Frequency Of Autonomic Dysfunction Research Articles

Asthenovegetative syndrome after COVID-19 in the practice of a family doctor

This study assesses and systematizes the signs of asthenovegetative syndrome (AVS) in patients who had COVID-19 a month ago. The survey was completed by 44 respondents aged 20 to 80 years. According to the results of the survey, the most common manifestation of asthenovegetative syndrome is weakness. The respondents also noted emotional disturbances, decreased attention, sleep disturbances, pain in the joints and muscles, weight loss, and headache. To assess the dynamics of the studied manifestations, a survey was conducted using the Vein's autonomic dysfunction scale. In 93.1 % of the respondents, the total score exceeded 15, which indicates the presence of autonomic dysfunction. The results demonstrate that among patients who have undergone COVID-19, the frequency of autonomic dysfunction is quite high. The manifestations which patients are most often concerned about are asthenic and psycho-emotional disorders. These consequences of COVID-19 significantly reduce the quality of life, which indicates the need for timely diagnosis and provision of qualified care to patients.

Frequency, Severity, and Duration of Autonomic Symptoms in Patients of Prodromal Dementia with Lewy Bodies.

Autonomic dysfunction is supportive clinical feature for diagnosis of prodromal dementia with Lewy bodies (DLB). To compare the features of autonomic symptoms in patients with mild cognitive impairment (MCI) due to Lewy bodies (MCI-LB) and Alzheimer's disease (MCI-AD). Autonomic symptoms were evaluated in the MCI-LB and MCI-AD patients using the Scales for Outcomes in Parkinson's disease for autonomic symptoms (SCOPA-AUT). Thirty patients with MCI-LB and 90 patients with MCI-AD were recruited. The frequency of autonomic dysfunction was higher in patients with MCI-LB compared to the MCI-AD patients (80% versus 54.4%, p = 0.013) and the gastrointestinal symptoms were predominant (73.3% versus 35.6%, p < 0.001). Salivation, constipation, incontinence, incomplete emptying, lightheadedness when standing up or standing for some times, diurnal or nocturnal hyperhidrosis, and sexual dysfunction were more severe and protracted in the MCI-LB group compared to the MCI-AD group. The MCI-LB patients showed higher frequency and severity, as well as longer duration of autonomic symptoms compared to the MCI-AD group. These symptoms can facilitate early diagnosis of patients with DLB.

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Distribution of Polymorphic Marker of Genes of the Renin-angiotensin System RAS (AGT, AGTR1, АСЕ), ITGB3, PPARG) in Pa-tients With Essential Arterial Hypertension Depending on the Nature of the Nocturnal De-crease of BP

A clinical-genetic study using ABPM (24-hour BP monitoring) and Holter’s ECG methods in 49 pa-tients with essential arterial hypertension (group 1: 17 patients without sufficient nocturnal BP de-crease СI≤10%, and group 2: 32 patients with suf-ficient nocturnal BP decrease СI≥10%,) was per-formed for comparative analysis of the genotype frequencies of ACE, AGT, AGTR1, ITGB3, and PPARG. The study was conducted in order to clari-fy the pathogenetic mechanisms of the implementa-tion of different dynamics of nocturnal blood pres-sure in patients with hypertension without metabol-ic syndrome. It was found that in group 1, protec-tive genotype II of the ACE gene was more com-mon (p ≤ 0.025) than in the population data. A sig-nificant increase (p ≤ 0.025) in the frequency of the CC genotype of the AGTR1 gene responsible for the formation of insulin resistance compared to the population data was combined with a significant increase in the frequency of autonomic dysfunction in patients of group 1 - 83.4% vs. 64.5% group 2 respectively. The results obtained indicate the pos-sible pathogenetic links between genetically deter-mined insulin resistance and autonomic nervous system dysfunction and allows us to determine therapeutic approaches for correcting the noctur-nal blood pressure profile.

Frequency of Autonomic Dysfunction in Patients of Guillain Barre Syndrome in a Tertiary Care Hospital.

IntroductionGuillain-Barré syndrome (GBS) is defined as a syndrome manifesting as an acute inflammatory demyelinating polyradiculoneuropathy (AIDP) with coexistent weakness and absent or diminished reflexes clinically.Autonomic dysfunction (AD) or dysautonomia is a common finding in GBS. Autonomic dysfunction usually occurs in the acute phase of the illness but can also be seen in the recovery phase. The rationale of our study is to determine the frequency of autonomic dysfunction in patients of GBS admitted to the Neurology department of Civil Hospital, Karachi.MethodsA total of 118 admitted patients at a tertiary care hospital in Pakistan who fulfilled the inclusion criteria were enrolled in the study after informed consent. The study was conducted for six months at the department of neurology, Civil Hospital, Karachi. Patients were assessed for autonomic dysfunction by recording blood pressures and pulse rate hourly (both lying and standing positions) by resident doctors. Urinary retention, diarrhea, and constipation were also recorded in a separate chart. All values entered in the pre-approved performa by researchers. The data was collected and analyzed on Statistical Package for Social Sciences (SPSS) version 18.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics included mean, standard deviation (SD) of continuous data, like age, duration of illness, motor weakness assessment by Medical Research Council (MRC) Scale, protein content in cerebrospinal fluid (CSF), pulse, and blood pressure at the time of presentation. Frequencies and percentages were calculated from the categorical data, like gender and patients with autonomic dysfunction (outcome variable). Effect modifiers were controlled by stratification of age, gender, duration of illness. Post-stratification chi-square test was applied with a p-value of ≤ 0.05 taken as significant.ResultsIn our study, the average age of the patients was 39.90±9.91 years. Frequency of autonomic dysfunction among patients with GBS was 41.53% (49/118). The most frequent autonomic manifestations were constipation and diarrhea; 22% and 21.2% respectively. Additional manifestations included urinary retention (15.3%) and fluctuation of blood pressure and heart rate at 13.6% each. ConclusionThis study showed that the frequency of autonomic dysfunction among patients of Guillain Barre Syndrome was significant, consistent with previous studies. Our study explored the adverse outcomes of autonomic dysfunction in patients with GBS. This will help physicians increase their understanding of dysautonomia so that effective management plans can be formulated for patients with GBS to prevent adverse outcomes and hence provide better patient care.

Prevalence of autonomic dysfunction among pre-dialysis chronic kidney disease patients in a tertiary hospital, South East Nigeria.

Autonomic dysfunction (AD) has been recognized as an important contributor to the poor outcome in chronic kidney disease (CKD) patients. Several studies have reported abnormalities in heart rate variability (HRV) among these patients. To determine the prevalence of Autonomic Dysfunction (AD) in pre-dialysis Chronic Kidney Disease (CKD) patients in a tertiary hospital in South East Nigeria. A cross sectional study of eighty chronic kidney disease patients attending the renal unit out-patient in the University of Nigeria Teaching Hospital (UNTH) Enugu was carried out. Forty subjects, drawn randomly, who had no kidney disease served as control. Autonomic function was assessed with non - invasive cardiovascular tests including, measurement of resting tachycardia, orthostatic hypotension, heart rate response (HRR) to standing test, heart rate response to Vasalva manoeuvre and heart rate response to respiration. With the battery of 5 tests used to assess AD, the frequency of autonomic dysfunction in pre-dialysis chronic kidney disease patients was 51.3% compared to 7.5% in the control group. Heart rate response to standing was the most sensitive test to detect AD in this group of subjects. AD is a common problem among pre-dialysis CKD patients in Nigeria.

Assessment of vegetative regulation in young people

Purpose. To estimate the prevalence and type of disturbance of the vegetative regulation in young adults and to compare the frequency of autonomic dysfunction with the severity of the phenotypic manifestations of inherited connective tissue disorders (ICTD).Methods. 350 young adults were examined in a clinical study (collection of complaints), and with help the special “questionnaire for detection of signs of autonomic dysfunction”. At 61 young men was performed Holter ECG monitoring and cardiovascular tests D. Ewing. Results. The average number of complaints in the group of 317 healthy students was 6.5 ± 1.7. Almost all of the complaints have found significantly more frequent in girls. Examination with help special questioning for detection of autonomic dysfunction (AD) revealed AD a bit more often in girls than in boys (79 % and 64 %, respectively). Due to gender differences, further study carried out in a group of 61 young men. Нeart rate variability and autonomic test results in the groups of young men with and without AD according to the questionnaire did not reveal significant differences. At the same time in 30 % of young men without AD according to questionnaire have found an abnormal result in the active orthostatic test (AOT). Estimation of anthropometric indices and clinical features of inherited connective tissue disorders revealed that young men with AD based on the results of the questionnaire have more of skeletal and skin symptoms than that of young men without AD. The involvement of the skeletal system was present significantly frequently in young men with abnormal result AOP than that of young men with a normal result of AOP (90% and 55% respectively, p < 0,001).Conclusion. Our study showed that AD present in the majority of young people. However, most often both subjective and objective signs of autonomic disorders common in young people with signs ICTD.

The phoenix from the ashes: cardiovascular autonomic dysfunction in behavioral variant of frontotemporal dementia.

Patients with autonomic failure may experience postural dizziness, syncope, and falls. Identifying symptomatic dysautonomia in dementia is of importance to ensure appropriate management and reduce risk of falls. The aim of this prospective study is to identify cardiovascular autonomic dysfunction in patients suffering from behavioral variant of frontotemporal dementia (bvFTD), compared to Alzheimer's disease (AD). Patients were prospectively recruited from 2009 until 2013. Clinical autonomic function tests were carried out in an Autonomic Unit according to Ewing's cardiovascular battery. Parasympathetic tests included resting heart rate variability, deep breathing, and Valsalva. Sympathetic function tests compromised blood pressure regulation on valsalva, cutaneous cold stimulation, and 70° head up tilt including of plasma noradrenaline. 26 patients (17 female) with bvFTD and 18 patients (10 female) with AD were examined. Mean age of bvFTD was 69 ± 11 years, AD 74 ± 9 years. History taking was often not conclusive and did not correlate with autonomic signs. In 42% bvFTD patients and 44% AD patients, autonomic dysfunction was demonstrated. Manifest orthostatic hypotension (OH) was present in 19% of bvFTD and 33% AD patients. Frequency of autonomic dysfunction and orthostatic hypotension did not differ between bvFTD and AD, but were significantly higher than in healthy controls. Autonomic dysfunction was associated with an increased risk of falling (assessed with Tinetti Score). This is the first prospective study to elucidate autonomic dysfunction in bvFTD patients. There is a considerable higher frequency of cardiovascular dysfunction and OH in bvFTD. History taking may be not conclusive thus cannot exclude cardiovascular dysautonomia.

Frequency of Autonomic Neuropathy Occurrence among Diabetic Patients

Objectives: Diabetic autonomic neuropathy (DAN) is the most common and grave complication of diabetes mellitus (DM). In this study, we determined the frequency of autonomic neuropathy among both type1 and type 2 diabetic patients in Pakistan. Materials and Methods: This study was conducted at Capital Development Authority (CDA) Hospital, Pakistan. The adult patients who had DM for at least last five years were assessed for this study. Four cardiovascular reflex tests were performed on each patient. Pre-prandial and two hours postprandial blood glucose were also measured. Results: A total of 200 patients were recruited for the study. Of them, 133 (66.5%) patients had autonomic neuropathy. Cardiovascular involvement was seen in 86 (43%), gastrointestinal involvement in 93(46%) and genitourinary involvement in 15 (7.5%) patients. The frequency of autonomic neuropathy did not differ between type 1 and type 2 DM patients (p=0.246). However, the frequency of autonomic neuropathy was found to be predominant among the subjects with long history of DM (p=0.016). Conclusion: We conclude that frequency of autonomic dysfunction is more common among patients with long standing DM patients. Hence, all the diabetic patients with disease duration of more than 5 years should be evaluated for autonomic dysfunction.

Evaluación de disfunción autonómica en pacientes con insuficiencia renal crónica en programa de hemodiálisis.

Objective: To determine the frequency of autonomic dysfunction and associated factors in patients with chronic renal failure in hemodialysis program. Material and methods: A case-control study we evaluated 30 patients in hemodialysis program and equal number of healthy volunters, using the heart rate variability test during deep breathing. Results: In hemodialysis group, twenty two patients (80%) had autonomic dysfunction, 67% were asimptomatics. In control group only two patients had autonomic dysfunction (6.7%). In both groups, we found positive correlation than age with autonomic dysfunction stage. Conclusion: Autonomic dysfunction is a frequent complication in hemodialysis patients; it’s frequently asymptomatic and it has age relationship.

Relationship between the frequency of autonomic dysfunction and the severity of chronic obstructive pulmonary disease

The relationship between the frequency of autonomic dysfunction (AD) and the severity of chronic obstructive pulmonary disease (COPD) has not been exactly known, despite its importance in the pathogenesis of COPD. Therefore, we aimed to evaluate the relationship between the clinical stage severity of the disease and the frequency of AD in COPD patients. The frequency and type of AD were determined according to the clinical severity of 35 stable COPD patients. The results were compared between the mild and moderate-severe COPD groups. Sympathetic system (SS) was evaluated with sympathetic skin response (SSR), QT and QTc intervals (ms) analyses. Parasympathetic system was evaluated with the heart rate interval variations (RRIV). For the total group, an AD was detected in 20 patients (57%), a parasympathetic dysfunction (PD) in 14 (40%), a mixed-type dysfunction in five (14%) and a sympathetic dysfunction (SD) in only one patient (3%). For the 12 mildly affected patients, there were cases of isolated SD in only one patient (8.5%), isolated PD in five (42%) and AD in six patients (50%). For the 23 moderate-severe COPD patients, mixed AD was detected in five patients (22%), isolated PD in nine (39%) and AD in 14 patients (61%). There were no significant differences between the two patient groups, neither for isolated parasympathetic and sympathetic, mixed form nor for total AD (P>0.05). The results suggested that PD was dominant in patients with COPD. However, the frequencies of autonomic parasympathetic and sympathetic dysfunction did not increase significantly with the severity of COPD. The severity of hypoxemia and/or airflow limitation may not be the only unique or definite reason for AD in COPD, as there was not an exact correlation between the presence of AD and the severity of airflow limitation and hypoxemia.

Identification of Patients at Risk of Arrhythmia in the Guillain-Barré Syndrome

The frequency of autonomic dysfunction and significant arrhythmia was investigated in a series of 100 patients who presented with an acute idiopathic neuropathy considered to be due to Guillain-Barré syndrome. Eleven of 33 patients requiring ventilation developed serious cardiac rhythm disturbances and seven of these patients died. Approximately 25 per cent of patients had a sinus tachycardia or raised systolic blood pressure and half had reduced sinus arrhythmia indicated by an abnormally low R-R interval variation on deep breathing. Systolic hypertension and reduced R-R interval variation were significantly more common in patients who subsequently developed serious arrhythmias than those who did not. Only those patients that required ventilation developed serious arrhythmias and these were often preceded by wide fluctuations of pulse or blood pressure and transient asystole following tracheal suction.