Significant Increase In Heart Rate Research Articles

Tradition to Concern: Health Risks and Nicotine Dependence of Midwakh Use in Young Males in the UAE

Abstract Background Midwakh smoking, a traditional practice, poses a growing public health concern in the Middle East region. Despite global efforts to curb tobacco use, smoking rates, particularly among young men, remain high. This study explores nicotine dependency, assesses acute health effects, and measures carbon monoxide levels among midwakh smokers. Methods A quasi-experimental before-and-after study involved 103 young male midwakh smokers in the UAE. Data collection included surveys featuring the Hooked-on Nicotine checklist (HONC), clinical measurements, and pre/post-smoking saliva samples. Statistical analyses, including descriptive, paired samples, correlation, and regression, assessed associations between midwakh smoking, dependency, and health outcomes. Results Preliminary findings found that 33% of midwakh smokers were under 21 years, 68% had below undergrad education, and household incomes over 15,000 AED monthly. Smoking initiation was as early as 10 years. Smoking habits revealed 37% exclusive midwakh, 54% midwakh with e-cigarettes, 21% with shisha, and 34% with cigarettes. Post-smoking clinical measurements showed significant increases in blood pressure, heart, pulse and respiratory rates, and carbon monoxide levels (p ≤ 0.05). Significant differences in pre- (134.6 ng/ml) and post-smoking (154.4 ng/ml) saliva cotinine levels (p ≤ 0.05) were observed. Regression analysis identified predictors of nicotine dependency: initiation age (β= -.315; -0.579,0.0512), household income (β = 1.221; 0.297,2.146), multiple tobacco use (β = 0.576; 0.129,1.024), quit attempts (β = 1.555; 0.519,2.590) and smoking risk perception (β = 3.420; 1.950,4.890) Conclusions Midwakh smoking adversely affects clinical measurements, with early start correlating with higher nicotine dependency, worsened by using multiple tobacco products. Urgent action is needed, including tailored prevention campaigns and support systems to aid youth cessation and raise awareness of midwakh smoking’s harmful effects. Key messages • Midwakh smoking is deeply ingrained in UAE tradition but poses significant adverse health outcomes and nicotine dependency. • There is a need to establish specialized cessation programs offering support and resources to midwakh users, addressing both the health consequences and addictive nature of midwakh.

Comparing cadence-based energy expenditure and oxygen cost indices in able-bodied male people.

Walking is a fundamental aspect of daily life and exercise, with clinical benefits for cardiovascular health and muscle strength. However, accurately measuring energy efficiency during walking poses challenges due to equipment and spatial constraints. In this study, we proposed the cadence-based energy expenditure index (cEEI) and analyzed its correlation with the previously proposed index for measuring energy expenditure under various gait conditions. We enrolled 15 healthy participants and conducted an experimental protocol on a treadmill to measure the following energy expenditure-related indices: oxygen cost index (OCI), energy expenditure index (EEI), and cEEI. The participants underwent stages of walking at different speeds and inclinations that comply with the modified Bruce protocol while their heart rate, oxygen uptake, and cadence were recorded. Participants showed significant increases in heart rate, oxygen uptake, and cadence with higher walking speeds and inclinations. Correlation analysis revealed strong associations between cEEI and OCI, especially during walking conditions. Bland-Altman plots and interclass correlation coefficient analysis demonstrated a favorable agreement between cEEI and OCI, outperforming EEI. In conclusion, this study proposes cEEI as a reliable metric for estimating energy expenditure during walking by proving a strong correlation and agreement with OCI across various gait conditions. This suggests the potential for cEEI to provide real-time, individualized feedback on energy expenditure during walking, facilitating more personalized exercise prescriptions.

Surgeon experience affects perioperative pain in cats undergoing elective ovariohysterectomy: a randomized clinical trial.

This study aimed to compare the outcomes between surgeries performed by either experienced or inexperienced surgeons by assessing intraoperative nociception and perioperative analgesia. 16 healthy, client-owned female cats were randomly allocated into 2 groups of 8: one undergoing surgery by an experienced surgeon (GES group) and the other by inexperienced surgeons (GIS group). Both groups received IM premedication with acepromazine (0.05 mg/kg) and methadone (0.3 mg/kg). After 20 minutes, venipuncture and induction with propofol (dose-response, IV) were performed. Maintenance was achieved with inhaled isoflurane. Intraoperative vital parameters were monitored, and fentanyl (2.5 µg/kg, IV) was administered as rescue analgesia when needed. Postoperatively, pain was assessed with a visual analog scale and the multidimensional pain scale of the Universidade Estadual Paulista in Botucatu; morphine (0.2 mg/kg, IM) was used for rescue analgesia, as necessary. In the GIS group, significant increases in heart rate and systolic blood pressure were noted during surgery, especially during pedicle clamping. Respiratory rate and end-tidal isoflurane levels were higher in the GIS group at specific surgical stages. Survival analysis indicated that the GIS group had a greater need for fentanyl. Postoperative pain scores were generally low, but a higher proportion of GIS cats required rescue analgesia. Surgeon experience influences intraoperative parameters and fentanyl consumption. Inexperienced surgeons contribute to increased postoperative pain and poorer wound healing outcomes in cats undergoing elective ovariohysterectomy. Ovariohysterectomy is a common procedure in veterinary practice, and surgical expertise significantly impacts pain management and recovery. Yet, its effects have been underexplored, potentially compromising animal welfare.

Evaluation of preoperative intraperitoneal injection of bupivacaine for intraoperative antinociception in cats undergoing ovariohysterectomy: A randomized clinical trial

ObjectiveTo determine if preoperative intraperitoneal bupivacaine can minimize intra- and postoperative nociception/pain in cats undergoing ovariohysterectomy. Study designProspective, randomized, investigator-blinded, placebo-controlled clinical trial. AnimalsForty-seven, intact female cats. MethodsCats were anesthetized using a standard protocol and randomized to receive ultrasound-guided intraperitoneal 0.9 % saline (US-S) or 0.25 % bupivacaine (US-IPLA) before ovariohysterectomy. On recovery, US-S cats received 2 mg/kg robenacoxib subcutaneously and US-IPLA cats received equivalent volume of 0.9 % saline subcutaneously. Intraoperative outcome variables included heart rate (HR), respiratory rate (fR), systolic arterial pressure (SAP), and vaporizer setting associated with relevant surgical events characterized by manipulation of each ovarian pedicle (OP1, OP2) and the uterine body (UB). The postoperative outcome variable was need for rescue analgesia, determined using the Glasgow Composite Measure Pain Scale during 6 h after tracheal extubation. Intraoperative data were analyzed using two-way ANOVA and Šidák's multiple comparisons test. The probability of postoperative rescue analgesia was analyzed using the Gehan–Breslow–Wilcoxon test. Significance was p < 0.05. ResultsCompared to baseline, all surgical events caused significant increases in HR and SAP in both groups, fR increased in US-IPLA but not in US-S, vaporizer settings remained unchanged during OP1, OP2 and UB in group US-IPLA, and were significantly higher only during OP1 in group US-S. There were no significant between-group differences in intraoperative variables and postoperative need for rescue analgesia. Conclusions and clinical relevancePreoperative intraperitoneal bupivacaine had minimal effects on intraoperative indicators of nociception. The need for rescue analgesia was not significantly different between groups.

Distance-dependent neuromodulation effect during thermal ablation for atrial fibrillation.

Thermal atrial fibrillation (AF) ablation exerts an additive treatment effect on the cardiac autonomic nervous system (CANS). This effect is mainly reported during ablation of the right superior pulmonary vein (RSPV), modulating the right anterior ganglionated plexus (RAGP), which contains parasympathetic innervation to the sinoatrial node in the epicardial fat pad between RSPV and superior vena cava (SVC). However, a variable response to neuromodulation after ablation is observed, with little to no effect in some patients. Our objective was to assess clinical and anatomic predictors of thermal ablation-induced CANS changes, as assessed via variations in heart rate (HR) postablation. Consecutive paroxysmal AF patients undergoing first-time PV isolation by the cryoballoon (CB) or radiofrequency balloon (RFB) within a 12-month time frame and with preprocedural cardiac computed tomography (CT), were evaluated. Preablation and 24-h postablation electrocardiograms in sinus rhythm were collected and analyzed to assess HR. Anatomic evaluation by CT included the measurement of the shortest distance between the SVC and RSPV ostium (RSPV-SVC distance). A total of 97 patients (CB, n = 50 vs. RFB, n = 47) were included, with similar baseline characteristics between both groups. A significant HR increase postablation (ΔHR ≥ 15 bpm) occurred in a total of 37 patients (38.1%), without difference in number of patients between both thermal ablation technologies (CB, 19 [51%]), RFB, 18 [49%]). Independent predictors for increased HR were RSPV-SVC distance (odds ratio [OR]: 0.49, CI: 0.34-0.71, p value < .001), and age (OR: 0.94, CI: 0.89-0.98, p value = .003). Thermal balloon-based PV isolation influences the CANS through its effect on the RAGP, especially in younger patients and patients with shorter RSPV-SVC distance.

Exploring the Relationship Between Examination-Induced Anxiety and Cardiovascular Responses Among PT Students

This study explores the relationship between examination-induced anxiety and cardiovascular responses among physical therapy (PT) students. A quasi-experimental repeated measures design was utilized to examine heart rate (HR), blood pressure (BP), and heart rate variability (HRV) at three stages: before, during, and after high-stakes Objective Structured Clinical Examinations (OSCEs). A total of 120 PT students (60 male, 60 female) were recruited using purposive sampling, with data collection extended over two academic years to ensure balanced gender representation. Anxiety was measured using the State-Trait Anxiety Inventory (STAI), while cardiovascular responses were continuously monitored using wearable devices. Results revealed significant increases in HR and BP, alongside decreases in HRV during the examination, reflecting heightened autonomic stress. Post-exam, cardiovascular markers demonstrated partial recovery but remained elevated compared to pre-exam levels, indicating lingering physiological effects of anxiety. Qualitative data from student interviews revealed cognitive impairments and lingering anxiety post-exam, corroborating the physiological findings. Repeated measures ANOVA indicated significant changes in cardiovascular responses over time, with no significant interaction effects for gender. These findings underscore the impact of examination-induced anxiety on both physiological and psychological outcomes in PT students. The persistent elevation in cardiovascular markers post-exam suggests that students may not fully recover from stress immediately, highlighting the need for targeted interventions, such as mindfulness or biofeedback, to help manage anxiety. Addressing examination stress could enhance both student well-being and academic performance, mitigating the long-term risks associated with chronic stress.

Abstract P212: Microinjection of the novel angiotensin, alamandine-(1-5) into insular cortex, increase blood pressure

It is well known that the renin-angiotensin system plays a critical role in cardiovascular control and hydro-electrolyte homeostasis. At least in some circumstances Alamandine (Ala) and Angiotensin-(1-7) can have selective actions such as reported in the insular córtex (IC). Hydrolysis of Angiotensin-(1-7) by angiotensin converting enzyme (ACE) can form the heptapeptide Angiotensin-(1-5) and recently our group demonstrated that hydrolysis of Ala by ACE can form Ala-(1-5). In this study we aimed to evaluate the cardiovascular effects produced by microinjection of Ala-(1-5) and Angiotensin-(1-5) into the rostral region of the posterior IC. Urethane (1.4g/kg) anesthetized rats were instrumented for measurement of mean arterial pressure (MAP), heart rate (HR) and renal sympathetic nerve activity (RSNA). Unilateral microinjection of vehicle (0,9% NaCl, 100nL, n=4), Ala (40pmol/100nl, n=7), Ala-(1-5) (400pmol/100nl, n=7) or Angiotensin-(1-5) (400pmol/100nl, n=5) were made into IC (+1.5mm rostral to the bregma). At the baseline, there was no difference between the groups (Vehicle: 85±2 mmHg and 388±5bpm, Ala: 83±9mmHg and 389±10bpm, Ala-(1–5): 91±6mmHg and 386±7bpm or Ang-(1-5): 96±9mmHg and 375±6bpm). Vehicle microinjection was performed as a control for nonspecific effects (ΔMAP:2±1mmHg, ΔHR:4±2bpm, ΔRSNA:3±1%). Ala microinjection into IC, confirmed our previous data showing a long-lasting (18±3min) increase in MAP (Δ=14±2mmHg), and this effect was associated with a significant increase in HR (Δ=32±4bpm) and in RSNA (Δ=36±6%). These responses were elicited immediately after Ala microinjection. When compared with vehicle and, very different from what was observed with Ala, microinjection of Ala-(1–5) evoked a significant increase in blood pressure without altering RSNA or HR (ΔMAP:22±2mmHg, ΔHR:-1±3bpm, ΔRSNA:1±3%). Differently from Ala evoked responses, the effects of Ala-(1–5) had a shorter duration (5.88±1.9min) without delay to beginning the effects. On other hand, microinjection of Angiotensin-(1-5) did not elicited autonomic and cardiovascular effects (ΔMAP:-1±3mmHg, ΔHR:-2±2bpm, ΔRSNA:2±3%). In conclusion, these data showed that the IC is a brain site that has unique effects of Ala (increase in MAP, HR and RSNA) and Ala-(1-5) (increase in MAP only) contrasting with the essentially absent effects of Angiotensin-(1-7) and Angiotensin-(1-5). These findings will contribute to extend our understanding of the brain renin-angiotensin system.

TDAH : quels sont les effets cardiovasculaires du méthylphénidate et quelles sont les conséquences éventuelles pour la pratique clinique ?

ContextMethylphenidate is the first-line pharmacological treatment for ADHD, and its prevalence continues to grow, with an increase of 116% over the last ten years in France. Its use in hospitals has been extended to neurologists, psychiatrists and pediatricians, and its prescription can be renewed by a general practitioner. Cardiovascular complications are rare, but life-threatening. Management practices currently vary widely from one medical center or doctor to another. ObjectivesReviewing the cardiovascular effects of methylphenidate in adults and children with ADHD, aiming to propose a practical management plan without intending to replace existing recommendations. MethodsThe subject under study aimed to answer the following PICO question “What are the cardiovascular consequences (outcomes) when using MPH (intervention) for an ADHD population (population) regardless of age”. We carried out systematic review of international reviews and meta-analyses, selected using the PRISMA methodology via the PubMed, Cochrane Library and Google Scholar databases. Their methodological quality was assessed using the AMSTAR-2 scale. Cardiovascular events considered were the adrenergic effects of MPH on the cardiovascular system, looking for changes in blood pressure and heart rate, and the serious cardiovascular effects represented by sudden death/arrhythmia, myocardial infarction and stroke. A total of 17 systematic reviews and meta-analyses met the eligibility criteria. ResultsOf the 734 articles found, twelve were finally selected. Four concerned a population of children, five a mixed population of adults and children and three a population of adults only. They included two systematic reviews and ten meta-analyses. Three reviews included cohort studies and nine included randomized controlled trials. Three clinical situations can be distinguished depending on the age of the patient and the length of exposure to methylphenidate. The first, on initiation of treatment, there was a marked by a short-term increase in blood pressure and heart rate. The second involves a patient under the age of 35 with short- to medium-term exposure to MPH. A persistent adrenergic effect tends to increase the risk of sudden death by 12% (if the resting heart rate increases by ten beats per minute). This risk is further increased if the patient has psychiatric comorbidities and their associated treatments, congenital heart disease and uses recreational substances. Finally, the last situation involves a patient exposed to MPH for several years and aged over 35, whose main risk is the onset of atheromatous disease with myocardial infarction and ventricular arrhythmia. In this case, a comprehensive approach is required, identifying risk factors and behavioral factors likely to exacerbate the risk of CV disease. ConclusionsThe short-term cardiovascular effects of MPH are well documented and statistically significant, with a moderate but significant increase in blood pressure (+2mmHg) and heart rate (+5bpm). Longer-term cardiovascular safety data are often lacking, leading to conflicting conclusions. Meta-analyses of cohort studies conclude that there is an increase in cardiovascular risk, while meta-analyses of randomized trials find no significant statistical association. This means that patients and their families need to be made aware of this lack of data. Personalized management based on age, duration of exposure to MPH and the clinical profile of patients as defined by cohort studies seems to us to be the most appropriate approach. In people under 35, the main risk is sudden death. In this population, it is important to identify any congenital heart disease and to look for psychiatric comorbidities, and by assessing the substance abuse. For people over 35, the main risk is coronary heart disease. In this case, a comprehensive approach is required, identifying risk factors and behavioral factors likely to exacerbate the risk of CV disease. Our daily practice is more in line with cohort studies including patients with co-morbidities associated with their ADHD, as well as a significant risk of having risky behaviors, depressive episodes, heart disease and prolonged exposure to MPH and other drugs. Prescribing MPH in this context is tricky, with a higher risk of cardiovascular events. Close clinical monitoring is therefore necessary, and specialist advice may be required.

Long-lasting effects of post-traumatic stress disorder in Yazidi women living in Northern Iraqi camps

The severity of post-traumatic stress disorder and its long-lasting effects among the Yazidi population has not yet been investigated. ObjectivesThis study evaluated the impact of PTSD severity and chronicity on physiological and anthropometric parameters in women survivors of the genocide-related events after the so-called Islamic State of Iraq and Syria (ISIS) attack in 2014. MethodsThe diagnosis PTSD was assessed using PTSD Checklist for DSM-5 (PCL-5). Participants were divided into: External control (healthy individuals living outside the camps), Internal control (healthy individuals living in the camps), and PTSD group (individuals diagnosed with PTSD). The PTSD group was subdivided according to chronicity <2 years, 2–5 years, and >5 years and subdivided according to PTSD severity into “Moderate”, “Severe” and “Extreme”. Systolic blood pressure (SBP), diastolic blood pressure (DBP), blood oxygen saturation (SPO2) and heart rate (HR) were evaluated. Weight, height and waist circumference were measured. Body mass index (BMI) and waist-to-height ratio (WHtR) were calculated. ResultsThe PTSD group showed significant increases in SBP, DBP, heart rate, BMI, WC, weight, and WHtR compared to the control groups. SPO2 values decreased in the PTSD group. As the disease progressed, there were further increases in SBP, DBP, heart rate, BMI, WC, WHtR, and weight. Similar increases were observed with the severity of the disease. ConclusionOur data indicates that a long-term impact on physiological and anthropometric parameters is present in women diagnosed with PTSD which might be aggravated by the severity and chronicity of the disease.

Stressful Effects of Individual and Combined Exposure to Low-Concentration Polylactic Acid Microplastics and Chromium on Marine Medaka Larvae (Oryzias melastigma).

Microplastics and heavy metal pollution frequently co-occur in the marine environment, raising concerns about their potentially harmful impacts on marine fish. This study undertook a comprehensive evaluation of the individual and combined stress effects of polylactide microplastics (PLA-MPs) and chromium (Cr) on marine medaka larvae. Following a 14-day exposure to PLA-MPs (100 μg/L) and Cr (50 μg/L), both individually and in combination, significant increases in heart rate and body length were observed. Notably, the combined exposure to PLA-MPs and Cr caused marked histopathological alterations, including shedding, atrophy, and lysis of the intestinal tissues. Furthermore, both individual and combined exposure induced oxidative stress in fish larvae, leading to changes in various enzyme activity indices. Individual exposure to either PLA-MPs or Cr led to anxious behavior in the larvae, whereas combined exposure not only caused anxious behavior but also altered swimming patterns. These findings suggest that combined exposure to PLA-MPs and Cr can exacerbate the toxic effects on marine medaka larvae.

A pilot study of the proarrhythmic effects of pimobendan injection in clinically healthy cats.

Pimobendan is not currently approved for use in cats, although its usefulness in feline hypertrophic cardiomyopathy has been suggested. Reports indicate an increase in arrhythmic events following oral administration to healthy cats. Given the greater potency of intravenous administration compared to oral intake, it is conceivable that the incidence of arrhythmias may be increased following pimobendan injection. Therefore, this study aimed to investigate the proarrhythmic effects of pimobendan injection in cats. Five clinically healthy cats underwent physical examination, echocardiography, blood pressure measurements, and 24-hour Holter electrocardiography immediately before and after receiving pimobendan as an intravenous bolus dose of 0.15mg/kg twice daily for 3 days. Additionally, a 24-hour Holter electrocardiography recording was conducted on the third day of pimobendan or placebo IV administration to assess heart rate, arrhythmias, and heart rate variability. Following pimobendan administration, there was a significant increase in total 24-hour heart rate. Echocardiography revealed a significant increase in mitral valve annulus systolic velocity (S') on the ventricular septal wall side, indicative of enhanced contractility. Only one cat exhibited paroxysmal ventricular tachycardia and an increase in the frequency of arrhythmic events. Conversely, in the remaining cats, a decreasing trend in the number of arrhythmias was observed. These findings indicate that intravenous administration of pimobendan may not be implicated in the onset of arrhythmias. Nevertheless, further research is warranted to explore the effects of intravenous pimobendan administration in cats with myocardial disease.

Abstract Tu033: CXCL5: The Next Guardian of the Galaxy to challenge Atherosclerosis

Atherosclerosis is a persistent inflammatory disease characterized by the buildup of lipid-laden macrophages (foam cells) in arterial walls and has been linked to several cardiovascular ailments. Despite advances in understanding its pathogenesis, the underlying mechanisms of atherogenesis, particularly regarding chemokine influence, has yet to be investigated. Our laboratory has previously identified CXCL5, a chemokine known for its involvement in inflammatory responses, as a potential mediator of atherosclerosis. We found that patients with elevated CXCL5 levels were less likely to have experienced a previous heart attack or develop coronary artery disease, suggesting that CXCL5 may be atheroprotective. To further investigate the role of CXCL5 in atherosclerosis, we conducted a study using mice on an apolipoprotein E (apoE) knockout background, to promote the formation of plaque, with varying alleles (0, 1, or 2) of CXCL5. Mice were placed on a high-fat diet regimen starting at approximately 10 weeks of age and continued until 26 weeks of age. Aortas, echocardiograms, and blood plasma were obtained to assess the development of atherosclerosis and its impact on cardiac function and metabolic parameters. Our en face oil red o staining results showed that the aortas of mice lacking one (p=.0314) or both alleles (p=.0783) of CXCL5 exhibited elevated plaque formation compared to that of wild-type mice. Echocardiographic data revealed that left ventricular mass (corrected) was highest in CXCL5 knockout mice and increased significantly over time (p=.0170) in these animals. Additionally, a significant increase in heart rate (p=.0095) and glucose (p=.0274) levels was only observed in CXCL5 heterozygous mice over the 16-week period, while triglyceride levels increased in both CXCL5 heterozygous (p=.0010) and knockout (p=.0241) mice. Interestingly, high-density lipoprotein (HDL) levels, which is often considered as "good cholesterol," increased significantly only in wild-type (p=.0031) mice, where CXCL5 was present, over the 16-week period. These findings suggest that CXCL5 may play a protective role against atherosclerosis and its associated cardiac complications. In conclusion, our study provides novel insights into the complex interplay between inflammation, lipid metabolism, and cardiovascular disease, highlighting the potential therapeutic value of CXCL5 in the prevention and treatment of atherosclerosis.

Behind conventional (micro)plastics: An ecotoxicological characterization of aqueous suspensions from End-of-Life Tire particles

Million tons of tires become waste every year, and the so-called End-of-Life Tires (ELTs) are ground into powder (ELT-dp; size < 0.8 mm) and granules (ELT-dg; 0.8 < size < 2.5 mm) for recycling. The aim of this study was to evaluate the sub-lethal effects of three different concentrations (0.1, 1, and 10 mg/L) of aqueous suspensions from ELT-dp and ELT-dg on Danio rerio (zebrafish) larvae exposed from 0 to 120 h post-fertilization (hpf). Chronic effects were assessed through biomarkers, real-time PCR, and proteomics. We observed a significant increase in swimming behavior and heart rate only in specimens exposed to ELT-dp suspensions at 1 and 10 mg/L, respectively. Conversely, the activities of detoxifying enzymes ethoxyresorufin-O-deethylase (EROD) and glutathione-S-transferase (GST) showed significant modulation only in specimens exposed to ELT-dg groups. Although no effects were observed through real-time PCR, proteomics highlighted alterations induced by the three ELT-dp concentrations in over 100 proteins involved in metabolic pathways of aromatic and nitrogen compounds. The results obtained suggest that the toxic mechanism of action (MoA) of ELT suspensions is mainly associated with the induction of effects by released chemicals in water, with a higher toxicity of ELT-dp compared to ELT-dg.

Propofol administration for induction is associated with peri-intubation instability in trauma critical care unit patients

IntroductionPeri-intubation hypotension is associated with increased hospital length of stay and morbidity. Propofol is associated with alterations in hemodynamics. We hypothesize that using propofol for induction leads to peri-intubation hypotension in trauma critical care patients. MethodsPatients that underwent unplanned intubation in the trauma intensive care unit (TICU) were prospectively enrolled. Peri-intubation vitals and medications were recorded to assess hypotension within 10 ​min of intubation. Patients were divided into propofol (PROP) or other medication (OTR) groups. ResultsData was complete for 69 patients; 31 PROP and 38 OTR. In OTR there was an 8.8-point (−21.1, 3.6) SBP decrease (p ​= ​0.159) and in PROP there was a 30.8-point (−45.6, −16.0) SBP decrease (p ​= ​0.0002) with significant increases in heart rate (HR) and shock index (SI) (HR p ​= ​0.001, SI p ​< ​0.0001). ConclusionIn patients without hypotension prior to intubation, we observed a statistically significant drop in the patients’ SBP with use of propofol. In trauma critical care unit patients, we recommend considering an induction medication for unplanned intubation other than propofol.

ВЛИЯНИЕ ПРОЦЕССА ЖЕВАНИЯ НА РЕСПИРАТОРНУЮ СИНУСОВУЮ АРИТМИЮ

Respiratory sinus arrhythmia (RSA) is a clockwise fluctuation in heart rate at the frequency of the respiratory cycle. RSA is an important homeostatic mechanism, the parameters of which change under various conditions - from stress to physical exercise. However, the direct effect of chewing, the most common form of muscle activity, on RSA has not yet been studied. We studied the dynamic evolution of RSA and the associated heart rate and respiratory rate during the transition from rest to chewing gum in 37 students (15 men). The measure of RSA in this study was the spectral power of high-frequency HF oscillations. Chewing was accompanied by a slight increase in respiratory rate (RR) and a significant increase in heart rate (HR), but a statistically insignificant increase in the HR/HR ratio. Although respiration was an important determinant of RSA in this study, we observed a significant decrease in HF in the presence of relatively stable RR and HR/RR levels, indicating that the main driver of the evolution of RSA during mastication is an increase in sympathetic tone due to the trigeminal reflex.

Studying Hemodynamics during Weaning from Mechanical Ventilation among Critically ill Pediatric Patients

Abstract Background Among the multiple causes of weaning failure from mechanical ventilation, cardiovascular dysfunction is increasingly recognized as a quite frequent cause that can be treated successfully. Knowledge of the changes in the cardiopulmonary pathophysiology occurring during mechanical ventilation and its withdrawal is a prerequisite for early recognition of weaning failure of cardiovascular origin and optimal patient management. Aim of the Work Identification of hemodynamic and biomarkers changes during weaning process from mechanical ventilation and how these changes predict weaning success Methodology This cross sectional study was conducted on 50 children who were admitted to Pediatric Intensive Care Units and were mechanically ventilated and ready to be weaned according to weaning criteria. assessment of hemodynamic changes during weaning was done by tracing and comparing vital data, echocardiography parameters and levels of serum BNP and troponin in all patients during pressure support ventilation and at the end of spontaneous breathing trial (SBT) for identification of changes during weaning and risk factors for weaning failure. Results There was statistically significant increase in heart rate, cardiac index and E/A ratio at the end of SBTin all studied patients with lower cardiac index in patients who failed weaning, significant increase in TAPSE at the end of SBT with lower TAPSE in patients who failed weaning. Levels of BNP1 during pressure support were significantly higher in patients who failed weaning however levels of troponin didn’t show significant changes. Conclusion Transthoracic echocardiography can accurately detect changes in central hemodynamics induced by the SBT. It helps the attending physician to identify patients at high risk of weaning failure, when documenting a lower cardiac index, low TAPSE values.

Cardiac autonomic modulation and exercise capacity in older adults with intellectual disability: A 6-month randomised control trial.

Despite reported physical and functional improvements with aerobic and sprint interval training (SIT) protocols in individuals with intellectual disability (ID), it is not known if these interventions' effectivity would promote improvements in cardiac autonomic modulation. This study aimed to investigate if a 6-month SIT or a continuous aerobic programme could enhance physical performance and cardiac autonomic modulation at rest, during physical activity (PA) and after it in older adults with an ID. This is a randomised control trial. Participants with ID (age: 50.58±7.25) were allocated to one of three groups [multicomponent aerobic training group (MATG), multicomponent interval sprint training group (MISTG) and control group (CG)]. The programmes lasted 24weeks, with three sessions/week, 75-90min per session. The HRV was analysed at rest and recovery, the delta of heart rate (HR) was analysed during 6MWT, and the HR t-off kinetics was analysed in recovery after 6MWT. There were not found differences between groups, moments, or interaction for cardiac autonomic modulation at rest and recovery. During exercise, only MSITG showed a significant increase of HR between rest and the first 30s of exercise (P<0.05). Physical performance increased only in MSITG (P<0.05), while CG showed a significant reduction (P<0.01). The MSITG improved the physical performance and the vagal withdrawal at the beginning of the submaximal exercise. These findings suggest that high-intensity exercise may positively impact baroreflex function, mitigating the decline in autonomic reflex response capacity associated with aging in individuals with ID.

Comparative assessment of the effect of anesthetics (propofol, sevoflurane, desflurane) on hemodynamics and gas exchange in the lungs during operations for acute pulmonary embolism

Introduction. To date, single studies have been published on the anesthesiological support of operations for acute pulmonary embolism. The issues of the influence of basic anesthetics on central hemodynamics and the functional state of lung tissue are not covered.The objective was to conduct a comparative assessment of the effect of anesthesia based on propofol, sevoflurane and desflurane on the parameters of central hemodynamics, myocardial contractility and functional state of the lungs during operations for acute pulmonary embolism.Materials and methods. The study included 75 patients (42 men and 33 women) aged 42.3 ± 14.3 years. All patients were operated for massive pulmonary embolism under cardiopulmonary bypass. The patients were randomized into three groups: in the first group (25 patients), propofol was used as the main anesthetic; in the secondgroup (25 patients) - sevoflurane; in the third group (25 patients) - desflurane. The indicators of central hemodynamics, myocardial contractile function and the functional state of the lungs during the operation were studied.Results. The comparative analysis of the anesthesia revealed that propofol had a more pronounced depressive effect on hemodynamics (a statistically significant decrease in blood pressure and EF LV), and desflurane had a moderate hyperdynamic effect (a statistically significant increase in heart rate). Anesthesia with propofol caused a statistically significant increase in the AAPO2 index (by 32.1%), a decrease in the PaO2/FiO2 index (by 24.1%) before cardiopulmonary bypass. After CPB, the oxygenation index decreased, intrapulmonary blood shunting increased, and pulmonary compliance decreased statistically significantly. The use of inhalation anesthetics (sevoflurane, desflurane) effectively preserved the functional parameters of the lungs: there were no statistically significant changes in the studied parameters.Conclusion. The inclusion of inhaled anesthetics (sevoflurane and desflurane) in the anesthesia regimen during surgery for acute pulmonary embolism ensures the stability of hemodynamic parameters and contractile function of the myocardium. The use of inhaled anesthetics maintains high lung function during surgery.

Effects of diet-induced metabolic syndrome on cardiac function and angiogenesis in response to the sodium-glucose cotransporter-2 inhibitor canagliflozin

IntroductionSodium-glucose cotransporter-2 inhibitors are antidiabetic medications that have been shown to decrease cardiovascular events and heart failure-related mortality in clinical studies. We attempt to examine the complex interplay between metabolic syndrome and the sodium-glucose cotransporter-2 inhibitor canagliflozin (CAN) in a clinically relevant model of chronic myocardial ischemia. MethodsTwenty-one Yorkshire swine were fed a high-fat diet starting at 6 weeks of age to induce metabolic syndrome. At 11 weeks, all underwent placement of an ameroid constrictor around the left circumflex coronary artery to induce chronic myocardial ischemia. After 2 weeks, swine received either control (CON) (n = 11) or CAN 300 mg by mouth daily (n = 10) for 5 weeks, whereupon all underwent terminal harvest. ResultsThere was a significant increase in cardiac output and heart rate with a decrease in pulse pressure in the CAN group compared with CON (all P values < .05). The CAN group had a significant increase in capillary density (P = .02). There was no change in myocardial perfusion or arteriolar density. CAN induced a significant increase in markers of angiogenesis, including Phospho-endothelial nitric oxide synthase, Endothelial nitric oxide synthase, vascular endothelial growth factor receptor-1, heat shock protein 70, and extracellular signal-regulated kinases (all P values < .05), plausibly resulting in capillary angiogenesis. ConclusionsCAN treatment leads to a significant increase in capillary density and augmented cardiac function in a swine model of chronic myocardial ischemia in the setting of metabolic syndrome. This work further elucidates the mechanism of sodium-glucose cotransporter-2 inhibitors in patients with cardiac disease; however, more studies are needed to determine if this increase in capillary density plays a role in the improvements seen in clinical studies.

Predictors of neuromodulation during single-shot thermal atrial fibrillation ablation: a computed tomography imaging analysis

Abstract Background Ganglionated plexi (GPs) are part of the cardiac autonomic nervous system (CANS), which play an important role in the induction and maintenance of atrial fibrillation (AF). Because of the anatomic proximity of the pulmonary veins with GPs, pulmonary vein isolation (PVI) using thermal (radiofrequency (RF) or cryo) ablation, has been shown to concomitantly affect the GPs, as suggested by increased heart rate (HR) after ablation. Right superior pulmonary vein (RSPV) isolation has been reported to have the most evident inhibitory responses to the CANS via modulation of the anterior right ganglionated plexus. Nonetheless, there are also cases with little to no effect on neuromodulation post-ablation. Purpose To assess the clinical and anatomical predictors of thermal ablation-induced CANS changes, as assessed via variations in resting HR post-ablation. Methods We retrospectively analyzed consecutive patients with symptomatic paroxysmal AF who underwent first-time PVI by cryoballoon (CB) or RF balloon (RFB) between January 2022 to November 2022. Patients who were not in sinus rhythm, had cardiac implantable electronic devices, or did not have a contrast-enhanced computed tomography before the ablation were excluded. Pre-ablation and 24-hour post-ablation ECGs in sinus rhythm were collected and analyzed to assess HR. Results A total of 83 patients (CB group, n = 43 vs RFB group, n = 40) were included in the analysis. Baseline patients’ characteristics were similar between the two groups (Table 1). A significant HR increase (ΔHR ≥ 15 bpm) at 24h post-ablation occurred in 31 patients [CB group 16 (52 %), RFB group 15 (48 %)]. Predictors of increased HR were the distance between superior vena cava (SVC) and RSPV (OR 0.51, CI 0.35 - 0.75, p value &amp;lt; 0.01) and age (OR 0.94, CI 0.89 - 0.99, p value &amp;lt; 0.01) (Table 2). Conclusions Single-shot thermal PVI influences the CANS, especially in patients with a shorter SVC - RSPV distance and in younger patients.Table 1Table 2