Prevalence of abdominal obesity in adolescents: a systematic review

The objectives of this study were to (i) review extant literature on the prevalence of abdominal obesity (AO) in adolescents of both sex (10-19 years old); (ii) analyse the cut-off points used for the diagnosis of AO and (iii) compare its prevalence between developed and developing countries. The search was carried out using online databases (MEDLINE, Web of Science, EMBASE, SPORTDiscus, SCIELO and BioMed Central), references cited by retrieved articles and by contact with the authors, considering articles published from the establishment of the databanks until 19 October 2009. Only original articles and those using waist circumference in the diagnosis were considered. Twenty-nine studies met the inclusion criteria. Fourteen of these studies were performed in developed countries. The prevalence of AO varied from 3.8% to 51.7% in adolescents from developing countries. The range of results was smaller among developed countries; with values from 8.7% to 33.2%. Eighteen different cut-off points were used. It was concluded the AO prevalence is high among adolescents, but is not clear what sex has a higher proportion and it is greater in adolescents from developing countries; however, there is no consensus in the literature about the criteria to be used.

Short-term environmental impact of clam dredging in coastal waters (south of Portugal): chemical disturbance and subsequent recovery of seabed

The physical and chemical changes in sediment and near bottom water caused by clam dredging were examined during July and September 1999, at two locations Vilamoura (VL) and Armona (AR), south coast of Portugal. Sediment cores and near bottom water were collected simultaneously before dredging (control samples) and within short time intervals (min-h) after dredging. After dredging operations, microphytobenthos coming from the path were accumulated in the re-worked sediment (ridge). Chlorophyll a in superficial sediment increased from 1.2 microg x g(-1) before dredging to 1.7 microg x g(-1) after dredging and these higher values remained for a few hours. However, the expected increase of chlorophyll a in near bottom water due to re-suspension was not observed. After sediment disturbance an instantaneous sorption of phosphorus onto iron oxides occurred in the upper sediment layers (from 2 to 3 micromol x g(-1) before dredging to 4-5 micromol x g(-1) after dredging). A microcosm experiment showed that after sediment disturbance HPO(4)(2-) dissolved in pore water decreased from 40 to 10 microM being simultaneously sorbed onto iron oxides formed in the top layer of sediment. The ammonium, nitrates, organic nitrogen, phosphate and silicate dissolved in pore water decreased immediately after dredging activity and simultaneously an increase in near bottom water was sporadically observed. Generally, the re-establishment of seabed was reached within a short time (min-h), at both stations (VL and AR).

[Hyperglycemia and glucosuria in preterm infants receiving parenteral glucose: influence of birth weight, gestational age and infusion rate]

OBJECTIVE: Morbidity and mortality of premature infants have decreased considerably over the last decades, therefore, adequate nutrition of the premature is a major concern. Enteral feeding is the route of choice, but when it is not possible the parenteral route, which contains glucose as one of its main components, is used. Glucose infusions are not devoid of risk as they facilitate the development of hyperglycemia leading to intracranial hemorrhage, glucosuria and dehydration. The aim of this paper is to relate hyperglycemia and glucosuria to birth weight, gestational age and glucose infusion rate.METHODS: The study was developed at the Nursery of Santa Catarina Hospital (São Paulo). The authors developed a prospective study; 511 concurrent determinations of glycemia and qualitative glucosuria were performed in 40 preterm newborn infants receiving parenteral glucose (mean of 12.8 dosages per newborn).RESULTS: Fifty-nine (11.5%) episodes of hyperglycemia were detected, and their frequency was higher at lower gestational ages (</=34 weeks), lower birth weights (< 1500g) and higher glucose infusion rates (>/= 6 mg/kg/min). Thirty-one (6.1%) episodes of glucosuria were detected, and were more frequent in lower gestational ages (</= 34 weeks), lower birth weights (< 1500g) and higher glucose infusion rates (>/= 6 mg/kg/min).CONCLUSIONS: The frequency of hyperglycemia and glucosuria in preterm newborn infants receiving glucose infusion was higher in lower gestational ages, lower birth weights and higher glucose infusion rates. In preterm newborn infants it is necessary to observe the glucose infusion rate and its respective glycemia, in order to avoid the complications of hyperglycemia.

Urinary tract infection in full-term newborn infants: risk factor analysis

OBJECTIVE

To analyze the correlation of risk factors to the occurrence of urinary tract infection in full-term newborn infants.

PATIENTS AND METHODS

Retrospective study (1997) including full-term infants having a positive urine culture by bag specimen. Urine collection was based on: fever, weight loss > 10% of birth weight, nonspecific symptoms (feeding intolerance, failure to thrive, hypoactivity, debilitate suction, irritability), or renal and urinary tract malformations. In these cases, another urine culture by suprapubic bladder aspiration was collected to confirm the diagnosis. To compare and validate the risk factors in each group, the selected cases were divided into two groups: Group I - positive urine culture by bag specimen collection and negative urine culture by suprapubic aspiration, and Group II - positive urine culture by bag specimen collection and positive urine culture by suprapubic aspiration.

RESULTS

Sixty one infants were studied, Group I, n = 42 (68.9%) and Group II, n = 19 (31.1%). The selected risk factors (associated infectious diseases, use of broad-spectrum antibiotics, renal and urinary tract malformations, mechanical ventilation, parenteral nutrition and intravascular catheter) were more frequent in Group II (p<0.05). Through relative risk analysis, risk factors were, in decreasing importance: parenteral nutrition, intravascular catheter, associated infectious diseases, use of broad-spectrum antibiotics, mechanical ventilation, and renal and urinary tract malformations.

CONCLUSION

The results showed that parenteral nutrition, intravascular catheter, and associated infectious diseases contributed to increase the frequency of neonatal urinary tract infection, and in the presence of more than one risk factor, the occurrence of urinary tract infection rose up to 11 times.

Relationship between plasma creatinine concentration and glomerular filtration in preterm newborn infants

Fluid management and dosage regimens of drugs in preterm infants should be based on the glomerular filtration rate. The current methods to determine glomerular filtration rate are invasive, time-consuming, and expensive. In contrast, creatinine clearance can be easy obtained and quickly determined. The purpose of this study was to compare plasma creatinine on the third and seventh day of life in preterm newborn infants, to evaluate the influence of maternal creatinine, and to demonstrate creatinine clearance can be used as a reliable indicator of glomerular filtration rate. We developed a prospective study (1994) including 40 preterm newborns (gestational age < 37 weeks), average = 34 weeks; birth weight (average) = 1840 g, in the first week of life. Inclusion criteria consisted of: absence of renal and urinary tract anomalies; O2 saturation >/= 92%; adequate urine output (>1ml/kg/hr); normal blood pressure; absence of infections and no sympathomimetic amines in use. A blood sample was collected to determine plasma creatinine (enzymatic method) on the third and seventh day of life and creatinine clearance (CrCl) was obtained using the following equation: [formula: see text], k = 0.33 in preterm infant All plasma creatinine determinations showed normal values [third day: 0.78 mg/dl +/- 0.24 (mean +/- SD)and seventh day: 0.67 mg/dl +/- 0.31 - (p>0.05)]. Also all creatinine clearance at third and seventh day of life were normal [third day: 19.5 ml/min +/- 5.2 (mean +/- SD) and seventh day: 23.8 ml/min +/- 7.3 - (p>0,05)]. All preterm infants developed adequate renal function for their respective gestational age. In summary, our results indicate that, for clinical practice, the creatinine clearance, using newborn length, can be used to estimate glomerular filtration rate in preterm newborn infants.

Urinary tract infection in full-term newborn infants: value of urine culture by bag specimen collection

OBJECTIVE

To evaluate the efficacy of urine culture by bag specimen for the detection of neonatal urinary tract infection in full-term newborn infants. Retrospective study (1997) including full-term newborn infants having a positive urine culture (> 100,000 CFU/ml) by bag specimen collection. The urinary tract infection diagnosis was confirmed by positive urine culture (suprapubic bladder aspiration method). The select cases were divided into three groups, according to newborn infant age at the bag specimen collection: GI (< 48 h, n = 17), GII (48 h to 7 d, n = 35) and GIII (> 7 d, n = 9). Sixty one full-term newborn infants were studied (5.1% of total infants). The diagnosis was confirmed on 19/61 (31.1%) of full-term infants born alive. Distribution among the groups was: GI = 2/17 (11.8%), GII = 10/35 (28.6%), and GIII = 7/9 (77.7%). The most relevant clinical symptoms were: fever (GI--100%, GII--91.4%) and weight loss (GI--35.3%, GII--45.7%). Urine culture results for specimens collected by suprapubic aspiration were: E. coli GI (100%), GII (40%) and GIII (28.6%), E. faecalis GI (30%), Staphylococcus coagulase-negative GII (20%) and GIII (42.8%), and Staphylococcus aureus GII (10%). Correlation between positive urine culture collection (bag specimen method) and urinary tract infection diagnosis, using relative risk analysis, produced the following results: GI = 0.30 (CI 95% 0.08-1.15), GII = 0.51 (CI 95% 0.25-1.06) and GIII = 3.31 (CI 95% 1.8-6.06). The most frequent urinary tract infection clinical signs in the first week were fever and weight loss, while non-specific symptomatology occurred later. E. coli was most frequent infectious agent, although from the 7th day of life, staphylococcus was noted. The urine culture (bag specimen method) was effective in detecting urinary tract infection only after the 7th day of life.

Is glycosuria a reliable indicator of adequacy of glucose infusion rate in preterm infants?

CONTEXT

Adequacy of glucose infusion may be monitored via the glycosuria levels, as there is a relationship between glycemia and glycosuria regulated by the renal glucose threshold. In the neonatal period, however, this relationship is not so clear.

OBJECTIVE

To evaluate the occurrence of glycosuria in preferm infants submitted to glucose infusion and to verify the relationship between glycosuria and blood glucose level.

DESIGN

Accuracy study.

SETTING

Neonatal intensive care unit of General Maternity Hospital.

PATIENTS

40 Preterm newborns receiving glucose infusion.

PROCEDURES

511 concomitant determinations of glycemia and glycosuria were performed. These 511 pairs were divided into stable and unstable, according to the clinical status of the newborn at the time of data collection, and they were studied in relation to the gestational age, birth weight and glucose infusion rate.

RESULTS

The results revealed a greater frequency of glycosuria in gestational age < or = 30 weeks, birth weight < 1500 g and glucose infusion rate > 6 mg/kg/min. Eight (25.8%) episodes of positive glycosuria occurred in the absence of hyperglycemia, indicating only a moderate concordance between them.

CONCLUSION

Glycosuria alone is an unreliable marker of blood glucose concentration and adequacy of glucose infusion rate. It is therefore necessary to monitor blood glucose levels in infants submitted to continuous glucose infusion.

Biogeochemical processes and nutrient cycling within an artificial reef off Southern Portugal

This study (2002/2004) examines the effect of artificial reef (AR) structures off the southern coast of Portugal on biogeochemical process and nutrient cycling. Organic and inorganic carbon, nitrogen, phosphorus and chlorophyll a were determined monthly in sediment cores and settled particles for a two-year period. Ammonium, nitrates, phosphates, silicates, total organic nitrogen and phosphorus, chlorophyll a and phaeopigments were also determined monthly in water samples within AR and control sites. Results of the two-year study showed that: (i) there was a significant exponential fit between organic carbon and chlorophyll a (r2=0.91; p<0.01) in reef sediment suggesting an increase of benthic productivity; (ii) organic carbon and nitrogen content in settled particles within AR environment was about four times higher two years after reef deployment; (iii) nutrients and chlorophyll a in the water column were higher at AR than control site. Two years after AR deployment, dissolved organic and inorganic compounds in near bottom water were 30-60% higher, emphasizing benthic remineralization processes at AR's organically rich sediment. Marked chemical changes in the ecosystem were observed during the two-year study period, reinforcing the importance of these structures for sandy coastal areas rehabilitation through trophic chain pull-out.

Effects of infauna harvesting on tidal flats of a coastal lagoon (Ria Formosa, Portugal): implications on phosphorus dynamics

The systematic collection of benthic organisms in tidal flats of coastal lagoons should be taken into account for the management of these systems, once sediment disturbance affects biogeochemical processes by favouring pore water renewal during tidal inundation. The objective of the present work was to evaluate the effects of infauna harvesting on the phosphorus dynamics of muddy and sandy intertidal areas in the Ria Formosa. Sediment cores and overlying water were collected during August 2000 and February 2001 from reworked and undisturbed sediment before and after flooding. Results obtained showed that during the first minutes of flooding there was a marked decrease of phosphate in pore water of disturbed sediments. However, phosphate tidal fluxes from sandy sediment were clearly higher (17 nmol cm(-2) d(-1) in summer and 3 nmol cm(-2) d(-1) in winter) than in muddy sediment (0.4 nmol cm(-2) d(-1) in summer and -0.01 nmol cm(-2) d(-1) in winter). After muddy sediment disturbance concentrations of iron oxides increased quickly (from 5 to 16 micromol g(-1)) and phosphate was sorbed onto these iron oxides, resulting in a buffering of phosphate pore water concentrations at low values in the oxidized sediment zone. The estimated P-output from muddy sediment decreased one to two orders of magnitude after sediment disturbance in contrast to sandy sediments in which the impact of infauna harvesting was minimal. Consequently, the P-cycle is influenced by the disruption of muddy habitats in tide-driven systems. Such information could be useful for the management of the lagoon.

PCR in the first oropharynx aspirate of the newborn: a possible source for identification of congenital infection agents

We present a case of prenatal diagnosis of congenital rubella. After birth, in addition to traditional serologic and clinical examinations to confirm the infection, we could identify the virus in the "first fluid aspirated from the oropharynx of the newborn", using polimerase chain reaction (PCR). We propose that this first oropharynx fluid (collected routinely immediately after birth) could be used as a source for identification of various congenital infection agents, which may not always be easily identified by current methods.

[Early-onset neonatal sepsis and late-appearing diaphragmatic hernia]

The interesting association between delayed presentation of right-sided diaphragmatic hernia and neonatal Group B streptococcal infections occurs rarely and its pathogenesis is still obscure. Two preterm newborn infants with early onset of neonatal sepsis (one due to Group B Streptococcus) followed by recognition of right-sided diaphragmatic hernia on the 9th and 25th day of life are reported. In both cases the course of neonatal sepsis and pneumonia was complicated due to the appearance of right-sided pleural effusion and atelectasis. On serial chest roentgenograms right-sided bowel gas was noticed and the liver shadow became gradually elevated. Diagnosis was confirmed by ultrasonography and computed tomography. Suspicion of associated diaphragmatic hernia should be raised in neonatal streptococcal infection whenever subsequent progressive respiratory deterioration ensues, requiring mechanical ventilation after initial clinical improvement or in the presence of right-sided pleural effusion.

Effectiveness of treat-and-extend versus pro re nata regimens in the treatment of Neovascular Age Macular Degeneration: A Real World Comparison

PURPOSE

Evaluate and compare the visual and morphological results of Pro re nata (PRN) and treat-and-extend (T&E) treatment regimens at 3 years in real world clinical practice.

METHODS

Retrospective study of patients with neovascular age macular degeneration (AMD) treated with anti-VEGF with 3 years of continuous follow-up and no previous anti-VEGF treatment. Best corrected visual acuity (BCVA), central foveal thickness (CFT) and number of intravitreal injections outcomes were tested for statistical differences between the two groups at baseline and during follow-up.

RESULTS

A total of 240 eyes were included in the study, 170 in the PRN group and 70 in the T&E group. At 12 months, mean BCVA (ETDRS letters) gain from baseline was at its highest point in the T&E group (+6.38±13.32; p=0.25). In the PRN group, BCVA peaked at 3 months and slowly decreased until end of follow-up. With both regimens, from baseline, CFT continued to decrease until the second year (PRN -138.81 [-846.7 to +162.77] and T&E -81 [-604 to +100] μm, p=0.06). After that, T&E group maintained this tendency, reaching the lowest CFT value at 36 months, whereas PRN group showed an increased in CFT values (PRN -104 [-807.7 to +297] μm and T&E -103 [-575 to +244], μm p=0.63). Patients treated with T&E regimen received a significantly higher number of injections (PRN 16.3±7.6 vs T&E 23.9 ±9.4, p<0.01).

CONCLUSION

Our results demonstrated a trend towards for T&E to achieve higher marks in BCVA, peaking at 12 months, and lower CFT thickness at the end of three years. Despite the higher number of injections performed in the T&E group the mean BCVA reverts to baseline values at 3 years.

[Congenital cardiopathies at an internal medicine service]

STUDY OBJECTIVE

Description of 32 cases of congenital heart disease in the adulthood, admitted in the First Department of Medicine of Hospital Santa Maria, Lisboa between 1980 and 1989.

DESIGN

Retrospective study.

SETTING

Admission from the Emergency Room and Outpatients Clinic to an Internal Medicine Department of a General Hospital.

PATIENTS

Adult patients with congenital heart disease.

MATERIAL AND METHODS

All the 32 cases of congenital heart disease admitted between the 1st January 1980 and the 31st December 1989 were studied retrospectively. The clinical findings diagnosis and special examinations were analysed.

MAIN RESULTS

The admission age varied between 15 and 83 years old being 21 female (65.6%) and 11 males (34.4%). The 32 cases of congenital heart disease, were distributed as follows: 19 were atrial septal defects (ASD); 4 were bicuspid aortic valves; 3 were coarctations of the aorta; 3 were tetralogy of Fallot; 2 were patent ductus arteriosus; 1 was an Ebstein anomaly with cianosis. From the 19 cases of atrial septal defect (ASD), 15 were female and 4 were male. The mean age of admission was 57.1 +/- 14.9. Congestive heart failure (CHF) was the reason for admission in 11 cases. The EKG findings were atrial fibrillation (AF) in 11 cases and atrial flutter in 1. Pulmonary hypertension was observed in the 17 echocardiographically documented cases. Infeccious endocarditis was diagnosed in 2 of the 4 bicuspid aortic valves.

CONCLUSIONS

Congenital heart disease is not a very rare disease. In our 32 cases, 19 (59%) were ASD. CHD and AF were very common in this patology, in relation to the advanced age of this population. The echocardiography was a very useful diagnostic procedure. The 2 infective endocarditis cases between the 4 bicuspid aortic valves, is a way to remember the importance of prophylaxis.

Body mass index values for newborns according to gestational age

OBJECTIVE

The combination of twho anthropometric parameters has been more appropriate to assess body composition and proportions in children, with special attention to the Body Mass Index (BMI), as it relates weight and length. However the BMI values for the neonatal period have not been determined yet. This study shows the BMI for newborns at different gestational ages represented in a normal smoothed percentile curve.

METHODS

Retrospective study including 2,406 appropriate for gestational age newborns following the Alexander et al curve (1996) from 29 to 42 weeks of gestational age. Weight and lenght were measured following standard procedures. For the construction a of a normal smoothed percentile curve, the 3rd, 5th, 10th, 25th, 50th, 75th, 90th and 95th percentiles were determined and a statistical procedure based on the mathematical model "sinosuoidal fit" was applied to establish a curve that estimates biological growth parameters.

RESULTS

The Body Mass Index values for gestational age in all percentiles shows a steady increase up to 38 weeks, levels off up to the 40th week, followed by a slight decrease to the 42nd week in both genders.

CONCLUSION

The results show a direct correlation between gestational age and Body Mass Index for both genders in the nine percentiles, and can provide a useful reference to assess intra-uterine proportional growth.

Prediction of hyperglycemia in preterm newborn infants

Many conditions are associated with hyperglycemia in preterm neonates because they are very susceptible to changes in carbohydrate homeostasis. The purpose of this study was to evaluate the occurrence of hyperglycemia in preterm infants undergoing glucose infusion during the first week of life, and to enumerate the main variables predictive of hyperglycemia. This prospective study (during 1994) included 40 preterm neonates (gestational age < 37 weeks); 511 determinations of glycemic status were made in these infants (average 12.8/infant), classified by gestational age, birth weight, glucose infusion rate and clinical status at the time of determination (based on clinical and laboratory parameters). The clinical status was classified as stable or unstable, as an indication of the stability or instability of the mechanisms governing glucose homeostasis at the time of determination of blood glucose; 59 episodes of hyperglycemia (11.5%) were identified. A case-control study was used (case = hyperglycemia; control = normoglycemia) to derive a model for predicting glycemia. The risk factors considered were gestational age (< or = 31 vs. > 31 weeks), birth weight (< or = 1500 vs. > 1500 g), glucose infusion rate (< or = 6 vs. > 6 mg/kg/min) and clinical status (stable vs. unstable). Multivariate analysis by logistic regression gave the following mathematical model for predicting the probability of hyperglycemia: 1/exp{-3.1437 + 0.5819(GA) + 0.9234(GIR) + 1.0978 (Clinical status)}The main predictive variables in our study, in increasing order of importance, were gestational age, glucose infusion rate and, the clinical status (stable or unstable) of the preterm newborn infant. The probability of hyperglycemia ranged from 4.1% to 36.9%.

[Relationship between ventricular arrhythmia and clinical and echocardiographic parameters in hypertensive patients]

OBJECTIVE

Evaluation in arterial hypertension (HTA) patients, of the relationship between supraventricular and ventricular arrhythmias, stage of hypertension and echocardiographic parameters.

DESIGN

Retrospective study based on the files of ambulatory electrocardiography (Holter).

SETTING

Arrhythmology Outpatients Clinic from a Cardiac Department.

PATIENTS

Adult patients with arterial hypertension, males and females, who underwent ambulatory electrocardiography (Holter) and echocardiography examinations.

MATERIAL AND METHODS

Thirty patients, 15 males and females, 54 +/- 12 years old, were studied. Arterial hypertension was stratified in three stages according with the diastolic value. Symptoms, serum potassium, left ventricular hypertrophy (LVH) on the ECG, and echocardiographic parameters such as left ventricular dimensions, shortening fraction, septal wall and posterior wall thickness and left atrium dimensions were analysed. These parameters were correlated with the arrhythmic pattern concerning the number of premature supraventricular contractions and the number and complexity of premature ventricular contractions (PVC), evaluated by ambulatory electrocardiography (Holter).

RESULTS

No relation was found between the arrhythmic pattern, stage of hypertension, symptoms and LVH on the ECG. Septal wall thickness was 14 +/- 3 mm in the group of patients with PVC greater than or equal to 10/hour and 12 +/- 3 mm in the population with PVC less than 10/hour (p less than 0.04). The shortening fraction was 27 +/- 8% in the group of repetitive PVC and 34 +/- 7% in the population without (p less than 0.003). A borderline relation was found between repetitive PVC and left atrium and left ventricular diastolic dimensions.

CONCLUSIONS

In a population of arterial hypertension (HTA) who performed ambulatory electrocardiography (Holter), the prevalence of frequent or repetitive PVC was low. A positive correlation between frequent PVC and septal wall thickness and an inverse relation between repetitive PVC and LV shortening fraction, was found. These conclusions are according with the literature, relating the ectopic activity with LVH or deterioration of LV function. No relation was found between arrhythmias and stage of hypertension.

[Biochemical glucose test x glucose strip test: results of 464 determinations in pre-term infants]

The preterm infant frequently requires glucose level monitorization. This paper compared determinations of blood glucose by two methods: glucose strip test and biochemistry. There was determined 464 pairs of glucose levels by both methods in 40 preterm infants receiving glucose infusion. The hypoglycemia interval showed that the precision of strips was lower than the biochemical method. The same was found in hyperglycemia interval, but the result was a few better. Concluding, the authors emphasize the use of glucose strip test only for screening and the biochemical test for treatment.

[Basis of nutritional support in pediatrics]

OBJECTIVE: To present an update and systematic review of the basis of nutritional support in pediatrics, emphasizing the importance of nutrition in critically ill patient. METHODS: Relevant studies were selected from databases (Medline, Scielo, Lilacs, etc.). Textbooks and theses were analyzed, and the authors personal experience was also considered. RESULTS: Nutritional therapy is part of the treatment. In order to reach the objective, it is important to determine specific nutritional requirements of water, calories, proteins, macro and micronutrients. So, nutritional evaluation should consist of clinical, anthropometric, and laboratory assessment, so that the best nutritional therapy (parenteral and/or enteral) is chosen. Patient monitoring is also indicated in order to prevent complications. CONCLUSION: Nutritional therapy is essential for the treatment. When well indicated and well monitored, it helps in the patient s recovery, and in the decrease of morbidity and mortality.

[A retrospective study of a population with intermittent atrial fibrillation]

OBJECTIVE

To analyse a population with intermittent atrial fibrillation, comparing the clinical characteristics of patients with the idiopathic form with those with structural pathology.

DESIGN

Intermittent atrial fibrillation retrospective study.

SETTING

Arrhythmology outpatients clinic of the cardiac department.

PATIENTS AND METHODS

Retrospective study of a population of 59 patients with intermittent atrial fibrillation referred to the arrhythmology outpatients clinic of the cardiac department. Forty patients were male and nineteen female with a mean age of 51 +/- 13 years. Idiopathic atrial fibrillation group with 18 patients was compared with the 41 patients group with identifiable pathology. Atrial fibrillation was recognised by 12 lead ECG and 24 hours ambulatory Holter monitoring. Clinical and echocardiographic parameters were analysed. Complications and the efficacy of anti-arrhythmic therapy were referred.

MAIN RESULTS

In the studied population, mean age at the identification of atrial fibrillation was lower in the idiopathic group than in the group with identifiable pathology. It was 36 +/- 12 years in the first group and 45.2 +/- 13 in the second. Left atrium dimension was 38.1 +/- 4 mm in the first group and 42.5 +/- 9 mm in the second (p = 0.04). In the group with mitral valvulopathy, left atrium dimension was 45.5 +/- 11 mm, also significantly different from patients with the idiopathic form (p = 0.012). Statistically significative difference between those groups was not found for left ventricular end-diastolic dimension and shortening fraction. Mean follow-up was 3 years with a range between 7 months and 10 years. Effective therapeutic control was obtained in 35 of 59 patients (59.3%). Six were from the idiopathic group (33.3%) and 29 from the group with identifiable pathology (70.7%). Control was not reached or was only partial in 24 patients (40.7%), belonging 66.7% to the first group and 29.3% to the second (p = 0.016). No embolic phenomenon was documented in the idiopathic not anti-coagulated group. Four embolic complications (9.8%) were observed in the group of identified pathology. Three of then were related with mitral valvulopathy and were submitted to effective anti-coagulation therapy.

CONCLUSIONS

Patients with idiopathic intermittent atrial fibrillation are younger, with smaller left atrium dimension (mainly in relation to those with mitral valve disease) but are more resistant to anti-arrhythmic therapy. They have a trend to less thromboembolic complications and anti-coagulation is probably not justified.