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2.
Cochrane Database Syst Rev ; 4: CD011792, 2020 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-32239759

RESUMO

BACKGROUND: This is an updated version of the original Cochrane Review, published in 2016, Issue 7. Sudden Unexpected Death in Epilepsy (SUDEP) is defined as sudden, unexpected, witnessed or unwitnessed, non-traumatic or non-drowning death of people with epilepsy, with or without evidence of a seizure, excluding documented status epilepticus and in whom postmortem examination does not reveal a structural or toxicological cause for death. SUDEP has a reported incidence of 1 to 2 per 1000 patient-years and represents the most common epilepsy-related cause of death. The presence and frequency of generalised tonic-clonic seizures (GTCS), male sex, early age of seizure onset, duration of epilepsy, and polytherapy are all predictors of risk of SUDEP. The exact pathophysiology of SUDEP is currently unknown, although GTCS-induced cardiac, respiratory, and brainstem dysfunction appears likely. Appropriately chosen antiepileptic drug treatment can render around 70% of patients free of all seizures. However, around one-third will remain drug-resistant despite polytherapy. Continuing seizures place patients at risk of SUDEP, depression, and reduced quality of life. Preventative strategies for SUDEP include reducing the occurrence of GTCS by timely referral for presurgical evaluation in people with lesional epilepsy and advice on lifestyle measures; detecting cardiorespiratory distress through clinical observation and seizure, respiratory, and heart rate monitoring devices; preventing airway obstruction through nocturnal supervision and safety pillows; reducing central hypoventilation through physical stimulation and enhancing serotonergic mechanisms of respiratory regulation using selective serotonin reuptake inhibitors (SSRIs); and reducing adenosine and endogenous opioid-induced brain and brainstem depression. OBJECTIVES: To assess the effectiveness of interventions in preventing SUDEP in people with epilepsy by synthesising evidence from randomised controlled trials of interventions and cohort and case-control non-randomised studies. SEARCH METHODS: For the latest update we searched the following databases without language restrictions: Cochrane Register of Studies (CRS Web, 4 February 2019); MEDLINE (Ovid, 1946 to 1 February 2019); SCOPUS (1823 to 4 February 2019); PsycINFO (EBSCOhost, 1887 to 4 January 2019); CINAHL Plus (EBSCOhost, 1937 to 4 February 2019); ClinicalTrials.gov (5 February 2019); and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP, 5 February 2019). We checked the reference lists of retrieved studies for additional reports of relevant studies and contacted lead study authors for any relevant unpublished material. We identified any grey literature studies published in the last five years by searching: Zetoc database; ISI Proceedings; International Bureau for Epilepsy (IBE) congress proceedings database; International League Against Epilepsy (ILAE) congress proceedings database; abstract books of symposia and congresses, meeting abstracts, and research reports. SELECTION CRITERIA: We aimed to include randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs; prospective non-randomised cohort controlled and uncontrolled studies; and case-control studies of adults and children with epilepsy receiving an intervention for the prevention of SUDEP. Types of interventions included: early versus delayed pre-surgical evaluation for lesional epilepsy; educational programmes; seizure-monitoring devices; safety pillows; nocturnal supervision; selective serotonin reuptake inhibitors (SSRIs); opiate antagonists; and adenosine antagonists. DATA COLLECTION AND ANALYSIS: We aimed to collect data on study design factors and participant demographics for included studies. The primary outcome of interest was the number of deaths from SUDEP. Secondary outcomes included: number of other deaths (unrelated to SUDEP); change in mean depression and anxiety scores (as defined within the study); clinically important change in quality of life, that is any change in quality of life score (average and endpoint) according to validated quality of life scales; and number of hospital attendances for seizures. MAIN RESULTS: We identified 1277 records from the databases and search strategies. We found 10 further records by searching other resources (handsearching). We removed 469 duplicate records and screened 818 records (title and abstract) for inclusion in the review. We excluded 785 records based on the title and abstract and assessed 33 full-text articles. We excluded 29 studies: eight studies did not assess interventions to prevent SUDEP; eight studies were review articles, not clinical studies; five studies measured sensitivity of devices to detect GTCS but did not directly measure SUDEP; six studies assessed risk factors for SUDEP but not interventions for preventing SUDEP; and two studies did not have a control group. We included one cohort study and three case-control studies of serious to critical risk of bias. The 6-month prospective cohort study observed no significant effect of providing patients with SUDEP information on drug compliance and quality of life, anxiety and depression levels. The study was too short and with no deaths observed in either group to determine a protective effect. Two case control studies reported a protective effect for nocturnal supervision against SUDEP. However due to significant heterogeneity, the results could not be combined in meta-analysis. One study of 154 SUDEP cases and 616 controls reported an unadjusted odds ratio (OR) of 0.34 (95% CI 0.22 to 0.53; P < 0.0001). The same study demonstrated the protective effect was independent of seizure control, suggesting that nocturnal supervision is not just a surrogate marker of seizure control. The second case-control study of 48 SUDEP cases and 220 controls reported an unadjusted OR of 0.08 (95% CI 0.02 to 0.27; P < 0.0001). The third case-control study of residential care centre patients who were already receiving physical checks more than 15 minutes apart throughout the night did not report any protective effect for additional nocturnal supervision (physical checks < 15 minutes apart; use of listening devices; dormitory setting; and use of bed sensors). However the same study did ascertain a difference between centres: the residential centre with the lowest level of supervision had the highest incidence of SUDEP. The case-control studies did not report on quality of life or depression and anxiety scores. AUTHORS' CONCLUSIONS: We found limited, very low-certainty evidence that supervision at night reduces the incidence of SUDEP. Further research is required to identify the effectiveness of other current interventions - for example seizure detection devices, safety pillows, SSRIs, early surgical evaluation, educational programmes, and opiate and adenosine antagonists - in preventing SUDEP in people with epilepsy.


Assuntos
Morte Súbita/prevenção & controle , Epilepsia/complicações , Segurança do Paciente , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Morte Súbita/etiologia , Epilepsia Tônico-Clônica/complicações , Epilepsia Tônico-Clônica/prevenção & controle , Feminino , Humanos , Masculino , Monitorização Fisiológica/métodos , Qualidade de Vida , Sono
3.
Sports Health ; 12(3): 241-245, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32271134

RESUMO

BACKGROUND: Sickle cell trait (SCT) has been associated with an increased risk of sudden death in athletes during strenuous exercise. In August 2010, the National Collegiate Athletic Association (NCAA) began requiring athletes to be screened for SCT, provide proof of SCT status, or sign a waiver and launched an educational campaign for athletes, coaches, and medical staff. The impact of this program is unknown. The purpose of this study was to determine the incidence of death associated with sickle cell trait (daSCT) in NCAA athletes before and after legislation. HYPOTHESIS: NCAA SCT legislation will decrease the incidence of daSCT. STUDY DESIGN: Observational study. LEVEL OF EVIDENCE: Level 2. METHODS: A database of NCAA athlete deaths from 2000 to 2019 was reviewed for daSCT. A total of 8,309,050 athlete-years (AY) were included. Incidence of death was calculated before and after legislation. RESULTS: The incidence of daSCT in Division I (DI) football athletes before legislation (n = 9) was 1:28,145 AY and after legislation (n = 1) was 1:250,468 AY (relative risk [RR], 0.112; 95% CI, 0.003-0.811; P = 0.022), an 89% reduction in risk after legislation was enacted. The incidence of daSCT in African American DI football athletes before legislation (n = 9) was 1:12,519 AY and after legislation (n = 1) was 1:118,464 AY (RR, 0.106; 95% CI, 0.002-0.763; P = 0.017), also an 89% risk reduction after legislation was enacted. For all NCAA athletes, the incidence of daSCT was 1:489,749 AY before legislation (n = 10) and 1:1,705,780 AY after legislation (n = 2) (RR, 0.288; 95% CI, 0.031-1.347; P = 0.146). CONCLUSION: The incidence of daSCT in DI football athletes has decreased significantly since legislation was enacted. Cases of daSCT outside of football are rare. It is unclear whether the decrease is related to screening for SCT, education, or both. CLINICAL RELEVANCE: This is the first evidence that NCAA SCT legislation may save lives.


Assuntos
Morte Súbita/epidemiologia , Testes Obrigatórios/legislação & jurisprudência , Traço Falciforme/complicações , Traço Falciforme/diagnóstico , Esportes/legislação & jurisprudência , Adolescente , Morte Súbita/prevenção & controle , Humanos , Incidência , Masculino , Estados Unidos/epidemiologia , Adulto Jovem
4.
Rev. esp. cardiol. Supl. (Ed. impresa) ; 18(supl.B): 24-30, dic. 2019. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192365

RESUMO

La coexistencia de insuficiencia cardiaca (IC) con fracción de eyección del ventrículo izquierdo (FEVI) reducida y diabetes es muy frecuente. En los últimos años, el sacubitrilo-valsartán (SV) y la familia de los inhibidores del cotransportador de sodio-glucosa tipo 2 (iSGLT2) han pasado a formar parte del arsenal terapéutico habitual del profesional dedicado a la IC. Comparado con el enalapril, se ha demostrado con el SV en pacientes con IC y FEVI reducida una clara mejoría a nivel pronóstico y de calidad de vida; la familia de fármacos glucosúricos ha mostrado beneficios significativos en protección renal y hospitalización por IC en una población más variada, donde la prevalencia de IC basal es baja. Se revisa la evidencia actual de los 2 fármacos y el uso combinado de ambos. Información sobre el suplemento: este artículo forma parte del suplemento titulado «Controversias para una nueva era en el tratamiento de la insuficiencia cardiaca», que ha sido patrocinado por Novartis


Heart failure with a reduced left ventricular ejection fraction (HFrEF) commonly coexists with diabetes. In recent years, sacubitril-valsartan and the family of sodium-glucose cotransporter-2 (SGLT2) inhibitors have become established as part of the routine therapeutic armamentarium for clinicians dealing with heart failure. In patients with HFrEF, sacubitril-valsartan has been associated with a substantially better prognosis and quality of life compared with enalapril. In addition, the family of SGLT2 inhibitors have demonstrated significant clinical benefits in a more varied patient population with a low prevalence of heart failure at baseline: they preserved renal function and reduced hospitalization for heart failure. The aim of this article was to review the evidence currently available on these two drugs classes and on their use in combination. Supplement information: this article is part of a supplement entitled "Questions on a new era for heart failure treatment" which is sponsored by Novartis


Assuntos
Humanos , Bloqueadores do Receptor Tipo 1 de Angiotensina II/administração & dosagem , Anti-Hipertensivos/administração & dosagem , Valsartana/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Medicina Baseada em Evidências , Qualidade de Vida , Consumo de Oxigênio , Atividade Motora , Morte Súbita/prevenção & controle , Biomarcadores/sangue
5.
Circulation ; 140(11): 952-964, 2019 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-31498700

RESUMO

Despite a 2% to 3% prevalence of echocardiographically defined mitral valve prolapse (MVP) in the general population, the actual burden, risk stratification, and treatment of the so-called arrhythmic MVP are unknown. The clinical profile is characterized by a patient, usually female, with mostly bileaflet myxomatous disease, mid-systolic click, repolarization abnormalities in the inferior leads, and complex ventricular arrhythmias with polymorphic/right bundle branch block morphology, without significant regurgitation. Among the various pathophysiologic mechanisms of electrical instability, left ventricular fibrosis in the papillary muscles and inferobasal wall, mitral annulus disjunction, and systolic curling have been recently described by pathological and cardiac magnetic resonance studies in sudden death victims and patients with arrhythmic MVP. In addition, premature ventricular beats arising from the Purkinje tissue as ventricular fibrillation triggers have been documented by electrophysiologic studies in MVP patients with aborted sudden death. The genesis of malignant ventricular arrhythmias in MVP probably recognizes the combination of the substrate (regional myocardial hypertrophy and fibrosis, Purkinje fibers) and the trigger (mechanical stretch) eliciting premature ventricular beats because of a primary morphofunctional abnormality of the mitral valve annulus. The main clinical challenge is how to identify patients with arrhythmic MVP (which imaging technique and in which patient) and how to treat them to prevent sudden death. Thus, there is a necessity for prospective multicenter studies focusing on the prognostic role of cardiac magnetic resonance and electrophysiologic studies and on the therapeutic efficacy of targeted catheter ablation and mitral valve surgery in reducing the risk of life-threatening arrhythmias, as well as the role of implantable cardioverter defibrillators for primary prevention.


Assuntos
Morte Súbita/epidemiologia , Prolapso da Valva Mitral/diagnóstico por imagem , Prolapso da Valva Mitral/mortalidade , Fibrilação Ventricular/diagnóstico por imagem , Fibrilação Ventricular/mortalidade , Ablação por Cateter/métodos , Morte Súbita/prevenção & controle , Humanos , Prolapso da Valva Mitral/cirurgia , Músculos Papilares/diagnóstico por imagem , Fibrilação Ventricular/cirurgia
6.
Pan Afr Med J ; 33: 114, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489092

RESUMO

Introduction: Sudden death that occurs during sporting activity affects patients with ignored heart disease. Black athlete's ECG has been little studied and the features of this ethnic group have been discussed. This study aims to study the epidemiological profile and the peculiarities of repolarization of black athletes. Methods: We conducted a descriptive study of black athletes selected among all the athletes followed in the sectoral Center of Sports Science and Medicine in Sousse over a period of 8 months from March to October 2014. Data were collected using a medical questionnaire. Results: Data on 35 athletes were collected, with a male predominance (94,28%), with an average age of 24,34 years. Four athletes had left ventricular hypertrophy on cardiac ultrasound. There were 8 athletes with atrioventricular block degree I and 8 athletes with electrical type of left ventricular hypertrophy (LVH). ST segment changes were more marked at the level of precordial leads. Five athletes (14.2%) had inverted T waves in V2 and V3. These were the same athletes who ST-segment depression in these same leads. Early repolarization was found in 3 athletes. All these cases had notch signaling. Conclusion: Black athletes have quite specific electrical modifications which are important to know. However, our sample is not sufficiently large to certify these results. A comparative study of white athletes would be very interesting.


Assuntos
Arritmias Cardíacas/diagnóstico , Atletas , Cardiopatias/diagnóstico , Hipertrofia Ventricular Esquerda/diagnóstico , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano , Arritmias Cardíacas/epidemiologia , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/epidemiologia , Morte Súbita/prevenção & controle , Ecocardiografia , Eletrocardiografia/métodos , Feminino , Cardiopatias/epidemiologia , Humanos , Hipertrofia Ventricular Esquerda/epidemiologia , Masculino , Estudos Retrospectivos , Esportes , Inquéritos e Questionários , Adulto Jovem
7.
Free Radic Biol Med ; 143: 275-287, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31442556

RESUMO

Platelet-activating factor (PAF) is a potent inflammatory agonist. In Swiss albino mice, intraperitoneal injection of PAF causes sudden death with oxidative stress and disseminated intravascular coagulation (DIC), characterized by prolonged prothrombin time, thrombocytopenia, reduced fibrinogen content, and increased levels of fibrinogen degradation products. However, the underlying mechanism(s) is unknown. The PAF-R antagonist WEB-2086 protected mice against PAF-induced death by reducing DIC and oxidative stress. Accordingly, general antioxidants such as ascorbic acid, α-tocopherol, gallic acid, and N-acetylcysteine partially protected mice from PAF-induced death. N-acetylcysteine, a clinically used antioxidant, prevented death in 67% of mice, ameliorated DIC characteristics and histological alterations in the liver, and reduced oxidative stress. WEB-2086 suppressed H2O2-mediated oxidative stress in isolated mouse peritoneal macrophages, suggesting that PAF signaling may be a downstream effector of reactive oxygen species generation. PAF stimulated all three (ERK, JNK, and p38) of the MAP-kinases, which were also inhibited by N-acetylcysteine. Furthermore, a JNK inhibitor (SP600125) and ERK inhibitor (SCH772984) partially protected mice against PAF-induced death, whereas a p38 MAP-kinase inhibitor (SB203580) provided complete protection against DIC and death. In human platelets, which have the canonical PAF-R and functional MAP-kinases, JNK and p38 inhibitors abolished PAF-induced platelet aggregation, but the ERK inhibitor was ineffective. Our studies identify p38 MAP-kinase as a critical, but unrecognized component in PAF-induced mortality in mice. These findings suggest an alternative therapeutic strategy to address PAF-mediated pathogenicity, which plays a role in a broad range of inflammatory diseases.


Assuntos
Morte Súbita/prevenção & controle , Inibidores Enzimáticos/farmacologia , Estresse Oxidativo , Fator de Ativação de Plaquetas/toxicidade , Substâncias Protetoras/farmacologia , Proteínas Quinases p38 Ativadas por Mitógeno/antagonistas & inibidores , Acetilcisteína/farmacologia , Animais , Morte Súbita/etiologia , Morte Súbita/patologia , Feminino , Depuradores de Radicais Livres/farmacologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Espécies Reativas de Oxigênio/metabolismo
8.
Heart Fail Rev ; 24(6): 847-866, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31147814

RESUMO

Heart failure (HF) with preserved ejection fraction (HFpEF) represents half of HF patients, who are more likely older, women, and hypertensive. Mortality rates in HFpEF are higher compared with age- and comorbidity-matched non-HF controls and lower than in HF with reduced ejection fraction (HFrEF); the majority (50-70%) are cardiovascular (CV) deaths. Among CV deaths, sudden death (SD) (~ 35%) and HF-death (~ 20%) are the leading cardiac modes of death; however, proportionally, CV deaths, SD, and HF-deaths are lower in HFpEF, while non-CV deaths constitute a higher proportion of deaths in HFpEF (30-40%) than in HFrEF (~ 15%). Importantly, the underlying mechanism of SD has not been clearly elucidated and non-arrhythmic SD may be more prominent in HFpEF than in HFrEF. Furthermore, there is no specific strategy for identifying high-risk patients, probably due to wide heterogeneity in presentation and pathophysiology of HFpEF and a plethora of comorbidities in this population. Thus, the management of HFpEF remains problematic due to paucity of data on the clinical benefits of current therapies, which focus on symptom relief and reduction of HF-hospitalization by controlling fluid retention and managing risk-factors and comorbidities. Matching a specific pathophysiology or mode of death with available and novel therapies may improve outcomes in HFpEF. However, this still remains an elusive target, as we need more information on determinants of SD. Implantable cardioverter-defibrillators (ICDs) have changed the landscape of SD prevention in HFrEF; if ICDs are to be applied to HFpEF, there must be a coordinated effort to identify and select high-risk patients.


Assuntos
Morte Súbita/prevenção & controle , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Volume Sistólico/fisiologia , Disfunção Ventricular Esquerda/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/metabolismo , Causas de Morte/tendências , Comorbidade , Morte Súbita/etnologia , Morte Súbita/etiologia , Desfibriladores Implantáveis/efeitos adversos , Desfibriladores Implantáveis/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Hospitalização/tendências , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade/etnologia , Prognóstico , Fatores de Risco , Função Ventricular Esquerda/fisiologia
9.
Epilepsy Behav ; 96: 33-40, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31077940

RESUMO

OBJECTIVE: Sudden death in the bathtub occurs relatively frequently in Japan, particularly among elderly people. We hypothesize that sudden death in epilepsy occurring in the bathtub (SDEPB) can be distinguished from sudden death in nonepilepsy occurring in the bathtub (SDnonEPB), but is identical to sudden unexpected death in epilepsy (SUDEP). METHODS: Tokyo Medical Examiner's Office conducts postmortem examinations for all sudden and unexpected deaths in Tokyo. Clinical, social, and autopsy findings of 43 SDEPB were compared with 76 SDnonEPB, 50 SUDEP outside the bathtub, and Japanese forensic autopsy data as controls. RESULTS: Extension of the leg(s) outside the bathtub was seen in 33% of SDEPB, but none of SDnonEPB. Sitting position was seen less frequently in SDEPB (37%) than in SDnonEPB (64%). Lung weight and pleural effusion volume were significantly lower in SDEPB than in SDnonEPB. Age at death in SDEPB was significantly younger than that in SDnonEPB. Sudden death in epilepsy occurring in the bathtub showed no differences in lung weight and pleural effusion volume from SUDEP. Living with family was more frequent in SDEPB (73%) than in SUDEP (48%). Few antiepileptic drugs, infrequent seizures, and low rate of mental retardation were identical between SDEPB and SUDEP. Lung weight was significantly heavier in all three groups than in age- and sex- matched autopsy controls. CONCLUSIONS: Leg extension outside the bathtub, lower lung weight, and absence of pleural effusion distinguish SDEPB from SDnonEPB in elderly people. Sudden death in epilepsy occurring in the bathtub may represent a form of SUDEP occurring in the bathtub, rather than drowning despite submergence in the bathtub at discovery. Conditions for bathing require careful attention from physicians and relatives, even for patients with epilepsy with few medications and infrequent seizures, and without mental retardation.


Assuntos
Banhos/efeitos adversos , Epilepsia/diagnóstico , Epilepsia/mortalidade , Morte Súbita Inesperada na Epilepsia/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticonvulsivantes/uso terapêutico , Banhos/tendências , Morte Súbita/epidemiologia , Morte Súbita/prevenção & controle , Epilepsia/tratamento farmacológico , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Convulsões/diagnóstico , Convulsões/tratamento farmacológico , Convulsões/mortalidade , Morte Súbita Inesperada na Epilepsia/prevenção & controle , Adulto Jovem
10.
J Athl Train ; 54(4): 361-373, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31017807

RESUMO

CONTEXT: Implementation of health and safety best practices for the leading causes of sudden death and catastrophic injury has been shown to mitigate risk. However, to our knowledge, no authors have examined progress toward health and safety policy implementation at the state level. OBJECTIVE: To investigate the progress made by state secondary school leaders in developing and implementing health and safety policies (ie, exertional heat stroke, sudden cardiac arrest, concussion, emergency action plans) and to explore perceived barriers to and strategies for implementation. DESIGN: Mixed-methods study. SETTING: State high school athletics associations and sports medicine advisory committees. PATIENTS OR OTHER PARTICIPANTS: Collaborative Solutions for Safety in Sport meeting attendees participated in this study. Thirty-five state leaders (current role experience = 8 ± 6 years) completed the survey. Ten of the 35 participated in follow-up interviews. DATA COLLECTION AND ANALYSIS: A survey assessing progress on health and safety policy implementation was administered. Respondents indicated whether their state had implemented a policy, made progress without implementation, or made no progress. We conducted follow-up telephone interviews so they could expand on the survey responses. The data were analyzed using descriptive statistics and the general inductive approach. RESULTS: A total of 89% of respondents reported their states made progress on or implemented health and safety policies during the 2015-2016 academic year. Barriers to policy implementation included cost, a lack of understanding regarding policies versus recommendations, the content and value of policy change, and a false sense of security. Strategies for implementation included varying approaches to change, education of all constituents, and collaborative relationships among key stakeholders. CONCLUSIONS: Although a majority of respondents reported progress in implementing health and safety policies in their states, perceived barriers pointed to the need for the continued education of state leaders in charge of developing and implementing health and safety policies. Despite these barriers, collaboration among key stakeholders is crucial to successful implementation of best-practice policies in secondary school athletics.


Assuntos
Traumatismos em Atletas/prevenção & controle , Morte Súbita/prevenção & controle , Implementação de Plano de Saúde/métodos , Liderança , Serviços de Saúde Escolar/normas , Medicina Esportiva/organização & administração , Esportes/normas , Adolescente , Traumatismos em Atletas/epidemiologia , Criança , Pré-Escolar , Feminino , Política de Saúde , Humanos , Incidência , Masculino , Estudos Retrospectivos , Instituições Acadêmicas , Medicina Esportiva/normas , Estados Unidos/epidemiologia
11.
Trends Neurosci ; 42(4): 242-250, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30905388

RESUMO

Premature, sudden death is devastating. Certain patient populations are at greater risk to succumb to sudden death. For instance, infants under 1year of age are at risk for sudden infant death syndrome (SIDS), and patients with epilepsy are at risk for sudden unexpected death in epilepsy (SUDEP). Deaths are attributed to these syndromic entities in these select populations when other diagnoses have been excluded. There are a number of similarities between these syndromes, and the commonalities suggest that the two syndromes may share certain etiological features. One such feature may be deficiency of arousal to CO2. Under normal conditions, CO2 is a potent arousal stimulus. Circumstances surrounding SIDS and SUDEP deaths often facilitate CO2 elevation, and faulty CO2 arousal mechanisms could, at least in part, contribute to death.


Assuntos
Nível de Alerta/fisiologia , Dióxido de Carbono/metabolismo , Morte Súbita/etiologia , Animais , Morte Súbita/prevenção & controle , Epilepsia Resistente a Medicamentos/metabolismo , Humanos , Lactente , Morte do Lactente/etiologia , Morte do Lactente/prevenção & controle , Sono/fisiologia
12.
Medicine (Baltimore) ; 98(8): e14697, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813218

RESUMO

BACKGROUND: Fulminant myocarditis (FM) is a sub-category myocarditis. Its primary characteristic is a rapidly progressive clinical course that necessitates hemodynamic support. FM can be difficult to predict at the onset of myocarditis. The aim of this meta-analysis was to identify the early characteristics in FM compared to those of non-fulminant myocarditis (NFM). METHODS: We searched the databases of MEDLINE, EMBASE, CENTRAL, for studies comparing FM with acute NFM from January 1, 2000 to June 1, 2018. The baseline variables were compared in each study. Mean differences (MD) and relative ratios (RR) were calculated. RESULTS: Seven studies (158 FM patients and 388 NFM patients) were included in the analysis. The FM group had significantly lower systolic blood pressure (SBP), higher creatine kinase (CK), wider QRS duration, lower left ventricular ejection fraction (LVEF), thicker left ventricular posterior wall diameter (LVPWd), higher incidence of ST depression, ventricular tachycardia/ventricular fibrillation (Vt/Vf) and syncope, less incidence of chest pain than the NFM groups. There was no difference in terms of heart rate (HR), c-reactive protein (CRP), fever, dyspnea, white blood cells (WBC), atrioventricular block (AVB), Q waves, ST elevation, interventricular septum diameter (IVSd), or end-diastolic left ventricular diameter (LVEDd) between FM and NFM. CONCLUSION: We found that the lower SBP, higher CK, wider QRS duration, lower LVEF, thicker LVPWd, higher incidence of ST depression, Vt/Vf and syncope as well as lower incidence of chest pain were early characteristics of FM.


Assuntos
Morte Súbita , Diagnóstico Precoce , Miocardite/diagnóstico , Morte Súbita/etiologia , Morte Súbita/prevenção & controle , Intervenção Médica Precoce , Testes de Função Cardíaca/métodos , Hemodinâmica , Humanos , Miocardite/complicações , Miocardite/fisiopatologia , Avaliação de Sintomas/métodos
13.
Chest ; 156(1): 172-181, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30711481

RESUMO

Epilepsy is the fourth most common neurologic disorde in the United States, affecting over 2.2 million people. Epilepsy is associated with a number of medical and psychiatric comorbidities, higher health-care use and cost, and substantial economic burden. OSA is twofold more common in adults with epilepsy than in age-matched control subjects, and the incidence increases with age. Self-reported daytime sleepiness is not helpful in predicting OSA, possibly related to the ceiling effect of general sleepiness among people with epilepsy from diverse causes. Mostly small retrospective series found a significant reduction in seizures in people with epilepsy and OSA adherent with positive airway pressure therapy compared with untreated individuals. This finding illustrates the potential beneficial effects of sleep therapies on epilepsy. Central apnea, oxygen desaturations, and hypercapnia can occur during the ictal and immediate postictal period, especially with generalized tonic-clonic seizures. Central apneas have been produced by electrical stimulation of mesial temporal structures. These respiratory disturbances suggest activation of the central autonomic network and may contribute to sudden unexpected death in epilepsy (SUDEP), the leading cause of epilepsy-related death in people with drug-resistant epilepsy. SUDEP typically occurs during sleep, and patients are more often found in a prone position and have a history of nocturnal seizures. Whether OSA contributes to SUDEP is unknown. Vagus nerve stimulation is a form of neuromodulation for drug-resistant focal epilepsy. When the device activates during sleep it causes reduction in airflow and respiratory effort, airflow obstruction, and oxygen desaturations, sometimes producing a clinical sleep apnea syndrome. The goal of this review is to discuss firmly established and recently recognized clinical, neurobiologic, electrophysiologic, and polysomnographic relationships between sleep-disordered breathing and epilepsy.


Assuntos
Epilepsia/complicações , Síndromes da Apneia do Sono/complicações , Morte Súbita/prevenção & controle , Eletroencefalografia , Epilepsia/fisiopatologia , Epilepsia/terapia , Humanos , Polissonografia , Síndromes da Apneia do Sono/fisiopatologia , Síndromes da Apneia do Sono/terapia
14.
Arch Cardiovasc Dis ; 112(4): 270-277, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30670362

RESUMO

BACKGROUND: Left ventricular ejection fraction lacks accuracy in predicting sudden cardiac death, resulting in unnecessary implantation of cardioverter defibrillators for the primary prevention of sudden cardiac death. Baroreflex sensitivity could help to stratify patients at risk of ventricular arrhythmia. AIM: To assess the association between cardiac baroreflex sensitivity and ventricular arrhythmias in patients implanted with an implantable cardioverter defibrillator for the primary prevention of sudden cardiac death after myocardial infarction. METHODS: This case-control single-centre study took place between 2015 and 2016. Cases (n=10) had experienced ventricular arrhythmias treated by the implantable cardioverter defibrillator in the previous 3 years; controls (n=22) had no arrhythmia during the same period. Baroreflex sensitivity was assessed using the temporal sequence method (mean slope) and cross-spectral analysis (low-frequency gain and high-frequency gain). RESULTS: The mean age was 65 years; 94% of the patients were men. 24-hour Holter electrocardiogram autonomous nervous system variables, left ventricular ejection fraction and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) concentration did not differ between cases and controls. The mean slope was lower in cases than in controls (8 vs. 15ms/mmHg [P=0.009] in the supine position; 7 vs. 12ms/mmHg [P=0.038] in the standing position). The mean slope in the supine position was still significantly different between groups after adjustment for age, left ventricular ejection fraction and NT-proBNP (P=0.03). By comparison, low-frequency gain and high-frequency gain did not differ between groups in either the supine or the standing position. CONCLUSION: Patients with ventricular arrhythmias had a lower mean slope compared with those who were free of arrhythmia. A prospective study is needed to confirm this association.


Assuntos
Arritmias Cardíacas/prevenção & controle , Barorreflexo , Morte Súbita/prevenção & controle , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Infarto do Miocárdio/complicações , Prevenção Primária/instrumentação , Idoso , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/fisiopatologia , Biomarcadores/sangue , Tomada de Decisão Clínica , Estudos Transversais , Morte Súbita/etiologia , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/fisiopatologia , Peptídeo Natriurético Encefálico/sangue , Seleção de Pacientes , Fragmentos de Peptídeos/sangue , Projetos Piloto , Pletismografia , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
15.
Epilepsy Behav ; 90: 99-106, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30522060

RESUMO

BACKGROUND: Sudden Unexpected Death in Epilepsy (SUDEP) is a significant cause of death in childhood epilepsy, and causes considerable concern to patients and their families. Despite this, the condition remains poorly understood. This systematic review investigates the risk factors, pathophysiology, and circumstances associated with childhood SUDEP. It aimed to explore the etiology of SUDEP and inform clinicians approaching SUDEP risk disclosure. METHODS: A structured electronic database search of MEDLINE, CENTRAL, EMBASE, and ISI web of science was conducted. Studies were included if they described clinical details of one or more patients, aged 18 years of age and below, who had SUDEP. Two reviewers independently reviewed each article for data extraction and quality assessment. RESULTS: Information on 108 cases of pediatric SUDEP was extracted from 22 included studies. These comprised five cohort studies, four retrospective case control studies, seven case series, and five case reports. Factors that appeared to be linked to pediatric SUDEP included those associated with severe epilepsy (early age of onset, high seizure frequency, intellectual impairment and developmental delay, multiple antiepileptic drug therapy, and structural abnormalities). The majority of included studies was noncomparative and had significant risk of bias. CONCLUSIONS: There is currently insufficient evidence to determine the etiology of pediatric SUDEP. Current best practice to prevent pediatric SUDEP is to optimize the management of epilepsy. A national SUDEP registry would provide invaluable high-quality data and insights into modifiable risk factors, genetic predispositions, and novel prevention strategies.


Assuntos
Morte Súbita/epidemiologia , Morte Súbita/prevenção & controle , Epilepsia/epidemiologia , Epilepsia/terapia , Adolescente , Anticonvulsivantes/uso terapêutico , Estudos de Casos e Controles , Criança , Estudos de Coortes , Morte Súbita/etiologia , Deficiências do Desenvolvimento/complicações , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/terapia , Epilepsia/complicações , Feminino , Predisposição Genética para Doença , Humanos , Masculino , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco
16.
Arch Dis Child ; 104(2): 189-192, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30266875

RESUMO

The relationship between sleep and seizure disorders is a particularly vicious cycle. Nocturnal seizures can interrupt sleep while a number of factors, including antiepileptics and sleep disorders that cause sleep fragmentation, can worsen seizures. Understanding and managing seizures and related sleep disturbance is therefore an important and treatable intervention target that could potentially improve children's sleep, but also their learning, mood, behaviour, seizures and parental quality of life.


Assuntos
Epilepsia/complicações , Privação do Sono/complicações , Transtornos do Sono-Vigília/complicações , Anticonvulsivantes/efeitos adversos , Criança , Morte Súbita/etiologia , Morte Súbita/prevenção & controle , Dieta Cetogênica , Epilepsia/terapia , Humanos , Deficiências da Aprendizagem/etiologia , Qualidade de Vida , Estimulação do Nervo Vago
17.
J Thorac Cardiovasc Surg ; 158(4): 996-1004.e3, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30578057

RESUMO

OBJECTIVES: The current guidelines do not consider chronic type A aortic dissection as one of the triggers for prophylactic aortic repair, and an aortic diameter of 55 mm is considered the threshold for surgery. METHODS: From the institutional database, we retrieved 82 patients who were diagnosed as having chronic type A aortic dissection but did not undergo immediate surgical repair from 1997 to 2016. The primary outcome was a composite of adverse aortic events defined as aortic rupture and sudden death. Conversion to elective surgery during follow-up was regarded as competing risk for adverse events. RESULTS: The median value of the maximal aortic diameter at baseline was 55.2 mm. During a median follow-up of 77.1 months, 19 adverse events occurred while 9 patients received elective aortic repair. On multivariable competing risk analyses, baseline aortic diameter and age emerged as significant and independent factors associated with aortic events. The estimated rates of aortic event within 5 years were 12.0%, 19.4%, and 29.7% for aortic diameters of 50, 60, and 70 mm, respectively, with escalating risk rates as age increased for the given aortic diameters. CONCLUSIONS: In unrepaired chronic type A aortic dissection, aortic events were not infrequent even for patients with an aortic diameter of less than 55 mm. This finding indicates that there may be a need to lower the surgical threshold for chronic type A aortic dissection.


Assuntos
Aneurisma Dissecante/fisiopatologia , Aorta/fisiopatologia , Aneurisma da Aorta Torácica/fisiopatologia , Ruptura Aórtica/fisiopatologia , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Ruptura Aórtica/etiologia , Ruptura Aórtica/prevenção & controle , Implante de Prótese Vascular , Doença Crônica/terapia , Morte Súbita/etiologia , Morte Súbita/prevenção & controle , Progressão da Doença , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Tomografia Computadorizada por Raios X
18.
Rev Med Chil ; 146(8): 902-908, 2018 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-30534869

RESUMO

The risk of sudden unexpected death in patients with epilepsy (SUDEP), is 20 to 25 times greater than in the general population. This increased risk is seen specially in refractory epilepsy, with an incidence of 9:1,000 patients-years. Risk factors have been established based on retrospective studies, finding that the frequency of seizures, specially generalized tonic clonic seizures, is the most important one. The physiopathological mechanism of SUDEP is not yet fully understood. Autonomic system abnormalities, as well as cardiac and respiratory changes have been found. The finding of new molecular biomarkers to identify patients with increased risk should be a priority. Treatment is based in the management of risk factors, although clear recommendations are hard to establish given the low level of evidence.


Assuntos
Morte Súbita/etiologia , Epilepsia/complicações , Epilepsia/mortalidade , Biomarcadores , Chile/epidemiologia , Morte Súbita/epidemiologia , Morte Súbita/prevenção & controle , Feminino , Humanos , Incidência , Fatores de Risco
19.
BMJ ; 363: k5094, 2018 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-30545967

RESUMO

OBJECTIVE: To determine if using a parachute prevents death or major traumatic injury when jumping from an aircraft. DESIGN: Randomized controlled trial. SETTING: Private or commercial aircraft between September 2017 and August 2018. PARTICIPANTS: 92 aircraft passengers aged 18 and over were screened for participation. 23 agreed to be enrolled and were randomized. INTERVENTION: Jumping from an aircraft (airplane or helicopter) with a parachute versus an empty backpack (unblinded). MAIN OUTCOME MEASURES: Composite of death or major traumatic injury (defined by an Injury Severity Score over 15) upon impact with the ground measured immediately after landing. RESULTS: Parachute use did not significantly reduce death or major injury (0% for parachute v 0% for control; P>0.9). This finding was consistent across multiple subgroups. Compared with individuals screened but not enrolled, participants included in the study were on aircraft at significantly lower altitude (mean of 0.6 m for participants v mean of 9146 m for non-participants; P<0.001) and lower velocity (mean of 0 km/h v mean of 800 km/h; P<0.001). CONCLUSIONS: Parachute use did not reduce death or major traumatic injury when jumping from aircraft in the first randomized evaluation of this intervention. However, the trial was only able to enroll participants on small stationary aircraft on the ground, suggesting cautious extrapolation to high altitude jumps. When beliefs regarding the effectiveness of an intervention exist in the community, randomized trials might selectively enroll individuals with a lower perceived likelihood of benefit, thus diminishing the applicability of the results to clinical practice.


Assuntos
Medicina Aeroespacial/métodos , Morte Súbita/prevenção & controle , Equipamentos de Proteção , Ferimentos e Lesões/prevenção & controle , Acidentes Aeronáuticos/prevenção & controle , Adulto , Aeronaves , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Senso de Humor e Humor como Assunto
20.
RELAMPA, Rev. Lat.-Am. Marcapasso Arritm ; 31(4): 173-175, out.-dez. 2018. ilus
Artigo em Português | LILACS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-999266

RESUMO

Relato de caso de uma paciente do sexo feminino, com 16 anos de idade à ocasião de sua admissão no Instituto de Cardiologia. A mesma foi encaminhada por serviço de saúde externo devido a síncopes durante atividade física e foi submetida à investigação, com diagnóstico final de taquicardia ventricular catecolaminérgica. Após a definição diagnóstica, foi realizado tratamento medicamentoso com betabloqueador, sendo necessário o implante de marcapasso definitivo por conta da incompetência cronotrópica secundária ao tratamento farmacológico instituído. Posteriormente, por persistência das arritmias ventriculares mesmo com o uso de terapia otimizada, optou-se por realizar um implante de CDI


Case report of a 16-year-old female patient at the time of her admission to the Institute of Cardiology. She was referred by an external healthcare service due to syncope during physical activity and was submitted to the investigation with a final diagnosis of catecholaminergic ventricular tachycardia. Once the diagnosis was established, the patient was administered a beta-blocker and definitive pacemaker implant was required due to chronotropic incompetence secondary to drug therapy. Subsequently, due to the persistence of ventricular arrhythmias despite the use of optimized therapy, we decided to implant an ICD


Assuntos
Humanos , Feminino , Adolescente , Taquicardia Ventricular , Desfibriladores Implantáveis , Marca-Passo Artificial , Síncope , Nadolol/uso terapêutico , Técnicas Eletrofisiológicas Cardíacas/métodos , Morte Súbita/prevenção & controle , Tratamento Farmacológico/métodos , Doenças Genéticas Inatas/diagnóstico
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