knowledge about hypertension among the Saudi population. This reliable instrument can assist medical professionals in establishing education programs.

Preparticipation State Cardiac Screening Forms for Athletes

Annual preparticipation physical evaluation (PPE) is used in the United States to screen adolescents for potential causes of sudden cardiac death. The American Heart Association recommends 14 screening elements of history and physical examination. This study sought to define the utilization of these screening elements by each of the 50 states before high school athletics. PPE forms were obtained from the public website of the high school athletics governing body in every state. Form content was analyzed to identify which of the 14 screening elements were explicitly fulfilled. Additional PPE forms provided by private/parochial schools, other professional societies, or independent groups were excluded from this study. A total of 48 states (96%) had PPE forms posted online. The remaining 2 states (4%) deferred the specific method of PPE documentation to individual school districts and provided no standardized form. Of the 48 states providing PPE forms, 13 (27%) included all 14 American Heart Association screening elements. The median criteria included by each state was 11 (range 3-14). The 3 criteria most commonly absent were (1) the examination of femoral pulses to exclude coarctation (58%), (2) a family history of specific inherited cardiac disease (31%), and (3) personal history of hypertension (27%). Annual preparticipation forms are important screening tools. Only a minority of states include all 14 cardiac screening elements recommended by the American Heart Association.

Paraclinoid unruptured giant aneurysm with therapeutic success

The global prevalence of intracranial aneurysms (IA) ranges from 5–10%, with a demographic variation. Large and giant aneurysms typically involve cavernous and paraclinoid segments of the internal carotid artery (ICA), and represent 5% of IA. Typically, these lesions involve segments of the ICA, especially the cavernous and paraclinoid segments. The remaining cases affect the vertebrobasilar region, middle cerebral artery (MCA), and anterior cerebral artery (ACA). From the morphological point of view, they are divided into saccular and fusiform. In cases of rupture, the subarachnoid hemorrhage (SAH) is the most common presentation followed by intracerebral hemorrhage (ICH), or both. Other manifestations can occur as occlusion of perforating vessels, embolic events, seizures, and mass effects. The management of unruptured intracranial aneurysms (UIA) is controversial, and the aim of treatment is to exclude the lesions and preserve neurological function. Endovascular techniques for the treatment of paraclinoid aneurysms, in particular, ICA reconstruction using flow-diverting stents, have become a valid option. However, surgery or endovascular treatment has a number of limitations and the choice of treatment is individual in each case. This type of lesion has an extremely poor natural history, and treatment is a challenge regardless of the technique used. The report described a clinical case of a 55-year-old female, with a personal history of hypertension, hyperthyroidism, and depressive syndrome. The patient started complaints of moderate-intensity right frontal headache, progressively worsening with two months of evolution. She also reported blurred vision and diplopia. Brain computed tomography (CT) documented a partially calcified sellar and parasellar lesion. Subsequently, magnetic resonance imaging (MRI)/MRI angiographies were performed and showed a saccular aneurysm of the right ICA, cavernous segment. The patient underwent a diagnostic and therapeutic angiography with stent placement. Clinical and imaging improvements were documented by angiography and MRI angiography with progressive reduction of the aneurysm during the period of follow-up.

Epigenetic mismatch repair deficiency in endometrioid endometrial cancer correlates with poor outcome (385)

Epigenetic mismatch repair deficiency in endometrioid endometrial cancer correlates with poor outcome (385)

Stroke Risk Factor Awareness Among Populations in Saudi Arabia.

BackgroundStroke is considered the second leading cause of death and the third leading cause of disability in the world. The incidence of stroke in Saudi Arabia is 43.8 per 100,000, due to the lack of knowledge and awareness of the population. This study intends to determine the level of stroke risk factor awareness among the Saudi population.MethodsA cross-sectional study was conducted in Saudi Arabia on 898 participants older than 18 years old. The validated online survey was randomly distributed and consisted of 20 questions in both English and Arabic languages to evaluate the level of awareness of stroke risk factors among the population.ResultsA total of 898 participants completed the survey. The results showed that the median risk factor score was 5 (IQ 3–8) out of 14. A total of 2.2% could recognize all 14 risk factors. Personal history of hypertension was chosen as a risk factor by the majority of the participants (81.7%) followed by personal history of stroke (74.1%) and personal history of dyslipidemia (57.2%).ConclusionThis study showed that there is an insufficient level of stroke risk factor awareness in Saudi Arabia. More than half of the participants identified the term (stroke), while only 2.2% could recognize all 14 risk factors. Hence, public education is needed to identify people with stroke risk factors.

Outcomes of Hospitalized COVID-19 Patients Receiving Renin Angiotensin System Blockers and Calcium Channel Blockers

Introduction: Use of certain antihypertensive medications has been an area of interest during the COVID-19 pandemic, and several hypotheses have been developed regarding the effects of renin-angiotensin system blockers as well as calcium channel blockers in those infected with COVID-19. We seek to determine the association between exposure to ACEI, ARB, and CCB and outcomes in those admitted to the hospital with COVID-19 infection. Methods: This retrospective cohort study included 841 adult patients hospitalized with COVID-19 infection at the University of Chicago Medical Center between March 25 and June 22, 2020. Out of these 841, 453 patients had a personal history of hypertension. For the first part, we evaluated primary outcomes of in-hospital mortality and ICU admission in hospitalized COVID-19 patients based on their exposure to particular medications regardless of a personal history of hypertension and compared them with those who were not on these medications. For the second part, we evaluated the aforementioned outcomes in 453 patients with a personal history of hypertension based on their medication exposure. Secondary outcomes of length of stay, readmission rate, and new-onset dialysis requirement were also compared across the study groups. Results: Out of 841 patients, 111 (13.19%) were on ACEI/ARB (median age: 66.1, SD 15.4; 52.25% females) and 730 (86.80%) were not on them (median age: 56.6, SD 20.3; 50.14% females), while 277 (32.93%) used CCB (median age: 64.6, SD 15.2; 57.04% females) and 564 (67.06%) did not use CCB (median age: 54.6, SD 21.2; 47.16% females). After adjusting for demographics and covariates, neither ACEI/ARB nor CCB exposure was associated with any effect on mortality, but ACEI/ARB exposure was associated with 42% reduction in risk of ICU admissions (OR 0.58, 95% CI [0.35, 0.95], p value 0.03). In addition, combined use of ACEI/ARB and CCB was associated with statistically significant (45%) reduction in ICU admission (OR 0.55, 95% CI [0.32, 0.94], p value 0.029). Out of 453 patients with a personal history of hypertension, 85 (18.76%) were taking ACEI/ARB (median age 65, SD 15.6; 56.47% females) and 368 (81.24%) were not on ACEI/ARB (median age 62.8, SD 16.4; 54.89% females), while 208 (45.92%) out of 453 were on CCB (median age 65; SD 14.8; 60.1% females) and 245 (54.08%) were not on CCB (median age 61.7, SD 17.3; 51.02% females). In the fully adjusted model in this group, ACEI use was associated with 71% reduction in in-house mortality (OR 0.29, 95% CI [0.09, 0.93], p value 0.03). Discussion/Conclusion: Among all hospitalized patients with COVID-19 infection, exposure to ACEI/ARB, as well as combined exposure to ACEI/ARB and CCB, were associated with reduced incidence of ICU admissions. In those admitted patients who had a personal history of hypertension, there was a trend towards reduced in-hospital mortality in those exposed to ACEI.

731 Risk factors for re-admission for postpartum hypertension

Identifying risks factors for postpartum hypertension (HTN) may lead to earlier diagnosis of the disease and improved maternal outcomes. We aimed to establish risk factors that predispose patients to readmission for postpartum HTN (regardless of their personal history of hypertension). This is a retrospective cohort study which included all deliveries at a single institution between January 1, 2012 – December 31, 2018. Case subjects included women readmitted for preeclampsia within 30 days of hospital discharge following delivery. Demographic and obstetric data were collected on all patients via data extraction and chart review. Two control groups were used for comparison: women not readmitted following delivery, and women readmitted for non-hypertensive diagnoses within 30 days of discharge following delivery. Univariable analysis were used to identify unique risk factors specific for postpartum readmission for preeclampsia. There were 46,494 women that delivered within the study window. 147 women were readmitted for postpartum HTN. 274 women were readmitted for a reason other than HTN. On univariable analysis, postpartum readmission for hypertension was significantly associated with maternal age ≥35 years (p=<0.001), black race (p=<0.001), history of gestational hypertension (p=<0.001), history of chronic hypertension (p=<0.0001), aspirin use in pregnancy (p=<0.001) and need for antihypertensive medications upon discharge (p = <0.001) compared to patients not readmitted. These same factors were also significant when the readmission for HTN group was compared to the patients admitted for another reason. Older age, black race, history of gestational hypertension and chronic hypertension, aspirin use in pregnancy, and need for antihypertensive medications upon discharge are uniquely associated with postpartum readmission for preeclampsia. Closer postpartum follow up and observation may be warranted in these patients.

Ischemic Stroke in Patients with Cancer: a Retrospective Cross-Sectional Study.

IntroductionAn increasing trend of cancer associated stroke has been noticed in the past decade.ObjectivesTo evaluate the risk factors and the incidence of neoplasia in stroke patients.Material and MethodA retrospective, observational study was undertaken on 249 patients with stroke and active cancer (SAC) and 1563 patients with stroke without cancer (SWC). The general cardiovascular risk factors, the site of cancer, and the general clinical data were registered and evaluated. According to the “Oxfordshire Community Stroke Project” (OCSP) classification, all patients were classified into the clinical subtypes of stroke. The aetiology of stroke was considered as large-artery atherosclerosis, small vessel disease, cardio-embolic, cryptogenic or other determined cause.ResultsThe severity of neurological deficits at admission were significantly higher in the SAC group (p<0.01). The haemoglobin level was significantly lower, and platelet level and erythrocyte sedimentation rate were significantly higher in the SAC group. Glycaemia, cholesterol and triglycerides levels were significantly higher in the SWC group. The personal history of hypertension was more frequent in the SWC group. In the SAC group, 28.9% had a cryptogenic aetiology, compared to 9.1% in SWC group. Cardio-embolic strokes were more frequent in the SAC group (24%) than the SWC group (19.6%). In the SAC group, 15,6% were diagnosed with cancer during the stroke hospitalization, and 78% of the SAC patients were without metastasis.ConclusionsThe most frequent aetiologies of stroke in cancer patients were cryptogenic stroke, followed by large-artery atherosclerosis. SAC patients had more severe neurological deficits and worse clinical outcomes than SWC patients. Stroke in cancer patients appears to be more frequently cryptogenic, probably due to cancer associated thrombosis. The association between stroke and cancer is important, especially in stroke of cryptogenic mechanism, even in the presence of traditional cardiovascular risk factors.

Incidence, Risk Factors, and Prediction of Myocardial Infarction and Stroke in Farmers: A Korean Nationwide Population-based Study.

ObjectivesThis study was conducted to determine the incidence and risk factors of myocardial infarction (MI) and stroke in farmers compared to the general population and to establish 5-year prediction models.MethodsThe farmer cohort and the control cohort were generated using the customized database of the National Health Insurance Service of Korea database and the National Sample Cohort, respectively. The participants were followed from the day of the index general health examination until the events of MI, stroke, or death (up to 5 years).ResultsIn total, 734 744 participants from the farmer cohort and 238 311 from the control cohort aged between 40 and 70 were included. The age-adjusted incidence of MI was 0.766 and 0.585 per 1000 person-years in the farmer and control cohorts, respectively. That of stroke was 0.559 and 0.321 per 1000 person-years in both cohorts, respectively. In farmers, the risk factors for MI included male sex, age, personal history of hypertension, diabetes, current smoking, creatinine, metabolic syndrome components (blood pressure, triglycerides, and high-density lipoprotein cholesterol). Those for stroke included male sex, age, personal history of hypertension, diabetes, current smoking, high γ-glutamyl transferase, and metabolic syndrome components (blood pressure, triglycerides, and high-density lipoprotein cholesterol). The prediction model showed an area under the receiver operating characteristic curve of 0.735 and 0.760 for MI and stroke, respectively, in the farmer cohort.ConclusionsFarmers had a higher age-adjusted incidence of MI and stroke. They also showed distinct patterns in cardiovascular risk factors compared to the general population.

Risk factors for cardiovascular disease from a population-based screening study in Tianjin, China: a cohort study of 36,215 residents.

BackgroundCardiovascular disease (CVD) is a harmful disease that poses a serious threat to human life. By effectively controlling its risk factors, the occurrence and development of CVD can be reduced, and people’s health status and quality of life can be improved.MethodsA total of 36,215 participants were collected from participants of the Early Screening and Comprehensive Intervention Program for High Risk Population of Cardiovascular Disease in Tianjin on July 31, 2017. We analyzed the relationship between CVD risk and personal information, personal and family medical history, biochemical index, and physical fitness index using Pearson’s chi-squared test with and without Yates’s correction for continuity, and Fisher’s exact test. CVD risk-related factors were examined through logistic regression and decision tree analysis.ResultsA personal history of hypertension and apoplexy had a contingency coefficient with CVD risk of more than 0.3. A higher risk of CVD was also found to be associated with biochemical markers of cholesterol, low-density lipoprotein cholesterol, and blood sugar. Logistic regression analysis revealed 12 indicators to be influencing factors of CVD, including age, systolic blood pressure (SBP), diastolic blood pressure (DBP), and the number of people aged >90 in the family. Hypertension, SBP, BMI, cholesterol, and blood glucose were associated with five or more other indicators.ConclusionsThe prevalence of CVD risk factors in Tianjin residents is relatively high. Family disease history and individual physical fitness indicators need to be taken into account during CVD screening and intervention, to reduce the risk of CVD.

Determinants of preeclampsia and eclampsia among women delivering in county hospitals in Nairobi, Kenya

Background: Preeclampsia is defined as the onset of a new episode of high blood pressure in a woman usually after 20 weeks gestation plus proteinuria, whereas eclampsia is defined as generalized seizures in a pregnant woman who generally has preeclampsia criteria. Preeclampsia and eclampsia are hypertensive disorders of pregnancy and thus, among the top causes of maternal death worldwide. The objective of this study was to investigate risk factors for preeclampsia/eclampsia. Methods: This was a hospital-based unmatched case-control study carried out among women of reproductive age (15-49 years) who have given birth at Nairobi County Hospitals and admitted to the postnatal ward July-September 2019 with a sample size of 352 participants (88 cases and 264 controls). All cases were selected, while controls were simple random sampled, as per eligibility criteria. Information or data were gathered using a structured interviewer-administered questionnaire and data abstraction tool. Descriptive analysis was carried out, where, categorical variables were presented in percentages or proportions, whereas; continuous variables were presented in means, standard deviations, and range. This was followed by a bivariable mixed-effect logistic regression analysis and a multivariable mixed-effect logistic regression analysis using the significant variables from bivariable analysis. Results: Of all the 88 cases enrolled in the study 5 (5.68%) had eclampsia and 83 (94.32%) had preeclampsia. There was a significant association between personal history of hypertension (AOR=7.1; 95% CI: 2.6-19.3, p=0.001), Occupation as a housewife (AOR=3.1; 95% CI: 1.1-8.8, p=0.034), nulliparity (AOR=7.5; 95% CI: 1.5-37.5, p=0.015) , primiparity (AOR=2.1; 95% CI: 1.1-4.2, p=0.031), advanced maternal age 35-49 years (AOR=5.9; 95% CI: 1.1-33.3, p=0.042), and the occurrence of preeclampsia/eclampsia. Conclusions: The following conclusions were made regarding the study findings: Personal history of hypertension, older/advanced maternal age (35-49 years), occupation, and parity were factors significantly associated with preeclampsia/eclampsia.

P867 Mitral stenosis: from mild to severe in less than a year

Abstract We report the case of an 82-year-old woman, with personal history of hypertension, diabetes mellitus, dyslipemia and permanent atrial fibrillation. In 2013 aortic valve substitution surgery was performed with a mechanic prosthetic valve. In her last echocardiogram in May 2018 a mild double mitral lesion was detected, with a normal aortic valve functioning. In March of 2019 she was admitted in hospital with symptoms of heart failure and 38ºC fever. A transthoracic echocardiogram was performed, which revealed a vegetation in the native mitral valve that caused a severe mitral stenosis (area 0.64 cm2). In blood cultures Streptococcus gallolyticycus was isolated. In this situation, a tranesophagical echocardiogram was performed, which confirmed the diagnosis of an infective endocarditis in the native mitral valve. It also showed spontaneous echocontrast as well as a thrombus in the left atrial appendage, despite anticoagulant medication. Given these findings, antibiotic therapy was initiated and surgery programmed. Substitution of the native mitral valve for a biological prosthesis was made. In the transthoracic echocardiographic control the prosthesis was normal functioning. A colonoscopy was performed taking into account the strong association between Streptococcus gallolyticus and colonic lesions, which showed no abnormal findings. At the discharge the patient had no signs or symptoms suggestive of heart failure or infection. Streptococcus gallolytycus is included in the D group of Streptococci. Among hospitalized patients, this group accounts for approximately 5% of streptococcal bloodstream isolates. For humans, the gastrointestinal tract is the most frequent entry point, other potential sources include the hepatobiliary tree and the urinary tract. Clinical manifestations include bacteremia and endocarditis, which is usually highly destructive and frequently bivalvular. Bone infection, meningitis or peritonitis can also be present. Due to the frequent association between this microorganism and colonic neoplasm, colonoscopy is necessary to dismiss pathological findings. Typically D Streptococci can be treated with penicillins, ceftriaxone, carbapenems, vancomycin, daptomycin, and linezolid. The preferred regimen for streptococcal prosthetic valve endocarditis includes a beta-lactam combined with an aminoglycoside, to achieve synergistic effect. Abstract P867 Figure. Mitral stenosis

Prevalence and Factors Associated with Dyslipidemia in Adults with Sickle Cell Disease in Parakou (Benin)

Objective: Determine the prevalence and factors associated with dyslipidemia in adult subjects with sickle cell disease in Parakou in 2017. Methods: This research work was a descriptive, analytical, cross-sectional and observational study carried out from January 6 to June 6, 2017. It involved 100 adult subjects with sickle cell disease (mean age: 28.77 ± 8.73 years) in the city of Parakou (Benin). Serum lipid parameters were measured through enzymatic colorimetric methods on Mindray ® BS-120 automaton (Guangdong, China). The different types of dyslipidemia were classified according to criteria defined in the National Cholesterol Education Program Adult Treatment Panel III. Results: The overall prevalence of the different types of dyslipidemia was estimated at 82% (95% CI [75.27; 88.34]). The different types of dyslipidemia were distributed as followed: HDL hypocholesterolemia (79%; 95%IC [69.71; 86.51]), LDL hypercholesterolemia (13.0%; 95%CI [7.11; 21.20]), total hypercholesterolemia (7.0%; 95%CI [02.86; 13.89]), hypertriglyceridemia (4.0%; 95%CI [1.10; 9.93]) and mixed hyperlipidemia (1.0%; 95%CI [0.03; 5.45]). Atherogenic dyslipidemia was not found out. HDL hypocholesterolemia was significantly associated with personal history of hypertension (P = 0.029), emaciation (P = 0.023) and age above or equal to 50 years (P = 0,016). Tobacco consumption (P = 0.01) and age below 50 years (P = 0.02) were significantly associated with hypertriglyceridemia. Conclusion: The prevalence of the different types of dyslipidemia is high among adults with sickle cell disease in Parakou.

Dimethylarginines in acute myocardial infarction: Association with lifestyle, sociodemographic, and somatometric factors.

Background:Recent findings associate asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) with the prognosis of acute myocardial infarction (AMI). The purpose of the current study was to associate patients’ lifestyle, sociodemographic, and somatometric characteristics with the time course of ADMA and SDMA concentrations in the serum of AMI patients.Patients and Methods:In the serum of 66 AMI patients, ADMA, SDMA, troponin T, and C-reactive protein (CRP) were measured upon hospital admission (<24 h) and on the 3rd day following. Lifestyle, sociodemographic, and somatometric characteristics were obtained through a questionnaire, filled on patient discharge.Results:ADMA concentrations on the 1st day positively correlated with daily reported hours of sleep (+0.497, P < 0.001) and delivery or eating out frequency (+0.285, P = 0.02), whereas it negatively correlated with reported physical condition (-0.304, P = 0.013). A personal history of hypertension indicated higher 1st-day ADMA concentration (1.818 vs 1.568, P = 0.042). Age positively correlated with 1st-day SDMA (+0.320, P = 0.009). All of the biomarker concentrations were reduced on the 3rd day measurements (P < 0.001). Self-reported lifetime minimum BMI positively correlated with either absolute (r = +0.366, P = 0.009) or percentage (r = +0.262, P = 0.045) ADMA reduction. A daily sleep in 5–8-h range was inversely correlated with percentage (-0.410, P = 0.001) or absolute (r = -0.369, P = 0.002) SDMA reduction.Conclusions:Modifiable factors such as BMI, eating habits, physical condition, and sleep seem to affect the baseline levels or time course of ADMA and SDMA in AMI patients. Changes in these factors may affect AMI prognosis by altering dimethylarginine levels.