Could specific EKG markers identify a pharmacologically induced type 1 Brugada pattern? Insights from a large, single-centre cohort

Abstract Funding Acknowledgements Type of funding sources: None. Background. Pharmacological (Ajmaline) induction of a type 1 Brugada pattern is currently considered mandatory for the diagnosis of Brugada syndrome. However, performing the test requires time and healthcare resources. Some EKG markers have been proposed as predictors of positive result at Ajmaline test. Aim. To evaluate in a large population the predictive value of multiple EKG markers for Ajmaline test results. Methods. We retrospectively analysed consecutive patients (pts) referred to our Centre to perform Ajmaline test. All pts had type 2 Brugada pattern detected at a conventional EKG or were relatives of pts with positive Ajmaline test, with or without type 2 Brugada pattern at EKG. All pts performed the Ajmaline pharmacological test (1 mg/Kg iv) with EKG "superior" right precordial unipolar derivations monitoring. To determine whether clinical parameters (age, gender, cardiomyopathy, history of arrhythmias, symptoms, familiarity) and EKG markers (heart rate (HR), PR duration, R1V1 and SV6 duration and amplitude, QRSV1/QRSV6 duration, V1 and V2 ST amplitude (coved or saddle back pattern) were independently associated to positivity at Ajmaline test, a logistic regression model was applied. Results. From January 2010 to December 2019 we evaluated 442 consecutive pts: mean age 40.1 ± 14.5 years; 273 (65%) male; 352 (80%) pts were included because of type 2 Brugada pattern at EKG and 90 (20%) for familial screening. The Ajmaline test was positive in 150 (34%) pts. At multivariate logistic regression analysis adjusted for baseline confounders, age > 45 years (OR= 1.64, 95%CI: 1.03 to 2.54; p = 0.0385), female gender (OR = 1.79, 95%CI: 1.12 to 2.85; p = 0.0141), HR > 60 bpm (OR = 2.44, 95%CI: 1.48 to 4.03; p = 0.0005), QRSV1/QRSV6 duration (msec) >1 (OR = 5.34, 95%CI: 3.28 to 8.69; p < 0.0001) and non isoelectric pattern (coved/saddle back) in V2 (OR = 1.93, 95%CI: 1.03 to 3.63, p = 0.0416) remained associated with a positive Ajmaline test. The percentage of pts with positive Ajmaline test increased according to the presence of significant EKG markers in their risk profile: 11.3% (8 out 71, absence of both QRSV1/QRSV6 duration (msec) >1 and V2 non isoelectric pattern), 24.3% (50 out 206, presence of only V2 non isoelectric pattern), 48.5% (16 out 33, presence of only QRSV1/QRSV6 duration (msec) >1), 57.6% (76 out 132, presence of both factors). Conclusions. In our large population: 1) we confirmed the positive predictive power of QRSV1/QRSV6 duration (msec) >1 and of a non isoelectric pattern (coved/saddle back) in V2 for a pharmacologically induced type 1 Brugada pattern; 2) we observed a non-negligible percentage of pts who would not be correctly diagnosed for type 1 Brugada pattern, if selected according to an EKG parameters-based prescreening.

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High Risk of One-year Stroke Recurrence in Patients with Younger Age and Prior History of Ischemic Stroke

Current Neurovascular Research ◽

10.2174/1567202616666190618164528 ◽

2019 ◽

Vol 16 (3) ◽

pp. 250-257 ◽

Cited By ~ 1

Author(s):

Jiann-Der Lee ◽

Ya-Han Hu ◽

Meng Lee ◽

Yen-Chu Huang ◽

Ya-Wen Kuo ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Multivariate Logistic Regression Analysis ◽

Stroke Recurrence ◽

Prior History ◽

Multivariate Logistic Regression ◽

Cart Analysis ◽

Younger Age ◽

History Of ◽

One Year

Background and Purpose: Recurrent ischemic strokes increase the risk of disability and mortality. The role of conventional risk factors in recurrent strokes may change due to increased awareness of prevention strategies. The aim of this study was to explore the potential risk factors besides conventional ones which may help to affect the advances in future preventive concepts associated with one-year stroke recurrence (OSR). Methods: We analyzed 6,632 adult patients with ischemic stroke. Differences in clinical characteristics between patients with and without OSR were analyzed using multivariate logistic regression and classification and regression tree (CART) analyses. Results: Among the study population, 525 patients (7.9%) had OSR. Multivariate logistic regression analysis revealed that male sex (OR 1.243, 95% CI 1.025 – 1.506), age (OR 1.015, 95% CI 1.007 - 1.023), and a prior history of ischemic stroke (OR 1.331, 95% CI 1.096 – 1.615) were major factors associated with OSR. CART analysis further identified age and a prior history of ischemic stroke were important factors for OSR when classified the patients into three subgroups (with risks of OSR of 8.8%, 3.8%, and 12.5% for patients aged > 57.5 years, ≤ 57.5 years/with no prior history of ischemic stroke, and ≤ 57.5 years/with a prior history of ischemic stroke, respectively). Conclusions: Male sex, age, and a prior history of ischemic stroke could increase the risk of OSR by multivariate logistic regression analysis, and CART analysis further demonstrated that patients with a younger age (≤ 57.5 years) and a prior history of ischemic stroke had the highest risk of OSR.

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The association between hypoglycemia and glycemic variability in elderly patients with type 2 diabetes: a prospective observational study

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-021-00656-1 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Takahisa Handa ◽

Akinobu Nakamura ◽

Aika Miya ◽

Hiroshi Nomoto ◽

Hiraku Kameda ◽

...

Keyword(s):

Type 2 Diabetes ◽

Logistic Regression ◽

Regression Analysis ◽

Observational Study ◽

Elderly Patients ◽

Prospective Observational Study ◽

Multivariate Logistic Regression Analysis ◽

Glycemic Variability ◽

Multivariate Logistic Regression

Abstract Background This study aimed to explore predictive factors of time below target glucose range (TBR) ≥ 1% among patients’ characteristics and glycemic variability (GV) indices using continuous glucose monitoring data in elderly patients with type 2 diabetes. Methods We conducted a prospective observational study on 179 (71 female) Japanese outpatients with type 2 diabetes aged ≥ 65 years. The characteristics of the participants with TBR ≥ 1% were evaluated by multivariate logistic regression analysis. Receiver-operating characteristic (ROC) curve analyses of GV indices, comprising coefficient of variation (CV), standard deviation, and mean amplitude of glycemic excursions, were performed to identify the optimal index for the identification of patients with TBR ≥ 1%. Results In the multivariate logistic regression analysis, none of the clinical characteristics, including HbA1c and C-peptide index, were independent markers for TBR ≥ 1%, while all three GV indices showed significant associations with TBR ≥ 1%. Among the three GV indices, CV showed the best performance based on the area under the curve in the ROC curve analyses. Conclusions Among elderly patients with type 2 diabetes, CV reflected TBR ≥ 1% most appropriately among the GV indices examined. Trial registration UMIN-CTR: UMIN000029993. Registered 16 November 2017

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EXPRESS: Pulmonary Hypertension Associated With Neurofibromatosis Type 2

Pulmonary Circulation ◽

10.1177/20458940211029550 ◽

2021 ◽

pp. 204589402110295

Author(s):

Hirohisa Taniguchi ◽

Tomoya Takashima ◽

Ly Tu ◽

RaphaÃ«l Thuillet ◽

Asuka Furukawa ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Neurofibromatosis Type ◽

Pulmonary Vascular Remodeling ◽

Life Threatening ◽

History Of ◽

Pulmonary Arterial ◽

First Time

Although precapillary pulmonary hypertension (PH) is a rare but severe complication of patients with neurofibromatosis type 1 (NF1), its association with NF2 remains unknown. Herein, we report a case of a 44-year-old woman who was initially diagnosed with idiopathic pulmonary arterial hypertension (IPAH) and treated with PAH-specific combination therapy. However, a careful assessment for a relevant family history of the disease and genetic testing reveal that this patient had a mutation in the NF2 gene. Using immunofluorescence and Western blotting, we demonstrated a decrease in endothelial NF2 protein in lungs from IPAH patients compared to control lungs, suggesting a potential role of NF2 in PAH development. To our knowledge, this is the first time that precapillary PH has been described in a patient with NF2. The altered endothelial NF2 expression pattern in PAH lungs should stimulate work to better understand how NF2 is contributing to the pulmonary vascular remodeling associated to these severe life-threatening conditions.

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Maternal history of type 2 diabetes is associated with diabetic nephropathy in type 1 diabetic patients

Diabetes & Metabolism ◽

10.1016/j.diabet.2006.09.003 ◽

2007 ◽

Vol 33 (1) ◽

pp. 37-43 ◽

Cited By ~ 8

Author(s):

S. Hadjadj ◽

F. Duengler ◽

F. Torremocha ◽

G. Faure-Gerard ◽

F. Bridoux ◽

...

Keyword(s):

Type 2 Diabetes ◽

Diabetic Nephropathy ◽

Diabetic Patients ◽

Maternal History ◽

History Of ◽

Type 1 Diabetic Patients

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Cannabinoids in health and disease: pharmacological potential in metabolic syndrome and neuroinflammation

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2018-0013 ◽

2018 ◽

Vol 36 (2) ◽

Cited By ~ 15

Author(s):

Andrea Mastinu ◽

Marika Premoli ◽

Giulia Ferrari-Toninelli ◽

Simone Tambaro ◽

Giuseppina Maccarinelli ◽

...

Keyword(s):

Cannabis Sativa ◽

Cannabinoid Receptor ◽

Receptor Type ◽

History Of ◽

Health And Disease ◽

Pharmacological Potential ◽

The Brain ◽

Synthesis And Degradation

Abstract The use of different natural and/or synthetic preparations of Cannabis sativa is associated with therapeutic strategies for many diseases. Indeed, thanks to the widespread diffusion of the cannabinoidergic system in the brain and in the peripheral districts, its stimulation, or inhibition, regulates many pathophysiological phenomena. In particular, central activation of the cannabinoidergic system modulates the limbic and mesolimbic response which leads to food craving. Moreover, cannabinoid agonists are able to reduce inflammatory response. In this review a brief history of cannabinoids and the protagonists of the endocannabinoidergic system, i.e. synthesis and degradation enzymes and main receptors, will be described. Furthermore, the pharmacological effects of cannabinoids will be outlined. An overview of the involvement of the endocannabinoidergic system in neuroinflammatory and metabolic pathologies will be made. Finally, particular attention will also be given to the new pharmacological entities acting on the two main receptors, cannabinoid receptor type 1 (CB1) and cannabinoid receptor type 2 (CB2), with particular focus on the neuroinflammatory and metabolic mechanisms involved.

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Factors associated with depression in the patients with diabetes mellitus type 2

Vojnosanitetski pregled ◽

10.2298/vsp170328029s ◽

2019 ◽

Vol 76 (11) ◽

pp. 1178-1183 ◽

Cited By ~ 1

Author(s):

Admir Sabanovic ◽

Natasa Maksimovic ◽

Mirjana Stojanovic-Tasic ◽

Marijan Bakic ◽

Anita Grgurevic

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Diabetes Mellitus Type 2 ◽

Multivariate Logistic Regression Analysis ◽

Multivariate Logistic Regression ◽

Factors Associated

Background/Aim. The assessment of association of depression and diabetes mellitus type 2 using the Patient Health Questionaire (PHQ-9) has not been done in Montenegro. The aim of this study was to assess the prevalence of depression in the patients with type 2 diabetes mellitus, and to identify the risk factors associated with the presence of depression. Methods. A cross-sectional study was conducted at the General Hospital in Bijelo Polje, from July to September, 2015. It included 70 patients over 35 years of age with the diagnosis of diabetes for at least six months. For the assessment of depression presence and intensity PHQ?9 was used. All variables associated with the presence of depression at a significance level of p < 0.05 were included into the final method of the multivariate logistic regression analysis. Results. Comorbidities were statistically significant more frequent among patients with depression (?2 = 5.40; p = 0.020). Duration of diabetes over five years was significantly associated with depression (?2 = 12.48; p < 0.001). Depression occurred more frequently among physically inactive subjects (?2 = 10.74; p = 0.005). The presence of diabetic polyneuropathy (?2 = 6.04; p = 0.014) and cataract (?2 = 5.351; p = 0.021) were also significantly associated with depression. A multivariate logistic regression analysis showed that the duration of diabetes over five years and presence of cataract were independently associated with depression. Conclusion. The risk factors for depression among the subjects with diabetes were disease duration more than five years and the presence of cataract. Since depression is a serious disease and can be a risk factor for many chronic diseases, the best way of prevention is its early detection and treatment.

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Fluid flow and faulting history of the Iano tectonic window (Southern Tuscany, Italy).

10.5194/egusphere-egu21-4423 ◽

2021 ◽

Author(s):

Paolo Fulignati ◽

Martina Zucchi ◽

Andrea Brogi ◽

Enrico Capezzuoli ◽

Domenico Liotta ◽

...

Keyword(s):

Fluid Inclusions ◽

Hydrothermal Fluids ◽

Normal Faults ◽

High Angle ◽

Quartz Veins ◽

History Of ◽

Tectonic Window ◽

Liquid Vapor

In the Iano area (Southern Tuscany) a small tectonic window of Tuscan metamorphic units is observed. This belongs to the northernmost part of the so-called Mid-Tuscan ridge and, during Pliocene, formed a submarine high, now defining the easternmost shoulder of the Volterra Pliocene basin. The area gives the opportunity to investigate the complete cycle of negative inversion from crustal thickening to crustal thinning, which characterizes Southern Tuscany. Our new data focus on the western margin of the Iano ridge, and in particular on a system of high angle normal faults that represents the youngest structures of the investigated area. These structures, deformed low angle regional detachments locally juxtaposing the uppermost units of contractional nappe stack (the ophiolite-bearing Ligurian units), with the Tuscan metamorphic units, with an almost complete excision of at least 3.5 Km thick Mesozoic to Tertiary Tuscan nappe succession. The high angle normal faults show variable Plio-Quaternary vertical displacements from few meters to about 500 meters, and acted as pathways for the upwelling of hydrothermal fluids, as revealed by Pleistocene travertine deposits, hydrothermal alteration and occurrence of different generations of fluid inclusions in hydrothermal veins associated with these fault systems. Fluid inclusions were studied in quartz veins hosted in the Verrucano metasediments forming the top of the Tuscan metamorphic unit, as well as in some carbonate lithotypes (Cretaceous to Tertiary in age) of the overlying Tuscan Nappe. Two different kinds of fluid inclusions were documented. The Type 1 are multiphase (liquid + vapor + 1 daughter mineral) liquid-rich fluid inclusions whereas the Type 2 are two-phase (liquid + vapor) liquid-rich fluid inclusions. Type 1 fluid inclusions are primary in origin and were found only in quartz veins present in Verrucano metarudites, whereas Type 2 fluid inclusions occur in quartz veins present in both Verrucano phyllites and quartzites and in the carbonate units of the Tuscan Nappe. These are secondary and can be furthermore distinguished in two sub-populations (Type 2a and Type 2b) on the basis of petrographic observation and microthermometric data. Fluid inclusion investigation evidenced an evolution of the hydrothermal fluids from relatively high-T (~265&#176;C) and hypersaline (35 wt.% NaClequiv.) fluids trapped at about 100 MPa, to lower temperature (~195&#176;C) and salinity (~9.5 wt.% NaClequiv.) fluids, having circulated in the high-angle fault system. Based on the new data and a revision of the local tectonic setting a fluid-rock interaction history has been reconstructed with new hints and constraints for the Plio-Quaternary extensional history of the Volterra basin.

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ORGANIZATION OF AMBULATORY CARE FOR TYPE 2 DIABETES MELLITUS

Vestnik ◽

10.53065/kaznmu.2021.72.26.041 ◽

2021 ◽

pp. 187-193

Author(s):

З.К. Манатбекова ◽

А. Озат ◽

А.Е. Бектур ◽

А.Р. Шаймерден ◽

Д.А. Ахат ◽

...

Keyword(s):

Type 2 Diabetes ◽

Outpatient Care ◽

Best Practice ◽

Self Management ◽

Order Sets ◽

History Of ◽

Insulin Use ◽

Quality Assurance Standards

Качественная амбулаторная помощь при диабете требует как стандартов оказания амбулаторной помощи, часто обеспечиваемой структурированными наборами заказов, так и стандартов обеспечения качества для улучшения процессов. Протоколы, обзоры и руководства «передовой практики» непоследовательно применяются в больницах. Чтобы исправить это, в больницах установлены протоколы для структурированного ухода за пациентами и структурированные наборы заказов, которые включают компьютеризированный ввод заказов врача (CPOE). В первоначальных заказах должен быть указан тип диабета (например, диабет 1 или 2 типа) или отсутствие диабета в анамнезе. Поскольку стационарное использование инсулина и приказы о выписке могут быть более эффективными, если основаны на уровне A1C при поступлении, выполните тест A1C у всех пациентов с диабетом или гипергликемией, госпитализированных в больницу, если тест не был проведен. выполнено за предыдущие 3 месяца. Целью данной работы является рассмотрение стандартов амбулаторного лечения пациентов с диабетом 2 типа, составление рекомендации по поведению и формировании навыков в отношении самоконтроля при диабете. Quality ambulatory diabetes care requires both outpatient care standards, often provided by structured ordering, and quality assurance standards to improve processes. “Best practice” protocols, reviews and guidelines are inconsistently applied in hospitals. To remedy this, hospitals have established protocols for structured patient care and structured order sets that include computerized entry of physician orders (CPOE). Initial orders must indicate the type of diabetes (such as type 1 or 2 diabetes) or no history of diabetes. Because inpatient insulin use and discharge orders may be more effective if based on admission A1C levels, perform an A1C test on all diabetic or hyperglycemic patients admitted to the hospital if the test has not been performed. completed in the previous 3 months. The aim of this work is to review the standards of outpatient treatment of patients with type 2 diabetes, to draw up recommendations on behavior and skills formation in relation to self-management in diabetes.

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Abstract P267: Burden of Disease Among Older Adults With Type 1 and Type 2 Diabetes: Results From the Study of Longevity in Diabetes (SOLID)

Circulation ◽

10.1161/circ.141.suppl_1.p267 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Mary E Lacy ◽

Paola Gilsanz ◽

Chloe Eng ◽

Michal S Beeri ◽

Andrew J Karter ◽

...

Keyword(s):

Type 2 Diabetes ◽

Older Adults ◽

Emergency Department ◽

Functional Impairment ◽

Coronary Bypass ◽

Emergency Department Utilization ◽

Geriatric Syndromes ◽

History Of

Introduction: Increasing incidence of type 1 diabetes (T1D) coupled with increasing life expectancy have resulted in an unprecedented number of older adults living with T1D. However, little is known about the burden of aging and diabetes-related complications in this unique group. We hypothesized that older adults with T1D would have greater diabetes and aging-related burden compared to an age, sex, race/ethnicity, and education-matched group of older adults with type 2 diabetes (T2D). Methods: We compared the following characteristics by diabetes type among older adults (aged ≥60) with T1D (n=805) and T2D (n=249) from the Study of Longevity in Diabetes (SOLID) using chi-squared tests: diabetes history (age of onset, diabetes duration); diabetes-related complications (retinopathy, neuropathy, nephropathy, severe hypo- and hyperglycemia resulting in hospitalization/emergency department utilization), cardiovascular disease (stroke, MI, coronary bypass), and geriatric syndromes (depression, incontinence, memory problems and functional impairment). Results: Average age at diagnosis and duration of diabetes, respectively, were 28 years old and 40 years duration for T1D and 56 years old and 13 years duration for T2D (Table 1). Compared to T2D, participants with T1D were more likely to report history of retinopathy, neuropathy, nephropathy, lifetime hypo- and hyperglycemic events resulting in hospitalization/emergency department utilization, and history of a coronary bypass. By contrast, those with T2D were more likely to be incontinent and have functional impairment. Conclusions: Our results show that diabetes-related complications are more prevalent in those with T1D than in comparable adults with T2D, while certain geriatric syndromes were more prevalent in those with T2D. Older adults with T1D are a growing population with unique diabetes-specific and aging-related considerations. Additional research is needed to understand the interplay of aging and diabetes in this group to inform patient care .

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Trends in the Immunomodulatory Effects of Cordyceps militaris: Total Extracts, Polysaccharides and Cordycepin

Frontiers in Pharmacology ◽

10.3389/fphar.2020.575704 ◽

2020 ◽

Vol 11 ◽

Author(s):

Chun-Ting Lee ◽

Keng-Shiang Huang ◽

Jei-Fu Shaw ◽

Jung-Ren Chen ◽

Wen-Shuo Kuo ◽

...

Keyword(s):

Ethyl Alcohol ◽

Folk Medicine ◽

Cordyceps Militaris ◽

Pharmacological Effect ◽

Immunomodulatory Effects ◽

Comprehensive Understanding ◽

Type 2 Immunity ◽

History Of

Cordyceps militaris (C. militaris) is a fungus with a long history of widespread use in folk medicine, and its biological and medicinal functions are well studied. A crucial pharmacological effect of C. militaris is immunomodulation. In this review, we catalog the immunomodulatory effects of different extracts of C. militaris, namely total extracts, polysaccharides and cordycepin. Total extracts obtained using water or 50% ethyl alcohol and polysaccharides from C. militaris were discovered to tend to promote type 1 immunity, whereas total extracts obtained using 70–80% ethyl alcohol and cordycepin from C. militaris were more likely to promote type 2 immunity. This article is the first to classify the immunomodulatory effects of different extracts of C. militaris. In addition, we discovered a relationship between different segments or extracts and differing types of immunity. This review can provide the readers a comprehensive understanding on the immunomodulatory effects of the precious folk medicine and guidance on its use for both health people and those with an immunodeficiency.

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