A novel device in evaluating syncope

2000 ◽  
Vol 9 (4) ◽  
pp. 288-293 ◽  
Author(s):  
LG Futterman ◽  
L Lemberg
Keyword(s):  
Physical Examination ◽  
Patient Activation ◽  
Cost Effective ◽  
The Elderly ◽  
Loop Recorder ◽  
Novel Device ◽  
Cardiac Syncope ◽  
Common Causes ◽  
Insertable Loop Recorder ◽  
Automatic Capture

Syncope may be a manifestation of many diseases. The etiology is often difficult to determine. Much effort, time, and expense have been required to determine a diagnosis. A thorough history and physical examination are essential (Table 3). Several clinical pearls may be of help in the diagnosis of syncope: (a) the most important elements in the evaluation of syncope are a detailed history and physical examination; (b) syncope is a common problem in young healthy adults and the elderly; (c) a heavy meal is a specific cause of syncopy in the elderly (postprandial), however this etiology often goes unrecognized; (d) syncope is caused by 1 of 3 mechanisms: decreased cardiac output, systemic vascular resistance, or cerebrovascular disease; (e) reflex-mediated syndromes (vasovagal) are common causes of syncope in young adults, and orthostatic hypotension is an important cause of syncope in the elderly; and (f) the 1-year mortality of cardiac syncope (18%-33%) is significantly higher than that from non-cardiac syncope (0%-12%). A proven and useful tool has recently been advanced to aid in the evaluation of syncope. The Reveal Plus insertable loop recorder has auto activation that allows automatic capture and recording of arrhythmic events. Patient activation is an option. The recorder lasts 12 to 14 months and has proven to be a valuable and reliable cost-effective asset in our quest to evaluate syncope.

Early experience of laparoscopic cholecystectomy in acutely inflamed gallbladder

2018 ◽  
Vol 9 (SPL1) ◽  
Author(s):  
Ali Abdul Hussein Handoz ◽  
Ahmed Kh Alsagban
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Gall Stone ◽  
The Elderly ◽  
Stone Disease ◽  
Definitive Treatment ◽  
Adjacent Structures ◽  
Common Causes ◽  
Gall Stone Disease ◽  
Male To Female

Gallstones are now among the most important disease in the era of surgery. Definitive treatment of gall stone disease remains cholecystectomy. One of the common causes of emergency surgical referral is acute cholecystitis of which 50-70% cases are seen in the elderly patients.50 patients were treated with laparoscopic cholecystectomy from October 2013 to October 2015. The patient’s age was from 20 to 65 years old with a mean age of 34 ±3 years old. The patients received in the emergency unit and their attack not more than 72 hrs of acute gall stone inflammation were included in this study.From the 50 patients,15 were males (34%) and females were 35 (74%) so the ratio of 1:2of male to female. Problems and complications that facing in this study at time of laparoscopy were mainly adhesions to the adjacent structures like stomach, colon, and omentum. Adhesion into CBD also considered.Early intervention for acute cholecystitis of calculus type by laparoscopy now regarding safe and gold standard approach that should be kept in mind when dealing with such cases.

A cost-effective preventative approach to potentially save lives in the coronavirus pandemic, jointly using Vitamin D, Curcumin, and Vitamin C. Authors Bakare T A and Soar J S

2020 ◽  
Author(s):  
Jagjit S Soar
Keyword(s):  
Vitamin D ◽  
Vitamin C ◽  
Cost Effective ◽  
Risk Groups ◽  
The Elderly ◽  
Pharmaceutical Drugs ◽  
Over The Counter ◽  
Literature Searches ◽  
Pharmaceutical Agents ◽  
And Control

he current COVID-19 pandemic now believed to be based on the mutation of the SARS-CoV virus (first reported in 2002) to SARS-CoV-2 emerging in 2019, is naturally causing extreme worry and concern around the world with sometimes mixed and incoherent messages on how to deal with it. There is a plethora of information from previous epidemics caused by other coronaviruses such as severe acute respiratory syndrome, SARS (2002) and Middle East respiratory syndrome MERS (2012) from which we can extrapolate guidance on how to deal with the current pandemic. In the current absence of specific pharmaceutical agents, we propose assessing the extended tools that we already possess in our biological armoury to combat, prevent and control the spread of this virus. Using a set of precise criteria to locate such possible contenders, we conducted literature searches to find compounds that met these criteria. We have now reduced this to a shortlist of three agents that may be the best candidates. We propose vitamin C, vitamin D and Curcumin fit our criteria well. These compounds are widely available to the general public. They are available online and over-the-counter as supplements. Otherwise healthy individuals are safely able to self-administer these agents as a prophylactic to protect themselves and to enhance their immune response. This would be especially desirable for the elderly and at risk groups. These agents can also be used as adjunct therapy, particularly for those who may have early symptoms. This preventative therapy could be implemented whilst awaiting specific pharmaceutical drugs to emerge as a treatment for COVID-19. Our suggested compounds are a highly cost-effective way to potentially reduce the mortality that is regretfully mounting as a result of COVID-19 infection. The biological mode of action and the dosing of these compounds are summarised.

Telemedicine in the control of intra-ocular pressure

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 126-128 ◽  
Author(s):  
G Michelson ◽  
W Striebel ◽  
W Prihoda ◽  
Volker Schmidt
Keyword(s):  
Cost Effective ◽  
Western World ◽  
Pressure Curve ◽  
Effective Technique ◽  
Intra Ocular Pressure ◽  
Continuous Evaluation ◽  
Common Causes ◽  
Cost Effective Technique ◽  
Email Message ◽  
Ocular Pressure

Glaucoma is one of the most common causes of blindness in the Western world and a major risk factor is increased intra-ocular pressure. We therefore used telemedicine in its control. Patients measured their intra-ocular pressure several times a day with a portable instrument and the values were then entered into a portable digital assistant. These data were transmitted by a modem to a central server. If the intra-ocular pressure was pathologically high, an email message was automatically sent to the ophthalmologist. The pressure curve, including a statistical analysis, was displayed in an easily readable chart format. Ten patients with glaucoma participated in a trial. Self-tonometry with telemedicine enabled continuous evaluation of the patient by the ophthalmologist. This approach offered the advantage of controlling the treatment remotely. Advantages for the patient were that the measurements were easily done at home under normal conditions, and the patient could control when the measurement and data transmission would be performed. Telemedicine is a cost-effective technique enabling the early diagnosis of pathologically increased intra-ocular pressure.

Enhanced output of ZnO nanosheet-based piezoelectric nanogenerator with a novel device structure

2021 ◽  
Author(s):  
Siju Mishra ◽  
P. Supraja ◽  
Vishnu V. Jaiswal ◽  
P. Ravi Sankar ◽  
R. Rakesh Kumar ◽  
...  
Keyword(s):  
Output Voltage ◽  
Photoluminescence Property ◽  
Cost Effective ◽  
Design Strategy ◽  
Aluminum Substrate ◽  
Device Structure ◽  
Novel Device ◽  
Voltage Output ◽  
Zno Nanosheets ◽  
Side Coating

Abstract We report the double-fold enhancement of piezoelectric nanogenerator output voltage with a simple design strategy. The piezoelectric nanogenerator is fabricated with ZnO nanosheets coated on both sides of the aluminum substrate in this new design strategy with necessary electrodes. The cost-effective hydrothermal method is employed to synthesize two-dimensional (2D) ZnO nanosheets on both sides of the aluminum substrate at a low growth temperature of 80˚C for 4 hours. The ZnO nanosheets were characterized for their morphology, crystallinity, and photoluminescence property. The nanogenerator is fabricated with a double-side coated aluminum substrate and compared its performance with a single-side coated aluminum substrate. The nanogenerators fabricated only with one side coating produced an output voltage of ~ 170 mV. In contrast, the nanogenerators fabricated with a double side coating produced an output voltage of ~ 285 mV. The nanogenerator with double-side coating produced ~1.7 times larger voltage output compared to the voltage output from one side coated nanogenerators fabricated with each side of the substrate. The enhancement in the output

Non-Ceruloplasmin Copper as a Stratification Biomarker of Alzheimer’s Disease Patients: How to Measure and Use It

2021 ◽  
Vol 18 ◽  
Author(s):  
Rosanna Squitti ◽  
Mariacarla Ventriglia ◽  
Alberto Granzotto ◽  
Stefano L. Sensi ◽  
Mauro Ciro Antonio Rongioletti
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Clinical Trials ◽  
Cognitive Impairment ◽  
Cost Effective ◽  
The Elderly ◽  
The Body ◽  
Eligibility Criterion ◽  
Growing Body ◽  
Proper Balance

: Alzheimer’s disease (AD) is a type of dementia very common in the elderly. A growing body of recent evidence has linked AD pathogenesis to copper (Cu) dysmetabolism in the body. In fact, a subset of patients affected either by AD or by its prodromal form known as Mild Cognitive Impairment (MCI) have been observed to be unable to maintain a proper balance of Cu metabolism and distribution and are characterized by the presence in their serum of increased levels of Cu not bound to ceruloplasmin (non-ceruloplasmin Cu). Since serum non-ceruloplasmin Cu is a biomark- er of Wilson's disease (WD), a well-known condition of Cu-driven toxicosis, in this review, we pro- pose that in close analogy with WD, the assessment of non-ceruloplasmin Cu levels can be exploit- ed as a cost-effective stratification and susceptibility/risk biomarker for the identification of some AD/MCI individuals. The approach can also be used as an eligibility criterion for clinical trials aim- ing at investigating Cu-related interventions against AD/MCI.

scholarly journals New Onset of AV- Nodal Reentrant Tachycardia (AVNRT) in the elderly – an uncommon diagnosis?

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Grosse ◽  
R Surber ◽  
K Kirsch ◽  
P C Schulze
Keyword(s):  
Elderly Patients ◽  
Pacemaker Implantation ◽  
The Elderly ◽  
Slow Pathway ◽  
Av Node ◽  
Loop Recorder ◽  
Duration Of Symptoms ◽  
Holter Ecg ◽  
Surface Ecg ◽  
New Onset

Abstract Background Arrhythmias in elderly patients (>70 years) are common in daily clinical practice. Most frequently, they are based on atrial fibrillation or other atrial tachycardia with an indication for oral anticoagulation and specific antiarrhythmic medications. The electrographic (ECG) documentation related to symptoms is essential before therapy initiation. In case of suspected AVNRT based on surface ECG, an electrophysiological study (EP) with ablation as curative strategy should be planned. Methods We analysed all patients >70 years with AVNRT diagnosed by electrophysiologic (EP) studies between May 2018 and December 2020. Results An EP study for suspected AVNRT was performed in 27 patients >70 years. The diagnosis of AVNRT was confirmed in 20 patients (75%). From all EP- studies with the diagnosis of AVNRT (n=93) in this period, 20 patients (22%) were older than 70 years (mean age 77 years with a range of 70–85 years), 12 were women. In most of the patients, the duration of symptoms was short (3 month). Only 4 patients had symptoms of paroxysmal tachycardia longer than 10 years. Except for 2 patients, all patients had at least one ECG- documentation (12- lead- ECG, Holter- ECG, telemetric ECG and/or in the loop recorder). In 12 patients, a 12- lead- ECG- documentation was available, in 5 patients the tachycardia has been registered in the Holter-ECG and in 1 in a loop recorder. In the 12- lead- ECG before ablation in sinus rhythm the PQ interval was with 196 (120- 300) ms in the upper range. In 16/ 20 patients was during the EP- study a sustained AVNRT (CL 410, 314- 538 ms) inducible. In the others, up to 3 typical AV- nodal- echo beats were induced in the EP- study. A slow pathway ablation/ modification was performed in all patients in typical position. In 2 patients, the implantation of a dual- chamber- pacemaker was necessary due to intermittent high- degree AV-nodal-block during the same hospital stay. In both patients, a first degree AV-block with PQ- interval of 250 and 300 ms was pre-existing. Discussion Especially for the elderly patients with new onset of clinical symptoms of arrhythmia, clinical anamnesis including an ECG- documentation is required for planning the therapeutic strategy. A borderline long PQ- interval as sign of an age- dependent fibrosis in the AV- node and, therefore, altered conduction properties in the AV node can be a cause of AVNRT in these older patients. In patients with pre-existing long PQ- interval (>250 ms), the risk of pacemaker implantation after successful ablation is higher. In this group of patients, medical therapeutic options are limited and often associated with the need of pacemaker implantation. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Shenxian-Shengmai Oral Liquid Improves Sinoatrial Node Dysfunction through the PKC/NOX-2 Signaling Pathway

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Heng Zhang ◽  
Miao Hao ◽  
Lingkang Li ◽  
Keyan Chen ◽  
Jing Qi ◽  
...  
Keyword(s):  
Heart Rate ◽  
Signaling Pathway ◽  
Sinoatrial Node ◽  
Cardiac Conduction ◽  
Potential Mechanism ◽  
Cardiac Syncope ◽  
Common Causes ◽  
Oral Liquid ◽  
Masson Staining

Sick sinus syndrome (SSS) is one of the common causes of cardiac syncope and sudden death; the occurrence of SSS is associated with the accumulation of ROS in the sinoatrial node (SAN). Shenxian-shengmai (SXSM) is a traditional Chinese medicine available as oral liquid that causes a significant increase in heart rate. The objective of this study is to observe the improvement of SXSM on SAN function in SSS mice and explore its potential mechanism. In the current study, SSS was simulated in mice by inducing SAN dysfunction using a micro-osmotic pump to inject angiotensin II (Ang II). The mouse model with SSS was used to determine the effect of SXSM on SAN function and to explore its potential mechanism. Furthermore, the HL-1 cell line, derived from mouse atrial myocytes, was used to simulate SAN pacemaker cells. Our results indicated that SXSM significantly increased the heart rate of SSS mice by reducing the AngII-induced accumulation of ROS in the SAN and by inhibiting the expression of HDAC4, thereby reducing the loss of HCN4, a critical component of the cardiac conduction system. MASSON staining revealed a reduction of SAN damage in SSS mice that were treated with SXSM compared with controls. In vitro experiments showed that AngII treatment caused an upregulation of the PKC/NOX-2 signaling pathway in HL-1 cells which could be prevented by pretreatment with SXSM. The protective effect of SXSM was attenuated upon treatment with the PCK agonist PMA. In conclusion, SXSM reduced the AngII-induced accumulation of ROS in the SAN through the PKC/NOX2 signaling pathway, improving the functioning of the SAN and preventing the decrease of heart rate in SSS mice.

Cost-effective analysis of influenza vaccination in the elderly

AGE ◽  
1990 ◽  
Vol 13 (4) ◽  
pp. 81-85 ◽  
Author(s):  
Jill M. Maucher ◽  
Steven R. Gambert
Keyword(s):  
Influenza Vaccination ◽  
Cost Effective ◽  
The Elderly ◽  
Effective Analysis

Changes in the Human Vocal Tract Due to Aging and the Acoustic Correlates of Speech Production

2003 ◽  
Vol 46 (3) ◽  
pp. 689-701 ◽  
Author(s):  
Steve An Xue ◽  
Grace Jianping Hao
Keyword(s):  
Speech Production ◽  
Vocal Tract ◽  
Cost Effective ◽  
The Elderly ◽  
Cross Sectional ◽  
Men And Women ◽  
Acoustic Reflection ◽  
Dimensional Changes ◽  
Formant Frequencies ◽  
Age Related

This investigation used a derivation of acoustic reflection (AR) technology to make cross-sectional measurements of changes due to aging in the oral and pharyngeal lumina of male and female speakers. The purpose of the study was to establish preliminary normative data for such changes and to obtain acoustic measurements of changes due to aging in the formant frequencies of selected spoken vowels and their long-term average spectra (LTAS) analysis. Thirty- eight young men and women and 38 elderly men and women were involved in the study. The oral and pharyngeal lumina of the participants were measured with AR technology, and their formant frequencies were analyzed using the Kay Elemetrics Computerized Speech Lab. The findings have delineated specific and similar patterns of aging changes in human vocal tract configurations in speakers of both genders. Namely, the oral cavity length and volume of elderly speakers increased significantly compared to their young cohorts. The total vocal tract volume of elderly speakers also showed a significant increment, whereas the total vocal tract length of elderly speakers did not differ significantly from their young cohorts. Elderly speakers of both genders also showed similar patterns of acoustic changes of speech production, that is, consistent lowering of formant frequencies (especially F1) across selected vowel productions. Although new research models are still needed to succinctly account for the speech acoustic changes of the elderly, especially for their specific patterns of human vocal tract dimensional changes, this study has innovatively applied the noninvasive and cost-effective AR technology to monitor age-related human oral and pharyngeal lumina changes that have direct consequences for speech production.

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