Syncope: experience at a tertiary care hospital in Karachi, Pakistan

Introduction:Our aim was to determine the characteristics of Patients presenting with syncope at a tertiary care hospital in Karachi, Pakistan.Methods: A review of medical records was conducted retrospectively at the Department of Medicine, Aga Khan University Hospital, Karachi. Patients aged 16 and above, admitted from January 2000 to December 2005 with the diagnosis of syncope made by the attending physician were included.Results:A total of 269 Patients were included (75% males, mean age: 57.4 years). Neurogenic (vasovagal) syncope was the most common cause (47%), followed by cardiogenic syncope (18%) and orthostatic syncope (9%). A total of 24% were discharged undiagnosed. Twenty Patients (7.4%) did not have any prodrome. Common prodromal symptoms included dizziness (61%), sweating (25%), palpitations (19%), nausea/vomiting (19%) and visual symptoms (17%). The distribution of symptoms according to cause of syncope revealed only breathlessness to be significantly associated with cardiogenic syncope (p = 0.002). Most Patients with cardiogenic syncope were aged above 40 (98%, p \u3c 0.001), had coronary artery disease (72%, p \u3c 0.001) and abnormal electrocardiogram at presentation (92%, p \u3c 0.001).Conclusion:Despite differences in burden of diseases, our findings were similar to those of published syncope literature. Further studies are needed to develop a protocol to expedite the evaluation and limit the work-up and admission in low-risk Patients

Effect of terminal accuracy requirements on temporal gaze-hand coordination during fast discrete and reciprocal pointings

Background\ud \ud Rapid discrete goal-directed movements are characterized by a well known coordination pattern between the gaze and the hand displacements. The gaze always starts prior to the hand movement and reaches the target before hand velocity peak. Surprisingly, the effect of the target size on the temporal gaze-hand coordination has not been directly investigated. Moreover, goal-directed movements are often produced in a reciprocal rather than in a discrete manner. The objectives of this work were to assess the effect of the target size on temporal gaze-hand coordination during fast 1) discrete and 2) reciprocal pointings.\ud \ud Methods\ud \ud Subjects performed fast discrete (experiment 1) and reciprocal (experiment 2) pointings with an amplitude of 50 cm and four target diameters (7.6, 3.8, 1.9 and 0.95 cm) leading to indexes of difficulty (ID = log2[2A/D]) of 3.7, 4.7, 5.7 and 6.7 bits. Gaze and hand displacements were synchronously recorded. Temporal gaze-hand coordination parameters were compared between experiments (discrete and reciprocal pointings) and IDs using analyses of variance (ANOVAs).\ud \ud Results\ud \ud Data showed that the magnitude of the gaze-hand lead pattern was much higher for discrete than for reciprocal pointings. Moreover, while it was constant for discrete pointings, it decreased systematically with an increasing ID for reciprocal pointings because of the longer duration of gaze anchoring on target.\ud \ud Conclusion \ud \ud Overall, the temporal gaze-hand coordination analysis revealed that even for high IDs, fast reciprocal pointings could not be considered as a concatenation of discrete units. Moreover, our data clearly illustrate the smooth adaptation of temporal gaze-hand coordination to terminal accuracy requirements during fast reciprocal pointings. It will be interesting for further researches to investigate if the methodology used in the experiment 2 allows assessing the effect of sensori-motor deficits on gaze-hand coordination

Complex Processes from Dynamical Architectures with Time-Scale Hierarchy

The idea that complex motor, perceptual, and cognitive behaviors are composed of smaller units, which are somehow brought into a meaningful relation, permeates the biological and life sciences. However, no principled framework defining the constituent elementary processes has been developed to this date. Consequently, functional configurations (or architectures) relating elementary processes and external influences are mostly piecemeal formulations suitable to particular instances only. Here, we develop a general dynamical framework for distinct functional architectures characterized by the time-scale separation of their constituents and evaluate their efficiency. Thereto, we build on the (phase) flow of a system, which prescribes the temporal evolution of its state variables. The phase flow topology allows for the unambiguous classification of qualitatively distinct processes, which we consider to represent the functional units or modes within the dynamical architecture. Using the example of a composite movement we illustrate how different architectures can be characterized by their degree of time scale separation between the internal elements of the architecture (i.e. the functional modes) and external interventions. We reveal a tradeoff of the interactions between internal and external influences, which offers a theoretical justification for the efficient composition of complex processes out of non-trivial elementary processes or functional modes

A Compact Representation of Drawing Movements with Sequences of Parabolic Primitives

Some studies suggest that complex arm movements in humans and monkeys may optimize several objective functions, while others claim that arm movements satisfy geometric constraints and are composed of elementary components. However, the ability to unify different constraints has remained an open question. The criterion for a maximally smooth (minimizing jerk) motion is satisfied for parabolic trajectories having constant equi-affine speed, which thus comply with the geometric constraint known as the two-thirds power law. Here we empirically test the hypothesis that parabolic segments provide a compact representation of spontaneous drawing movements. Monkey scribblings performed during a period of practice were recorded. Practiced hand paths could be approximated well by relatively long parabolic segments. Following practice, the orientations and spatial locations of the fitted parabolic segments could be drawn from only 2–4 clusters, and there was less discrepancy between the fitted parabolic segments and the executed paths. This enabled us to show that well-practiced spontaneous scribbling movements can be represented as sequences (“words”) of a small number of elementary parabolic primitives (“letters”). A movement primitive can be defined as a movement entity that cannot be intentionally stopped before its completion. We found that in a well-trained monkey a movement was usually decelerated after receiving a reward, but it stopped only after the completion of a sequence composed of several parabolic segments. Piece-wise parabolic segments can be generated by applying affine geometric transformations to a single parabolic template. Thus, complex movements might be constructed by applying sequences of suitable geometric transformations to a few templates. Our findings therefore suggest that the motor system aims at achieving more parsimonious internal representations through practice, that parabolas serve as geometric primitives and that non-Euclidean variables are employed in internal movement representations (due to the special role of parabolas in equi-affine geometry)