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Introduction: Bipolar disorders (BD) are characterized by mood symptoms that can worsen medication side effects. We aimed to study the association between residual mood signs and self‐reported side effects in the euthymic phase of BD. Methods: We assessed residual mood signs using the Montgomery–Asberg Depression Rating scale (MADRS) and Young Mania Rating scale (YMRS) and self‐reported side effects using the Patient‐Rated Inventory of Side Effects (PRISE‐M) for 880 males and 1369 females with BD. We conducted a network analysis to test the associations between 52 items of the three scales for males and females separately. We then identified clusters of nodes that fit the networks well. Results: We report only positive associations between residual mood signs and side effects. An elevated mood (YMRS) in females and increased energy (YMRS) in males were central nodes, strongly influencing the development of additional mood symptoms and side effects. Furthermore, we identified three clusters of nodes in both sexes: (1) a "mood cluster", including most YMRS and MADRS items and the PRISE‐M items evaluating sedation, sleep, and restlessness, (2) a cluster of nonsexual side effects (mostly PRISE‐M items), and (3) a cluster of sexual side effects. In both sexes, we identified bridge nodes that may favor the communication between mood and side effects, namely palpitations (PRISE‐M) and agitation (PRISE‐M). Conclusions: The results justify the particular attention of practitioners to monitor elevated moods or increased energy to try to reduce self‐reported side effects and other residual mood symptoms in the euthymic phase of BD. Our findings suggest that clinicians could consider patient‐reported loss of energy, difficulty in falling asleep, and restlessness as mood symptoms rather than medications' side effects. Palpitations and agitation may contribute to the development of additional mood symptoms or somatic complaints. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion In patients with frequent premature ventricular contractions (PVCs), palpitations may not always be directly caused by PVCs, and therefore, it is essential to establish symptom‐rhythm correlations to determine the appropriate treatment. This study aims to analyze the palpitations and related factors in patients with frequent PVCs.The study enrolled patients with frequent PVCs who were not combined with other arrhythmias or structural heart disease. Through face‐to‐face consultation, patients were divided into symptomatic and asymptomatic groups. For symptomatic patients, the correlation between palpitations and PVC was further evaluated based on the temporal consistency of symptom onset and PVC occurrence. The demographic, clinical, and electrocardiogram features of the patients in each group were compared.Of the 214 patients enrolled, 124(57.9%) experienced palpitations. Compared to the asymptomatic group, the symptomatic group had a higher proportion of females (63.7% vs. 47.8%; p = .020) and a higher proportion of subjects with anxiety (44.4% vs.14.4%; p = .000). Within the symptomatic patients, 72 (33.60%) who had palpitations that were clearly correlated with PVCs were classified as the PVC‐relevant group. In this group, the PVC CI ratios were significantly lower (55% [52% −60%] vs. 62% [55% −67%]; p = .001) and the Post‐PVC CI were longer (1170 [1027–1270] vs. 1083 [960–1180] ms; p = .018) than in the PVC‐irrelevant group.A direct relationship between palpitations and PVCs could be established only in a minority of patients with frequent PVCs. PVCs with a relatively short PVC CI and a long post‐PVC CI were more likely to cause palpitations, whereas palpitations lasting only a few seconds were more likely to be directly relevant to PVCs. [ABSTRACT FROM AUTHOR]

Purpose: Post COVID-19 Condition (PCC), being persistent COVID-19 symptoms, is reminiscent of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)—a chronic multi-systemic illness characterised by neurocognitive, autonomic, endocrinological and immunological disturbances. This novel cross-sectional investigation aims to: (1) compare symptoms among people with ME/CFS (pwME/CFS) and people with PCC (pwPCC) to inform developing PCC diagnostic criteria; and (2) compare health outcomes between patients and people without acute or chronic illness (controls) to highlight the illness burdens of ME/CFS and PCC. Methods: Sociodemographic and health outcome data were collected from n = 61 pwME/CFS, n = 31 pwPCC and n = 54 controls via validated, self-administered questionnaires, including the 36-Item Short-Form Health Survey version 2 (SF-36v2) and World Health Organization Disability Assessment Schedule version 2.0 (WHODAS 2.0). PwME/CFS and pwPCC also provided self-reported severity and frequency of symptoms derived from the Canadian and International Consensus Criteria for ME/CFS and the World Health Organization case definition for PCC. Results: Both illness cohorts similarly experienced key ME/CFS symptoms. Few differences in symptoms were observed, with memory disturbances, muscle weakness, lymphadenopathy and nausea more prevalent, light-headedness more severe, unrefreshed sleep more frequent, and heart palpitations less frequent among pwME/CFS (all p < 0.05). The ME/CFS and PCC participants' SF-36v2 or WHODAS 2.0 scores were comparable (all p > 0.05); however, both cohorts returned significantly lower scores in all SF-36v2 and WHODAS 2.0 domains when compared with controls (all p < 0.001). Conclusion: This Australian-first investigation demonstrates the congruent and debilitating nature of ME/CFS and PCC, thereby emphasising the need for multidisciplinary care to maximise patient health outcomes. [ABSTRACT FROM AUTHOR]

Thoracic deformity affects circulatory dynamics, and postural changes may affect hemodynamics. We report on the case of a 10-year-old girl with straight back syndrome (SBS) and funnel chest in which a right ventricular outflow tract (RVOT) obstruction was demonstrated by dynamic echocardiography. The patient occasionally experienced chest discomfort in the standing and sitting positions. Chest radiography and computed tomography showed SBS and funnel chest as well as limited anteroposterior chest space. Although she had a grade 3 systolic ejection murmur due to RVOT obstruction, it disappeared in the supine position. The cardiothoracic ratio was 56 % in the supine position but increased to 67 % in the upright position. Echocardiography showed that the RVOT was maintained in the supine (1.0 m/s) but narrowed in the sitting (1.7 m/s) position. This is the first pediatric case showing RVOT obstruction during the upright position that has been shown by dynamic echocardiography. Dynamic echocardiography in both positions may be useful for evaluating RVOT stenosis. Patients with straight back syndrome and funnel chest have limited anteroposterior chest space, which may cause posture-dependent right ventricular outflow tract (RVOT) obstruction. Dynamic echocardiography in the supine and sitting position is useful to detect posture-dependent RVOT obstruction, which can be also observed in the pediatric population. [ABSTRACT FROM AUTHOR]

Copyright of China Brewing is the property of China Brewing Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Oxycodone, often used as an analgesic, is a potent opioid. While its effectiveness has been proven in the control of moderate to acute pain, excessive use of oxycodone imposes heart failure, heart palpitations, reduction of red blood cells, bone pain, and even death. Therefore, monitoring the oxycodone concentration in blood is vital for emergency care. For this purpose, a novel electrochemical sensor was designed based on a glassy carbon electrode modified with mesoporous g-C3N4 (M-C3N4), carbon nano-onions doped with nitrogen (N-CNO), and gold nanoparticles. At first, the SEM and XRD techniques were employed to characterize prepared M-C3N4 and N-CNO samples. The electro-oxidation behavior of the oxycodone was evaluated by cyclic and differential pulse voltammetric methods. Based on the influence of the potential scanning rate and solution pH on the voltammetric response of oxycodone oxidation, a redox mechanism was proposed. A 16 nM detection limit was acquired for the oxycodone analysis with a linear response in the 0.05–150 µM range. This sensor showed a remarkable ability for oxycodone detection in plasma samples. The long-term stability, superior selectivity, and reproducibility of this sensor prove its ability to measure oxycodone accurately and precisely in authentic spices. [ABSTRACT FROM AUTHOR]

Heart palpitations are the sensations or feelings that accompany an excessively rapid, skip-beat, or fluttering heartbeat. Heart palpitations can be brought on by a variety of factors, such as anxiety, tension, fear, caffeine, nicotine, some medications, dietpills, physical activity, and fever. Herbal remedies have long been utilized widely in the therapeutic management of palpitations because available synthetic medications have substantial negative effects. The purpose of this study is to assess the safety and effectiveness of the Unani medication Jawarish-e-Shahi in patients experiencing palpitations. The information provided here is an open-level, multicentric clinical study that was carried out at the "Regional Research Institute of Unani Medicine in Aligarh", Uttar Pradesh, from 2016 to 2019 on 74 cases of palpitation streated with Jawarish-e-Shahi. A p-value of<0.05 was proved to be significant in the statistical analysis of the presented data, which was conducted using one-way analysis of variance (ANOVA) and Dunnett's test. The study's findings, which were compared to baseline data from various follow-ups of palpitation cases treated with Jawarish-e-Shahi, demonstrated a notable improvement in a number of palpitation symptoms, including anxiety, perspiration, nausea, vomiting, and chest heaviness. A significant decline in diastolic pressure and pulse rate had also been observed. Reduction in number of pallor (pale appearance of patients) in baseline, 1st follow-up and post-treatment had been noted. Based on the investigation, the Unani medicine is safe and non-toxic. More research on a large size of population with palpitations is suggested for further study. [ABSTRACT FROM AUTHOR]

This article provides guidance on the evaluation and management of palpitations in primary care. It emphasizes the importance of conducting a thorough history and physical examination, as well as ordering diagnostic tests based on clinical assessment. Specialist referral should be considered for suspected cardiac causes or persistent symptoms. Therapy should be directed towards the underlying cause, and lifestyle modifications and reassurance can be effective in managing symptoms. The text also discusses the importance of targeted laboratory investigations and the use of screening tools for anxiety. [Extracted from the article]

ABSTRACT An 80‐year‐old patient, previously implanted for idiopathic sustained ventricular tachycardia with a Rivacor VR‐T DX implantable cardioverter defibrillator (ICD Biotronik, Berlin, Germany), came to our pacemaker clinic for palpitations. Electrocardiogram (ECG) showed sinus bradycardia with interpolated ventricular ectopic beats. A ventricular‐paced event occurred with a coupling interval shorter than the expected one suggesting ventricular undersensing. The phenomenon can be explained by the default ICD sensitivity setting proposed by the manufacturer. [ABSTRACT FROM AUTHOR]

Nondilated left ventricular cardiomyopathy (NDLVC) has been recently differentiated from dilated cardiomyopathy (DCM). A comprehensive characterization of these 2 entities using cardiac magnetic resonance (CMR) and genetic testing has never been performed. This study sought to provide a thorough characterization and assess clinical outcomes in a large multicenter cohort of patients with DCM and NDLVC. A total of 462 patients with DCM (227) or NDLVC (235) with CMR data from 4 different referral centers were retrospectively analyzed. The study endpoint was a composite of sudden cardiac death or major ventricular arrhythmias. In comparison to DCM, NDLVC had a higher prevalence of pathogenic or likely pathogenic variants of arrhythmogenic genes (40% vs 23%; P < 0.001), higher left ventricular (LV) systolic function (LV ejection fraction: 51% ± 12% vs 36% ± 15%; P < 0.001) and higher prevalence of free-wall late gadolinium enhancement (LGE) (27% vs 14%; P < 0.001). Conversely, DCM showed higher prevalence of pathogenic or likely pathogenic variants of nonarrhythmogenic genes (23% vs 12%; P = 0.002) and septal LGE (45% vs 32%; P = 0.004). Over a median follow-up of 81 months (Q1-Q3: 40-132 months), the study outcome occurred in 98 (21%) patients. LGE with septal location (HR: 1.929; 95% CI: 1.033-3.601; P = 0.039) was independently associated with the risk of sudden cardiac death or major ventricular arrhythmias together with LV dilatation, older age, advanced NYHA functional class, frequent ventricular ectopic activity, and nonsustained ventricular tachycardia. In a multicenter cohort of patients with DCM and NDLVC, septal LGE together with LV dilatation, age, advanced disease, and frequent and repetitive ventricular arrhythmias were powerful predictors of major arrhythmic events. [Display omitted] [ABSTRACT FROM AUTHOR]

Background Gender-related aspects in cardiac arrhythmias have gained increasing attention, still the understanding of peripartum electrical disorders remains vague. Case summary A 28-year-old woman developed palpitations and presyncopes during the post-partum period after her second pregnancy. Palpitations remained unclear until a self-recorded single-lead smartwatch ECG revealed a complete episode of a fast broad complex tachycardia (260 b.p.m.) that led to hospital admission. Echocardiography, cardiac magnetic resonance imaging, and exercise testing, showed no relevant abnormalities. Recording the tachycardia in a 12-lead-ECG could eventually be achieved revealing an inferior axis and positive concordance in the precordial leads. Episodes of ventricular tachycardia (VT) could be provoked by breast feeding and mental stress, but not induced in two electrophysiological studies. Genetic testing was normal. The patient continued to experience repeated, self-terminating VT episodes, lasting between 10 and 40 s, leading to presyncopes and a syncope with a fall. The beginning of symptoms subsequent to child birth and frequent premature ventricular contractions in her first pregnancy made hormone-induced arrhythmia a tentative diagnosis. Heart rate-corrected QT (QTc) intervals showed significant variability corresponding to the frequency of episodes in a retrospective evaluation. The cessation of breastfeeding led to a termination of arrhythmias. The patient was temporarily equipped with a wearable cardioverter defibrillator vest, an implantable cardioverter defibrillator (ICD) was not implanted. Discussion The case report highlights the potential of self-recorded, patient-activated ECG monitoring in diagnosing recurrent palpitations, and the dilemma of timing for implanting ICDs in young patients with ventricular arrhythmias (VTs). Additionally, it underlines the role of post-partum hormones in the susceptibility to ventricular arrhythmias, calling for further research of gender-specific, and pregnancy-associated arrhythmias. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine whether Foreign Language Anxiety (FLA) exists among adults in German-speaking countries and how it manifests itself in order to develop didactic implications for intervention. An online questionnaire based on the Foreign Language Classroom Anxiety Scale (Horwitz et al., 1986) and respective modifications (Bottger & Koltzsch, 2020) was used, along with closed and open-ended questions. The findings (n=412) confirmed the prevalence of FLA (31.7% with a strong manifestation), which was found to vary in different situations. Next to physical (e.g., palpitation) and behavioural symptoms (e.g., avoidance strategies), anxiousness and nervousness were reported and hinted to be person-dependent and situation independent. Finally, didactic consequences are drawn. [ABSTRACT FROM AUTHOR]

Context: Post-COVID palpitation with paresthesia, commonly referred to as long COVID, presents a complex challenge affecting a significant portion of individuals recovering from acute infection. The signs and symptoms of long COVID encompass a spectrum of manifestations, ranging from physical dysfunction to emotional anxiety and cognitive impairment. The treatment of long COVID has been a challenge for the community and affects individuals' personal well-being. Case Presentation: The patient was a 60-year-old female educational assistant from a high school. She complained of post-COVID palpitation with paresthesia. She sought acupuncture treatment after several emergency visits due to palpitation attacks. She underwent several cardiovascular examinations, which revealed no significant heart condition. She was treated with traditional Qi acupuncture along with kinesiology taping along the heart channels and home self-taping. Outcomes: The Qi Acupuncture was administered, encompassing eighteen acupuncture points spanning from the foot to the head, alongside the application of 4 strips of kinesiology taping along the heart and pericardium channels. Subsequent to the acupuncture intervention, the patient attested to a cessation of palpitations. Furthermore, an observed reduction of 90% in pins/needles paresthesia sensation was noted during a subjective interview following treatment. Conclusions: This case illustrates the use Qi Acupuncture and Kinesiology taping along the heart and pericardium channels to provide a favorable short-term outcome in a patient with Post COVID Palpitation with Paresthesia. [ABSTRACT FROM AUTHOR]

Background: Children who experience chest discomfort, palpitations, vasovagal syncope, and underlying heart disease often present a complex clinical picture. Not only are they dealing with potential cardiac issues, but they may also exhibit behavioral problems that can complicate the diagnostic and treatment process. Moreover, parental acceptance or rejection can significantly influence the child's well-being and medical outcomes in such cases. This study aims to explore the comorbidity of behavioral problems and parental acceptance-rejection in children diagnosed with these cardiac symptoms and underlying heart disease. Methods: In a case-control study, the Parental Acceptance - Rejection Questionnaire and Parental version of Strengths and Difficulties Questionnaire (SDQ) was filled by parents of 314 patients from pediatric cardiology clinic. Results: The control group scored substantially lower overall according to SDQ. The vasovagal syncope subgroup was found to have considerably lower scores on the subscale. The group with chest discomfort scored highly in hostility and aggression in the PARQ. In comparison to the other groups, the vasovagal syncope and chest pain group demonstrated higher scores in undifferentiated rejection and total score. Conclusion: This study showed a correlation between children's behavioral and emotional problems and cardiac symptoms. This states that children's relationship with their parents has an impact on their symptoms. It will be necessary to conduct further studies to determine a causal association and devise preventative measures. [ABSTRACT FROM AUTHOR]

Background: Since the COVID-19 pandemic, several cases of COVID-19 have been linked to the development of autoimmune disorders, including of the thyroid. Graves' disease (GD) is a rare complication that can occur following SARS-CoV-2 infection. Reports have linked COVID-19 to new onset and exacerbation of GD. We present a case of a 42-year-old woman with a history of GD presenting with impending thyroid storm 3 weeks following a diagnosis of COVID-19. Case Report: A 42-year-old woman with a history of GD presented to the Emergency Department (ED) for an acute exacerbation of hyperthyroidism 3 weeks after SARS-CoV-2 infection was diagnosed on a home test. Symptoms included daily headaches, increased bilateral eye pressure, fatigue, muscle weakness, episodes of confusion and agitation, persistent heart palpitations, and goiter. Elevated free T4 of 5.57, free T3 of 15.68, total T3 of 4.43, and near-absent thyroid stimulating hormone were noted. The Burch-Wartofsky scale was 40, which was concerning for an impending thyroid storm; however, at the time of admission, she was not in a thyroid storm. Treatment included propylthiouracil, potassium iodide oral solution, and propranolol, with symptom improvement. Due to prior history of intolerance to antithyroid medications and recent exacerbation, a thyroidectomy was performed once she was in a euthyroid state. Conclusions: Our case demonstrates the importance of recognizing COVID-19 as an etiology or a trigger for new onset or exacerbation of GD. Our case highlights that being vigilant to recognize the association between COVID-19 and thyroid abnormalities for early diagnosis and treatment is imperative. [ABSTRACT FROM AUTHOR]

Hypokalemic Periodic Paralysis (HPP) is a neurological manifestation of hypokalemia, with a prevalence of 1 in 100,000. HPP is recognized by the sudden onset of muscle paralysis and low serum potassium. Due to its various causes, it may be misdiagnosed and neglected. We present a case of 42-year-old Asian female with weakness of both legs and cramps. The weakness was felt upon awakening from sleep. She also complained of palpitation, tiredness, sweating, heat intolerance, and hand tremors. In the recent weeks, her appetite increased. Periodic paralysis (PP) is characterized by bursts of painless muscle weakening. A possible cause of periodic paralysis is hypokalemia which was found in our case. Hyperthyroid is classified into potassium depletion by extra renal route which was found in this case. Management When managing a patient with sudden onset weakness or paralysis, it is crucial to consider the possibility of periodic paralysis. HPP is a rare but serious medical emergency. This should be suspected in any patient presenting with sudden muscle weakness. Prompt correction of any abnormalities in potassium levels can lead to rapid and complete symptom resolution. To avoid persistent or recurrent paralysis, any underlying causes should be effectively managed wherever possible. [ABSTRACT FROM AUTHOR]

In the realm of complementary and alternative medicine, Cuscuta reflexa is sometimes referred as an Aftimoon, Amarbel, Akashbel, or Dodder. It is known as the miracle plant traditionally. The plant's medicinal characteristics are used to treat a number of ailments. It is frequently employed in the Unani system of medicine for its beneficial therapeutic benefits because of its active ingredients. Since ancient times, many herbal doctors have utilized this plant to cure a variety of illnesses, including epilepsy, schizophrenia, melancholia, and other neurological and mental diseases. It is also used as a mufrad (single drug) in the forms of powder, decoction, mixture, and murakkab (compound formulations) for the treatment of a variety of different ailments, including hepatitis, palpitations, and skin disorders including vitiligo, pityriasis, etc. Many compounds with medicinal potential and pharmacological and ethnomedical properties have been identified from this wonder plant. Cuscutin, Cuscutalin, Bergenin, Kaempferol, Amarbelin, and Sterol Glycosides are a few of the significant compounds found in it. Diverse pharmacological studies of Aftimoon have been reported such as antiinflammatory, cytotoxic, antipyretic, hepatoprotective, anticonvulsant, nematicide, anti-androgenic, hypocholestrolemic, antiandrogenic, hemolytic, diuretic, dermatigenic, immunostimulant, antiarthritic, antiasthma and anticancer activities. The information and understanding on ethnomedical applications, pharmacological studies from numerous classical Unani literature as well as contemporary research journals, and various scientific studies being done on Cuscuta reflexa will be provided through this review. [ABSTRACT FROM AUTHOR]

Introduction: Paraganglioma of the urinary bladder (PUB) is an extremely rare extra-adrenal catecholamine-secreting neuroendocrine tumor, accounting for only 0.05% of all bladder tumors and 1% of all pheochromocytomas. The clinical presentation of PUB can be diverse and challenging to diagnose. Case Presentation: This case report presents a 37-year-old man with post-micturition palpitation, headache, and sweating, with no history of hematuria or other irritative urinary symptoms. Ultrasound and contrast-enhanced computed tomography revealed a suspicious mass in the right posterolateral wall of the urinary bladder. Despite normal functional hormonal tests, the diagnosis of PUB was confirmed after surgical enucleation and histopathological examination. Conclusion: This report emphasizes the importance of considering PUB as a differential diagnosis in patients with post-micturition symptoms and paroxysmal hypertension, as well as the need for a multidisciplinary approach in the evaluation and management of such rare and complex cases. Early recognition and surgical intervention are crucial for optimal management and favorable clinical outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Heart & Vascular Diseases / Choroby Serca & Naczyn is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Numerous symptoms of hypothyroidism, or an underactive thyroid, include fatigue, joint discomfort, heart palpitations, and sadness. Additionally, hypothyroidism slows down metabolism in general, increasing a person's risk of weight gain. Exercise helps increase muscle mass and cardiovascular health while easing many hypothyroidism symptoms. Objective: This research examines the influence of Pilates and aerobic exercise on depression, life' quality, and functional capacity in women diagnosed with hypothyroidism. Methods: Sixty adult women with a history of controlled primary hypothyroidism were randomly subdivided into three groups (A, B, C ). Group(A)(n=25) received Pilates in addition to medication and nutritional advice, Group(B) (n=25) received aerobic exercises in addition to medication and nutritional advice. Group(C), the control group (n=10), received medication and nutritional advices only. The assessment of functional capacity involved the measurement of the 6-minute Walk Distance, quality of life was assessed by the SF-36 scale, and depression was evaluated by Primary care Screening Questionnaire for Depression PSQ4D. Results: 6-minute Walk Distance and SF-36 scale significantly elevated (p= 0.05), and primary care screening questionnaire for depression (p= 0.05), the scores of the three groups exhibited a significant decrease when compared to the baseline. The results of the inter-group comparison proved that both group A and group B exhibited significantly greater scores compared to group C in relation to the final 36-Item Short Form Survey scale, 6-minute Walk Distance, and primary care screening questionnaire for depression. Conclusion: 12 weeks of training with Pilates exercises had a more significant effect on functional capacity and quality of life than aerobic exercise or medications only. Both Pilates and aerobic exercises had the same effect on depression levels. [ABSTRACT FROM AUTHOR]

Objective: To see the hematological manifestations in patients with aplastic anemia presenting with hypocellular marrow. Study Design: Cross-sectional study. Setting: Department of Pathology, Pak Emirates Hospital, Rawalpindi. Period: January 2022 to June 2022. Material & Methods: Using non-probability consecutive sampling was done. All the patients were diagnosed of Aplastic anemia using standard established criteria. All the patients with hypocellular marrow without any granuloma, fibrosis or abnormal cells were included. A detailed history was taken from the patients, proforma was filled by consultants or trained doctors. Patients' interview was followed by Bone Marrow Examination. Statistical analysis was done using SPSS version 17.0. Descriptive statistics included frequency distribution of qualitative variables and calculation of mean with range for quantitative variables was done. Limitations were a lack of molecular testing to exclude the inherited bone marrow failure syndromes. Results: A total of 247 bone marrows were done in one year which were included in the study. Out of which ten patients had aplastic anemia and one patient had pure red cell aplasia which is the early form of aplastic anemia. Frequency of aplastic anemia in our study during the study period was found to be 4.45%. Minimum age of presentation is 5 years and maximum is 78 years with mean age of 43 years. Gender distribution is as 6 were males and 5 females out of total 11 aplastic anemia patients. In haematological manifestations 7 patients presented with history of bleeding from nose and gum. While rest of the 4 patients had fever, palpitations, breathing difficulties and generalized weakness. Conclusion: As we concluded that predisposing factors like younger age group and male predominance are leading toward genetic inheritance in aplastic anemia etiology especially among the South Asian population. The most common and foremost presentation in these patients was bleeding so aplastic anemia should be excluded when patients present with bleeding, fever and palpitations., Therefore, it is far better to early diagnosis and treat the patients to minimize the disease evolution. [ABSTRACT FROM AUTHOR]

Background. Depression stands as a significant mood disorder on a global scale. It is known that some physical symptoms show significant positive predictive values (PPV) for depression, such as sleep disturbances (PPV – 61%), fatigue (PPV – 60%), experiencing three or more complaints (PPV – 56%), nonspecific musculoskeletal complaints (PPV – 43%), back pain (PPV – 39%), amplified complaints (PPV 39%), and vaguely expressed complaints (PPV – 37%). The aim of this study. This study aims to evaluate the correlations of subjective expressions of somatic, cognitive, and depressive symptoms severity among individuals at risk of depressive disorder. Methods. The survey consisted of a questionnaire designed by the authors regarding sociodemographic information and two standard questionnaires: PHQ-9 and PHQ-15. Results. 189 individuals had significant severity of depressive symptoms. Multivariable regression analysis indicated that PHQ-9 factor 2 (somatic symptoms) was associated with higher rates of back pain (β = 0.250, p < 0.001), pain in arms, legs, or joints (β = 0.488, p < 0.001), menstrual cramps (β = 0.640, p < 0.001), pain or problems during sexual intercourse (β= 0.270, p < 0.001), headaches (β = 0.304, p < 0.001), chest pain (β = 0.304, p < 0.001), dizziness (β = 0.594, p < 0.001), heart palpitations (feeling heart pound or race) (β = 0.266, p < 0.001), nausea, gas or indigestion (β = 0.281, p < 0.001) and feeling tired or having low energy (β = 0.223, p < 0.001), after adjusting each regression model for the potential confounders. Conclusions. It can be emphasized that individuals who are at risk of developing depression may experience various somatic symptoms that are conditioned by their depressive state. The obtained results indicate that the following research is required to identify other factors affecting the severity of the disease and to determine more sufficient treatment plans. [ABSTRACT FROM AUTHOR]

IgG4-related pericarditis has rarely been reported. Here, we report a case of IgG4-related disease that presented with pericardial effusion. A 67-year-old female who presented with palpitations and chest pain was admitted because of a large amount of pericardial effusion that required drainage. The patient underwent pericardial drainage, and the symptoms were gradually alleviated. IgG4 levels were elevated in the serum and pericardial effusions. A biopsy specimen of 18F-FDG accumulated in the submandibular gland showed lymphocyte infiltration with IgG4-positive cells. The patient was diagnosed with IgG4-related pericarditis. Glucocorticoids resolved serological and imaging abnormalities. Prompt treatment improves the disease status. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Middle‐aged male athletes, with or without underlying coronary artery disease, exhibiting exercise induced blood pressure (BP) variability and diabetes can have an increased risk of developing atrial fibrillation (AF). Assessment in athletes should include long‐term arrhythmia monitoring. In addition, it is important to exert patients beyond their calculated target heart rate (HR) during an exercise stress test to detect exercise‐induced AF. We suggest this strategy be specifically used for athletes with complaints of intermittent palpitation and chest pain. Referral to an electrophysiologist for a possible ablation procedure should be considered for the management of AF in athletes in whom the use of beta‐blockers may limit exercise tolerance. Bleeding risk with the use of oral anticoagulation needs to be adequately evaluated in athletes with AF who engage in high‐intensity exercise or activities. The report highlights the case of a 54‐year‐old Caucasian male (height 5.11′, BMI 29.8) who presented with complaints of chest pain, mild coronary artery disease, palpitation, dizziness, and labile BP with high‐intensity biking exercise. Diagnostic tests (exercise stress test, cardiac catheterization, Holter monitor, and Bardy patch) using standard procedure were unsuccessful at detecting the problem. In a repeat exercise stress test, the patient was exerted beyond the calculated HRmax (up to 117%) when the patient's heart rhythm flipped from sinus rhythm to AF. The patient was referred to a cardiac electrophysiologist and an ablation procedure was performed to prevent exercise‐induced AF with high‐intensity exercise. Young adults, with or without early coronary artery disease, performing high‐intensity endurance exercises may be at risk of developing exercise‐induced AF. This phenomenon is prevalent and well documented in the skiing population and patients with variance in BP during exercise. Endurance athletes tend to have a lower resting HR. As such, the use of standard rate‐control medications in patients with exercise‐induced AF may not be appropriate. Referral to a cardiac electrophysiologist and ablation procedures should be considered in this population for management and symptom control. If tolerated, especially in young adults with complaints of palpitation and chest pain, patients should be exerted beyond their calculated HRmax during an exercise stress test to diagnose an underlying condition of exercise‐induced AF. [ABSTRACT FROM AUTHOR]

Introduction: Despite advances in the treatment of bipolar disorder (BD), most patients do not achieve complete inter-episode recovery and functional disability is common. During periods of relative remission, many patients continue to experience neurocognitive dysfunction, reduced daytime activity levels, and sleep disturbances. This 8-week, randomized, placebo-controlled pilot study evaluated the feasibility, safety and preliminary efficacy of the wake-promoting drug, modafinil (Provigil®), on neurocognitive functioning, daytime sleepiness, and sleep quality in affectively-stable BD patients. Methods: Twelve individuals with affectively-stable BD were recruited and randomized to a flexible dose of modafinil (100 to 200 mg/day) or placebo, adjunctive to a therapeutic dose of a mood stabilizer. Weekly in-person visits tracked sleep quality and daytime sleepiness as well as side effects and mood symptoms. Neurocognitive functioning was assessed at baseline, week 4, and week 8. Results: No serious adverse events were reported. Newly emergent side effects in the modafinil group included heart palpitations, itching, fatigue, and decreased energy. Two patients discontinued modafinil owing to side effects and one of these patients withdrew from the study. One patient discontinued placebo and was withdrawn from the study. Preliminary evaluations of clinical efficacy showed a marginally significant interaction between treatment group and time in two cognitive domains (speed of processing and verbal learning), indicating greater improvement in the modafinil group versus placebo. Additionally, there was a marginally significant effect of treatment group on daytime sleepiness, suggesting lower daytime sleepiness in the modafinil group versus placebo. Counterintuitively, we found a significant treatment group by time interaction effect on sleep quality, suggesting greater improvement in sleep quality in the placebo group versus the modafinil group. Discussion: Results suggest that modafinil is a relatively safe medication for affectively-stable BD patients when given with adjunctive mood stabilizers. Results are suggestive of cognitive benefit and improved daytime sleepiness, but worse sleep quality in those patients prescribed modafinil. A fully powered clinical trial is warranted with specific attention to the characteristics of patients who are most likely to benefit from treatment with modafinil and other methodological lessons learned from this pilot. [ABSTRACT FROM AUTHOR]

A 54-year-old male without medical history presented to our emergency department with sudden chest pain and palpitations. Electrocardiogram showed wide QRS tachycardia similar to left bundle branch block. Electrophysiological study showed fast/slow type atrioventricular nodal reentrant tachycardia and revealed transient HV block during tachycardia. [ABSTRACT FROM AUTHOR]

Background: Parathyroid cysts are rare entities. They account for less than 0.5% of parathyroid lesions. They are divided into two main groups: functioning and non-functioning. Case description: We present a 36-year-old woman with complaints of palpitations, sweating, and nervousness of about 2 months' duration. From an ultrasound of the thyroid gland with data on anechoic formation under the lower pole of the left lobe of the thyroid gland with dimension 14/16/24 mm. Fine needle aspiration (FNA) of the formation was performed with aspiration of about 5 ml of clear liquid and examination of washout. PTH from the washout of the extrathyroidal lesion-1040 pg/ml. A month later with ultrasound data on recurrence of the formation; repeated aspiration of about 5 ml of blood fluid was performed with subsequent application of 1 ml of absolute alcohol intranodal. Conclusion: Thirty days after the procedure with ultrasound data of slight regression in the dimension: 10/11/20 mm. [ABSTRACT FROM AUTHOR]

Key Clinical Message Middle‐aged male athletes, with or without underlying coronary artery disease, exhibiting exercise induced blood pressure (BP) variability and diabetes can have an increased risk of developing atrial fibrillation (AF). Assessment in athletes should include long‐term arrhythmia monitoring. In addition, it is important to exert patients beyond their calculated target heart rate (HR) during an exercise stress test to detect exercise‐induced AF. We suggest this strategy be specifically used for athletes with complaints of intermittent palpitation and chest pain. Referral to an electrophysiologist for a possible ablation procedure should be considered for the management of AF in athletes in whom the use of beta‐blockers may limit exercise tolerance. Bleeding risk with the use of oral anticoagulation needs to be adequately evaluated in athletes with AF who engage in high‐intensity exercise or activities. Abstract The report highlights the case of a 54‐year‐old Caucasian male (height 5.11′, BMI 29.8) who presented with complaints of chest pain, mild coronary artery disease, palpitation, dizziness, and labile BP with high‐intensity biking exercise. Diagnostic tests (exercise stress test, cardiac catheterization, Holter monitor, and Bardy patch) using standard procedure were unsuccessful at detecting the problem. In a repeat exercise stress test, the patient was exerted beyond the calculated HRmax (up to 117%) when the patient's heart rhythm flipped from sinus rhythm to AF. The patient was referred to a cardiac electrophysiologist and an ablation procedure was performed to prevent exercise‐induced AF with high‐intensity exercise. Young adults, with or without early coronary artery disease, performing high‐intensity endurance exercises may be at risk of developing exercise‐induced AF. This phenomenon is prevalent and well documented in the skiing population and patients with variance in BP during exercise. Endurance athletes tend to have a lower resting HR. As such, the use of standard rate‐control medications in patients with exercise‐induced AF may not be appropriate. Referral to a cardiac electrophysiologist and ablation procedures should be considered in this population for management and symptom control. If tolerated, especially in young adults with complaints of palpitation and chest pain, patients should be exerted beyond their calculated HRmax during an exercise stress test to diagnose an underlying condition of exercise‐induced AF.

Background: Observational studies suggest that electrocardiogram (ECG) indices might be influenced by obesity and other anthropometric measures, though it is difficult to infer causal relationships based on observational data due to risk of residual confounding. We utilized mendelian randomization (MR) to explore causal relevance of multiple anthropometric measures on P-wave duration (PWD), PR interval, QRS duration, and corrected QT interval (QTc). Methods and findings: Uncorrelated (r2 < 0.001) genome-wide significant (p < 5 × 10−8) single nucleotide polymorphisms (SNPs) were extracted from genome-wide association studies (GWAS) on body mass index (BMI, n = 806,834), waist:hip ratio adjusted for BMI (aWHR, n = 697,734), height (n = 709,594), weight (n = 360,116), fat mass (n = 354,224), and fat-free mass (n = 354,808). Genetic association estimates for the outcomes were extracted from GWAS on PR interval and QRS duration (n = 180,574), PWD (n = 44,456), and QTc (n = 84,630). Data source GWAS studies were performed between 2018 and 2022 in predominantly European ancestry individuals. Inverse-variance weighted MR was used for primary analysis; weighted median MR and MR-Egger were used as sensitivity analyses. Higher genetically predicted BMI was associated with longer PWD (β 5.58; 95%CI [3.66,7.50]; p = < 0.001), as was higher fat mass (β 6.62; 95%CI [4.63,8.62]; p < 0.001), fat-free mass (β 9.16; 95%CI [6.85,11.47]; p < 0.001) height (β 4.23; 95%CI [3.16, 5.31]; p < 0.001), and weight (β 8.08; 95%CI [6.19,9.96]; p < 0.001). Finally, genetically predicted BMI was associated with longer QTc (β 3.53; 95%CI [2.63,4.43]; p < 0.001), driven by both fat mass (β 3.65; 95%CI [2.73,4.57]; p < 0.001) and fat-free mass (β 2.08; 95%CI [0.85,3.31]; p = 0.001). Additionally, genetically predicted height (β 0.98; 95%CI [0.46,1.50]; p < 0.001), weight (β 3.45; 95%CI [2.54,4.36]; p < 0.001), and aWHR (β 1.92; 95%CI [0.87,2.97]; p = < 0.001) were all associated with longer QTc. The key limitation is that due to insufficient power, we were not able to explore whether a single anthropometric measure is the primary driver of the associations observed. Conclusions: The results of this study support a causal role of BMI on multiple ECG indices that have previously been associated with atrial and ventricular arrhythmic risk. Importantly, the results identify a role of both fat mass, fat-free mass, and height in this association. In a Mendelian randomization study, Fu Siong Ng and colleagues investigate how different anthropometric measures influence proarrhythmic 12-lead ECG indices. Author summary: Why was the study done?: Previous studies have shown that a higher body mass index (BMI) is associated with changes in electrocardiogram (ECG) measurements. However, it is unclear from available research whether this is driven by fat mass or by lean mass because BMI does not differentiate between these. Additionally, most available data come from observational studies, which are liable to confounding and reverse causation. This limitation can be overcome by the use of mendelian randomization (MR) What did the researchers do and find?: In this MR study, the authors explored the association between higher genetically predicted BMI, fat mass, fat free mass, weight, height, and waist:hip ratio and ECG measures of atrial and ventricular conduction. The authors found that higher genetically predicted BMI was associated with many ECG indices that have been linked to arrhythmic risk and that this was driven by fat mass, fat free mass, and height. What do the findings mean?: In this study, lean body mass traits appear to correlate with proarrhythmic electrophysiological remodeling. These data may help to risk stratify individuals who would benefit from targeted weight management interventions. The main limitations are inclusion of data from only predominantly European ancestry populations, and the inability to establish whether a single body size measure might be the most important in driving the associations. [ABSTRACT FROM AUTHOR]

Patients infected with SARS-CoV-2 Omicron, referred to as a pathogenic toxin in traditional Chinese medicine (TCM), in the convalescent period suffer from a high incidence of palpitations and generally present TCM patterns of qi deficiency. The main pathogenic mechanisms are that (i) the toxin of plague severely injured the human body,resulting in acute deficiency of vital qi; (ii) the damage of sanjiao (a TCM term) energy resulted in the deficiency of producing nutrient qi, defensive qi, and pectoral qi; and (iii) the qi and yin of heart and lung were drained, leading to internal blockade of blood stasis, qi collapse in the chest, qi obstruction, malnutrition of heart blood, and static blood blocking the hear collateral. There is also the pathogenesis of palpitations caused by excessive sweating and disharmony of yin and yang. Furthermore, some COVID-19 patients with palpitations in the convalescent period suffer from qi deficiency inducing dampness obstruction and lingering remnant pathogen. Treatment of symptoms related to palpitations caused by SARS-CoV-2 Omicron should focus on strengthening vital qi to eliminate the pathogenic factor, including benefiting qi and nourishing yin, invigorating qi for ascending, and promoting blood circulation for removing blood stasis, while diffusing pathogen and removing dampness in the condition of lingering remnant pathogen. [ABSTRACT FROM AUTHOR]

Lipomatous hypertrophy of the interatrial septum is increasingly recognized and should be considered as part of the differential diagnosis of any cardiac tumor. We present the case of a 70-year-old patient who presented to the outpatient service for palpitations. Transthoracic echocardiogram (TTE) detected thickening of the interatrial septum with proximal predominance with respect to the fossa ovalis. The diagnosis was confirmed by cardiac magnetic resonance imaging. In such cases, the opinion of a cardiologist with expertise in cardiac imaging would help to avoid misdiagnosis and unnecessary intervention. This condition is more common than initially thought and remains under-recognized by most physicians. [ABSTRACT FROM AUTHOR]

This study aims to determine academics' conflict resolution skills when problems arise in their interpersonal relationships. The data obtained to achieve this objective included academics' sociodemographic distribution and administrator-staff relations in the university, the atmosphere among the stakeholders, the administrators' relationships with teachers, students, and parents, the distribution of jobs between administrators and staff, and academics' physical reactions of academic to conflict resolution. This qualitative study was conducted as a case study. The population of the study consisted of 20 academics working in a private university in Nicosia, in Northern Cyprus (Turkish Republic of Northern Cyprus) during the 2021-2022 academic year. Purposeful sampling to represent the study population was first determined using the purposeful sampling method; the snowball sampling technique would be used as long as different views were obtained. The majority of the participants consisted of women, most of whom were aged 30-40 years, married, had children, and 16 or more years of professional experience. A semi-structured interview form, which was prepared by the researcher, was used as a data collection tool. The research data were analyzed using the content analysis method. The results showed that the established relationship was positive and authoritarian. The participants expressed their views on the need to create a positive atmosphere among stakeholders and strengthen communication, and highlighted such illnesses as physical stress, heart palpitations, difficulty in breathing, headache, neck pain, shoulder pain, and depressive mood. [ABSTRACT FROM AUTHOR]

Mephentermine, a stimulant drug, is used as vasoconstrictor to maintain blood pressure in hypotensive states and shock, but due to its stimulant effects on the central nervous system, it has also been used for performance enhancement by athletes. Here, we discuss three cases where the patients had used mephentermine to enhance their work performance. Case 1: A male in his 30's, presented with palpitation, headache, and hypertension after 1 year of use of mephentermine which he had started using with the purpose of increasing his work performance. Case 2: A 22-year-old male presented with depressive symptoms following a 3-year history of use of mephentermine after being suggested by peers to enhance performance at gym. Case 3: A 22-year-old male with 2-year history of mephentermine, presented with withdrawal symptoms, after being introduced to mephentermine by his peers to improve physical performance and difficulty stopping its use on his own. It was found that the purpose of mephentermine abuse in all three discussed cases was to enhance performance, either at sports or workplace, which gradually lead to physical or mental complications or withdrawal symptoms. It thus seems imperative to create awareness about the harmful and addictive effects of mephentermine to masses, and simultaneously limiting its easy availability. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases are the leading cause of morbidity and mortality in adults worldwide. There is one common pathophysiological aspect present in all cardiovascular diseases—dysfunctional heart rhythm regulation. Taking this aspect into consideration for cardiovascular risk predictions opens important research perspectives, allowing for the development of preventive treatment techniques. The aim of this study was to find out whether certain pathologically appearing signs in the heart rate variability (HRV) of an apparently healthy person, even with high HRV, can be defined as biomarkers for a disturbed cardiac regulation and whether this can be treated preventively by a drug-free method. This multi-phase study included 218 healthy subjects of either sex, who consecutively visited the physician at Gesundheit clinic because of arterial hypertension, depression, headache, psycho-emotional stress, extreme weakness, disturbed night sleep, heart palpitations, or chest pain. In study phase A, baseline measurement to identify individuals with cardiovascular risks was done. Therefore, standard HRV, as well as the new cardiorhythmogram (CRG) method, were applied to all subjects. The new CRG analysis used here is based on the recently introduced LF drops and HF counter-regulation. Regarding the mechanisms of why these appear in a steady-state cardiorhythmmogram, they represent non-linear event-based dynamical HRV biomarkers. The next phase of the study, phase B, tested whether the pathologically appearing signs identified via CRG in phase A could be clinically influenced by drug-free treatment. In order to validate the new CRG method, it was supported by non-linear HRV analysis in both phase A and in phase B. Out of 218 subjects, the pathologically appearing signs could be detected in 130 cases (60%), p < 0.01, by the new CRG method, and by the standard HRV analysis in 40 cases (18%), p < 0.05. Thus, the CRG method was able to detect 42% more cases with pathologically appearing cardiac regulation. In addition, the comparative CRG analysis before and after treatment showed that the pathologically appearing signs could be clinically influenced without the use of medication. After treatment, the risk group decreased eight-fold—from 130 people to 16 (p < 0.01). Therefore, progression of the detected pathological signs to structural cardiac pathology or arrhythmia could be prevented in most of the cases. However, in the remaining risk group of 16 apparently healthy subjects, 8 people died due to all-cause mortality. In contrast, no other subject in this study has died so far. The non-linear parameter which is able to quantify the changes in CRGs before versus after treatment is FWRENYI4 (symbolic dynamic feature); it decreased from 2.85 to 2.53 (p < 0.001). In summary, signs of pathological cardiac regulation can be identified by the CRG analysis of apparently healthy subjects in the early stages of development of cardiac pathology. Thus, our method offers a sensitive biomarker for cardiovascular risks. The latter can be influenced by non-drug treatments (acupuncture) to stop the progression into structural cardiac pathologies or arrhythmias in most but not all of the patients. Therefore, this could be a real and easy-to-use supplemental method, contributing to primary prevention in cardiology. [ABSTRACT FROM AUTHOR]

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Background: The brain and heart are strictly linked and the electrical physiologies of these organs share common pathways and genes. Epilepsy patients have a higher prevalence of electrocardiogram (ECG) abnormalities compared to healthy people. Furthermore, the relationship between epilepsy, genetic arrhythmic diseases and sudden death is well known. The association between epilepsy and myocardial channelopathies, although already proposed, has not yet been fully demonstrated. The aim of this prospective observational study is to assess the role of the ECG after a seizure. Materials and Methods: From September 2018 to August 2019, all patients admitted to the emergency department of San Raffaele Hospital with a seizure were enrolled in the study; for each patient, neurological, cardiological and ECG data were collected. The ECG was performed at the time of the admission (post-ictal ECG) and 48 h later (basal ECG) and analyzed by two blinded expert cardiologists looking for abnormalities known to indicate channelopathies or arrhythmic cardiomyopathies. In all patients with abnormal post-ictal ECG, next generation sequencing (NGS) analysis was performed. Results: One hundred and seventeen patients were enrolled (females: 45, median age: 48 ± 12 years). There were 52 abnormal post-ictal ECGs and 28 abnormal basal ECGs. All patients with an abnormal basal ECG also had an abnormal post-ictal ECG. In abnormal post-ictal ECG, a Brugada ECG pattern (BEP) was found in eight patients (of which two had BEP type I) and confirmed in two basal ECGs (of which zero had BEP type I). An abnormal QTc interval was identified in 20 patients (17%), an early repolarization pattern was found in 4 patients (3%) and right precordial abnormalities were found in 5 patients (4%). Any kind modification of post-ictal ECG was significantly more pronounced in comparison with an ECG recorded far from the seizure (p = 0.003). A 10:1 higher prevalence of a BEP of any type (particularly in post-ictal ECG, p = 0.04) was found in our population compared to general population. In three patients with post-ictal ECG alterations diagnostic for myocardial channelopathy (BrS and ERP), not confirmed at basal ECG, a pathogenic gene variant was identified (KCNJ8, PKP2 and TRMP4). Conclusion: The 12-lead ECG after an epileptic seizure may show disease-related alterations otherwise concealed in a population at a higher incidence of sudden death and channelopathies. Post-ictal BEP incidence was higher in cases of nocturnal seizure. [ABSTRACT FROM AUTHOR]

Study Objective: This report highlights the effects of discontinuing venlafaxine on thyroid function in an older adult with previously well‐managed Hashimoto thyroiditis and sleep apnea. Design: Concurrent intervention. Case study. Setting Community‐based psychiatry practice Patient ‐ 66 year old female Intervention Over 8 months, a 66‐year‐old patient slowly reduced the venlafaxine dose. She was treated simultaneously for sleep apnea. Measurements Clinical data including venlafaxine and levothyroxine dosing, thyroid hormone laboratory values, subjective complaints, and objective electrocardiographic (ECG) findings were aggregated and analyzed. Main Results: As venlafaxine dose was decreased over time, the patient complained of bounding heart palpitations shown to be premature ventricular contractions, and wide and narrow complex ventricular tachycardia on ECG. Thyroid‐stimulating hormone decreased from a baseline value of 0.791 uIU/mL to a nadir of 0.18 uIU/mL during venlafaxine dosage reduction from 225 mg/day to 155 mg/day. Cardiac symptoms subsided following levothyroxine dosage reduction. Conclusions: There was a direct relationship between antidepressant dosage reduction and levothyroxine dosage requirements. Cautious monitoring is recommended during venlafaxine deprescribing in patients with pre‐existing thyroid disease. [ABSTRACT FROM AUTHOR]

Background: Post-COVID-19 syndrome is a result of triggering various immune pathways and metabolic disturbances. Basti is an important per rectal Ayurveda-based treatment having multi-targeted actions. Basti and Rasayana treatment modulate immune responses by regulating pro-inflammatory cytokines, immune globulins, and functional properties of T cell. We propose to study the clinical evaluation of Basti along with Rasayana (rejuvenation therapy) on symptoms of post-COVID 19 syndrome. Methods and analysis: We designed a prospective, open-labeled proof of concept pragmatic study. The study duration is 18 months, and the intervention period are 35 days from the day of enrollment of the patients. The patients will be treated on the basis of Ayurvedic classification of Santarpanottha (over nutrition) symptoms and Apatarpanottha (lack of nutrition) symptoms. The Santarpanottha group will be treated within 3–5 days of oral Guggulu Tiktak Kashayam followed by 8 days of Yog Basti treatment and then 21 days of Rasayana therapy with Brahma Rasayan. The Apatarpanottha group will be treated within 3–5 days of oral Laghumalini Vasant, followed by 8 days of Yog Basti treatment and then 21 days of Kalyanak Ghrit. The outcome measures of this study will be to evaluate the changes in fatigue severity scale, MMRC dyspnea chest pain scale, pain score assessed by VAS scale, smell and taste scale, WOMAC scale, Hamilton depression scale, Hamilton anxiety scale, Insomnia Severity Index, change in Cough Severity Index, facial aging scale, dizziness scale, Pittsburgh Sleep Severity Quality Index, functional status scale, and heart palpitation scale. All adverse events will be monitored at each time throughout the study visit time. A total of 24 participants will be recruited to demonstrate with 95% confidence interval and 80% power. Discussion: Ayurveda treats Santarpanottha (originated from over nutrition) symptoms and Apatarpanottha (symptoms originated from undernutrition) symptoms differently; hence, inspite of the same disease or symptom management, changes depend upon the type of the origin. This pragmatic clinical study is developed on the fundamental grounds of Ayurveda. Ethics and dissemination: Ethics approval was obtained through the Institutional Ethics Committees of Government Ayurved College and Hospital on 23 July 2021. Trial registration : The trial is prospectively registered with the Clinical Trial Registry of India on 17 August 2021 [CTRI/2021/08/035732] after the Institutional Ethics Committee approval [GACN/PGS/Synopsis/800/2021 Date 23/7/2021]. [ABSTRACT FROM AUTHOR]

Licorice has been traditionally prescribed for palpitation, whereas its overdose has caused lethal arrhythmias including torsade de pointes. Licorice contains glycyrrhizic acid of ≥ 2% (w/w), which is hydrolyzed to glycyrrhetinic acid (GRA) in the intestine. Since their cardiac electropharmacological properties are not fully understood, we assessed them to ask mechanism of licorice-induced torsade de pointes. GRA at 0.1, 1 and 10 μg/mL was cumulatively applied to the human induced pluripotent stem cell-derived cardiomyocytes sheets (n = 6). GRA shortened spontaneous activation interval and repolarization period, and decreased maximum contraction velocity, indicating Ca2+ channel blockade. It prolonged effective refractory period and post-repolarization refractoriness with a steep frequency-dependency, whereas it delayed conduction with a modest use-dependency, resembling lidocaine in the mode of Na+ channel-blocking action. Meanwhile, Kanzoto containing a decoction of licorice alone in a dose of 2 or 6 g/body/day was orally administered to the conscious chronic atrioventricular block dogs for 3 days (n = 4). Kanzoto prolonged QT interval with increasing its temporal dispersion, suggesting K+ channel suppression, and slightly decreased the plasma K+ concentration without inducing torsade de pointes. Moreover, it significantly suppressed atrial and idioventricular rates, leading to sinus arrest along with the onset of ventricular fibrillation in one animal, possibly due to Na+ channel blockade. These results indicate that electropharmacological profile of licorice can be explained by Na+, Ca2+ and K+ channels blockade, which may be associated with low torsadogenic risk, but might contribute to the onset of other types of lethal ventricular arrhythmias. [ABSTRACT FROM AUTHOR]

Abstract Background It is reported that the adverse impact of nonpharmaceutical interventions (NPIs) on the mental health of children and adolescents may lead to psychologically related disorders during the coronavirus disease 2019 (COVID-19) period. Subject symptoms such as chest pain, chest tightness, and palpitation may be related to increased stress and anxiety in children and adolescents. The present research aimed to determine the number of pediatric consults and etiology of subject symptoms during the COVID-19 pandemic period and compared it with the same timelines in 2019 and 2021 to discuss the impact of different periods on the organic disease onset of children with subject symptoms, especially in cardiac involvement. Methods Children who visited Qingdao Women and Children’s Hospital, Qingdao University between January 23 to April 30, 2019 (pre-COVID-19 period), January 23 to April 30, 2020 (COVID-19 period), and January 23 to April 30, 2021 (post-COVID-19 period) presenting chest pain, chest tightness, and palpitation were recruited. Information to determine gender, age, medical history, department for the initial visit, clinical manifestations, time from the latest onset to the visit, and diagnosis were recorded. Result A total of 891 patients were enrolled in the present study (514 males; median age: 7.72). One hundred twenty-three patients presented during the pre-COVID-19 period while 130 during the COVID-19 period, nevertheless, the number substantially increased during the post-COVID-19 period (n = 638). Cardiac etiology accounted for 1.68% (n = 15) of the patient population, including arrhythmias (n = 10, 1.12%), myocarditis (n = 4, 0.44%), and atrial septal defect (n = 1, 0.11%). There was no significant difference among groups in the distribution of organic etiology. The median time from the latest onset to the visit during the pre-COVID-19 period was 7 days compared to 10 days during the COVID-19 period and 3 days during the post-COVID period. Conclusion During the post-COVID-19 period, the median time from the latest onset to the visit was significantly shorter than that in the pre-COVID-19 period or COVID-19 period. The pediatric consult of children with subject symptoms presented increased substantially during the post-COVID-19 period, while there was no significant difference in the number of patients involving the cardiac disease. Clinicians ought to be more careful to screen heart diseases to prevent missed diagnosis and misdiagnosis during special periods.

Background: SARS-CoV-2 mRNA vaccination has been associated with both side effects and a reduction in COVID-related complaints due to the decrease in COVID-19 incidence. We aimed to investigate if individuals who received three doses of SARS-CoV-2 mRNA vaccines had a lower incidence of (a) medical complaints and (b) COVID-19-related medical complaints, both as seen in primary care, when compared to individuals who received two doses. Methods: We conducted a daily longitudinal exact one-to-one matching study based on a set of covariates. We obtained a matched sample of 315,650 individuals aged 18–70 years who received the 3rd dose at 20–30 weeks after the 2nd dose and an equally large control group who did not. Outcome variables were diagnostic codes as reported by general practitioners or emergency wards, both alone and in combination with diagnostic codes of confirmed COVID-19. For each outcome, we estimated cumulative incidence functions with hospitalization and death as competing events. Results: We found that the number of medical complaints was lower in individuals aged 18–44 years who received three doses compared to those who received two doses. The differences in estimates per 100,000 vaccinated were as follows: fatigue 458 less (95% confidence interval: 355–539), musculoskeletal pain 171 less (48–292), cough 118 less (65–173), heart palpitations 57 less (22–98), shortness of breath 118 less (81–149), and brain fog 31 less (8–55). We also found a lower number of COVID-19-related medical complaints: per 100,000 individuals aged 18–44 years vaccinated with three doses, there were 102 (76–125) fewer individuals with fatigue, 32 (18–45) fewer with musculoskeletal pain, 30 (14–45) fewer with cough, and 36 (22–48) fewer with shortness of breath. There were no or fewer differences in heart palpitations (8 (1–16)) or brain fog (0 (− 1–8)). We observed similar results, though more uncertain, for individuals aged 45–70 years, both for medical complaints and for medical complaints that were COVID-19 related. Conclusions: Our findings suggest that a 3rd dose of SARS-CoV-2 mRNA vaccine administered 20–30 weeks after the 2nd dose may reduce the incidence of medical complaints. It may also reduce the COVID-19-related burden on primary healthcare services. [ABSTRACT FROM AUTHOR]

Aim: To analyse the potential usefulness and clinical relevance of the assessment by echocardiography with left atrial strain, based on the myocardial atrial deformation curves with speckle-tracking velocity vector imaging (VVI), in the analysis of shortform recurrent atrial extra systoles in ambulatory patients not suffering from organic cardiopathy. Methods: We designed a descriptive, prospective, and observational study including 270 patients between the ages of 18 and 75 assessed during an outpatient cardiology consultation attended due to palpitations over a period of two years. Using ambulatory electrocardiographic monitoring, we selected cases with short forms of repetitive atrial extrasystole, isolated or recurrentatrial fibrillation and a control group formed by those patients without repetitive ectopia. All patients underwent a thorough echocardiographic study during their first cardiological visit. Results: The analysis of the dynamic curves segmental deformation generated after an atrial extrasystole can reveal different points of origin of the extrasystole and detect specific anatomical alterations in the interatrial conduction at the level of the Bachmann's fascicle showing different models of electro anatomical activation possibly involved in the appearance of repetitive forms. Higher values of dyssynchrony between the septal and lateral wall and elongation in the time of interatrial electromechanical conduction could also be related to the existence of repetitive ectopic beats. Conclusions: Our ambulatory study employing the left atrial longitudinal strain, particularly in its segmental analysis, provides new insights into its the usefulness and potential clinical relevance. [ABSTRACT FROM AUTHOR]

An 18-year-old man presented with palpitations and chest discomfort, and an electrocardiogram revealed supraventricular tachycardia. Further examination revealed tingling and numbness in his hands and feet, as well as hyperpigmented spots on his hands, back, and chest. Laboratory studies showed high levels of arsenic in his blood, and a diagnosis of chronic arsenic toxicity with cardiac, dermatological, and neurological manifestations was made. The patient's symptoms improved after discontinuing the homeopathic medications he had been taking. [Extracted from the article]