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During June 2022, Spain was one of the countries most affected worldwide by a multicountry monkeypox outbreak with chains of transmission without identified links to disease-endemic countries. We provide epidemiologic features of cases reported in Spain and the coordinated measures taken to respond to this outbreak. Sí

Background and aims: The most common cause of acute flaccid paralysis of all ages is Guillain-Barre syndrome (GBS). Further understanding of this disease is important because of its life-threatening nature in life. The aim of this study was to conduct a 10-year survey on epidemiological and clinical features of GBS in Tohid and Besat hospitals, Sanandaj, Iran, from 2005 to 2014. Methods: This study was a retrospective study, based on medical records, in which 98 hospitalized cases in Tohid and Besat hospitals (tertiary referral hospitals), Sanandaj, Iran, between 2005 and 2014 were investigated. The epidemiological and clinical information was obtained from eligible cases. Data analysis was performed using SPSS version 16. Chi-square and t test were used for analyses. The significant level was considered at P

Background and purpose Moyamoya vasculopathy, a rare steno-occlusive progressive cerebrovascular disorder, has not been thoroughly studied in Caucasian populations. We established a registry of Finnish patients treated at the Helsinki University Hospital, to collect and report demographic and clinical data. Methods We collected data both retrospectively and prospectively from all the patients with a moyamoya vasculopathy referred to our hospital between January 1987 and December 2014. All patients underwent a neurological outpatient clinic visit. Results We diagnosed 61 patients (50 females, 10 children) with moyamoya vasculopathy. The mean age at the disease-onset was 31.5 ± 17.9 years. The two most common presenting symptoms were ischemic stroke (n = 31) and hemorrhage (n = 8). Forty-four percent underwent revascularization surgery, and 70% were prescribed antithrombotic treatment. Conclusions The results support in part the Western phenotype of the disease considering the later presentation and larger female predominance compared to the Asian moyamoya vasculopathy reports. However, the proportion of ischemic strokes and hemorrhagic strokes is closer to Japanese population than German population. The absence of familial cases points to a different genetic profile in the Finnish patients.

Background: Cholera is a diarrheal disease, if untreated, leads to high morbidity and mortality. It has economic and social impact, several epidemics occurred in Iraq during the last years. Objective: To describe the cholera epidemic in a person place,and time epidemiologic model Methodology: This is a descriptive cross sectional study (describe the occurrence of disease in person , place ,and time descriptive epidemiologic approach) . Data were collected using records of patients admitted to merjan and pediatric teaching hospitals in Hilla city who were diagnosed and confirmed by stool culture(according to the central public health laboratory results) during the period of the last epidemic (from the first of August through November 2015). The duration of this study started from the beginning of February to the end of May 2016. A sample of150 confirmed cholera cases were selected in a systematic random sample technique ,the missed data of these cases were completed by phone after getting the verbal consents of patients or their families . Results: This study revealed that the peak frequency incidental cholera cases was on September, and most of cholera cases occured in Al-Tajea district. The most affected age group was (5-20), no significant difference was reported according to gender. p>0.05 most of the cases were illiterate , lived in overcrowded houses , The disease is more common in internally displaced persons and those who drink water from wells and rivers. Conclusion: Cholera cases were at highest incidental rate in September and in Al-Tajea district, the most affected age group was(5-20years) , the disease was more common among Illiterate people, living in overcrowded houses . Internally displace and those who use river and well water

The study involved 622 women of reproductive age with such hyperproliferative processes of the pelvic organs as uterine leiomyoma, endometrial hyperplasia and endometriosis. We studied main epidemiological factors inherent in these diseases. We have found that such diseases as uterine leiomyoma, endometriosis and endometrial hyperplasia have common risk factors: obesity, early menarche, increased frequency of PID, anemia, hypertension, surgical interventions for gynecological pathology. At the same time, specific features unique to the combination of uterine leiomyoma and endometrial hyperplasia were found: increased frequency of PCOS and type 2 diabetes, as well as for endometriosis and uterine leiomyoma – reduction of menstrual cycle length, increase of infertility frequency.

AIM: The study was designed to investigate the prognosis and the epidemiologic features of people who was diagnosed having type 2 DM and Applied to the Community Health Center. METHOD: This study which was carried out at Catak Health Branch of Trabzon Erdogdu Health Center in April, May, and June in 2008 is a descriptive and cross-sectional field study. All of the patients with Type 2 DM diagnosis who came to the Health Center for routine control (55 people) were involved in the study. The aim of the study was explained to each participant in the study and their oral consent was taken. As the data collection instrument, diabetes surveillance form which includes of socio-demographic features, risk factors, blood sugar diagnosis criteria, body mass index, chronic complications and foot examination was used. Diabetes surveillance form was shaped by modifying the diabetes diagnosis form which was structured by Erdogan and Nahcivan (1999). The data obtained were evaluated through number and percentage distribution, mean, chi square test, correlation and variant analyses techniques. RESULTS: Age mean of the patients was 59.4±10.7 and 85.5% of them was female. Average diagnosis age was 53.2±12.5, average diabetes year was 6,6±6,6. 45.5% of the patients were obese, 12.7% of them morbid obese and diabetes history in the family was about 54.5%. It was found that 56.3% patients had blood glucose level was 140 mg/dl and 54.5% of the patients’ HbA1c level were higher than 7%. When lipid parameter levels of the patients were examined, it was seen that HDL cholesterol level was (E

Background: The fatality attributed to pandemic influenza A H1N1 was not clear in the literature. We described the predictors for fatality related to pandemic influenza A H1N1 infection among hospitalized adult patients. Methods: This is a multicenter study performed during the pandemic influenza A H1N1 [A(H1N1) pdm09] outbreak which occurred in 2009 and 2010. Analysis was performed among laboratory confirmed patients. Multivariate analysis was performed for the predictors of fatality. Results: In the second wave of the pandemic, 848 adult patients were hospitalized because of suspected influenza, 45 out of 848 (5.3%) died, with 75% of fatalities occurring within the first 2 weeks of hospitalization. Among the 241 laboratory confirmed A(H1N1) pdm09 patients, the case fatality rate was 9%. In a multivariate logistic regression model that was performed for the fatalities within 14 days after admission, early use of neuraminidase inhibitors was found to be protective (Odds ratio: 0.17, confidence interval: 0.03-0.77, p = 0.022), nosocomial infections (OR: 5.7, CI: 1.84-18, p = 0.013), presence of malignant disease (OR: 3.8, CI: 0.66-22.01, p = 0.133) significantly increased the likelihood of fatality. Conclusions: Early detection of the infection, allowing opportunity for the early use of neuraminidase inhibitors, was found to be important for prevention of fatality. Nosocomial bacterial infections and underlying malignant diseases increased the rate of fatality.

Presented are the results of long-term investigations which enabled to identify the principal regularities of epidemiologic process of acute hepatitis B in modern social and economical conditions in the Saratov region. The reasons of significant morbidity decrease and the routes of infection transmission are shown. The region is differentiated as regards hepatitis B and the high priority measures on prevention of this disease are identified.

Objective-To investigate the occurrence of heart failure complications, and to identify variables that predict heart failure in patients with (recurrent) persistent atrial fibrillation, treated aggressively with serial electrical cardioversion and antiarrhythmic drugs to maintain sinus rhythm.Design-Non-randomised controlled trial; cohort; case series; mean (SD) follow up duration 3.4 (1.6) years.Setting-Tertiary care centre.Subjects-Consecutive sampling of 342 patients with persistent atrial fibrillation (defined as > 24 hours duration) considered eligible for electrical cardioversion.Interventions-Serial electrical cardioversions and serial antiarrhythmic drug treatment, after identification and treatment of underlying cardiovascular disease.Main outcome measures-heart failure complications: development or progression of heart failure requiring the institution or addition of drug treatment, hospital admission, or death from heart failure.Results-Development or progression of heart failure occurred in 38 patients (11%), and 22 patients (6%) died from heart failure. These complications were related to the presence of coronary artery disease (p Conclusions-Aggressive serial electrical cardioversion does not prevent heart failure complications in patients with persistent atrial fibrillation. These complications are predominantly observed in patients with more severe underlying cardiovascular disease, Randomised comparison with rate control treatment is needed to define the optimal treatment for persistent atrial fibrillation in relation to heart failure.

Background:Acinetobacter baumannii has become an increasingly important nosocomial pathogen, particularly in intensive care units (ICUs). The aim of this investigation was to study the molecular epidemiology of A baumanii in a university hospital in Italy. Methods: All A baumanii isolates were collected and typed with phenotypic and genotypic methods during a 7-month period. A 1-year prospective surveillance of ICU-acquired infections was performed by using the National Nosocomial Infections Surveillance methodology. Results:A baumanni accounted for 28.4% of all infections and 46.7% of all pneumonia acquired in the ICU, with a nosocomial infection rate of 12.4% or 8 infections per 1000 patient-days. Risk factors for A baumannii acquisition in the ICU were mechanical ventilation and previous use of broad-spectrum antibiotics, whereas administration of carbapenems showed a significant protective effect. Pulsed-field gel electrophoresis of genomic Apa I digests identified at least 5 outbreaks in the ICU caused by 5 different clones, one replacing the other in a well-defined temporal order. Conclusions: Whereas the sequential temporal cluster of epidemic clones in the ICU is intriguing and requires further research, the clear evidence of cross-contamination of A baumannii isolates involved with infections in the ICU demands extensive preventive efforts. (AJIC Am J Infect Control 1999;27:247-53)

Gene Expression in Human Atrial Fibrillation, Introduction: Atrial fibrillation (AF) leads to a loss of atrial contraction within hours to days. During persistence of AF, cellular dedifferentiation and hypertrophy occur, eventually resulting in degenerative changes and cell death, Abnormalities in the calcium handling in response to tachycardia-induced intracellular calcium overload play a pivotal role in these processes.Methods and Results: The purpose was to investigate the mRNA expression of proteins and ion channels influencing the calcium handling in patients with persistent AF, Right atrial appendages were obtained from 18 matched controls in sinus rhythm (group 1) and 18 patients with persistent AF undergoing elective cardiac surgery. Previous duration of AF was less than or equal to 6 months in 9 (group 2) and > 6 months in 9 patients (group 3), In a single semiquantitative polymerase chain reaction, the mRNA of interest and of glyceraldehyde-3-phosphate dehydrogenase, were coamplified and separated by gel electrophoresis. L-type calcium channel alpha(1) subunit mRNA content was inversely related to the duration of AF: -26% in group 2 compared to group 1 (P = 0.2), and -49% in group 3 compared to group 1 (P = 0.01), Inhibitory guanine nucleotide binding protein i alpha(2) mRNA content was reduced in group 3 compared to group 1 (-30%, P = 0.01), Sarcoplasmic reticulum calcium ATPase, phospholamban and sodium-calcium exchanger mRNA contents were not affected by AF,Conclusions: AF-induced alterations in mRNA contents of proteins and ion channels involved in the calcium handling seem to occur in relation to the previous duration of AF, In the present patient population, these changes were significantly only if AF lasted > 6 months.

Background Prolonged periods of atrial fibrillation or rapid atrial pacing induce shortening of the atrial effective refractory period (AERP), which is thought to be related to the lower success rates of various antifibrillatory treatments when the arrhythmia has lasted for a longer period of time.Methods and Results To investigate whether an increase in intracellular calcium could be the stimulus for electrical remodeling, the effects of verapamil on shortening of the AERP in response to 24 hours of rapid atrial pacing (300 bpm) were studied in five chronically instrumented conscious goats during infusion of saline or verapamil. During rapid atrial pacing, the ventricular rate was kept constant by ventricular pacing (150 bpm). The AERP was measured by programmed electrical stimulation at basic cycle lengths of 430, 300, and 200 ms. Verapamil had no effects on the AERP before rapid atrial pacing. However, in the course of 24 hours of rapid atrial pacing, the AERP shortened significantly less (27% to 58%) in the presence of verapamil compared with control (at 430, 300, and 200 ms, PConclusions Electrical remodeling of the atrium during rapid atrial pacing was significantly attenuated by verapamil. This suggests that electrical remodeling of the atrium is triggered by the high calcium influx during rapid atrial pacing rates.

The study involved 622 women of reproductive age with such hyperproliferative processes of the pelvic organs as uterine leiomyoma, endometrial hyperplasia and endometriosis. We studied main epidemiological factors inherent in these diseases. We have found that such diseases as uterine leiomyoma, endometriosis and endometrial hyperplasia have common risk factors: obesity, early menarche, increased frequency of PID, anemia, hypertension, surgical interventions for gynecological pathology. At the same time, specific features unique to the combination of uterine leiomyoma and endometrial hyperplasia were found: increased frequency of PCOS and type 2 diabetes, as well as for endometriosis and uterine leiomyoma – reduction of menstrual cycle length, increase of infertility frequency., В иссле­довании принимало участие 622 женщины репродуктивного возраста с такими гиперпролиферативными процессами органов малого таза, как лейомиома матки, гиперплазия эндометрия и эндометриоз. В ходе рабо­ты изучены основные эпидемиологические факторы, присущие указанным заболеваниям. Выявлено, что такие заболевания, как лейомиома матки, эндометриоз и гиперплазия эндометрия имеют общие факторы риска –повышенная масса тела, раннее менархе, повышенная частота ВЗОМТ, анемии, гипертонической болезни, оперативных вмешательств по поводу гинекологической патологии. В то же время выявлены специфические черты, присущие только сочетанию лейомиомы матки и гиперплазии эндометрия – повышение частоты СПКЯ и сахарного диабета второго типа, а также для лейомиомы матки и эндометриоза – сокращение про­должительности менструального цикла, повышение частоты бесплодия.

The present study was undertaken to reassess prospectively the immediate and long-term results of direct-current electrical cardioversion in chronic atrial fibrillation or atrial flutter, and to determine factors predicting clinical outcome of the arrhthmia after direct-current cardioversion. Two-hundred forty-six patients underwent direct-current electrical cardioversion and were followed during a mean of 260 days. Multivariate analysis was used to identify factors predicting short- and long-term arrhythmia outcome. Cardioversion was achieved in 70% of patients with atrial fibrillation and in 96% of patients with atrial flutter. Stepwise logistic regression analysis revealed that arrhythmia duration (p

Introduction: The meningococcal disease is an acute bacterial infection caused by Neisseria meningitidis. Its clinical manifestations may vary from an asymptomatic form to meningitis and sepsis. Objective: To evaluate risk factors for meningococcal disease. Methods: A review of medical literature on the subject, using scientific review articles from Pubmed-MEDLINE archives published in the period of 1997 to 2007 and reference books on Internal Medicine and Infection. Summary of the findings: The risk factors for meningococcal disease can be individualized as deficiency of terminal complement components, deficiency of humoral immunity, and young age, but also general as crowded living conditions, exposure to tobacco smoke and cold months of the year. The colonization of upper respiratory tract is the focus for the organism dissemination. Conclusions: Despite of extensive understanding of the epidemiologic features, pathogenesis, risk factors, advances in diagnosis, treatment and prevention of meningococcal disease, this illness remains a leading cause of meningitis and sepsis. The routine vaccination of general population with conjugated vaccine, the vaccination of high-risk individuals, when this vaccine is not available for the general population, and chemoprophylaxis of close contacts are effective public health strategies. The study of these risk factors brings an important contribution for a better understanding of this disease. Introdução: A doença meningocócica é uma infecção bacteriana aguda, causada pela Neisseria meningitidis. As apresentações clínicas vão desde a forma assintomática até a meningite e sepse. Objetivo: Avaliar os fatores de risco da doença meningocócica. Métodos: Uma revisão de literatura sobre o assunto, incluindo artigos científicos indexados no banco de dados PubMed-MEDLINE, no período de 1997 a 2007 e livros de referência em Infectologia e Clínica Médica. Resultados: Os fatores de risco para a doença meningocócica podem ser individuais, como: a deficiência de componentes terminais do sistema complemento, a deficiência da imunidade humoral, a baixa idade; mas também gerais como: aglomerados em locais fechados, a exposição ao tabaco e os meses frios do ano. A colonização do trato respiratório superior constitui o fóco a partir do qual ocorre a disseminação do organismo. Conclusão: Apesar do conhecimento abrangente dos aspectos epidemiológicos, patogenia, fatores de risco e dos avanços em diagnóstico, tratamento e prevenção da doença meningocócica, esta continua sendo uma importante causa de meningite e sepse. A vacinação de rotina da população geral com a vacina conjugada, e quando esta não é possível, dos indivíduos com alto risco é uma medida eficaz de saúde pública, assim como a quimioprofilaxia para os contactantes íntimos. O estudo dos fatores de risco traz contribuição importante para a melhor compreensão da doença.

Hripavac (pertusis) klinički je i javnozdravstveno važna visokokontagiozna akutna infekcija dišnog sustava koju uzrokuje gram-negativni pleomorfni bacil Bordetella pertussis (BP), u tipičnim slučajevima obilježena intenzivnim iscrpljujućim kašljem kod dojenčadi i male djece, s razmjerno učestalim težim, potencijalno i fatalnim komplikacijama, koja i danas obvezuje stručnjake i širu javnost na stalan oprez. I u visokorazvijenim sredinama hripavac se ističe kao problem među preventibilnim dječjim zaraznim bolestima. Porastom procijepljenosti i smanjenjem cirkulacije Bordetelle pertussis (BP) dramatično opada ukupna pojavnost hripavca, ali rastu pojavnost i epidemiološko značenje u male dojenčadi i odraslih osoba. Pojavnost hripavca u Hrvatskoj se kreće u zavidnom rasponu od 2,7 do 18,8 oboljelih na 100.000 stanovnika i procijepljenost od oko 90% kod primovakcinacije i revakcinacije. Ukupni letalitet od hripavca danas se procjenjuje na 0,1%, kod dojenčadi on doseže 0,5%-1%, a 75% umrlih su djeca mlađa od 12 mjeseci. Jedini poznati domaćin BP je čovjek. Hripavac se prenosi kapljičnim putem, kontagioznost mu kod osjetljivih osoba doseže i 100%, a kod kućnih kontakata 70-100%. Uz BP sindrom hripavca mogu izazvati i Bordetella bronchiseptica, adenovirusi, respiratorni sincicijski virus (RSV), Mycoplasma pneumoniae, Chlamydia trachomatis i drugi respiratorni virusi. Klinička slika infekcije bordetelom znatno ovisi o dobi oboljelih, ranijoj infekciji ili imunizaciji, pasivno stečenim protutijelima i dopunskim čimbenicima, poput stupnja izloženosti, naslijeđenih i stečenih značajki oboljelih, genotipa bordetele. Može biti tipična ili atipična, specifi čna u nekim subpopulacijama (novorođenčad, dojenčad, trudnice, odrasle infi cirane osobe). Zlatni standard etiološke dijagnoze ostaje dokaz BP kultivacijom, dokaz uzročnika iz nazofaringalnog sekreta direktnom imunofl uorescencijom (DFA) i lančanom reakcijom polimerazom (PCR). U serološkoj dijagnostici rabi se imunoenzimska metoda - ELISA. Etiološka terapija obuhvaća makrolide, a nadopunjava se uz simptomatsku i suportivnu terapiju. Prevencija i profi laksa obuhvaćaju cijepljenje, izolaciju i kemoprofi laksu., Pertussis is a highly contagious acute respiratory infection caused by gram-negative pleomorphic bacillus Bordetella pertussis (BP). Typical cases include whooping cough in infants and young children, with relatively frequent severe and potentially fatal complications. In spite of great progress in its prevention and therapy, pertussis remains an infectious diseases requiring continuous caution. Even in highly developed countries, pertussis represents a problem among preventable childhood diseases. Although the incidence of pertussis is dramatically reduced by high vaccination rates and reduced BP circulation, its occurrence and epidemiologic role in young infants and adults is increasing. The actual incidence of pertussis is probably much higher than that offi cially declared. In Croatia, it reaches 2.7 - 18.8 cases /100 000 inhabitants, while the primo- and revaccination rate is about 90%. Total pertussis lethality rate reaches 0.1%, and 0.5% - 1% in infants. Children below 12 months of age account for 75% of death cases. Man is the only BP host. Pertussis is spread by droplet infection and its contagiosity in susceptible persons is almost 100%, while in in-house contacts it is 70-100%. Besides by BP, pertussis can be caused by B. bronchiseptica, adenoviruses, RSV, M. pneumoniae, C. trachomatis and other respiratory viruses. The clinical picture of a bordetella infection largely depends on the patient age, previous infection or immunization, passively acquired antibodies and other factors (exposition rate, inherited and acquired patient characteristics, bordetella genotype). It can be typical or atypical, and specifi c in some subpopulations (newborns, infants, pregnant women, infected adults). The cultivation of B. pertussis remains the gold standard for the etiologic diagnosis. The enzyme-linked immunosorbent assay (ELISA) is frequently used. B. pertussis can be also directly detected in nasopharyngeal secretion by direct fl uorescent antibody test (DFA) and polymerase chain reaction (PCR). The etiologic pertussis treatment includes macrolides. It is usually supplemented with symptomatic and supportive measures. Prevention and prophylaxis are based on immunization, chemoprophylaxis and isolation.

Objective-To investigate the occurrence of heart failure complications, and to identify variables that predict heart failure in patients with (recurrent) persistent atrial fibrillation, treated aggressively with serial electrical cardioversion and antiarrhythmic drugs to maintain sinus rhythm. Design-Non-randomised controlled trial; cohort; case series; mean (SD) follow up duration 3.4 (1.6) years. Setting-Tertiary care centre. Subjects-Consecutive sampling of 342 patients with persistent atrial fibrillation (defined as > 24 hours duration) considered eligible for electrical cardioversion. Interventions-Serial electrical cardioversions and serial antiarrhythmic drug treatment, after identification and treatment of underlying cardiovascular disease. Main outcome measures-heart failure complications: development or progression of heart failure requiring the institution or addition of drug treatment, hospital admission, or death from heart failure. Results-Development or progression of heart failure occurred in 38 patients (11%), and 22 patients (6%) died from heart failure. These complications were related to the presence of coronary artery disease (p

Gene Expression in Human Atrial Fibrillation, Introduction: Atrial fibrillation (AF) leads to a loss of atrial contraction within hours to days. During persistence of AF, cellular dedifferentiation and hypertrophy occur, eventually resulting in degenerative changes and cell death, Abnormalities in the calcium handling in response to tachycardia-induced intracellular calcium overload play a pivotal role in these processes. Methods and Results: The purpose was to investigate the mRNA expression of proteins and ion channels influencing the calcium handling in patients with persistent AF, Right atrial appendages were obtained from 18 matched controls in sinus rhythm (group 1) and 18 patients with persistent AF undergoing elective cardiac surgery. Previous duration of AF was less than or equal to 6 months in 9 (group 2) and > 6 months in 9 patients (group 3), In a single semiquantitative polymerase chain reaction, the mRNA of interest and of glyceraldehyde-3-phosphate dehydrogenase, were coamplified and separated by gel electrophoresis. L-type calcium channel alpha(1) subunit mRNA content was inversely related to the duration of AF: -26% in group 2 compared to group 1 (P = 0.2), and -49% in group 3 compared to group 1 (P = 0.01), Inhibitory guanine nucleotide binding protein i alpha(2) mRNA content was reduced in group 3 compared to group 1 (-30%, P = 0.01), Sarcoplasmic reticulum calcium ATPase, phospholamban and sodium-calcium exchanger mRNA contents were not affected by AF, Conclusions: AF-induced alterations in mRNA contents of proteins and ion channels involved in the calcium handling seem to occur in relation to the previous duration of AF, In the present patient population, these changes were significantly only if AF lasted > 6 months.

Background Prolonged periods of atrial fibrillation or rapid atrial pacing induce shortening of the atrial effective refractory period (AERP), which is thought to be related to the lower success rates of various antifibrillatory treatments when the arrhythmia has lasted for a longer period of time. Methods and Results To investigate whether an increase in intracellular calcium could be the stimulus for electrical remodeling, the effects of verapamil on shortening of the AERP in response to 24 hours of rapid atrial pacing (300 bpm) were studied in five chronically instrumented conscious goats during infusion of saline or verapamil. During rapid atrial pacing, the ventricular rate was kept constant by ventricular pacing (150 bpm). The AERP was measured by programmed electrical stimulation at basic cycle lengths of 430, 300, and 200 ms. Verapamil had no effects on the AERP before rapid atrial pacing. However, in the course of 24 hours of rapid atrial pacing, the AERP shortened significantly less (27% to 58%) in the presence of verapamil compared with control (at 430, 300, and 200 ms, P Conclusions Electrical remodeling of the atrium during rapid atrial pacing was significantly attenuated by verapamil. This suggests that electrical remodeling of the atrium is triggered by the high calcium influx during rapid atrial pacing rates.

The present study was undertaken to reassess prospectively the immediate and long-term results of direct-current electrical cardioversion in chronic atrial fibrillation or atrial flutter, and to determine factors predicting clinical outcome of the arrhthmia after direct-current cardioversion. Two-hundred forty-six patients underwent direct-current electrical cardioversion and were followed during a mean of 260 days. Multivariate analysis was used to identify factors predicting short- and long-term arrhythmia outcome. Cardioversion was achieved in 70% of patients with atrial fibrillation and in 96% of patients with atrial flutter. Stepwise logistic regression analysis revealed that arrhythmia duration (p