Central-to-peripheral systolic blood pressure different phenotypes and relation to accuracy of daily used cuff devices

Background. Cuff blood pressure (BP) measurement has been the standard method for taking BP in routine daily practice for more than a century. However, some concerns were raised about the accuracy of this method which could lead to misclassification of BP in many situations. We aimed primarily to confirm a recent major discovery that distinct BP phenotypes based on central-to-peripheral systolic blood pressure (SBP) amplification do exist, and whether application of a validated cuff BP method (e.g. oscillometric) could accurately discriminate these differences. Material and methods. Among 106 participants (mean age 62 ± 11; 58% males) undergoing coronary angiography, intra-arterial BP was measured at 3 points (ascending aorta, brachial and radial arteries). Central-to-peripheral SBP amplification (SBPamp) was defined as ≥ 5 mm Hg SBP increased from aorta-to-brachial and/or from brachial-to-radial arteries. A validated cuff BP device (oscillometric) was used to measure BP at 4 different time points. Results. Four different BP phenotypes were confirmed based on the magnitude of SBPamp; phenotype-I, both aortic-to brachial and brachial-to radial SBPamp; phenotype-II, only aortic-to-brachial SBPamp; phenotype-III, only brachial-to-radial SBPamp; and phenotype-IV, no SBPamp at all. Aortic SBP was significantly higher in phenotypes-III and IV compared to phenotypes-I and II (p = 0.001). This was not discriminated using a validated cuff BP device measurement (p = 0.996). Results for the pulse pressure (PP) followed the same pattern. Conclusion. Distinct BP phenotypes do exist based on SBPamp. A validated cuff BP method failed to discriminate this. Improving quality of BP measurements in daily practice is a priority

Prolongation of corrected QT interval in diabetic patients with ketoacidosis

Background: Diabetic ketoacidosis (DKA) is the most common acute hyperglycemic complication of diabetes. According to a recent report DKA affects approximately 8 per 1000 diabetics annually. It is associated with significant morbidity and mortality, with a worldwide mortality rate of 2-10%.Objective: The aim of the work was to assessment of QTc interval prolongation among patients with DKA.Patients and Methods: This prospective observational cohort study included 100 patients who were diagnosed with DKA. The mean age of patients was 37.29±11.63 years, and 53% of them were males. All patients were subjected to detailed history taking, full clinical examination, laboratory investigations and 12-lead ECG.Results: Frequency of Prolonged QTmaxc amongst studied patients was 59%. Mean QTmaxc declined significantly after treatment to be 414.6±44.1ms compared to 482.45±63.56ms before treatment with p<0.0001 and Frequency of prolonged QTmaxc was significantly decreased with treatment from 59% to 20%. Anion gap was significantly higher for Prolonged QTmaxc patients compared to normal QTmaxc patients p<0.0001. While ABG (PH, HCO3) were significantly lower for Prolonged QTmaxc patients compared to normal QTmaxc patients p<0.0001. Logistic regression revealed that anion gap was significant independent risk factor for QTmaxc prolongation while.Conclusion: patients with DKA have a potential risk of QTmaxc interval prolongation due to acidosis regardless electrolytes abnormalities, and associated with a relative risk of 1.732-fold for mortality. Carful measuring of anion gap at time of admission can be used in diagnosis and prediction of occurrence of prolonged QTmaxc with high sensitivity and specificity

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Familial hypercholesterolaemia in children and adolescents from 48 countries : a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11848 individuals. Median age at registry entry was 9·6 years (IQR 5·8–13·2). 10 099 (89·9%) of 11235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05–6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50–75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life.peer-reviewe

Protection of DFIG wind turbine using fuzzy logic control

In the last 15 years, Double Fed Induction Generator (DFIG) had been widely used as a wind turbine generator, due its various advantages especially low generation cost so it becomes the most important and promising sources of renewable energy. This work focuses on studying of using DFIG as a wind turbine connected to a grid subjected to various types of fault. Crowbar is a kind of protection used for wind turbine generator protection. ANFIS controller is used for protection of DFIG during faults. The fault current under symmetric and asymmetric fault is presented as well as a way to control the increase in rotor current which leads to voltage increase in DC link between wind generator and the grid. ANFIS is used for solving such problem as it is one of the most commonly AI used techniques. Also the current response of DFIG during fault is improved by adapting the parameters of PI controllers of the voltage regulator using fuzzy logics. ANFIS also in this paper is used for detecting and clearing the short circuit on the DC capacitor link during the operation. A simulation study is illustrated using MATLAB/Simulink depending on currents and voltages measurement only for online detection of the faults. The proposed technique shows promising results using the simulation model

Load Frequency Control for Multi Area Smart Grid based on Advanced Control Techniques

One of the main interested subjects in electric power systems is the integration of electric vehicles to the existing power network as well as the influence of this integration with the other types of renewable sources connected to the multi area power system networks.Load Frequency Control (LFC) are used to regulate and control the output frequency signal of the electric generated power within an area in response to changes in system loads and power in tie line changed with other area.This paper presents a new design of various types of load frequency PI controllers based on different types of Artificial Intelligent (AI) optimization techniques such as Fuzzy logic, FOPID tuned by fuzzy and Model Predictive Control (MPC) for a four area power system. The performance of the controller under study shows an enhancement in the frequency deviation signal as well as the peak overshoot and Settling time for the frequency output signal.The performance of the proposed scheme is validated using MATLAB/SIMULINK tools. Keywords: LFC, PI, FOPID, Fuzzy, MPC, Multi area power syste

Protection of DFIG wind turbine using fuzzy logic control

In the last 15 years, Double Fed Induction Generator (DFIG) had been widely used as a wind turbine generator, due its various advantages especially low generation cost so it becomes the most important and promising sources of renewable energy. This work focuses on studying of using DFIG as a wind turbine connected to a grid subjected to various types of fault. Crowbar is a kind of protection used for wind turbine generator protection. ANFIS controller is used for protection of DFIG during faults. The fault current under symmetric and asymmetric fault is presented as well as a way to control the increase in rotor current which leads to voltage increase in DC link between wind generator and the grid. ANFIS is used for solving such problem as it is one of the most commonly AI used techniques. Also the current response of DFIG during fault is improved by adapting the parameters of PI controllers of the voltage regulator using fuzzy logics. ANFIS also in this paper is used for detecting and clearing the short circuit on the DC capacitor link during the operation. A simulation study is illustrated using MATLAB/Simulink depending on currents and voltages measurement only for online detection of the faults. The proposed technique shows promising results using the simulation model

Acute effect of sildenafil on myocardial ischemic territories in patients with stable coronary artery disease

Objectives: To test the safety of sildenafil in patients with stable coronary artery disease (CAD). Methods: Sixty-one patients with stable CAD, documented by coronary angiography were included in this phase I study. Patients were randomized to either single dose sildenafil or matched placebo. Speckle tracking echocardiography was done at baseline and 60 min after sildenafil/placebo intake to calculate peak systolic strain (PSS) of the most severely affected myocardial segments and the global longitudinal PSS. Results: The baseline mean segmental PSS in the sildenafil group changed by 52%, −3 ± 1% at baseline versus −7 ± 2% after sildenafil intake, P = 0.01. However, no significant changes were reported in the placebo group, −7 ± 3% at baseline versus −7.25 ± 3%, P = 0.1. The baseline mean global longitudinal PSS in the sildenafil group changed by 9% (−15 ± 4% at baseline versus −18 ± 3% after sildenafil, P = 0.03). In placebo patients, the change was only 3% from baseline (−14.8 ± 2% at baseline compared to −15 ± 2% after placebo intake, P = 0.1). Sildenafil was well tolerated without clinical or hemodynamic deterioration after its intake. Conclusion: Sildenafil intake is safe in patients with stable CAD, it induced marginal improvements in the peak systolic strain of different myocardial ischemic territories