P351Therapeutic inefficacy and pro-arrhythmic nature of metoprolol succinate and carvedilol therapy in patients with idiopathic, frequent, monomorphic premature ventricular contractions

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
O E Turan ◽  
C Hasdemir
Keyword(s):  
Drug Therapy ◽  
Therapeutic Efficacy ◽  
Poor Response ◽  
Holter Monitoring ◽  
P Value ◽  
Premature Ventricular Contractions ◽  
Metoprolol Succinate ◽  
Presenting Symptoms ◽  
First Line Therapy ◽  
Study Population

Abstract Funding Acknowledgements None Background Anti-arrhythmic drugs remain the first-line therapy for treatment of idiopathic ventricular arrhythmias in clinical practice. Purpose The aim of this study was to assess the therapeutic efficacy of extended-release metoprolol succinate (MetS) and carvedilol for idiopathic, frequent, monomorphic premature ventricular contractions (PVCs). Methods Study population consisted of 115 consecutive patients: 72 received MetS and 43 received carvedilol.  All patients underwent 24-hour Holter monitoring at baseline and during drug therapy.  PVC burden response to drug therapy was categorized as "Good" (≥80% reduction), "Poor" (either < 80% reduction or ≤ 50% increase) and "Pro-arrhythmic" response (> 50% increase) based on change in PVC burden compared to baseline. Results Presenting symptoms were palpitations in 69 (60%), shortness of breath/chest pain/syncope in 12 (10.5%), and coincidentally discovered in 34 (29.5%) patients.  Mean MetS and carvedilol dosages were 65.57 ± 30.67 mg/day and 23.66 ± 4.26 mg/day, respectively.  "Good", "Poor" and "Pro-arrhythmic" response was observed in 13.9% and 23.3%, 61.1% and 60.5%, and 25% and 16.2% of patients treated with MetS and carvedilol, respectively.  In patients with relatively high (≥16%) PVC burden, "Poor" response was observed in 86.9% and 76% of patients treated with MetS and carvedilol, respectively.  Side-effects and/or intolerance were observed in 5.5 % and 13.9 % of patients treated with MetS and carvedilol, respectively. Conclusions MetS and carvedilol for idiopathic, frequent, monomorphic PVCs is frequently inefficient.  Therapeutic efficacy decreases further in patients with relatively high (≥16%) PVC burden.  "Pro-arrhythmic" response was observed in approximately one quarter of the patients. All patients Metoprolol Succinate (n = 71) Carvedilol (n = 43) p value Good response,n (%) 7 (9.9) 7 (16.3) 0.38 Poor response,n (%) 46 (64.8) 29 (67.4) 0.38 Pro-arrhythmic response,n (%) 18 (25.4) 7 (16.3) 0.38 Patients with PVC burden≥%16 Metoprolol Succinate (n = 22) Carvedilol (n = 25) Good response,n (%) 1 (4.5) 3 (12) 0.56 Poor response,n (%) 20 (91) 20 (80) 0.56 Pro-arrhythmic response,n (%) 1 (4.5) 2 (8) 0.56 Therapeutic response to Metoprolol Succinate and Carvedilol

scholarly journals Epidemiology and Clinical Characteristics of Covid-19 Mortality in Jos, Nigeria

2021 ◽  
Vol 4 (1) ◽  
pp. 51-62
Author(s):  
SS Gomerep ◽  
SI McHenry ◽  
DB Kumbak ◽  
NY Galam ◽  
JE Ogwuche ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
University Teaching ◽  
P Value ◽  
Chi Square ◽  
Ventilator Support ◽  
Presenting Symptoms ◽  
Duration Of Hospitalization ◽  
Study Population ◽  
Chi Square Analysis

Background: Coronavirus Disease 2019 mortality figures in Africa are comparatively lower than the figures in Europe, Asia and the Americas. Many reasons have been adduced for the differences which include the younger population in Africa. We therefore out set to describe the epidemiology and clinical features among in-hospital mortalities in our setting. Methods: This was a retrospective study of all mortalities due to confirmed COVID-19 at the Jos University Teaching Hospital from April 2020 to April 2021. Descriptive statistics were used to present results and Chi Square analysis used to determine the association between morbidities, sex and ventilator use. A p-value of <0.05 was considered statistically significant. Results: A total of 80 mortalities were recorded over the 12 month period. Sixty one (76.0%) were males. The mean age of the study population was 61 ± 15 years and twenty nine (36.3%) were aged ≤59 years. The median duration of hospitalization for in-hospital mortality was 4days (IQR 1-35). Fever; 61(76.3%), cough; 59(73.8 %) and dyspnea; 56 (70.0%) were the commonest presenting symptoms and 35(43.8%) had the three symptoms. Hypertension; 48(60.0%) and type 2 diabetes mellitus; 36(45.0%) were the commonest co-morbidities in the patients, and 31(38.8%) had at least two co-morbidities. Eighteen (22.5%) had both hypertension and diabetes mellitus. Hypertension and having two or more co-morbidities where associated with requirement for ventilator support (P <0.013 and P<0.001 respectively). Conclusion: Fever, cough, dyspnea and two or more co-morbidities are common among COVID-19 mortalities in Jos. Efforts to quickly identify such patients and manage comorbidities are needed to reduce mortality.

scholarly journals Association of age and symptoms with frequency of Premature Ventricular Contractions on 24 hours Holter monitoring

2021 ◽  
Vol 37 (2) ◽  
Author(s):  
Shazadi Ambreen ◽  
Humaira Fayyaz Khan ◽  
Azmat Hayyat ◽  
Nasar Abbas Shamsi
Keyword(s):  
Chest Pain ◽  
Health Care Professionals ◽  
Armed Forces ◽  
Holter Monitoring ◽  
P Value ◽  
Shortness Of Breath ◽  
Cross Sectional ◽  
Premature Ventricular Contractions ◽  
Specific Symptom ◽  
Asymptomatic Patients

Objectives: This study was done with the objective to identify the determinants of mild, moderate and frequent burdens of premature ventricular contractions (PVCs) which may guide the health care professionals to stratify the high risk patients on basis of their symptoms. Methods: It was a cross sectional descriptive study conducted in Islamic International Medical College (IIMC) in collaboration with Armed Forces Institute of Cardiology (AFIC) from 18th April 2016 to 20th March 2018. It comprised 60 diagnosed patients of PVCs, divided into three groups on the basis of their PVCs burden determined by Holter monitoring report. Each group of mild (Group-A), moderate (Group-B) and frequent burden (Group-C) constituted 20 patients having PVC burden <10%, 10-20% and >20% respectively. All patients were evaluated for their symptoms by a cardiologist. Statistical analysis was done to determine the association of patient’s symptom and age with mild, moderate and frequent PVCs burden. Results: PVCs were significantly associated with presence of symptoms as compared to asymptomatic patients. While no significant correlation of age or any specific symptom (palpitations, chest pain, dizziness, shortness of breath) was found with mild, moderate and frequent PVCs burden with p-value of 0.466. Conclusions: Mild, moderate or frequent PVCs burden are not associated with any specific symptom predominantly or old age. So, it is equally important for all the patients presenting with any symptom of palpitations, chest pain, dizziness or shortness of breath to undergo the work up of PVCs, irrespective of their age. doi: https://doi.org/10.12669/pjms.37.2.2873 How to cite this:Ambreen S, Fayyaz H, Hayat A, Shamsi NA. Association of age and symptoms with frequency of Premature Ventricular Contractions on 24 hours Holter monitoring. Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.2873 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals AHR-dependent genes and response to MTX therapy in rheumatoid arthritis patients

2021 ◽  
Author(s):  
Anna Wajda ◽  
Ewa Walczuk ◽  
Barbara Stypińska ◽  
Jakub Lach ◽  
Danat Yermakovich ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Lymphoblastic Leukemia ◽  
Mrna Level ◽  
Poor Response ◽  
Evolutionary Analysis ◽  
First Line ◽  
Aryl Hydrocarbon ◽  
First Line Therapy ◽  
Genes Expression ◽  
Ahr Gene

AbstractMethotrexate (MTX) is the first-line therapy for rheumatoid arthritis. Nevertheless, MTX resistance is quite a common issue in clinical practice. There are some premises that aryl hydrocarbon receptor (AhR) gene battery may take part in MTX metabolism. In the present retrospective study, we analyzed genes expression of AHR genes battery associated with MTX metabolism in whole blood of RA patients with good and poor response to MTX treatment. Additionally, sequencing, genotyping and bioinformatics analysis of AHR repressor gene (AHRR) c.565C > G (rs2292596) and c.1933G > C (rs34453673) have been performed. Theoretically, both changes may have an impact on H3K36me3 and H3K27me3. Evolutionary analysis revealed that rs2292596 may be possibly damaging. Allele G in rs2292596 and DAS28 seems to be associated with a higher risk of poor response to MTX treatment in RA. RA patients with poor response to MTX treatment revealed upregulated AhR and SLC19A1 mRNA level. Treatment with IL-6 inhibitor may be helpful to overcome the low-dose MTX resistance. Analysis of gene expression revealed possible another cause of poor response to MTX treatment which is different from that observed in the case of acute lymphoblastic leukemia.

Cervical Cancer: Assessment of Its Knowledge, Utilization of Services and Its Determinant Among Female Undergraduate Students in a Low Resource Setting

2021 ◽  
pp. 0272684X2110066
Author(s):  
Chidebe Christian Anikwe ◽  
Philip Chidubem Osuagwu ◽  
Cyril Chijioke Ikeoha ◽  
Okechukwu B Ikechukwu Dimejesi ◽  
Bartholomew Chukwunonye Okorochukwu
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Pap Smear ◽  
Health Workers ◽  
P Value ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Resource Setting ◽  
Study Population

Background Cervical cancer is a preventable disease that contributes significantly to the death of women. This study is aimed at determining the level of knowledge and utilization of cervical cancer screening and its determinants among female undergraduates of Ebonyi State University. Methods A structured questionnaire was used for a cross-sectional survey of the study population between January 1 and March 3, 2018. The data were analyzed using IBM SPSS Statistics version 20. Data were represented with frequency table, simple percentage, mode, range, Chi square and pie chart. The level of significance is at P-value < 0.05. Results Majority (74.8%) of the respondents were aware of cervical cancer and it could be prevented (70.8%). More than three-fifths (68.30%) were informed via health workers, and 86.8% were aware that post-coital vaginal bleeding is a symptom. Less than half (49.8%) knew that HPV is the primary cause, and only 32.9% were aware of the HPV vaccine. One-quarter of the respondent were aware that early coitarche is a risk factor for cervical cancer. Only 41.8% of the women were aware of Pap smear, 9.2% had undergone screening, and 97.6% were willing to be screened. Marital status was the significant determinant of being screened while class level did not significantly influence uptake of cervical cancer screening. The most common reason (20.6%) for not being screened was lack of awareness of the test. Conclusion Our study population had a good knowledge of cervical cancer, but utilization of cervical cancer screening was poor. Awareness creation through the mass media and provision of affordable screening services can promote the use of cervical cancer screening in the study area.

HUBUNGAN INTELEGENSI DENGAN PERILAKU NERS TINGKAT II STIKES SANTA ELISABETH MEDAN

2016 ◽  
Vol 1 (1) ◽  
pp. 21-30
Author(s):  
Imelda Derang
Keyword(s):  
Student Nurses ◽  
Sampling Technique ◽  
P Value ◽  
Test Results ◽  
Cross Sectional ◽  
Intelligence Level ◽  
Level Ii ◽  
Study Population ◽  
Cross Sectional Design ◽  
The Relationship

Intelligence is the ability to apply the knowledge and experiences that have been gained into the effort tasks are challenging and flexible book. Behaviour is an action that involves aspects of affective, cognitive, and psychomotor. Goal: This study aims to determine the relationship between the behavior of student nurses intelligence level II STIKes Santa Elisabeth Medan. Method: This study uses correlation with cross sectional design. The study population was all students / i Ners Level II STIKes Santa Elisabeth Medan as 65. The samples used were 65 respondents, the sampling technique in this research is using purposive sampling. The instrument of this study using questionnaire and observation sheets by using product moment test person. Result: Intelligence students as many as 30 people (46.2%) classified as having an average level of intelligence. A total of 32 people (49.2%) classified as well-behaved students. Person product moment test results obtained p value = 0.172 where a significant level of p> 0.05 so that this value proves that the absence of a relationship between the behavior of student nurses intelligence level II STIKes Santa Elisabeth Medan. Conclusion: Recommended for institutions, motivating students in balancing the behavior and intelligence. 

Updates in insomnia diagnosis and treatment

2019 ◽  
Vol 54 (4-5) ◽  
pp. 275-289 ◽  
Author(s):  
Scott Bragg ◽  
JJ Benich ◽  
Natalie Christian ◽  
Josh Visserman ◽  
John Freedy
Keyword(s):  
Drug Therapy ◽  
Behavioral Therapy ◽  
Treatment Plan ◽  
Treatment Options ◽  
First Line ◽  
Safety Concerns ◽  
Diagnostic And Statistical Manual ◽  
First Line Therapy ◽  
Appropriate Treatment ◽  
Central Nervous System Depression

Introduction Insomnia is the most commonly reported sleep disorder and remains undertreated in many patients. New changes to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, have changed the way insomnia is diagnosed. In patients who suffer from insomnia, a number of available treatment options exist including both behavioral therapy and medications. Literature Review: First line therapy for insomnia should always include behavioral modifications such as sleep hygiene and insomnia-oriented cognitive behavioral therapy. In patients deemed to need pharmacotherapy, first line medications include nonbenzodiazepine hypnotics (i.e., z-drugs) and antidepressants depending on the patients’ needs and comorbidities. The risk of next day impairment, parasomnias, and central nervous system depression are some of the most feared side effects with z-drugs. Second line drug therapy includes melatonin and suvorexant. Several concerns exist for suvorexant similar to other insomnia medications, but melatonin remains one of the safest medication alternatives. Other medication options such as benzodiazepines, antihistamines, and antipsychotics should rarely be used because of weak effectiveness data or serious safety concerns. Discussion The most appropriate treatment plan needs to be tailored to meet the needs of individual patients. Many patient factors (e.g., age, other comorbidities, specific problems with sleep) need to be considered before prescribing drug therapy for patients suffering from insomnia. Medications with the best evidence and fewest safety concerns should be prioritized when clinicians work with patients to determine the most appropriate treatment plan. Conclusions Nondrug treatment should be the emphasis for managing insomnia, but several options exist for patients needing multimodal therapy to improve their symptoms and maximize their quality of life. Z-drugs and antidepressants are first line medications options, but other options may be considered when tailored to individual patients. Medications should only be used intermittently and short term until nondrug treatments help to change a patient’s sleep routine.

scholarly journals Kejadian Hiperbilirubinemia Ditinjau dari Berat Badan Lahir

2020 ◽  
Vol 5 (1) ◽  
pp. 36-42
Author(s):  
Yeviza Puspitasari
Keyword(s):  
Random Sampling ◽  
Statistical Tests ◽  
Univariate Analysis ◽  
Bivariate Analysis ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
Study Population ◽  
Relationship Of ◽  
The Relationship

Hyperbilirubinemia is one of the clinical phenomena most often found in neonates occurring in the first week of life, which is also one of the factors causing infant death is influenced by the immature liver function of the baby to process erythrocytes (red blood cells), resulting in the accumulation of bilirubin. The purpose of this study was to determine the relationship of birth weight of infants with the incidence of hyperbilirubinemia in RSUD dr. Ibnu Soetowo Baturaja Ogan Komering Ulu Regency in 2019. This study uses analytic methods with a cross-sectional approach. The study population was all infants aged 0-7 days in the neonatal room at RSUD dr. Ibnu Soetowo Baturaja Ogan Komering Ulu Regency in 2019, with a random sampling. Data analysis uses univariate analysis and bivariate analysis using distribution tables and Chi-Square statistical tests, with a 95% confidence level. In the univariate analysis, of 203 respondents found 26.5% had hyperbilirubinemia and those without hyperbilirubinemia 72.5%, 24.6% of infants with LBW and non-LBW infants 75.4%. Bivariate analysis showed that there was an LBW relationship with the incidence of hyperbilirubinemia (p-value 0,000).

scholarly journals Serological Characterisation of Auto-antibodies in Patients with Direct Antiglobulin Test Positive Autoimmune Haemolytic Anaemia at a Tertiary Care Teaching Hospital in Tirupati, India

2021 ◽  
Author(s):  
Chinthapeta Keerthi ◽  
Rajendran Arun ◽  
Bandi Suresh Babu ◽  
Kinnera Vijaya Sreedhar Babu ◽  
Alladi Mohan ◽  
...  
Keyword(s):  
Haemolytic Anaemia ◽  
Teaching Hospital ◽  
Tertiary Care ◽  
Direct Antiglobulin Test ◽  
P Value ◽  
Igg Antibody ◽  
Tertiary Care Teaching Hospital ◽  
Care Teaching ◽  
Antiglobulin Test ◽  
Study Population

Introduction: Haemolysis in Autoimmune Haemolytic Anaemia (AIHA) is a result of Immunoglobulin G (IgG) or Immunoglobulin M (IgM) auto-antibodies with or without complement components binding to the Red Blood Cell (RBC) surface and initiating its destruction. Serologic evidence is provided by autocontrol or Direct Antiglobulin Test (DAT). Diagnostic work-up is essential as the management depends on the antibody type. Characteristics of the bound antibody and the target antigen determine the degree of haemolysis. Serological characterisation in AIHA helps to differentiate into its various types which help the clinician to decide on the treatment to be given. Aim: To serologically characterise the auto-antibodies in patients with DAT positive AIHA at a tertiary care teaching hospital. Materials and Methods: This cross-sectional study was carried out in the Department of Transfusion Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India, from March 2019 to February 2020. A 40 consecutive patient samples were included in the study. Characterisation of antibody was done using polyspecific Anti-Human Globulin (AHG) reagent followed by mono-specific AHG reagent by gel method. If antibody was of IgG type, then the subclass was determined by a mono specific anti-IgG1 and anti-IgG3 gel card. Association between antibody types, subtype, and strength of DAT with severity of haemolysis were compared using Chi-square/Fisher’s-exact test. A p-value of less than 0.05 was considered statistically significant. Results: The total study population was 40 patients. The mean age of the study population was 45 years (range 13-78). Out of 40 patients, males were 30 (75%) and females were 10 (25%). The primary and secondary causes for AIHA include 4 (10%) and 36 (90%) respectively. Among 40 patients, 22 (55%) patients had IgG antibody alone, 17 (42.5%) patients had IgG antibody with combination of other antibodies and 1 (2.5%) had only complement (C3d). IgG1 was identified in 7 (18%) of patients, combination of IgG1 and IgG3 in 3 (7.7%). There was a significant association with IgG+combination (p-value=0.03), IgG1+IgG3 (p-value=0.029) and strength of reaction (p-value=0.003) with respect to severity of haemolysis. Conclusion: Presence of multiple antibodies, presence of IgG1 and IgG3 and with complement combination and presence of higher grading of reaction in gel column were associated with severity of haemolysis. We recommend that serological characterisation of auto-antibody in AIHA would help the clinician in assessing the severity of haemolysis so that management can be done appropriately.

scholarly journals Spiritual and Psychological Well-Being of Soldiers in Military Barracks: A Case Study in Iran

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Mohammad Hosein Fadaei ◽  
Mahya Torkaman ◽  
Jamileh Farokhzadian
Keyword(s):  
Military Service ◽  
Well Being ◽  
P Value ◽  
Psychological Well Being ◽  
Spiritual Well Being ◽  
Study Population ◽  
Combination Studies ◽  
The Relationship ◽  
Military Barracks

Background: Spiritual well-being is the newest dimension of health, which is placed along with the physical, mental, and social aspects of health. Since soldiers in military barracks are exposed to multiple psychological pressures, their psychological well-being can be affected. Objectives: This study aimed to evaluate the spiritual well-being and psychological well-being and the relationship between these two concepts among soldiers in military service. Methods: A descriptive-analytical study was conducted at a military barracks in Iran in 2019. The study population included 301 soldiers selected using a convenience sampling method. Data were collected using three questionnaires for data on sociodemographic, psychological well-being, and spiritual well-being. Results: The results showed that soldiers' spiritual well-being (Mean ± SD: 100.6 ± 12, 30, range: 50 – 120) and Psychological well-being (PWB) (Mean ± SD: 85.85 ± 7.91, range: 48 – 104) were at high levels. Furthermore, a significant correlation was observed between spiritual well-being and psychological well-being (P value< 0.001, r = 0.41). Conclusion: Considering the correlation between spiritual well-being and psychological well-being among soldiers in military service, it is possible to improve their psychological well-being by promoting spiritual well-being. In this regard, more interventional and combination studies are recommended in the field of psychological well-being and spiritual well-being.

scholarly journals Frequency of familial short stature identified in children presenting with short stature at a Tertiary Care Hospital in Multan, Pakistan.

2021 ◽  
Vol 28 (7) ◽  
pp. 993-996
Author(s):  
Waqas Imran Khan ◽  
◽  
Asia Noreen ◽  
Summera Tabasum ◽  
◽  
...  
Keyword(s):  
Short Stature ◽  
Tertiary Care ◽  
Female Gender ◽  
P Value ◽  
Care Hospital ◽  
Pediatric Endocrinology ◽  
Multicenter Studies ◽  
Study Population ◽  
Age Range ◽  
Study Setting

Objectives: The objective of my study was to determine the frequency of familial short height in children aged 3 to 14 years with short height. Study Design: Descriptive study. Setting: Department of Pediatric Endocrinology at The Children Hospital & Institute of Child health Multan (CH& ICH). Period: 1st November 2018 to 31st October 2019. Material & Methods: Eighty four patients were enrolled after taking informed consent from parents/guardians. Heights of all patients, parental heights, mid parental heights were plotted on CDC growth charts. Patients having familial short stature were noted down. Results: Out of 84 patients, 59 (70.2%) were males and 25 (29.85%) were females. Age range was 3-14 years. Mean age of the population was 8.68 ± 3.42 years and mean height and weight were 114.29 ± 24.62cm and 28.95±10.01 kg, respectively. Mean height for mother and father of the patients were 154.39 ±4.56cm and 171.10 ± 3.52cm, respectively. Out of 84 children, 21 (25%) patients had FSS. In our study population FSS was more seen in children < 8 years of age, female gender and families with income of > 20K/months with p value of 0.879, 0.129 and 0.592 respectively. Conclusion: Majority of children presenting with short stature have FSS and CDG and do not have an endocrine disorder. In our study, frequency of familial short stature in children aged 3 to 14 years was 25%. The results should be validated in multicenter studies.

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