Given the widespread use of continuous external ventricular drainage in patients with aneurysmal subarachnoid hemorrhage (SAH), this investigation was undertaken to define the relationship of ventricular drainage to aneurysmal rebleeding. A historical cohort study of 128 patients with confirmed aneurysmal SAH was performed using a multivariate stepwise logistic regression analysis to examine the relationship between aneurysmal rerupture and ventricular drainage, while controlling for important clinical and radiological independent variables. The variables for ventricular drainage selected in the regression analysis were clinical grade, aneurysm size, and presence of hydrocephalus. The rate of rerupture was significantly higher in cases with ventricular drainage (odds ratio 5.31:1, p less than 0.05), poor clinical grade (odds ratio 4.90:1, p less than 0.02), and large aneurysm size (odds ratio 11.25:1, p less than 0.01). The significant effect of ventricular drainage was limited to patients with hydrocephalus. The increased risk of aneurysmal rebleeding in patients undergoing ventricular drainage may result from both: 1) a rise in aneurysmal transmural pressure, since intracranial pressure is lowered by ventricular drainage; and 2) an association between ventricular drainage and a more severely disrupted aneurysm which is more prone to rebleed as part of its natural history. This study found an increased risk of aneurysmal rebleeding among patients undergoing ventricular drainage, particularly in the presence of hydrocephalus.

Background: ambient air pollution has been associated with asthma-related hospital admissions and emergency department visits (hospital encounters). We hypothesized that higher individual exposure to residential traffic-related air pollutants would enhance these associations. Methods: We studied 11,390 asthma-related hospital encounters among 7492 subjects 0-18 years of age living in Orange county, california. ambient exposures were measured at regional air monitoring stations. Seasonal average traffic-related exposures (PM 2.5 , ultrafine particles, nO x , and cO) were estimated near subjects' geocoded residences for 6-month warm and cool seasonal periods, using dispersion models based on local traffic within 500 m radii. associations were tested in case-crossover conditional logistic regression models adjusted for temperature and humidity. We assessed effect modification by seasonal residential traffic-related air pollution exposures above and below median dispersion-modeled exposures. Secondary analyses considered effect modification by traffic exposures within race/ethnicity and insurance group strata. Results: asthma morbidity was positively associated with daily ambient O 3 and PM 2.5 in warm seasons and with cO, nO x , and PM 2.5 in cool seasons. associations with cO, nO x , and PM 2.5 were stronger among subjects living at residences with above-median traffic-related exposures, especially in cool seasons. Secondary analyses showed no consistent differences in association, and 95% confidence intervals were wide, indicating a lack of precision for estimating these highly stratified associations. Conclusions: associations of asthma with ambient air pollution were enhanced among subjects living in homes with high traffic-related air pollution. this may be because of increased susceptibility (greater asthma severity) or increased vulnerability (meteorologic amplification of local vs. correlated ambient exposures).

Background: Decreased heart rate variability (HRV) has been associated with future cardiac morbidity and mortality and is often used as a marker of altered cardiac autonomic balance in studies of health effects of airborne particulate matter. Fewer studies have evaluated associations between air pollutants and cardiac arrhythmia. oBjectives: We examined relationships between cardiac arrhythmias, HRV, and exposures to airborne particulate matter. Methods: We measured HRV and arrhythmia with ambulatory electro cardiograms in a cohort panel study for up to 235 hr per participant among 50 nonsmokers with coronary artery disease who were ≥ 71 years of age and living in four retirement communities in the Los Angeles, California, Air Basin. Exposures included hourly outdoor gases, hourly traffic-related and secondary organic aerosol markers, and daily size-fractionated particle mass. We used repeated measures analyses, adjusting for actigraph-derived physical activity and heart rate, temperature, day of week, season, and community location. results: Ventricular tachy cardia was significantly increased in association with increases in markers of traffic-related particles, secondary organic carbon, and ozone. Few consistent associations were observed for supraventricular tachy cardia. Particulates were significantly associated with decreased ambulatory HRV only in the 20 participants using ACE (angiotensin I-converting enzyme) inhibitors. conclusions: Although these data support the hypothesis that particulate exposures may increase the risk of ventricular tachy cardia for elderly people with coronary artery disease, HRV was not associated with exposure in most of our participants. These results are consistent with previous findings in this cohort for systemic inflammation, blood pressure, and ST segment depression.

RATIONALE: Asthma is a multifactorial, complex disease whose prevalence has been increasing in the last years globally. Cockroach sensitization may be a risk factor for asthma morbidity. We aimed to demonstrate that cockroach sensitization is a risk factor for a lack of control of this disease. METHODS: Cross-sectional study of a cohort with 150 children with asthma aged 6 to 14 years who lived in the urban or rural region of the Aburr a Valley-Colombia, were recruited for the study to evaluate sensitization to cockroach (Per a) through skin tests. A logistic regression model to adjust the prevalence ratio (PR) of asthmatic disease by age, sex, sociodemographic condition, cockroach sensitization, cosensitizations and asthma control measured by asthma control test (ACT) was applied. RESULTS: Fifty-five patients (36.6%) had uncontrolled asthma. A total of 31 patients were sensitized to cockroach of which 16 had uncontrolled asthma. An association with cockroach sensitization and poor asthma control was demonstrated in the this population in the multivariate analysis (adjusted odds ratio [aOR] 5 3,27; 95% IC, 1.08-9.89), (p50,035). CONCLUSIONS: This finding has also been evidenced in other populations indicating that the control of this indoor source of allergens may be important in controlling the disease and future development of immunotherapy would be valuable.

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