Infekcija virusom Zapadnog Nila s neurološkim poremećajima: prikaz slučaja i kratak pregled stanja u Bugarskoj

A case of a 66-year-old man with West Nile neuroinvassive disease manifested with fever, weakness, fa-tigue, consciousness disorders and underlying diabetes mellitus type 2 and cardiovascular diseases is pre-sented. Laboratory data showed elevated erythrocyte sedimentation rate and fibrinogen. Serological tests revealed West Nile virus specific antibodies of class IgM and IgG in serum. West Nile virus RNA was de-tected in urine sample. Supportive therapy was applied.Prikazuje se slučaj 66-godišnjeg bolesnika s neuroinvazivnom bolešću Zapadnog Nila koja se manifestirala grozni-com, umorom, poremećajem svijesti uz osnovnu bolest dijabetesa tipa 2 i kardiovaskularnom bolešću. Laboratorij-ski podaci pokazali su povišenu sedimentaciju i fibrinogen. Serološki testovi utvrdili su protutijela specifična za virus Zapadnog Nila klase IgM i IgG u serumu. Virusna RNA otkrivena je u uzorku mokraće. Primijenjena je suportivna terapija

Removal of power-line interference from the ECG: a review of the subtraction procedure

BACKGROUND: Modern biomedical amplifiers have a very high common mode rejection ratio. Nevertheless, recordings are often contaminated by residual power-line interference. Traditional analogue and digital filters are known to suppress ECG components near to the power-line frequency. Different types of digital notch filters are widely used despite their inherent contradiction: tolerable signal distortion needs a narrow frequency band, which leads to ineffective filtering in cases of larger frequency deviation of the interference. Adaptive filtering introduces unacceptable transient response time, especially after steep and large QRS complexes. Other available techniques such as Fourier transform do not work in real time. The subtraction procedure is found to cope better with this problem. METHOD: The subtraction procedure was developed some two decades ago, and almost totally eliminates power-line interference from the ECG signal. This procedure does not affect the signal frequency components around the interfering frequency. Digital filtering is applied on linear segments of the signal to remove the interference components. These interference components are stored and further subtracted from the signal wherever non-linear segments are encountered. RESULTS: Modifications of the subtraction procedure have been used in thousands of ECG instruments and computer-aided systems. Other work has extended this procedure to almost all possible cases of sampling rate and interference frequency variation. Improved structure of the on-line procedure has worked successfully regardless of the multiplicity between the sampling rate and the interference frequency. Such flexibility is due to the use of specific filter modules. CONCLUSION: The subtraction procedure has largely proved advantageous over other methods for power-line interference cancellation in ECG signals

Dataset of manually measured QT intervals in the electrocardiogram

BACKGROUND: The QT interval and the QT dispersion are currently a subject of considerable interest. Cardiac repolarization delay is known to favor the development of arrhythmias. The QT dispersion, defined as the difference between the longest and the shortest QT intervals or as the standard deviation of the QT duration in the 12-lead ECG is assumed to be reliable predictor of cardiovascular mortality. The seventh annual PhysioNet/Computers in Cardiology Challenge, 2006 addresses a question of high clinical interest: Can the QT interval be measured by fully automated methods with accuracy acceptable for clinical evaluations? METHOD: The PTB Diagnostic ECG Database was given to 4 cardiologists and 1 biomedical engineer for manual marking of QRS onsets and T-wave ends in 458 recordings. Each recording consisted of one selected beat in lead II, chosen visually to have minimum baseline shift, noise, and artifact. In cases where no T wave could be observed or its amplitude was very small, the referees were instructed to mark a 'group-T-wave end' taking into consideration leads with better manifested T wave. A modified Delphi approach was used, which included up to three rounds of measurements to obtain results closer to the median. RESULTS: A total amount of 2*5*548 Q-onsets and T-wave ends were manually marked during round 1. To obtain closer to the median results, 8.58 % of Q-onsets and 3.21 % of the T-wave ends had to be reviewed during round 2, and 1.50 % Q-onsets and 1.17 % T-wave ends in round 3. The mean and standard deviation of the differences between the values of the referees and the median after round 3 were 2.43 ± 0.96 ms for the Q-onset, and 7.43 ± 3.44 ms for the T-wave end. CONCLUSION: A fully accessible, on the Internet, dataset of manually measured Q-onsets and T-wave ends was created and presented in additional file: 1 (Table 4) with this article. Thus, an available standard can be used for the development of automated methods for the detection of Q-onsets, T-wave ends and for QT interval measurements

Coronary artery disease risk assessment of liver transplant candidates

Сърдечно-съдовите усложнения са основна причина за заболяемост и смъртност при пациентите с краен стадий на чернодробно заболяване, подложени на чернодробна трансплантация (ЧТ). Коронарната артериална болест (КАБ) допринася за голяма част от тях и следователно налага оценка в предоперативния период. Пациентите, чакащи ЧТ, са специална подгрупа, която носи разнородни рискови фактори и има уникални патогенетични и клинични характеристики. Тези пациенти обикновено демонстрират повишен сърдечен дебит и компрометиран отговор на стрес. Понижената системна съдова резистентност и брадикардия също често се наблюдават при цироза и могат да се засилят при използване на бета-блокери. Настоящите неинвазивни тестове, които оценяват за субклинична КАБ, са с ниска чувствителност и променената хемо-динамика по време на хирургичната интервенция за ЧТ може да демаскира латентното сърдечно-съдово заболяване в интраоперативния или в непосредствения следоперативен период. Този обзор се фокусира върху разширяващата се информация за диагноза и стратификация на риска за КАБ при кандидатите за ЧТ. Систематичният подход за оценка на предоперативния риск за КАБ при кандидатите за ЧТ може да е полезен за оптимизиране на изхода след ЧТ. Cardiovascular complications are a major cause of morbidity and mortality in patients with end-stage liver disease undergoing liver transplantation (LT). Coronary artery disease (CAD) contributes to major portion of cardiovascular complications and therefore warrants evaluation in the preoperative period. Patients awaiting LT are a special subgroup that carries heterogeneous risk factors and has unique pathogenic and clinical characteristics. These patients usually demonstrate increased cardiac output and a compromised response to stress. Low systemic vascular resistance and bradycardia are also commonly seen in cirrhosis and can be aggravated by beta-blocker use. Current non-invasive tests that assess for subclinical CAD have low sensitivity, and altered hemodynamics during the LT surgery can unmask latent cardiovascular disease either intraoperatively or in the immediate postoperative period. This review focuses on the expanding body of evidence for diagnosis and risk stratifi cation of CAD in LT candidates. The systematic approach to evaluate preoperative CAD risk in LT candidates may be helpful to optimize post-LT outcome

Echocardiography in liver transplant candidates

Сърдечно-съдовите усложнения са основна причина за заболяемост и смъртност при пациентите в краен стадий на чернодробна недостатъчност след чернодробна трансплантация (ЧТ). Образните изследвания на сърцето играят интегрална роля при оценката на кандидатите за ЧТ. Ехокардиографията остава най-често прилаганата техника. В този обзор разглеждаме ролята на ехокардиографията в неинвазивната предоперативна оценка за състояния като коронарна артериална болест, циротична кардиомиопатия, хепатопулмонален синдром, портопулмонална хипертония, обструкция на левокамерния изходен тракт, перикардни изливи. Cardiovascular complications are a major cause of morbidity and mortality in patients with end-stage liver disease undergoing liver transplantation (LT).  Cardiac imaging plays an integral role in the assessment of LT candidates. Echocardiography remains the most commonly utilized technique. In this review, we discuss the role of echocardiography in non-invasive pre-operative assessment of coronary artery disease, cirrhotic cardiomyopathy, hepatopulmonary syndrome, portopulmonary hypertension, left ventricular outfl ow tract obstruction, pericardial effusions

Assessment of atrial fibrillation and flutter by T-P internal signal rectification in ECG

Ivaylo Christov is supported by CNR-NATO. Individual Fellowship 219.32 in LADSEB-CNR, Padua, ItalyConsiglio Nazionale delle Ricerche - Biblioteca Centrale - P.le Aldo Moro, 7 Rome / CNR - Consiglio Nazionale delle RichercheSIGLEITItal

Automatic detection of atrial fibrillation and flutter: a combined algorithm

Consiglio Nazionale delle Ricerche - Biblioteca Centrale - P.le Aldo Moro, 7 Rome / CNR - Consiglio Nazionale delle RichercheSIGLEITItal

Mitral annular systolic velocity as a marker of preclinical systolic dysfunction among patients with arterial hypertension

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to investigate early changes in left ventricular longitudinal systolic function in patients with hypertension (HTN) with and without concomitant diastolic dysfunction (DD) and the clinical implications of these findings.</p> <p>Method</p> <p>We enrolled 299 patients with HTN and 297 age-matched patients with HTN and DD and compared both groups with an age-matched control group consisting of 100 healthy subjects. The long axis systolic function was investigated by determining the average peak systolic velocity of the septal and lateral mitral sites (Sm_avg) using spectral pulsed wave tissue Doppler imaging (TDI).</p> <p>Results</p> <p>We found a strong negative trend toward the reduction of velocity, which is dependent on the grade of HTN, on the magnitude of DD, and also on the gender and age of the subjects (r=−0.891/-0.580; p<0.0001). The data showed that the beginning and evolution of HTN are related to a slight but significant reduction in the long axis systolic function (10.2-10.0 cm/s; p<0.0001), and DD worsens this initial finding (9.8-8.8 cm/s; p<0.0001).</p> <p>Conclusion</p> <p>The strength of the study is the analysis of incremental changes in longitudinal contraction in patients with different stage of HTN but not so many the classification of the degree of systolic dysfunction. The importance of our results lies in the fact that these initial changes in systolic contraction could be used as an early sign that should prompt optimization of the treatment of HTN.</p