Iyengar Yoga Increases Cardiac Parasympathetic Nervous Modulation Among Healthy Yoga Practitioners

Relaxation techniques are established in managing of cardiac patients during rehabilitation aiming to reduce future adverse cardiac events. It has been hypothesized that relaxation-training programs may significantly improve cardiac autonomic nervous tone. However, this has not been proven for all available relaxation techniques. We tested this assumption by investigating cardiac vagal modulation during yoga.We examined 11 healthy yoga practitioners (7 women and 4 men, mean age: 43 ± 11; range: 26–58 years). Each individual was subjected to training units of 90 min once a week over five successive weeks. During two sessions, they practiced a yoga program developed for cardiac patients by B.K.S. Iyengar. On three sessions, they practiced a placebo program of relaxation. On each training day they underwent ambulatory 24 h Holter monitoring. The group of yoga practitioners was compared to a matched group of healthy individuals not practicing any relaxation techniques. Parameters of heart rate variability (HRV) were determined hourly by a blinded observer. Mean RR interval (interval between two R-waves of the ECG) was significantly higher during the time of yoga intervention compared to placebo and to control (P < 0.001 for both). The increase in HRV parameters was significantly higher during yoga exercise than during placebo and control especially for the parameters associated with vagal tone, i.e. mean standard deviation of NN (Normal Beat to Normal Beat of the ECG) intervals for all 5-min intervals (SDNNi, P < 0.001 for both) and root mean square successive difference (rMSSD, P < 0.01 for both). In conclusion, relaxation by yoga training is associated with a significant increase of cardiac vagal modulation. Since this method is easy to apply with no side effects, it could be a suitable intervention in cardiac rehabilitation programs

Termination of Ventricular Tachycardia with Antitachycardia Pacing after Ineffective Shock Therapy in an ICD Recipient with Hypertrophic Cardiomyopathy

Implantable Cardioverter Defibrillator (ICD) implantation is the only established therapy for primary or secondary prevention of sudden cardiac death in patients with Hypertrophic Cardiomyopathy (HCM). Ineffectiveness of shock therapy for the termination of potentially fatal ventricular arrhythmias in ICD recipients is rare in the presence of appropriate arrhythmia detection by the device. We report the case of a 48-year-old woman with HCM and a single chamber ICD, who received five inefficient high-energy (35 Joules) shocks for the termination of an appropriately detected episode of Ventricular Tachycardia (VT). The episode was safely terminated with a subsequent application of Antitachycardia Pacing (ATP) by the device. At the following ICD control, an acceptable defibrillation threshold was detected

Ambulatory arterial stiffness index, mortality, and adverse cardiovascular outcomes; Systematic review and meta-analysis.

The ambulatory arterial stiffness index (AASI) is a novel measure of both blood pressure (BP) variability and arterial stiffness. This systematic review and meta-analysis was designed to evaluate the strength of the association between AASI and mortality and major adverse cardiovascular events (MACE). PubMed, Scopus, CINAHL, Google Scholar. and the Cochrane library were searched for relevant studies to July 31, 2023. Two investigators independently extracted data. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of all included articles. The relationship between baseline AASI and outcomes were examined using relative risk (RR) ratios with 95% confidence intervals (CI) with RevMan web. Thirteen studies were included and representing 28 855 adult patients who were followed up from 2.2 to 15.2 years. A 1-standard deviation (1-SD) increase in AASI was associated with a significant increase in all-cause death (RR 1.12; 95% CI: 0.95-1.32), stroke (RR 1.25; 95% CI: 1.09-1.44), and MACE (RR 1.07; 95% CI: 1.01-1.13; [I2  = 32%]). Higher dichotomized AASI (above vs. below researcher defined cut-offs) was associated with a significant increase in all-cause mortality (RR 1.19; 95% CI: 1.06-1.32), cardiovascular death (RR 1.29; 95% CI: 1.14-1.46), stroke (RR 1.57; 95% CI: 1.33-1.85), and MACE (RR1.29; 95% CI: 1.16-1.44). There was a significant risk of bias in more than 50% of studies with no evidence of significant publication bias. Higher AASI is associated with an increased risk of all-cause and cardiovascular death, stroke, and MACE. Further high-quality studies are warranted to determine reproducible AASI cut-offs to enhance its clinical risk precision

Safety and efficacy of venous mechano-chemical ablation of the great saphenous vein

Introduction: Endovenous mechano-chemical ablation of the incompetent great saphenous vein (MOCA) is a new technique that combines mechanical endothelial injury and infusion of a sclerosant agent. Material and methods: This is a prospective study was conducted on 40 patients who presented with the chronic venous disease at Kasr Al Ainy outpatient vascular surgery clinic with CEAP classification namely C2-C6. Results: A total of 40 patients were presented with great saphenous vein incompetency, the mean age was (30), 23 patients were male and 17 were female. The vein occlusion rate at one month was 93 percent and at six months was 87 percent respectively. Conclusions: Endovenous mechanochemical ablation is a safe and effective method for the management of incompetent great saphenous veins compared to open surgery

Reliability of carotid-femoral arterial waveforms for the derivation of ultra-short term heart rate variability in injured British servicemen: An inter-rater reliability study

In this study, the comparative precision of carotid versus femoral arterial waveforms to measure ultra-short term heart rate variability (HRVUST) following traumatic injury was investigated for the first time. This was an inter-rater reliability study of 50 British servicemen (aged 23–44 years) with non-acute combat-related traumatic injury (CRTI). Paired continuous arterial waveform data for HRVUST analysis, were simultaneously sampled at the carotid and femoral arterial sites (14–16 seconds) during pulse wave velocity (PWV) measurement. HRVUST was reported as the root mean square of the successive differences (RMSSD). Following the determination of the superior sampling site (carotid versus femoral), the blinded inter-rater agreement in RMSSD for the preferred site was quantified using the Intra-class Correlation Coefficient (ICC) and the Bland-Altman plot. The mean age of participants was 34.06±4.88 years. The femoral site was superior to the carotid site with a significantly higher number of reliable signals obtained (Fisher’s Exact test; p<0.001). The inter-rater agreement in femoral-derived RMSSD was excellent [ICC 0.99 (95%CI: 0.994–0.997)] with a moderate level of agreement (mean difference [bias]: 0.55; 95% CI: -0.13–1.24 ms). In this study, we demonstrated that the femoral artery is a more reliable site than the carotid artery for HRVUST measurement and post-trauma risk stratification following CRTI

Influence of blend ratio on the electrical characteristics of vulcanized SBR/NBR blends compatibilized by Cis-polybutadiene rubber

Blends composed of styrene butadiene rubber (SBR) and acrylonitrile-butadiene rubber (NBR) have been fabricated by melt-blending technique using two-roll mill blend machine. Cis-polybutadiene rubber (CBR) was used as a compatibilizer for enhancing the homogeneity between blend phases. No previous reports were found to discuss improving electrical properties of vulcanized SBR/NBR blends using unfilled rubber system (i.e. no fillers incorporation). SEM micrographs were utilized to verify the compatibility between two rubber ingredients in various blends, owing to the use of compatibilizer. Thermal stability of blends was investigated by differential thermal analysis (DTA) and differential scanning calorimetric (DSC) to evaluate the influence of blend ratio on the compatibility of investigated samples. Results revealed that the dielectric properties of blends are dramatically influenced by altering the blend ratio. The results revealed that the SEM observations confirmed the compatibilization effect of CBR on vulcanized SBR/NBR blends. Meanwhile, thermal properties of vulcanized SBR/NBR blends were enhanced with increasing of SBR contents in blends. The complex impedance graphs showed circular arcs showing the bulk contribution to overall electrical behavior for investigated vulcanized SBR/NBR blends. During I-V characteristics have been presented, where a remarkably change from linear behavior to nonlinear conduction at lower temperatures was found for 0SBR/100NBR blends. These findings supported and confirmed that the compatibilization effect and the blend ratio between rubber compositions have strongly influenced on their thermal and electrical properties of vulcanized blends

Epidemiology of Stroke in the MENA Region: A Systematic Review.

Introduction: Stroke is a major burden on the health system due to high fatality and major disability in survivors. Whilst Stroke incidence has declined in the developed world, it continues to increase in developing nations, including the MENA (Middle East and North Africa) region. This may reflect different risk factors and strategies to treat and manage patients prior to and after Stroke. Methods: We have conducted a systematic review of the prevalence, incidence and mortality of Stroke in the 23 countries of MENA region following the PRISMA guidelines. Results: 8,874 published papers were retrieved through both PubMed and Embase. Of those, 38 studies were found to be eligible for inclusion in this review. Only thirteen countries in the MENA region had data points for the critical stroke parameters. Of these qualified studies, 14 were prospective, population-based studies. In the age-adjusted studies, incidence ranged widely between 16/100,000 in a prospective population-based in Iran to 162/100,000 in Libya. Age-adjusted prevalence was available only from Tunisia at 184/100,000. Mortality for all strokes from the eight countries reporting this measure found the 30 day-case fatality ranged from 9.3% in Qatar to 30% in Pakistan. Most stroke studies in the MENA region were small sized, hospital-based, lacked confidence intervals and did not provide prevalence and mortality figures. Conclusion: National policymakers, public health and medical care stakeholders need more reliable epidemiologic studies on Stroke from the MENA region to plan more effective preventive and therapeutic strategies

The Association between Inflammatory Biomarkers and Cardiovascular Autonomic Dysfunction after Bacterial Infection.

Heart rate variability (HRV) is a known measure of cardiac autonomic function. A cardiovascular autonomic dysfunction (CAD), measured as changes in HRV, is usually presented after an infectious process. The aim of the present study is to assess the association between serum inflammatory markers and CAD. For this purpose, 50 volunteers (13 of them recovering from an infection) were recruited and followed-up for 6 weeks. Their serum inflammatory biomarkers (CRP, IL1, IL4, IL6, IL10, and TNFalpha) were quantified throughout those weeks, along with their HRV resting, in response to the Valsalva maneuver, metronome breathing, standing and sustained handgrip. The correlation of within-subject changes in both HRV and inflammatory biomarkers was assessed to evaluate the concurrent changes. An inverse within-subject correlation was found between CRP and HRV in response to the Valsalva maneuver (rho (95% CI)