Bradycardia Research Articles

Implantable Loop Recorders in patients with Brugada Syndrome: the BruLoop Study

Abstract Aims Available data on continuous rhythm monitoring by implantable loop recorders (ILRs) in patients with Brugada syndrome (BrS) are scarce. Aim of this multicentre study was to evaluate the diagnostic yield and clinical implication of a continuous rhythm monitoring strategy by ILRs in a large cohort of BrS patients, and to assess the precise arrhythmic cause of syncopal episodes. Methods and Results A total of 370 patients with BrS and ILRs (mean age 43.5±15.9, 33.8% females) from 18 international centers were included. Overall, 274 (74.1%) were implanted due to symptoms (69.3% syncope, 30.7% palpitations). Over a median follow-up of 3 years, an arrhythmic event was recorded in 30.7% of symptomatic patients (18.6% atrial arrhythmias (AAs); 10.2% bradyarrhythmias (BAs) and 7.3% ventricular arrhythmias (VAs)). In patients with recurrent syncope, the etiology was arrhythmic in 22.4% (59.3% BAs, 25.0% VAs and 15.6% AAs). The ILR led to drug therapy initiation in 11.4%, ablation procedure in 10.9%, implantation of PM in 2.5% and ICD in 8%. At multivariate analysis, the presence of symptoms (HR 2.5, p=0.001) and age >50 years (HR 1.7, p=0.016) were independent predictors of arrhythmic events, while inducibility of VF at EP study (HR 9.0, p<0.001) was predictor of ventricular arrhythmias. Conclusion ILR detects arrhythmic events in nearly 30% of symptomatic BrS patients, leading to an appropriate therapy in 70% of them. The most commonly detected arrhythmias are AAs and BAs, while VAs are detected only in 7% of cases. Symptom status can be used to guide ILR implantation.General ResultsArrhythmias

Mountaintop Gamma Ray Observations of Three Terrestrial Gamma‐Ray Flashes at the Säntis Tower, Switzerland With Coincident Radio Waveforms

AbstractWe report on the mountain top observation of three terrestrial gamma‐ray flashes (TGFs) that occurred during the summer storm season of 2021. To our knowledge, these are the first TGFs observed in a mountaintop environment and the first published European TGFs observed from the ground. A gamma‐ray sensitive detector was located at the base of the Säntis Tower in Switzerland and observed three unique TGF events with coincident radio sferic data characteristic of TGFs seen from space. We will show an example of a “slow pulse” radio signature (Cummer et al., 2011, https://doi.org/10.1029/2011GL048099; Lu et al., 2011, https://doi.org/10.1029/2010JA016141; Pu et al., 2019, https://doi.org/10.1029/2019GL082743; Pu et al., 2020, https://doi.org/10.1029/2020GL089427), a −EIP (Lyu et al., 2016, https://doi.org/10.1002/2016GL070154; Lyu et al., 2021, https://doi.org/10.1029/2021GL093627; Wada et al., 2020, https://doi.org/10.1029/2019JD031730), and a double peak TGF associated with an extraordinarily powerful and complicated positive‐polarity sferic, where each TGF peak is possibly preceded by a short burst of stepped leader emission.

Compare Clinical Characteristics of Psittacosis Pneumonia in 35 Patients and of Non Psittacosis Bacterial Pneumonia in 46 Patients.

We aimed to describe the difference between Chlamydia psittaci pneumonia group and non C. psittaci bacterial pneumonia group in community acquired pneumonia in this single-center clinical study. We collected the data of 35 patients with C. psittaci pneumonia cases and 46 patients with non C. psittaci bacterial pneumonia cases diagnosed with metagenomic next-generation sequencing assays from February 2019 to December 2021 in Huaihua First People's Hospital in China. In the C. psittaci pneumonia group, 35 patients (100%) had a chance of exposure to poultry or birds, and their body temperature was greaterthanorequalto 39.0°C. The other common symptoms were a slow pulse (68.6%), cough (65.7%), expectoration (54.3%), chills (51.4%) and a shortness of breath (37.1%). Laboratory tests showed that >90% of the cases had markedly elevated infection indicators, and 97.1% of the cases had markedly declined calcium.The most common imaging finding was patchyshadows (94.3%), pleuraleffusion (68.6%), bilateral in 54.3% (n = 19) and unilateral in 45.7% (n = 16) participants, and 51.4% (n = 18) of cases met the criteria for severe pneumonia. In the non C. psittaci bacterial pneumonia group, 18 patients (39.1%) had a chance of exposure to poultry or birds, and 11 patients (23.9%) body temperature was greaterthanorequal to 39.0°C. Laboratory tests showed that >67% of cases had a mildlyelevated infection indicators, and mildly declined serumalbumin. The following characteristics are more likely to help distinguish C. psittaci pneumonia from non C. psittaci bacterial pneumonia. Including had a chance of exposure to poultry or birds, high fever, exhibit chills, expectoration, relatively slow pulse, and progress into severe pneumonia. Percentage of neutrophils, C-reactive protein, procalcitonin, lactate dehydrogenase, and myoglobin levels are higher. Blood calcium and corrected calcium are lower. Chest CT showed pleural effusion, pericardial effusion, and mediastinal lymphadenopathy.

Multi–Organ Damage Due to Glufosinate Ammonium Poisoning

Glufosinate Ammonium herbicide poisoning is one of the diseases with a complicated course, a period of 4-60 hours without symptoms followed by sudden appearance of damage to multiple organs such as nerves, breathing, heart. A 67-year-old female patient admitted to our poison control center with symptoms of vomiting and impaired consciousness. Exploiting the patient's information, it was discovered that the patient bought Glufosinate ammonium and Metsulfuron methyl to take it with the intention of committing suicide. The patient was quickly treated with gastric lavage and activated charcoal. After 1 day, the patient lost consciousness, stopped breathing, and had a slow pulse of 45 beats per min, NH3 of blood 93.3 µmol/L, ECG: Sinus bradycardia, no ST elevation. The patient was then prescribed endotracheal tube placement and controlled ventilation. After 7 days of treatment, the patient's condition improved and the patient was extubated. This article aims to talk about multi-organ damage caused by Glufosinate Ammonium poisoning.

Temporary and highly variable recovery of neuromuscular dysfunction by electrical stimulation in the follow-up of acute critical illness neuromyopathy: a pilot study

BackgroundIn sepsis-associated critical illness neuromyopathy (CIPNM) serial electrical stimulation of motor nerves induces a short-lived temporary recovery of compound muscle action potentials (CMAPs) termed facilitation phenomenon (FP). This technique is different from other stimulation techniques published. The identification of FP suggests a major functional component in acute CIPNM.MethodsFrom our previous study cohort of 18 intensive care unit patients with sepsis associated CIPNM showing profound muscle weakness and low or missing CMAPs on nerve conduction studies, six patients with different severity could be followed. In a pilot sub-study we analyzed the variability of FP during follow up. Over up to 6 weeks we performed 2–6 nerve conduction studies with our novel stimulation paradigm. Motor nerves were stimulated at 0.2–0.5 Hz with 60–100 mA at 0.2–0.5 ms duration, and CMAP responses were recorded. Standard motor nerve conduction velocities (NCV) could be done when utilizing facilitated CMAPs. Needle electromyography was checked once for spontaneous activity to discover potential denervation and muscle fiber degeneration. Serum electrolytes were checked before any examination and corrected if abnormal.ResultsIn all six patients a striking variability in the magnitude and pattern of FP could be observed at each examination in the same and in different motor nerves over time. With the first stimulus most CMAPs were below 0.1 mV or absent. With slow serial pulses CMAPs could gradually recover with normal shape and near normal amplitudes. With facilitated CMAPs NCV measurements revealed low normal values. With improvement of muscle weakness subsequent tests revealed larger first CMAP amplitudes and smaller magnitudes of FP. Needle EMG showed occasional spontaneous activity in the tibialis anterior muscle.ConclusionIn this pilot study striking variability and magnitude of FP during follow-up was a reproducible feature indicating major fluctuations of neuromuscular excitability that may improve during follow-up. FP can be assessed by generally available electrophysiological techniques, even before patients could be tested for muscle strength. Large scale prospective studies of the facilitation phenomenon in CIPNM with or without sepsis are needed to define diagnostic specificity and to better understand the still enigmatic pathophysiology.Trial registration: This trial was registered at the Leipzig University Medical Center in 2021 after approval by the Ethics Committee.

Early risk assessment and prediction model for osteoporosis based on traditional Chinese medicine syndromes

ObjectiveTo evaluate the risk factors of osteoporosis and establish a risk prediction model based on routine clinical information and traditional Chinese medicine (TCM) syndromes. MethodsAdults aged 30–82 who lived in 12 grass-roots communities or rural towns in Shanghai, Jilin Province, and Jiangsu Province from December 2019 to January 2022 through a multi-stage sampling method were included in this study. The risk factors and risk prediction of osteoporosis in women and men were explored and established by univariate analysis and multivariate logistic regression model. ROC curve and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the prediction model. ResultsA total of 3000 subjects including 2243 females (75 %) and 757 males (25 %) were included in this study. The logistic prediction model of osteoporosis in women was Logit (P) = −2.946 + 0.960 (age ≥50 years old) + 0.633 (BMI ≥24 kg/m2) - 0.545 (daily exposure to sunlight >30 min) + 0.519 (no intake of dairy products) + 0.827 (coronary heart disease) + 0.383 (lumbar disc herniation) + 0.654 (no intake of calcium tablets and vitamin D) - 0.509 (insomnia) + 0.580 (flushed face and congested eyes) + 1.194 (thready and rapid pulse) + 1.309 (sunken and slow pulse). The logistic prediction model of osteoporosis in men was Logit (P) = −1.152–0.644 (daily exposure to sunlight >30 min) + 0.975 (no intake of calcium tablets and vitamin D) - 0.488 (insomnia). The area under the ROC curve (AUC) of female and male osteoporosis prediction models was 0.743 and 0.679, respectively. The Hosmer-Lemeshow goodness-of-fit test was >0.5. ConclusionsThere are some significant differences in risk factors between female and male patients with osteoporosis. The risk of osteoporosis are found to be associated with TCM syndromes, and osteoporosis risk prediction models based on routine clinical information and TCM syndrome is effective.

FRI419 Progesterone Regulation Of The GnRH Pulse Generator

Abstract Disclosure: E.G. Wall: None. A group of kisspeptin neurons located in the arcuate nucleus (ARN) of the hypothalamus represent the GnRH pulse generator and their activity is thought to be controlled primarily by the feedback actions of estradiol and progesterone (P4). In a healthy menstruating woman, following the mid-cycle ovulation, P4 levels dramatically increase and exert a negative feedback action onto the hypothalamus to slow pulsatile LH secretion. However, the exact mechanism by which P4 negatively feeds back to the hypothalamus remains unknown. The ARN kisspeptin neurons display synchronized episodes (SEs) of activity approximately every hour for most of the cycle but these dramatically reduce in number following the LH surge. As these ARN kisspeptin neurons express the progesterone receptor (PR) it is hypothesized that they may be the site at which P4 negative feedback occurs. Given the lack of detailed information in the mouse, we first assessed the profile of circulating P4 levels in mice at 8-hr intervals throughout the estrous cycle. Terminal blood samples were taken from individual mice along the 4 stages of the estrous cycle at 3-time points 8 hrs apart and the gonadal hormones were analyzed using LC-MS. The concentration of P4 was found to peak around the time of the LH surge at 6 pm on proestrus (21.94 ± 3.78 ng/ml) and was at its lowest at diestrus 10 am (0.42 ± 0.11 ng/ml). We next assessed the impact of circulating P4 on the activity of the ARN kisspeptin pulse generator using GCaMP fibre photometry in freely behaving mice. A prior study found that IP administration of 8 mg/kg P4 resulted in circulating P4 concentrations reaching 34 ng/ml (Wong et al., J Pharm Pharmacol 64, 2012). Hence, in this study, diestrus mice equipped for monitoring the activity of the kisspeptin pulse generator were injected with either 8 or 4 mg/kg P4 at 10 am and SEs monitored for 24 hrs. Both doses resulted in a significantly decreased frequency of SEs compared to the vehicle (p<0.05), which persisted for 6 hrs. To next examine whether P4 may be acting directly on the ARN kisspeptin neurons to slow pulse generation, P4 (25 ng/ml) was infused directly into the ARN while the activity of the pulse generator was monitored. Again, this resulted in a decreased frequency of SEs compared to the vehicle with the effects lasting approximately 5 hrs (p<0.05).These results indicate that P4 exerts powerful inhibitory control over the activity of the kisspeptin pulse generator and that these effects may be direct. Elucidating the mechanisms of P4 negative feedback may provide a platform for the development of new therapeutic strategies in the infertility clinic. Presentation: Friday, June 16, 2023

Associations of Serum Testosterone and Sex Hormone-binding Globulin With Incident Arrhythmias in Men From UK Biobank.

Sex hormones have been identified as cardiovascular risk factors, whereas the relationship between sex hormones and the risk of arrhythmias in men has not yet been well studied in the prospective cohort study. To analyze associations of serum testosterone and SHBG concentrations and calculate free testosterone (cFT) with arrhythmias in men. Sex hormones were measured at baseline from UK Biobank. Main outcomes were incidence of atrial fibrillation/flutter (AF), ventricular arrhythmia (VA), and bradyarrhythmia (BA). Of 173 498 men (aged 37-73 years, followed for 11 years), 11 368 had incident AF, 1646 had incident VA, and 4788 had incident BA. Compared with the third quartiles, the lowest category of serum testosterone was associated with increased risks of AF (hazard ratio [HR], 1.06; 95% CI, 1.00-1.12) and BA (HR, 1.11; 95% CI, 1.02-1.20) after multivariable adjustment, but no VA. Likewise, similar associations were found between cFT values and AF and BA events. Furthermore, higher levels of cFT were associated with increased risks of AF (HR, 1.07; 95% CI, 1.02-1.13) and VA (HR, 1.18; 95% CI, 1.01-1.37). Higher SHBG concentrations were associated with increased risks of AF (HR, 1.44; 95% CI, 1.34-1.54), VA (HR, 1.27; 95% CI, 1.07-1.52), and BA (HR, 1.17; 95% CI ,1.05-1.29). Lower levels of testosterone and cFT were associated with increased risk of AF and BA. Higher cFT levels were associated with increased risk of AF and VA. Higher SHBG levels were associated with increased risk of AF, VA, and BA.

Complete Sino Atrial Block in Acute Coronary Syndrome with ST Segment Elevation: Incidence, Predictive Factors and Related Mortality

Background: Sino atrial block in acute coronary syndrome with ST segment elevation is not rare and may be dangerous by causing severe bradycardia. Its incidence was reported in the literature, but no data about its predictive factors or related mortality, also its epidemiological data is lacking in Algeria. Aims: The main objective of our study is the determination of the frequency of Sino Atrial Block in acute coronary syndrome with ST segment elevation, the secondary objective was the analysis of predictive factors of this Brady arrhythmia, and related mortality. Methods and materials: In this prospective study, conducted in the cardiology department of Hussein Dey hospital (Algiers-Algeria), 467 patients with acute coronary syndrome with elevated ST segment (87 women and 380 men) were enrolled between 28 February 2014 and 16 July 2015. The average age is 60 ± 13 years; at admission, a Holter recorder was attached for continuous ECG monitoring during 48 hours Kruskal’s ANNOVA or H tests were used for comparison of quantitative variables, χ2 test or Fisher’s exact test, were used for qualitative variables, all tests were performed with 1st species risk of 5%. Results: The frequency of complete Sino atrial block is 2.6 % (12 patients), CI 95%: [1.2%-4%], multivariate analysis identified the following independent predictors: right ventricular acute coronary syndrome, infero basal acute coronary syndrome, and large right atrium surface. The risk of mortality expressed by Hazard Ration (HR) is 5.4. (CI95%: [1.2-24], p = 0.024); right acute coronary syndrome is the only predictive factor of mortality identified in our study. Conclusion: Sino atrial block is not rare in acute coronary syndrome with elevated ST segment, its predictive factors according to our study are: right ventricular acute coronary syndrome, infero basal acute coronary syndrome, and large surface of right atrium, its occurrence increases the risk of hospital mortality.

Low-Pass NGD Digital Circuit Application for Real-Time Greenhouse Temperature Prediction

An original application of low-pass (LP) negative group delay (NGD) digital circuit for real-time prediction of greenhouse temperature is investigated. Synthesis formulas allowing to determine the LP-NGD parameters in function of the targeted time-advance are established. The characterization technique of LP-NGD digital circuit implemented on microcontroller platform is validated with a deterministic analytical and real temperature slow pulse signals presenting several hour time-duration. The real-time temperature prediction is tested by employing a commercial temperature sensor in the greenhouse environment. As expected, very good prediction of greenhouse temperature is observed. The experimental result demonstrates an outstanding prediction of ambient temperature variation with -30 minutes time-advance during more than fifty-hour or more than two-day real-time sensing. The present research result opens an innovative roadmap for the future smart buildings and industries where the temperature control and monitoring are particularly key challenging tasks.

Manipulation of magnetization and spin transport in hydrogenated graphene with THz pulses

Terahertz (THz) field pulses can now be applied in scanning tunneling microscopy (THz-STM) junction experiments to study time-resolved dynamics. The relatively slow pulse compared to the typical electronic time-scale calls for approximations based on a time-scale separation. Here, we contrast three methods based on non-equilibrium Green’s functions: i) the steady-state, adiabatic results, ii) the lowest-order dynamic expansion in the time variation, and iii) the auxiliary mode propagation method without approximations in the time variation. We consider a concrete THz-STM junction setup involving a hydrogen adsorbate on graphene where the localized spin polarization can be manipulated on/off by a local field from the tip electrode and/or a back-gate affecting the in-plane transport. We use steady-state non-equilibrium Green’s function theory combined with density functional theory to obtain a Hubbard model for the study of the junction dynamics. Solving the Hubbard model in a mean-field approximation, we find that the near-adiabatic first-order dynamic expansion in the time variation provides a good description for STM voltage pulses up to the 1 V range.

Graphing Deep Hypermeter in the Scherzo Movement of Beethoven’s Ninth Symphony

Abstract This paper reinterprets my 1992 analysis of the scherzo of Ludwig van Beethoven’s Ninth Symphony using more recently introduced modes of representation: ski-hill graphs, ski-path networks, and metric cubes. It provides a tutorial on the three metric modes of representation, while using those modes to reveal different aspects of the scherzo’s metric form. It presents evidence in support of the proposition that slow pulses and deep hypermeter can “exist,” be aesthetically relevant, and have analytical value.

Zhenwu Decoction:connotation interpretation based on severe cases and modern pathophysiological mechanisms and application in treatment of heart failure in critical care unit

Zhenwu Decoction is recorded in Treatise on Febrile Diseases by an outstanding physician ZHANG Zhong-jing in the Han dynasty. With effect of warming yang, transforming Qi, and promoting urination, Zhenwu Decoction is mainly used to treat edema due to yang deficiency. The studies of the severe and critical cases and the pathophysiological mechanisms have demonstrated that the record of Zhenwu Decoction in Treatise on Febrile Diseases describes the clinical symptoms and therapeutic regimen of acute heart failure. The syndrome treated by this formula may be related to the misdiagnosis and wrong treatment. Due to the difficult distinguishing between cardiogenic dyspnea and pulmonary dyspnea, high doses of Ephedrae Herba may be misused for inducing sweating, which may finally lead to the acute aggravation of heart failure, electrolyte disorder, and pulmonary infection. The syndrome treated by Zhenwu Decoction can illustrate the lack of experience of ancient physicians in treating acute heart failure. The description of "trembling and shivering" may be the clinical manifestation of heart failure, which is an upgraded version of "trembling and shaking" treated by Linggui Zhugan Decoction.(1)In terms of diseases, Zhenwu Decoction is suitable for the treatment of acute or chronic heart failure, cardiorenal syndrome, and diuretic resistance. The decoction is especially suitable for treating whole heart failure, acute heart failure, heart failure with reduced ejection fraction, and heart failure with the syndrome of sold and dampness. In addition, it can be used to treat both type Ⅱ and type Ⅳ cardiorenal syndrome.(2)In terms of symptoms, Zhenwu Decoction can be used for treating chest tightness, palpitations, lower limb edema, difficult urination or increased urine output, fear of cold, pale fat tongue with teeth marks, white and slippery tongue fur, and deep or slow pulse.(3)In terms of the pharmacological mechanism, Zhenwu Decoction treats heart failure following the principle of promoting urination, expanding blood vessels, and invigorating heart in modern medicine. Aconiti Lateralis Radix Praparata is the sovereign herb in the formula, with the recommended dosage of 30-60 g. However, arrhythmia may be caused by high doses of Aconiti Lateralis Radix Praparata, which should be used with concern. In addition to Zhenwu Decoction, Shenqi Pills, Renshen Decoction, Wuling Powder, and Fangji Huangqi Decoction with the effect of invigorating spleen, replenishing Qi, warming Yang, and promoting urination can be used in the recovery stage. The therapy of reinforcing Yang was the last choice for critical cases due to the lack of medical conditions, unclear clinical diagnosis in history, which should be treated objectively now.

Vadose Zone Soil Flushing for Chromium Remediation: A Laboratory Investigation to Support Field‐scale Application

AbstractCr(VI) flushing from the vadose zone to the groundwater (with subsequent Cr(VI) removal in groundwater by pump‐and‐treat system) is a promising remedial technique that has recently been used at field scale. This laboratory study was conducted to provide the technical basis to design a field soil flushing strategy. The objectives were to (1) quantify the relationship between sediment Cr(VI) and Cr(III) mass and release rates and subsequent Cr(VI) leaching; (2) investigate different methodologies to maximize Cr(VI) leaching, and (3) investigate methods to minimize leaching of remaining residual Cr. Characterization of Cr‐contaminated sediments (Hanford Site, WA) exhibited Cr(VI) showed that leach rates that were correlated to different Cr surface phases. Sediments with low leachable Cr(VI) (<2 μg/g) leached Cr rapidly, so slow infiltration of water in a single pulse was sufficient to leach most Cr. In contrast, sediments with high Cr (2 to 200 μg/g) released some Cr(VI) quickly but 10 to 50% Cr(VI) slowly (tens to hundreds of hours). Efficient unsaturated leaching of these sediments required a different infiltration strategy that includes: multiple slow leach pulses with time between flushing cycles; the use of a surfactant to increase Cr leaching from low‐permeability zones, and the use of a reductant (Na‐dithionite or Ca‐polysulfide) in the final leach water was highly effective at decreasing residual Cr leaching. This study clearly demonstrated that the methodology of basing laboratory Cr flushing on parameters such as Cr release mass and rates could be used to improve the efficiency of soil flushing at field scale.

Producing slow light in warm alkali vapor using electromagnetically induced transparency

We present undergraduate-friendly instructions on how to produce light pulses propagating through warm Rubidium vapor with speeds less than 400 m/s, i.e., nearly a million times slower than c. We elucidate the role played by electromagnetically induced transparency (EIT) in producing slow light pulses and discuss how to achieve the required experimental conditions. The optical setup is presented, and details provided for preparation of pump, probe, and reference pulses of the required size, frequency, intensity, temporal width, and polarization purity. EIT-based slow light pulses provide the most widely studied architecture for creating quantum memories. Therefore, the basic concepts presented here are useful for physics and engineering majors who wish to get involved in the development of cutting-edge quantum technologies.

Prevalence and Impact of Arrhythmia on Outcomes in Restrictive Cardiomyopathy-A Report from the Beijing Municipal Health Commission Information Center (BMHCIC) Database.

Data on the outcomes of restrictive cardiomyopathy (RCM) are limited, when the condition is complicated with arrhythmia. This study was designed to investigate the prevalence of atrial fibrillation (AF), ventricular tachycardia (VT) and bradycardia (BC) and their impact on adverse outcomes (intra-cardiac thrombus, stroke and systematic embolism [SSE], heart failure and death) of RCM. The retrospective cohort study used data collected from the Beijing Municipal Health Commission Information Center (BMHCIC) database from 1 January 2010 to 31 December 2020. There were 745 (64.9%) patients with AF, 117 (10.2%) patients with VT and 311 (27.1%) patients with bradycardia. The presence of AF was associated with an increased risk of SSE (adjusted HR:1.37, 95%CI:1.02-1.83, p = 0.04) and heart failure (aHR:1.36, 95%CI:1.17-1.58, p < 0.001). VT was associated with an increased risk of intracardiac thrombus (aHR:2.34, 95%CI:1.36-4.01, p = 0.002) and death (aHR:2.07, 95%CI:1.19-3.59, p = 0.01). Bradycardia did not increase the adverse outcomes in RCM. The results remained consistent and steady when AF, VT and bradycardia were adjusted as competing factors. Cardiac arrhythmia are highly prevalent and associated with adverse outcomes in patients with RCM. AF and VT are more likely to be associated with intracardiac thrombosis, and the presence of AF increased the risk of SSE and HF. The presence of VT increased the risk of death.

In-Hospital Mortality of Patients with ST Elevation Myocardial Infarction in Diabetic Versus Non-Diabetic Patients

Background and Aim: Diabetic mellitus is an epidemic health issue causing almost twice the mortality compared to non-diabetic. Diabetes and non-diabetics with acute myocardial infarction were compared for in-hospital mortality and complications. Material and Methods: This comparative cross-sectional study was conducted on 264 successive diabetic and non-diabetic patients in the Department of Cardiology Pakistan Institute of Medical Sciences Islamabad with study duration of 6 months. All the acute myocardial infarction patients with ST-elevation were admitted and treated with thrombolytic agent such as streptokinase. Patients were categorized into two groups: 1) Diabetic patients 2). Non-diabetic patients. All the patients of either gender with age ranges from 15 years to 80 years and having chest pain for &gt;30 minutes and &lt;24 hours with ST-elevation were enrolled. After 60 minutes of thrombolysis, an ECG was taken to measure the baseline and the following day's ECG. SPSS version 26 was used for data analysis. Results: Out of 264 patients, there were 196 (74.2%) male and 68 (25.8%) females. Diabetic and non-diabetic group included 132 patients. Diabetic group patients had higher frequency of ST elevation in myocardial infarction than non-diabetic patients. Brady arrhythmias, post MI angina, LV failure, atrial fibrillation, and cardiogenic shock were the main complications observed in all the patients after ST Elevation MI. Diabetes patients are more likely to experience all these complications post MI angina than non-diabetics. Conclusion: The present study concluded that the prevalence of arrhythmias and left ventricular failure complications were higher in diabetic patients. Also, the mortality rate was significantly higher in diabetic patients. The non-diabetic patients had higher post MI angina than diabetic patients. It is also important to decrease the prevalence of diabetes mellitus in our population since it is a modifiable risk factor that leads to more complications following MI than non-diabetic patients. Keywords: In-hospital mortality, ST elevation, Myocardial infarction, diabetic and non-diabetic

Clinical Characteristics of Cardiac Arrhythmias in Pediatric Age Group

Background: The Symptomatic manifestation of pediatric arrhythmias varies according to the age. Patients with disturbances in cardiac rhythm have several complaints, but also could be totally asymptomatic. This study aimed to assess clinical characteristics of Tachy and Brady arrhythmia in neonates, infant, children and adolescents of various age groups.&#x0D; Methods: This cross-sectional study included 253 patients of pediatric age below 18 years old presented with different types of tachyarrhythmia or bradyarrhythmia. All patients were subjected to clinical general examination of patient, vital data collection, local cardiac examination, 12 leads electrocardiography, ambulatory ECG Holter monitoring, exercise ECG stress testing if indicated and transthoracic echocardiography. &#x0D; Results: There was a significant relation between age of presentation of the study patients and classification of arrhythmia (P &lt; 0.001). Palpitations was the most common presentations of arrhythmia in our study patients (32%) followed by dyspnea in 17.8 % of the patients. 20.6 % of the study patients with arrhythmias were asymptomatic. Congenital heart anomalies were in 43 % of the patients.&#x0D; Conclusion: Pediatric arrhythmia can be totally asymptomatic and discovered accidentally. Congenital cardiac anomalies and cardiac arrhythmias are closely correlated. Holter monitoring and exercise ECG testing can help in diagnosing pediatric arrhythmia. Untreated or persistent arrhythmia causes LV myopathy and dilatation. Antiarrhythmic drugs can have their harmful effect on the growing child.

An Experimentally Parameterized Equivalent Circuit Model of a Solid-State Lithium-Sulfur Battery

This paper presents and parameterizes an equivalent circuit model of an all-solid-state lithium-sulfur battery cell, filling a gap in the literature associated with low computational intensity models suitable for embedded battery management applications. The paper addresses this gap by parameterizing a three-state equivalent circuit model using experimental pulse power characterization data from a laboratory-fabricated lithium-sulfur cell. The cell is mechanically loaded during electrical cycling to achieve maximum ionic conductivity and consistent capacity. A nested combination of linear and nonlinear least squares regression is used to estimate the model parameters. The model captures slow cycling and fast pulse charge/discharge dynamics within 34 mV RMS error. The series resistance changes significantly at high/low states of charge and low C-rates. A sensitivity analysis determines that accurately modeling the dependence of resistance on C-rate and state of charge is important for model fidelity.

Eitt sindur um tuberklasmittuna

This paper is part of a treatise dealing with the clinical features of primary tuberculous infection, and the purpose of the present work is to contribute to the clinic of primary tuberculosis. Some literature about the theme is surveyed. The material used has been collected at the Tuberculosis Station of the Faroe Islands at Hoydal during the author's time of service there from 1939 to 1947. An account is given of the working plan of this tuberculosis station, where besides ordinary station work special attention is paid to the tuberculin register. The tuberculin reaction used has been Pirquet 's test. The material comprises a total of 430 cases of initial fever. The fever curve for adults was typically continual, while with children it vas irregular; the duration of the fever was similar for children and adults, generally 2 or 3 weeks; in l/4 of the cases it lasted more than one month. Maximum temperature generally about 39 degrees C might, however, be higher, especially with children. The duration and height of the fever had no prognostic significance. Slow pulse was a constant symptom witli adults, but was seldom noticed with children. This relative bradycardiagenerally lasted till the middle of ihe fever period. Krythema nodosum was a frequent symptom ot' initial fever and occurred 76 times among the 430 cases of initial fever. Sedimentation rate practically always increased, as a rule moderately, and decreased as the fever fell, but more slowly. X-rays examinations have been made during initial fever in 146 cases. X-rays changes were stated in all the children and in more than % of the adults. The changes stated were chifly enlarged hilar shadows, some had also infiltrations. Rather more than *4 had subjective symptoms, a number which is undoubtedly too low. The most frequent symptoms where retrosternal pain and soreness of the lower end of sternum, a stitch in the side, and pain between the shoulderblades. The mentioned symptoms must be supposed to bi' caused by tlie pathologic anatomic changes.