Intermittent Monitoring Research Articles

Unexpected Acute Hyperglycemia Following Pre-Surgical Discontinuation of SGLT2 Inhibitors in a Type 1 Diabetic Patient.

BACKGROUND Sodium-glucose transporter 2 (SGLT2) inhibitors serve as adjuncts in managing type 1 diabetes. Preoperative guidelines suggest discontinuing SGLT2 inhibitors to avoid associated adverse events. We report an unusual case of acute hyperglycemia following the discontinuation of SGLT2 inhibitors in a patient undergoing surgery, posing substantial challenges to glycemic control. CASE REPORT A 47-year-old female with type 1 diabetes was hospitalized for benign thyroid tumor surgery. She discontinued her SGLT2 inhibitors a day after admission. Unexpectedly, her glycemic control worsened with her mean sensor glucose value spiking from 109 mg/dL on admission to 273.9 mg/dL five days post-discontinuation. Despite increasing insulin doses, glycemic control remained suboptimal. The glucose level improved to a mean sensor value of 160.4 mg/dL only after SGLT2 inhibitors were resumed three days post-surgery. CONCLUSIONS This report highlights a case of acute hyperglycemia following preoperative discontinuation of SGLT2 inhibitors in a patient with type 1 diabetes. Such changes in glucose levels were captured using intermittent continuous glucose monitoring. Given the potential for similar cases during preoperative discontinuation of SGLT2 inhibitors, it is advisable to intensify bolus insulin administration, under continuous glucose monitoring, in patients discontinuing SGLT2 inhibitors before surgery.

Usefulness of Intermittent Intersticial Glucose Monitoring in Patients Admitted to The Intensive Care Unit of The Hospital Universitario San Cecilio in Granada

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

PO-04-155 LONG TERM POST-ABLATION ATRIAL FIBRILLATION MONITORING USING AUTOMATED SINGLE-LEAD ELECTROCARDIOGRAM ANALYSIS

Wearable and handheld consumer electrocardiogram devices may allow for noninvasive, frequent, and symptom driven monitoring after atrial fibrillation (AF) ablation. We sought to evaluate the performance of the KardiaMobile device and AliveCor algorithm in monitoring for arrythmia recurrence after AF ablation. Patients in a prospective randomized controlled trial of adjunctive therapy in AF ablation (NCT04625946) were provided with a KardiaMobile and asked to obtain symptomatic or at least weekly recordings before ablation and during 1 year of follow up. A total of 3174 recordings from 50 patients were obtained. The performance of the automated diagnosis was compared to the human interpretation which was considered the gold standard. A total of 772 tracings (24%) demonstrated AF occurring in 38/50 patients. The automated analysis had an overall sensitivity of 90.2% and specificity of 94.3% for the diagnosis of AF. The precision of the automated analysis had significant inter-patient variation (interquartile range 66.6-100%). In 3/12 patients without tracings of AF the automated analysis assigned a diagnosis of AF to one or more tracings. Inaccurate identifications of AF were most frequently adjudicated as sinus rhythm (47.7%), sinus rhythm with premature atrial contractions (23.5%), atrial flutter (8.8%), or uninterpretable (6.0%). A total of 58 tracings demonstrated atrial tachycardia or atrial flutter and were classified as ‘tachycardia’ (26%), AF (21%), or ‘unclassified’ (53%) by the automated analysis. The use of intermittent home electrocardiogram monitoring may facilitate the diagnosis of recurrent atrial arrythmias after AF ablation. Manual adjudication of the automated diagnosis or additional clinical event monitoring is likely required especially in patients with ectopy or postoperative atrial flutter.

Arrhythmias in Williams Syndrome

Williams syndrome (WS) is a congenital, multisystem disorder in which 80% of patients have cardiovascular abnormalities. Sudden cardiac death occurs 25 to 100 times more often in WS than in the general population, and cardiac repolarization is abnormal in WS. We sought to determine the prevalence of primary arrhythmias in patients with WS and whether QTc prolongation impacts arrhythmia risk. We retrospectively reviewed all patients with WS with ambulatory electrocardiogram (ECG) monitoring at our institution between October 2017 and January 2022. The primary outcome was the presence of arrhythmia. Predictors pre-determined for analysis included premature ventricular and atrial complex burden (%), degree of QTc change with varying heart rates, intervals and rhythm on 12-lead ECG, age, gender, symptomatology, and clinical and surgical history. A total of 74 patients (55% female, median age 8years (3, 13) underwent 108 ambulatory monitors. Arrhythmias were present in 9 patients (12%). Within this group of 9 patients, 18/24 serial monitors were abnormal, and 3/9 patients (33%) had >1 arrhythmia type. Older age (p=0.002) and symptoms (syncope, p=0.005) were associated with arrhythmias. Arrhythmia was not associated with the degree of structural heart disease. Atrial tachycardia was the most identified arrhythmia (n=6; 67% of patients with arrhythmias and 8% of the total cohort). The QTc abnormally increased with higher heart rates in all groups. There was a higher number of premature ventricular and atrial complexes per hour in patients with arrhythmias. In conclusion, atrial arrhythmias were the most common arrhythmia in patients with WS and routine ambulatory ECG and intermittent rhythm monitoring are indicated in WS, particularly given the high risk of sudden cardiac death in WS.

Reducing the Frequency of Pulse Oximetry Alarms at a Children's Hospital.

Alarm fatigue is exacerbated by frequent, nonactionable physiologic monitor alarms. Overutilization of pulse oximetry (SpO2) compounds this alarm burden. Narrow default alarm limits and overutilization of continuous (CSpO2) rather than intermittent monitoring contribute to nonactionable alarms. There were 1.12 million SpO2 alarms on included units during the baseline period, of which 41.0% were for SpO2 ≥ 88%. We aimed to decrease SpO2 alarms per patient day by 20% within 12 months. This quality improvement study included patients admitted January 2019 to June 2022. Intensive care and cardiology units were excluded. Interventions included (1) changing default alarm SpO2 limits on monitors from <90% to <88%, (2) changing SpO2 order default from continuous to intermittent, and (3) adding indication requirements for CSpO2. Outcome measures were total SpO2 alarms and alarms for SpO2 ≥ 88% per patient day. Balancing measures were high acuity transfers and code blues without CSpO2 ordered. Control charts were used for each. Our study included 120 408 patient days with 2.98 million SpO2 alarms. Total SpO2 alarms and alarms for SpO2 ≥ 88% per patient day decreased by 5.48 (30.57 to 25.09; 17.9%) and 4.48 (12.50 to 8.02; 35.8%), respectively. Special cause improvement was associated with changing default monitor alarm parameters. Balancing measures remained stable. SpO2 monitors alarm frequently at our children's hospital. Widening default alarm limits was associated with decreased SpO2 alarms, particularly nonactionable alarms (≥88%). This high-reliability intervention may be applied, when appropriate, to other monitor alarm parameters to further mitigate alarm burden.

Distributed bipartite consensus of linear multi‐agent systems based on periodic event‐triggered mechanism

AbstractThis article considers the bipartite event‐triggered consensus problem for linear multi‐agent systems based on periodic sampling data. The cooperative and antagonistic communications are considered at the same time. The bipartite time‐triggered consensus with maximum sampling period is first addressed. Then, the bipartite periodic event‐triggered control strategy with two event‐triggered mechanisms is designed. Compared with previous control schemes, the proposed control method can realize intermittent communication, intermittent controller update and intermittent triggering condition monitoring. Moreover, considering the constraint of limited data rate, a quantized consensus with both state and input quantization is taken into account. The Zeno behavior is completely avoided due to the fact that the sampling time can be taken as the lower bound of trigger interval. Finally, three illustrative examples are provided to demonstrate the effectiveness of the proposed methods.

Deep Learning for Laying Hen Activity Recognition Using Wearable Sensors

Laying hen activities in modern intensive housing systems can dramatically influence the policies needed for the optimal management of such systems. Intermittent monitoring of different behaviors during daytime cannot provide a good overview, since daily behaviors are not equally distributed over the day. This paper investigates the application of deep learning technology in the automatic recognition of laying hen behaviors equipped with body-worn inertial measurement unit (IMU) modules in poultry systems. Motivated by the human activity recognition literature, a sophisticated preprocessing method is tailored on the time-series data of IMU, transforming it into the form of so-called activity images to be recognized by the deep learning models. The diverse range of behaviors a laying hen can exhibit are categorized into three classes: low-, medium-, and high-intensity activities, and various recognition models are trained to recognize these behaviors in real-time. Several ablation studies are conducted to assess the efficacy and robustness of the developed models against variations and limitations common for an in situ practical implementation. Overall, the best trained model on the full-feature acquired data achieves a mean accuracy of almost 100%, where the whole process of inference by the model takes less than 30 milliseconds. The results suggest that the application of deep learning technology for activity recognition of individual hens has the potential to accurately aid successful management of modern poultry systems.

Heavy Metals, Profile of the Proposed Dump-Site at Ntak-Inyang Itam, Akwa Ibom State, Nigeria

Levels of trace metals (Cr, Cd, Mn, Fe, Cu, Co, Ni, V, Zn and Pb) in soil from Ntak-Inyang Itam, Itu Local Government Area were determined using standard analytical procedures involving the use of atomic absorption spectrophotometry. Results of the analysis shows that at the debt of 0-15cm at five locations distributed in the area, Cr at sample sites B and E had a mean value of 5.00± 0.55µg/kg which is lower when compared to sample sites A, C and D. Also Cr in the study area had a coefficient of variation (C.V) of 3.14% which signifies stability. Cd in the four sampling points (A, B, C and E) seems to maintain a constant mean value of 0.14± 0.01µg/g except for point D (Esuk in Ntak-Inyang) which has a mean concentration of 0.19± 0.02µg/g. Mn exhibited different mean value at different (five) sampling points and a C.V of 1.99% which was the least and the most stable in the area among the ten metals analysed. Fe exhibited the highest concentration in all the sampling points, with a C.V of 4.99%. The result of analysis of copper (Cu) shows a total mean concentration of 8.29± 0.67µg/g while Cobalt (Co) in the four sampling points had the same mean value of 0.11± 0.1µg/g except in sample point A (sloping area of AKRUBEL) which increases to a value of 0.22± 0.6µg/g. Nickel (Ni) in sampling point C and D exhibited the same mean value of 0.83± 0.9µg/g while other sampling points (A, B, D and E) the mean varies. Vanadium (V) in the samples were generally low, sample point A and D had a mean concentration of 0.10± 0.01µg/g. Sample point C, D and E had 0.05± 0.01µg/g each. Zinc (Zn) had a mean concentration of 2.72± 0.60µg/g and a C.V of 10.4% while Lead (Pb) stood at a C.V of 3.2%. The results were compared with various National and International standards, on the whole the area was not found to be polluted by these metals. Hence the area is suitable for sitting the dump-site, with intermittent monitoring.

Numerical and clinical precision in hypoglycemia of the intermittent FreeStyle Libre glucose monitoring through an NFC-Bluetooth transmitter associated with the xDrip+ algorithm in diabetic patients under insulin therapy

IntroductionThere are data capture devices that attach to the FreeStyle Libre sensor and convert its communication from NFC (Near-field communication) to Bluetooth technology, generating real-time continuous glucose monitoring. The accuracy of hypoglycemia measurements displayed by smartphone apps using this device has not been established. MethodsStudy of diagnostic tests. Numerical accuracy was evaluated, utilizing the absolute difference with respect to capillary glucometry (ISO 15197:2015 standard) and clinical accuracy, using the Clarke and Parkes (Consensus) error grids, for glucose measurements less than 70mg/dL performed with the FreeStyle Libre system and with the digital estimation xDrip+ app, in diabetic patients managed with insulin therapy. ResultsTwenty-seven patients were included (TIR 73.4%, TBR70 5.6%), who contributed 83 hypoglycemic events. Numerical accuracy was adequate in similar proportions with the FreeStyle Libre system compared to the xDrip+ app (81.92% vs. 68.67%, p=0.0630). The clinical accuracy evaluation showed that 92.8% of the measurements for xDrip+ and 98.8% for FreeStyle libre met the criteria according to the Parkes (Consensus) grid (p=0.0535); and 79.5% and 91.6% of the measurements met the criteria according to the Clarke grid (p=0.0273), being higher with FreeStyle libre. ConclusionsThe use of the NFC-Bluetooth transmitter (Miao-Miao) associated with the xDrip+ app does not improve numerical or clinical accuracy for detecting hypoglycemic events in diabetic patients managed with insulin therapy, compared to the FreeStyle Libre device.

Continuous and Intermittent Glucose Monitoring in 2022.

Continuous and Intermittent Glucose Monitoring in 2022.

Intermittent versus continuous control of tracheal cuff pressure in patients undergoing mechanical ventilation: Asystematic review and meta-analysis.

To evaluate the effects and safety of intermittent versus continuous control of cuff pressure in patients with mechanical ventilation. Tracheal cuff pressure management is vital to the prognosis of patients with mechanical ventilation. A meta-analysis. This meta-analysis was conducted and reported according to the PRISMA checklist. We searched Pubmed, Embase, The Cochrane Library, BMJ Best Practice, Web of Science, ProQuest Dissertations, as well as the Chinese Biomedical Literature Database, Wanfang, and China national knowledge infrastructure databases up to 5 August 2022 for randomised controlled trials (RCTs) on the intermittent versus continuous control of cuff pressure. Review Manager 5.3 software was used for relevant data analysis. A total of 18 RCTs involving 1998 patients with mechanical ventilation were included. The synthesised outcomes indicated that continuous control of cuff pressure is beneficial to reduce the incidence of ventilator-associated pneumonia (VAP) [RR=0.41, 95%CI (0.35, 0.49)], aspiration [RR=0.36, 95%CI (0.21, 0.63)], duration of mechanical ventilation [MD=-3.23, 95%CI (-4.66, -1.79)], length of ICU stay [MD=-4.12, 95%CI (-5.40, -2.83)], and increase the volume of subglottic drainage [MD=18.54, 95%CI (16.50, 20.58)]. There was no significant difference in the mortality between two groups [RR=1.01, 95%CI (0.84, 1.21)]. Egger regression analyses showed that there were no obvious publication biases in the synthesised results (all p > .05). Existing evidence shows that compared with intermittent monitoring of cuff pressure, continuous monitoring of cuff pressure can reduce the occurrence of aspiration and VAP, shorten the patient's duration of mechanical ventilation and length of ICU stay. Continuous monitoring of cuff pressure is more beneficial and should be promoted in clinical nursing care of patients undergoing mechanical ventilation.

Fault Prediction for Electromechanical Equipment Based on Spatial-Temporal Graph Information

Fault prediction of electromechanical equipment can greatly reduce its maintenance cost and prevent catastrophic damage. In order to realize the accurate fault prediction of electromechanical equipment, a fault prediction method based on spatial-temporal graph information is proposed in this article. In the proposed method, the signal data of each intermittent monitoring period are expressed by Markov field graph information, and the spatial-temporal correlation features of graph information are extracted and studied by multivariate spatial-temporal graph neural networks. The effectiveness of Markov graph information for different state expressions is demonstrated by motor fault data from the motor fault experimental platform, and the bearing fault prognostics data is used to demonstrate the feasibility and accuracy of the proposed fault prediction method. The results show that based on the local spatial state information and global time correlation information of monitoring signals, this method could accomplish accurate long-term and short-term fault prediction tasks, respectively.

Importance of Intermittent Cardiotocographic Monitoring Prior to Misoprostol-Assisted Induction of Labour

Aim: To determine the importance of intermittent cardiotocographic monitoring during misoprostol-assisted induction of labour in pregnancies lasting weeks or more. Methods: This descriptive study was carried out in the Obstetrics and Gynecology department of Combined Military Hospital, Kharian Cantt for the duration from January 2022 to August 2022 among 130 primigravida patients underwent CTG before receiving transvaginal dose of misoprostol. Neonatal admissions, the mode of delivery, the Apgar score, and indications of induction were the variables examined. Results: Forty-two (70%) of the C-section patients had reassuring CTG and significantly low Apgar scores at 1 minute. Seven (8.5%) of the patients with thick meconium had non-reassuring CTG. Twelve neonates (9.2%) in total required resuscitation, 9 (75%) of whom had reassuring CTGs while 3(25%) had non-reassuring CTGs. The overall admission rate in NICU was 10%, and 38.5% of neonates that required resuscitation had non-reassuring CTG. Neonatal mortality was nil during the study time. Conclusions: Patients who had their labour induced with misoprostol had non-reassuring CTG among 50% of cases and had thick meconium stained liquor. Therefore, we can lower neonatal morbidity and mortality by early foetal impairment detection. Neonatal mortality was nil during the study time. Keywords: cardiotocography, induction, resuscitation, Apgar score and caesarean section

Detecting Patient Deterioration Early Using Continuous Heart rate and Respiratory rate Measurements in Hospitalized COVID-19 Patients

BackgroundPresenting symptoms of COVID-19 patients are unusual compared with many other illnesses. Blood pressure, heart rate, and respiratory rate may stay within acceptable ranges as the disease progresses. Consequently, intermittent monitoring does not detect deterioration as it is happening. We investigated whether continuously monitoring heart rate and respiratory rate enables earlier detection of deterioration compared with intermittent monitoring, or introduces any risks.MethodsWhen available, patients admitted to a COVID-19 ward received a wireless wearable sensor which continuously measured heart rate and respiratory rate. Two intensive care unit (ICU) physicians independently assessed sensor data, indicating when an intervention might be necessary (alarms). A third ICU physician independently extracted clinical events from the electronic medical record (EMR events). The primary outcome was the number of true alarms. Secondary outcomes included the time difference between true alarms and EMR events, interrater agreement for the alarms, and severity of EMR events that were not detected.ResultsIn clinical practice, 48 (EMR) events occurred. None of the 4 ICU admissions were detected with the sensor. Of the 62 sensor events, 13 were true alarms (also EMR events). Of these, two were related to rapid response team calls. The true alarms were detected 39 min (SD = 113) before EMR events, on average. Interrater agreement was 10%. Severity of the 38 non-detected events was similar to the severity of 10 detected events.ConclusionContinuously monitoring heart rate and respiratory rate does not reliably detect deterioration in COVID-19 patients when assessed by ICU physicians.

A Practical Green Infrastructure Intervention to Mitigate Air Pollution in a UK School Playground

Air pollution severely compromises children’s health and development, causing physical and mental implications. We have explored the use of site-specific green infrastructure (green barriers) in a school playground in Sheffield, UK, as an air-pollution-mitigation measure to improve children’s environment. The study assessed air quality pre-post intervention and compared it with two control sites. Nitrogen dioxide (NO2) and particulate matter &lt;2.5 µm in size (PM2.5) concentration change was assessed via three methods: (1) continuous monitoring with fixed devices (de-seasonalised); (2) monthly monitoring with diffusion tubes (spatial analysis); (3) intermittent monitoring with a mobile device at children’s height (spatial analysis). De-seasonalised results indicate a reduction of 13% for NO2 and of 2% for PM2.5 in the school playground after two years of plant establishment. Further reductions in NO2 levels (25%) were observed during an exceptionally low mobility period (first COVID-19 lockdown); this is contrary to PM2.5 levels, which increased. Additionally, particles captured by a green barrier plant, Hedera helix ‘Woerner’, were observed and analysed using SEM/EDX techniques. Particle elemental analysis suggested natural and potential anthropogenic origins, potentially signalling vehicle traffic. Overall, green barriers are a valid complementary tool to improve school air quality, with quantifiable and significant air pollution changes even in our space-constrained site.

AI-Powered Respiratory and Circulatory Distress Monitoring System Alerts to Potential Complications Post-Discharge

The Pulse| January 2023 AI-Powered Respiratory and Circulatory Distress Monitoring System Alerts to Potential Complications Post-Discharge Catlin Nalley Catlin Nalley Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor January 2023, Vol. 87, 22. https://doi.org/10.1097/01.ASM.0000911760.87237.ab Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Catlin Nalley; AI-Powered Respiratory and Circulatory Distress Monitoring System Alerts to Potential Complications Post-Discharge. ASA Monitor 2023; 87:22 doi: https://doi.org/10.1097/01.ASM.0000911760.87237.ab Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: patients' rooms, vital signs, denmark, surgical procedures, operative After a major surgery, there is an approximately 30% risk for serious adverse events during the first 30 postoperative days, and postoperative complications are ranked as the third most likely cause of death worldwide. “These numbers are not due to complications occurring in the OR, PACU, or ICU, but mainly in the general ward, where nurses are responsible for high patient volumes and infrequent intermittent manual vital sign monitoring result in late detection of complications and failure to rescue,” said Eske Kvanner Aasvang, MD, DMSci, Professor and Chief Consultant, Department of Anesthesiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark. Despite decades of use, international standards for track-and-trigger systems, such as the National Early Warning Score (NEWS), have not been proven to have any effect on morbidity or mortality. Recognizing this, Dr. Aasvang and his colleague Christian S. Meyhoff, MD, PhD, Professor and Chief Consultant, Department of Anesthesia and Intensive Care, Copenhagen University... You do not currently have access to this content.

Use of Continuous Glucose Monitoring System in Children with Type 1 Diabetes Mellitus in a Resource Limited Setting.

Regular self-monitoring of blood glucose (SMBG) remains the mainstay method for diabetes monitoring. The major limitation of SMBG is poor compliance and it only provides a snapshot of glucose values at that point of time. Continuous glucose monitors (CGMs) are non-invasive devices which measure subcutaneous interstitial glucose for every five minutes and provide glucose variability throughout the day. To assess the effectiveness of intermittent continuous blood glucose monitoring in comparison with SMBG on the percentage reduction in HbA1c level in children with type 1 diabetes mellitus (DM). Children diagnosed with type 1 DM of age group 3-18 years were enlisted into the study. Participants were randomised to the study arm (CGMs+SMBG) or the control arm (SMBG alone). Subjects in the study group were given CGM along with regular SMBG for 14 days. The control group was asked to perform SMBG. HbA1c levels were measured in both groups after three months of intervention. There were 62 children in each group. After three months, in the intervention group HbA1c level dropped from 11.23% ± 1.53% (Mean ± SD) to 10.14% ± 1.99%, in control group HbA1c level dropped from 11.62% ± 1.62% to 11.32% ± 1.57%. The fall in HbA1c level in intervention group is significant (p value -0.01). In a resource-limited setting, intermittent use of CGMs atleast once every two to three months will help in understanding the factors influencing glucose variation throughout the day and, with appropriate therapeutic modifications, will aid in achieving optimal glycaemic control.

Comparison of hemodynamic stability with continuous noninvasive blood pressure monitoring and intermittent oscillometric blood pressure monitoring in hospitalized patients: A systematic review and meta-analysis

Comparison of hemodynamic stability with continuous noninvasive blood pressure monitoring and intermittent oscillometric blood pressure monitoring in hospitalized patients: A systematic review and meta-analysis

Effects of Intraoperative Nerve Monitoring Techniques on Voice and Swallowing Disorders after Uncomplicated Thyroidectomy: Preliminary Report of a Bi-Institutional Prospective Study.

Background: Voice and swallowing problems are frequently associated with thyroidectomy. Intermittent nerve monitoring (i-IONM) seems to provide a positive effect in reducing its prevalence. The aim of this study was to test the hypothesis that continuous intraoperative nerve monitoring (c-IONM) may reduce the prevalence of these disorders even further than i-IONM. Methods: This 3-arm prospective bi-institutional study compared 179 consecutive patients that underwent thyroidectomy: 56 without IONM, 55 with i-IONM and 67 with c-IONM. Neck dissections and laryngeal nerve palsies were excluded. Two questionnaires (VHI-10 for voice disorders and EAT-10 for swallowing disorders; both validated for Italian language use) were administered before and 1 month after surgery. Statistical significance was analyzed by the chi-squared test. Results: After thyroidectomy, no statistically significant differences were found in the three groups concerning EAT-10. although these symptoms seemed to be influenced by gastro-esophageal reflux. VHI-10 worsened in the “no-IONM” group compared with both i-IONM (p < 0.09, not quite statistically significant) and c-IONM (p < 0.04). Conclusion: Both i- and c-IONM improve voice quality independently of laryngeal nerve integrity. Reduced dissection and particularly restrained manipulation could explain these results, being particularly favorable for c-IONM.

Changes in Pharmacokinetics and Pharmacodynamics of Losartan in Experimental Diseased Rats Treated with Curcuma longa and Lepidium sativum.

The current study investigated "pharmacodynamics and pharmacokinetics interactions" of losartan with Curcuma longa (CUR) and Lepidium sativum (LS) in hypertensive rats. Hypertension was induced by oral administration of L-NAME (40 mg/kg) for two weeks. Oral administration of CUR or LS shows some substantial antihypertensive activity. The systolic blood pressure (SBP) of hypertensive rats was decreased by 7.04% and 8.78% 12 h after treatment with CUR and LS, respectively, as compared to rats treated with L-NAME alone. LS and CUR display the ability to potentiate the blood pressure-lowering effects of losartan in hypertensive rats. A greater decrease in SBP, by 11.66% and 13.74%, was observed in hypertensive rats treated with CUR + losartan and LS + losartan, respectively. Further, both the investigated herbs, CUR and LS, caused an increase in plasma concentrations of losartan in hypertensive rats. The AUC0-t, AUC0-inf and AUMC0-inf of losartan were increased by 1.25-fold, 1.28-fold and 1.09-fold in hypertensive rats treated with CUR + losartan. A significant (p &lt; 0.05) increase in AUC0-t (2.41-fold), AUC0-inf (3.86-fold) and AUMC0-inf (8.35-fold) of losartan was observed in hypertensive rats treated with LS + losartan. The present study affirms that interactions between CUR or LS with losartan alter both "pharmacokinetics and pharmacodynamics" of the drug. Concurrent administration of losartan with either CUR or LS would require dose adjustment and intermittent blood pressure monitoring for clinical use in hypertensive patients. Additional investigation is necessary to determine the importance of these interactions in humans and to elucidate the mechanisms of action behind these interactions.