Optimal ablation index parameters for radiofrequency ablation therapy of atrial fibrillation

Objective: To explore the optimal ablation index (AI) parameters for radiofrequency catheter ablation (RA) for treating atrial fibrillation (AF). Method: Patients with AF (186) who underwent bilateral PVAI in the Department of Cardiology, Zhuhai People’s Hospital, Guangdong Province, from March 2018 to October 2019 and received catheter ablation as first-round treatment, were grouped according to the received AI. Control group included patients (95) who received the recommended AI ablation (350–400 for posterior wall, 400–450 for non-posterior wall). Patients in optimal AI group were ablated with optimal AI (300–330 for posterior wall, 350–380 for non-posterior wall). Results: Of 186 patients, 66 patients had paroxysmal atrial fibrillation and a mean CHA2DS2-VASc score of 2.83±1.64. Isolation rates of bilateral PVI in both groups were 91.4% and 93.6%, for patients with paroxysmal atrial fibrillation, and 81.7% and 80% for patients with persistent atrial fibrillation (P > 0.05). Left atrial function index (LAFI) decreased under the condition of sinus rhythm at the 3rd and 6th months (P < 0.05). LAFI improvement was significantly better in the optimal AI group than in the control group (P < 0.05). Rates of pain and cough during the ablation, and postoperative gastrointestinal discomfort and use of PPIs were higher in the control group (P < 0.05). Conclusion: Radiofrequency ablation of AF, guided by optimal AI combined with impedance, can minimize atrial injury, prevent atrial failure, promote the recovery of atrial function, reduces intraoperative cough, pain, and postoperative gastrointestinal discomfort and use of PPIs. doi: https://doi.org/10.12669/pjms.38.3.4971 How to cite this:Qin X, Jiang X, Yuan Q, Xu G, He X. Optimal ablation index parameters for radiofrequency ablation therapy of atrial fibrillation. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.4971 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.

Involvement of Gut Microbiota in the Development of Psoriasis Vulgaris

Objectives: Psoriasis is a common chronic recurrent dermatitis. Accumulating observations show gut microbiota dysbiosis in psoriasis. We intend to further investigate the relationship between intestinal microbiota and psoriasis development.Design: We first performed an epidemiological investigation on differences of gastrointestinal discomfort symptoms between patients with psoriasis and general population. Then variation of gut microbiota in patients with psoriasis (un)treated with acitretin plus narrow-band ultraviolet B (NB-UVB) was analyzed by 16S rRNA sequencing. We last compared recovery status and vital cytokines (lesion and intestine) of mouse psoriasiform models, which were transplanted with fecal microbiota from patients with psoriasis or healthy controls.Results: (1) About 85.5% of patients with psoriasis vs. 58.1% of healthy controls presented with at least one gastrointestinal symptom. The prevalence of investigated symptoms (e.g., abdominal distension and constipation) were significantly higher in patients, compared with controls (p &lt; 0.05). Passing flatus and constipation were significantly correlated with psoriasis (p &lt; 0.05 in both cases). (2) The abundance of Ruminococcaceae family, Coprococcus_1 genus, and Blautia genus were decreased with psoriasis improvement (p &lt; 0.05, respectively), which had been demonstrated significantly increased in psoriasis. (3) Mice receiving psoriatic microbes transplantation showed delayed recovery of psoriasiform dermatitis and less reduction of interleukin (IL)-17A than those receiving healthy microbiota or blank control (p &lt; 0.05 and p &lt; 0.01, respectively).Conclusion: Multiple evidence we provided here preliminarily demonstrates the involvement of gut microbiota in the different degree of psoriasis activity. The strategy based on overall microbial communities is expected to be a promising supplementary for long-term management of psoriasis.

The Ketogenic Effect of Medium-Chain Triacylglycerides

Medium-chain triacylglycerides (MCTs) are dietary supplements that can induce ketosis without the need for a traditional ketogenic diet or prolonged fasting. They have the potential to marginally delay the progression of neurodegenerative diseases, such as Alzheimer's disease. However, there have been inconsistencies in reports of the MCT dose–response relationship, which may be due to differences in MCT composition, participant characteristics, and other factors that can influence ketone generation. To resolve these discrepancies, we reviewed studies that investigated the ketogenic effect of MCTs in healthy adults. Aside from the treatment dose, other factors that can influence the ketogenic response, such as accompanying meals, fasting duration, and caffeine intake, were assessed. Based on the available literature, four practical recommendations are made to optimize the ketogenic effect of MCTs and reduce unwanted side effects (primarily gastrointestinal discomfort and diarrhea). First, the starting dose should be either 5 g of octanoic acid [caprylic acid (C8); a component of MCTs] or 5 g of a combination of C8 and decanoic or capric acid (C10; another component of MCTs), and the dose should be progressively increased to 15–20 g of C8. Second, MCTs should be consumed after an overnight fast, without an accompanying meal if tolerable, or with a low-carbohydrate meal. Third, the addition of caffeine may slightly increase the ketogenic response. Fourth, emulsifying the MCTs might increase their ketogenic effect and alleviate side effects.

EFEKTIVITAS PENGGUNAAN ASAM TRANEKSAMAT ORAL PADA PASIEN MELASMA

This study aims to determine the effectiveness of using oral tranexamic acid in melasma patients, as well as to explain the definition of melasma, melasma epidemiology, melasma etiopathogenesis, and to explain the effectiveness of using oral tranexamic acid in melasma. The method used was to collect and analyze research articles on the effectiveness of the use of oral tranexamic acid topical drugs in Melasma patients. The articles are obtained through a search using Google Scholar, Pubmed. The term melasma comes from the Greek word "melas" which means black. Clinically melasma appears as macules or brown spots. Complaints of melasma usually occur symmetrically. The areas of melasma predilection are most commonly the cheeks, upper lip, chin and forehead, but can also be affected in other areas. (Debabrata, Handel et al., 2014). Research conducted for 6 months by Sufan et al ,. It is known that after therapy using Tranexamic Acid, there was a decrease in hyperpigmentation. After 6 months of treatment, the results were very good (10.8%, 8/74), good (54%, 40/74), moderate (31.1%, 23/74), and bad (4.1%). , 3/74). There were 4 patients (5.4%) who experienced mild gastrointestinal discomfort, 6 patients (8.1%) hypomenorrhea, subjects who rarely reported skin rash due to allergies as well as dizziness, alopecia, drowsiness and hyposexuality. From these results it is concluded that oral Tranexmatic Acid has good effectiveness in melasma therapy. (Sufan et al., 2012). From the results of this study it can be concluded that Tranexamic Acid has good effectiveness in the therapy of melasma. Where there are several risk factors that cause melasma, which can occur due to genetic factors, UV exposure, hormonal factors and inflammatory factors. Tranexamic acid will inhibit the action of tyrosinase activity by blocking the interaction of melanocytes and keratinocytes through inhibition of the plasminogen system. Keywords: Melasma, treatment for melasma, epidemiologi, etiologi, tranexamic acid,.

AmphotericinB and Fluorocytosine Combined with Voriconazole for the Treatment of Non-HIV- and Non-Transplant-Associated Cryptococcal Meningitis: A Retrospective Study

Background This retrospective study aimed to explore the curative effect of amphotericin B (AMB) and fluorocytosine (5-FC) combined with voriconazole (VOR) in the induction period for the treatment of non-HIV- and non-transplant-associated cryptococcal meningitis (CM). Methods Clinical data from patients admitted to the Third Affiliated Hospital of Sun Yat Sen University from January 2011 to December 2020 were collected. The patients were stratified based on antifungal treatment methods in the induction period (group I with AMB + 5-FC + VOR, group II with AMB + 5-FC + FLU, group III with AMB + 5-FC). Results The length of hospital stay in group I was significantly shorter than those in group II (p = 0.000) and group III (p = 0.000). Among the patients who achieved CSF sterility within 10 weeks, the number of days to reach CSF sterility in group I was shorter than that in group II (p = 0.046). The incidence of hypokalemia in group I was significantly lower than those in group II (p = 0.003) and group III (p = 0.004). The incidence of gastrointestinal discomfort in group I was significantly lower than that in group II (p = 0.004). Conclusion AMB plus 5-FC combined with VOR for the induction treatment of non-HIV- and non-transplant-associated cryptococcal meningitis is a better choice than AMB plus 5-FC combined with FLU and AMB plus 5-FC. This new triple antifungal treatment method rapidly cleared the cryptococci from the CSF, substantially shortened the hospital stay, and decreased the incidences of hypokalemia and gastrointestinal discomfort.

Consumption of Analeptics and Energizing Drinks to Improve Academic Performance in Students From First to Third Level of the Career of Medicine

Central nervous system stimulant drugs are frequently used by college students as factors to alleviate fatigue, maintain wakefulness, and stimulate cognitive abilities, which has become a problem because the physical or emotional consequences that may occur are not considered. produce. At the time of marketing these products they do not keep any type of control, it is freely distributed to the general public. Objective: to analyze how the consumption of analeptics and energy drinks affects the academic performance of students. Methods: An explanatory, cross-sectional, quantitative-qualitative study was carried out, to obtain data, the survey was applied to first to third level students of the Medicine School of the Polytechnic School of Chimborazo (ESPOCH). Results: From the compilation of the information it can be determined that 65% of the students use stimulants to increase their performance, without considering the consequences such as palpitations, insomnia, headache, tremor, vomiting, gastrointestinal discomfort as well as affections to different organs and body systems. Bottom Line: The cognitive effects of stimulants commonly bring about changes in performance by accelerating the production of dopamine in the brain, which is a neurotransmitter that is related to attention, pleasure, memory and performance. Adverse effects can vary from mild to very serious, causing irritability, headache, arrhythmias, hypertension, dizziness, and lesser degrees such as difficulty in bowel movement, itching or skin rash, among others. Keywords: analleptic, stimuli, effects, academic performance. Resumen Los estudiantes universitarios consumen con frecuencia los fármacos estimulantes del sistema nervioso central como factores para aliviar la fatiga, mantener la vigilia y estimular las capacidades cognitivas, lo cual se ha convertido en un problema, porque no se consideran las consecuencias físicas o emocionales que se pueden producir. Al momento de comercializar estos productos no guardan algún tipo de control, es de libre distribución al público general. Objetivo: analizar como el consumo de analépticos y bebidas energizantes incide en el rendimiento académico de los estudiantes. Métodos: Se realizó un estudio explicativo de corte transversal, de tipo cuanti- cualitativo, para la obtención de datos se aplicó la encuesta a los estudiantes de primer a tercer nivel de la Carrera de Medicina de la Escuela Superior Politécnica de Chimborazo (ESPOCH). Resultados: De la recopilación de la información se puede determinar que un 65% de los estudiantes utilizan los estimulantes para elevar su rendimiento, sin considerar las consecuencias como palpitaciones, insomnio, cefalea, temblor, vómito, molestias gastrointestinales así como afecciones a distintos órganos y sistemas del cuerpo. Conclusión: Los efectos cognitivos de los estimulantes, comúnmente aportan cambios en el rendimiento al acelerar la producción de dopamina en el cerebro, que es un neurotransmisor que se relaciona con la atención, el placer, la memoria y el rendimiento. Los efectos adversos pueden variar de leves a muy graves causando irritabilidad, dolor de cabeza, arritmias, hipertensión, mareos y los de menor grado como dificultad para la evacuación intestinal, picazón o erupción en la piel, entre otras. Palabras clave: analépticos, estímulos, efectos, rendimiento académico.

Prognostic Value of Cardiac Troponin and Risk Assessment in Pediatric Supraventricular Tachycardia

Cardiac troponin I (cTnI) elevation is common in an acute episode of supraventricular tachycardia (SVT). However, there is limited evidence regarding the prognostic value of cTnI and the predictors of SVT recurrence in pediatric patients. We screened the electronic medical records of all pediatric patients presenting to the emergency departments at five Taiwanese hospitals from 1 January 2010 to 31 May 2021. Our primary outcomes were the occurrence of major adverse cardiac events (MACEs) during the follow-up period and 30-day SVT recurrence. A total of 112 patients were included in our study. Of these, 29 (25.9%) patients had positive cTnI values. Patients with cTnI elevation had significantly more complaints of dyspnea (27.6% vs. 7.2%, p = 0.008) and gastrointestinal discomfort (24.1% vs. 4.8%, p = 0.006). There were significantly more intensive care unit admissions (41.4% vs. 16.9%, p = 0.007) among the cTnI-positive group. One MACE was found in the cTnI-negative group. For 30-day SVT recurrence, the cTnI-positive group had a higher recurrence rate, without a statistically significant difference (20.7% vs. 7.2%, p = 0.075). Multivariable logistic regression analysis showed hypotension as an independent predictor of 30-day SVT recurrence (OR = 4.98; Cl 1.02–24.22; p = 0.047). Troponin had low value for predicting the outcomes of pediatric patients with SVT. The only significant predictor for recurrent SVT was initial hypotension.

An extract of hops (Humulus lupulus L.) modulates gut peptide hormone secretion and reduces energy intake in healthy weight men: a randomised, cross-over clinical trial

Background: Gastrointestinal enteroendocrine cells express a range of chemosensory receptors involved in detecting the chemical composition of food during digestion. These receptors, including bitter taste receptors (T2Rs), may play an important role in regulating gut function and appetite. Objective: To establish the ability of Amarasate®, a bitter supercritical CO2 extract of hops (Humulus lupulus L.) to modify acute energy intake, appetite and hormonal responses and establish a site of action. Design: Nineteen healthy-weight (BMI = 23.5 ± 0.3 kg/m2) male volunteers completed a randomised three-treatment, double blind, cross-over study with a 1 week washout between treatments. Overnight-fasted participants were cannulated and provided with a standardised 2 MJ breakfast meal. Treatments comprised a vehicle control (Placebo) or hops extract administered in either quick release (Gastric) or delayed release (Duodenal) capsules. Ad libitum energy intake was recorded at an outcome lunch (1200 h) and afternoon snack (1400 h), with blood samples taken and subjective ratings of appetite, gastrointestinal discomfort, vitality, meal palatability and mood assessed throughout the day. Results: Compared with placebo, both gastric and duodenal treatments significantly reduced total ad libitum energy intake by 911 ± 308 kJ and 944 ± 309 kJ, respectively. Both gastric and duodenal treatments significantly increased pre-meal ghrelin and post-prandial CCK, GLP-1 and PYY responses while reducing postprandial insulin, GIP and PP secretion with no significant impact on glycemia. In addition, gastric and duodenal treatments produced small but significant changes in measures of gastrointestinal discomfort, vitality and mood, with mild-moderate adverse GI symptoms reported in the gastric treatment only. However, no significant treatment effects were observed for any subjective measures of appetite or meal palatability. Conclusion: Both gastric and duodenal delivery of Amarasate modulate the release of hormones involved in appetite and glycaemic regulation, providing a potential bitter brake on energy intake in healthy-weight men.

Effects of two different doses of carbohydrate ingestion on taekwondo-related performance during a simulated tournament

Background Carbohydrate (CHO) ingestion enhances exercise performance; however, the efficacy of CHO intake on repeated bouts of exercise simulating a taekwondo tournament is unknown. Therefore, the purpose was to compare the effects of two different doses of CHO on a sports-specific kicking test during a simulated taekwondo tournament compared to placebo (PLA). Methods In a double-blind, randomized-placebo controlled, cross-over trial, eleven junior male professional taekwondo athletes (age: 16 ± 0.8 years, body mass: 55.3 ± 7.3 kg) ingested one of three solutions: (i) high dose (C45): 45 g of CHO (60 g∙h− 1), (ii) low dose (C22.5): 22.5 g of CHO (30 g∙h− 1; both solutions containing 2:1 glucose:fructose), or a PLA immediately following each kicking test. The kicking test was repeated 5 times, separated by 45 mins of rest, simulating a typical taekwondo competition day. Ratings of perceived exertion (RPE) and gastrointestinal discomfort (GI) scores were collected immediately after, and blood glucose before each test. Results The results revealed that C45 and C22.5 did not improve total, successful, or percentage of successful kicks compared to PLA (p > 0.05). Blood glucose was significantly higher following both CHO conditions compared with PLA across all five tests (p < 0.05). There were no differences between treatments or across tests for RPE (p > 0.05). Conclusion CHO intake, independent of the dose, did not alter taekwondo kick performance during a simulated taekwondo tournament.