Advances in the diagnosis of vasoinhibitory vasovagal syncope in children / 国际儿科学杂志

Vasoinhibitory vasovagal syncope（VVS-VI）in children is the most common type of responses in vasovagal syncope（VVS）and has a high incidence. VVS-VI is a recurrent disorder caused by a malfunctioning autonomic nervous system. VVS-VI can be caused by a variety of stimuli such as strong emotions，sudden changes in posture，hot and stuffy environments and prolonged standing. It was found that VVS-VI is a benign disease without organic lesions and is self-limiting and reversible，but VVS-VI children often suffer irreversible consequences due to secondary injuries. VVS-VI seriously affects the life and academic performance of children，endangers their physical and mental health，and causes anxiety among parents，so the number of studies on VVS-VI has increased in recent years. This article summarizes the progress of diagnostic research on VVS-VI in children，and provides a reference for related research.

Effects of three rehydration methods on prevention of on-site and delayed blood donation-related vasovagal responses: a cluster-randomized trial / 中国输血杂志

【Objective】 To compare the effects of 3 rehydration methods before blood donation on the prevention of on-site and delayed blood donation-related vasovagal response (VVR) . 【Methods】 From January to June 2021, 6 250 whole blood donors in 6 fixed blood donation sites signed informed consent and were divided into 198 clusters according to donor sites and dates, then they were randomly assigned to receive either oral rehydration salts (ORS), sugar water, or water group, and each drank 500 mL of ORS, sugar water or water within 20 minutes before blood donation. The researchers recorded the actual intervention accepted on site, and recorded the immediate VVR and related information. At rest after blood donation, donors submitted an electronic questionnaire containing socio-demographic information. At 48 hours after blood donation, the researchers called back every donor to record delayed VVR and related information. Logistic regression based on intention to treat (ITT) was used to analyze the difference of the incidence of VVR among the three groups, and the average treatment effect on treated (ATT) was calculated. PASS 2021was used to estimate the sample size and R (4.2.0) for statistical analysis. 【Results】 The cumulative incidence of blood donation-related VVR was 2.67% (2.29%-3.11%) among street whole blood donors under the 3 rehydration methods, in which, the incidence of immediate and delayed VVR was 1.02% (0.79%-1.31%) and 1.65% (1.36%-2.01%) respectively. ITT analysis found that ORS were more effective than water in reducing the incidence of delayed VVR【OR=0.59,95% CI[0.37,0.94]】.There was no significant difference in the incidence of immediate VVR between any two groups (P > 0.05), and there was no significant difference in the incidence of delayed VVR in the sugar water group compared with the water group (P > 0.05). There was a difference of -0.013 (【95% CI[-0.022, -0.004]】or -0.008【95% CI[-0.017, -0.000]】in the incidence of delayed VVR in the ORS group compared with water group or sugar water group, the difference was significant (P<0.05). The cumulative VVR of the three groups showed similar results to the delayed VVR. 【Conclusion】 Drinking ORS before blood donation is the most effective rehydration method to prevent delayed VVR. The next step is to establish the predictive model of delayed VVR to screen the susceptible population and provide them with ORS before blood donation, while other population can choose any liquid they like, thus achieving personalized blood donation-related VVR prevention and control.

Correlation between heart rate variability and psychological evaluation before blood donation / 中国输血杂志

【Objective】 To investigate the correlation between heart rate variability (HRV) and the degree of nervousness before blood donation. 【Methods】 The psychological state of 253 blood donors before blood donation was assessed by the self-rating anxiety scale (SAS) and the degree of nervousness and their HRV were measured. The correlation between the SAS score, the degree of nervousness and the HRV parameters was analyzed, and the differences were compared among different types of donors by multivariate linear regression. 【Results】 A total of 247 blood donors were included in the study. Five HRV parameters in blood donors aged 18-24 were higher than in those aged 25 years and above(all P<0.05), and the anxiety level was higher in female donors(SAS score 41-46) than in males(SAS score 35-43)(P<0.001); the pre-donation SAS score was consistent with the assessment of the tension level (r=0.970, P<0.001); the pre-donation tension level and the SAS score were all significantly negatively correlated with VLF in HRV parameters(r=0.179, P=0.005), and the associations were independent of confounders such as age, body mass index and gender (P<0.05). 【Conclusion】 Compared with SAS and tension assessment, HRV is more objective, and can be used as one of the tests for assessing the tension level of blood donors. The inclusion of HRV in the routine screening of blood donors deserves further study for its application in assessing the anxiety level of blood donors before blood donation, identifying people prone to blood donation-related vasovagal reaction (DRVR), preventing and reducing the risk of DRVR, and improving the safety of blood donation.

Current Status and Prospect of Non-surgical Treatment of Vasovagal Syncope / 中国循环杂志

Vasovagal syncope is one of the most common forms of syncope.There are limited drug therapy options for patients with cardiosuppressive syncope,and permanent pacemaker therapy is recommended.This article reviews the tortuous development of pacemaker implication in the treatment of vasovagal syncope and summarizes the underlying reasons,and potential patients,who might benefit from pacing therapy and the limitations of its application according to the current guidelines.In the future,cardioneuroablation might become a therapeutic choice for patients with vasovagal syncope,the safety,efficacy and suitable patinets groups need to be validated in coming large sample randomized controlled clinical trials.

Prevention and treatment of vasovagal reflex during and after operation in diseases of urinary system / 中国现代医生

@#Objective To explore the prevention and treatment of vasovagal reflex during and after operation in diseases of urinary system.Methods From February 2020 to April 2023,1436 patients who completed inpatient surgery in Department of Urology,Songshan Hospital,Qingdao University Medical College were selected to analyze the emergency management measures of vasovagal reflex during and after operation and summarize the diagnosis and treatment experience.Results Among 1436 patients,vasovagal reflex occurred in 4 cases during operation and 14 cases after operation,with an incidence of 1.25%.Most patients showed simultaneous decrease in blood pressure and heart rate.After intravenous injection of atropine and dopamine,blood pressure and heart rate returned to normal,and various concomitant symptoms disappeared,and no death cases were reported.Conclusion Urological specialists should pay attention to vasovagal reflex,sum up experience,do early identification,timely treatment to ensure the safety of patients.

Delayed adverse reactions in whole blood donors: Importance of active surveillance in identifying the missing gaps in the donor safety

Background & objectives: The information available regarding delayed adverse donor reactions (D-ADRs) is limited. Proactive follow up of donors for delayed reactions is not done routinely. This study was undertaken to analyze frequency and type of D-ADRs in whole blood donors as also the contributory factors. Methods: In this prospective observational study, all eligible whole blood donors were contacted telephonically twice (24 h and 2 wks after donation) and asked about general health and ADR specific questions. The International Society of Blood Transfusion standard guidelines were used to categorize ADRs. Results: The ADR data of 3514 donors were analyzed in the study. D-ADRs were more common as compared to immediate delayed adverse donor reactions (I-ADRs) (13.7 vs. 2.9%, P<0.001). The most common D-ADRs were bruises (4.98%), fatigue or generalized weakness (4.24%) and sore arms (2.25%). D-ADRs were more common in first time donors as compared to the repeat blood donors (16.1 vs. 12.5%, P=0.002). Females were more prone to D-ADRs (17 vs. 13.6%). Localized D-ADRs were more frequent as compared to systemic D-ADRs (P<0.001). Repeat donors had a lower incidence of systemic D-ADRs (4.11% vs. 7.37%, P<0.001). Interpretation & conclusions: D-ADRs were more common than I-ADRs with a different profile. First time, female and young donors were more prone to D-ADRs. These categories need special care at the time of blood donation. Active follow up of blood donors should be done from time to time to strengthen donor safety

Progress in diagnosis and treatment of orthostatic intolerance / 中华老年医学杂志

Orthostatic intolerance is a syndrome characterized by a series of symptoms that occur when standing upright, resulting in the loss of ability to maintain an upright position.This condition can be further classified into orthostatic hypotension, postural orthostatic tachycardia syndrome, and vasovagal syncope.Some scholars suggest that orthostatic hypertension may also be considered a part of this syndrome.The most significant risk associated with orthostatic intolerance is falls, which can lead to physical injury and psychological distress.This article aims to review the advancements made in the diagnosis and treatment of orthostatic intolerance, so as to enhance the standardization of clinical diagnosis and improve the effectiveness of treatment.

Progress on diagnosis and treatment of vasovagal syncope in children / 国际儿科学杂志

Vasovagal syncope(VVS), the most common type of syncope in children, is a functional cardiovascular disease that rarely threatens life, but repeated syncope episodes seriously affect children′s learning and daily life, and some children even appear accidental physical injury, which has gradually become a hot topic of research at home and abroad.According to the positive reaction type of VVS in the head-up tilt test, the children can be further divided into vascular inhibitory type, cardiac inhibitory type and mixed type, in which the mixed type and vascular inhibitory type are main.This article mainly reviews the progress of diagnosis and treatment of VVS in children in recent years, in order to provide reference for clinical diagnosis and treatment.

Research progress of treatment for vasovagal syncope in children / 中国小儿急救医学

Vasovagal syncope (VVS) is the most common cause of syncope in children, accounting for more than 50% of all syncope events.Frequent attacks of VVS often affect children′s normal life and learning, so effective intervention is needed to prevent the onset of syncope.Selection of individualized therapeutic protocol to improve efficacy and reduce recurrence rate is a hotspot in current research.Currently, the treatment has gradually shifted from empirical treatment to individualized precision therapy based on hemodynamics mechanism and therapeutic efficacy biomarkers.This review summarized the progress of VVS treatment from three aspects: non-drug therapy, drug therapy and interventional therapy, in order to promote the further study of the treatment strategy for children with VVS.

Research progress on biomarkers for diagnosis and treatment of neurally mediated syncope in children / 中国小儿急救医学

Vasovagal syncope (VVS) and postural orthostatic tachycardia syndrome (POTS) are the most common types of neurally mediated syncope, which is prevalent in school-age children and adolescents, seriously affecting their daily life and learning quality, and increasing the risk of accidental injury due to syncope.Because the clinical signs of these two diseases are very similar, diagnosis between VVS and POTS can easily be confused, and the pathogenesis of these two is not the same, the curative effect of empirical treatment is not very ideal.Therefore, finding a sensitive and reliable method for differential diagnosis and formulating individualized treatment plans have become an urgent clinical need in pediatrics syncope.In recent years, pediatricians utilizing biomarkers for study on differentiating VVS from POTS and predicting individualized treatment outcomes have made significant progress, thus promoting the precise treatment of syncope in children.

Effect of applied muscle tension on improving vasovagal reactions among blood donors: a meta-analysis / 中国输血杂志

【Objective】 To systematically evaluate the effect of applied muscle tension (AMT) exercises on reducing vasovagal reactions(VVRs) among blood donors by meta-analysis. 【Methods】 Nine related databases including MEDLINE, Web of Science and CINAHL were searched using "applied muscle tension" and "vasovagal reactions" as keywords to collect clinical studies on the effects of AMT exercise on VVRs during blood donation. Two researchers independently screened, evaluated the quality and extracted data from the retrieved literature according to the inclusion and exclusion criteria. RevMan 5.4 was used to conduct meta-analysis on the extracted data. 【Results】 A total of 7 articles were finally included, 5 in English and 2 in Chinese, covering 6 808 blood donors. The experimental group performed AMT during blood donation, while the control group did not. Compared with the control group, the difference in reducing the incidence of VVRs [ RR = 0.60, 95%CI (0.42, 0.87), P<0.01] was statistically significant in the AMT group. 【Conclusion】 AMT can effectively reduce the incidence of VVRs during blood donation. However, due to the limitation in the included studies, high-quality studies with perspectiveness, multicenter, large-sample size are further needed for validation in the future.

Analysis of heart rate variability during blood donation / 中国输血杂志

【Objective】 To observe the regulation of autonomic nerves in blood donors during blood donation by heart rate variability analysis and explore the possible mechanism of donation related vasovagal reaction. 【Methods】 Electrocardiogram (ECG) of 90 blood donors was monitored by Fontaine Ⅰlead during the whole process of blood donation, and the 5-min heart rate variation before, during and after blood donation was analyzed. 【Results】 During the whole process of blood donation, the sympathetic HRV index (LF nu) and the sympathetic and vagal balance ability index (LF/HF) increased, whereas the vagal nerve index (pNN50, RMSSD, HFnu) and heart rate variability index (SDNN, Total power) decreased. For baseline heart rate variability of different blood donors (first-time vs. repeated, male vs. female, 18-24 years old vs. ≥25 years old, <400 mL vs. 400 mL) before blood donation, the pNN50, RMSSD and Total power of 18-24 years old blood donors were higher, but other indicators showed no significant difference. There were differences in HRV indexes of different types of blood donors during blood donation compared with before blood donation. The decrease of pNN50 and HFnu and the increase of LF/HF were larger in experienced blood donors than in first-time blood donors. The decrease of RMSSD was larger in male blood donors than in female blood donors; the change of LF/HF was larger in blood donors aged≥25 years than in blood donors aged 18-24 years; other indicators had no significant difference. 【Conclusion】 Blood donation leads to reflex readjustment of the cardiac autonomic tone: the sympathetic nerve is excited while the vagal nerve is suppressed. The cardiac autonomic nerve function of first-time blood donors, female donors and low-age (18-24 years old) donors to blood donation stress is not fully regulated. Donation related vasovagal reaction may be related to the autonomic nerve regulation function of blood donors.

Perfil Clínico, Autonômico e Escore de Calgary Modificado de Crianças e Adolescentes com Presumida Síncope Vasovagal Submetidos ao Teste de Inclinação / Clinical and Autonomic Profile, and Modified Calgary Score for Children and Adolescents with Presumed Vasovagal Syncope Submitted to the Tilt Test

Resumo Fundamento A síncope, na população pediátrica, tem como sua principal causa, a vasovagal (SVV). Sua avaliação deve ser feita por métodos clínicos e o teste de inclinação (TI) pode contribuir para seu diagnóstico. Objetivos Analisar o perfil clínico, os escores de Calgary e de Calgary modificado, a resposta ao TI e a variabilidade da frequência cardíaca (VFC) de pacientes ≤ 18 anos de idade, com presumida SVV. Comparar as variáveis entre pacientes com resposta positiva e negativa ao TI. Método Estudo observacional e prospectivo, com 73 pacientes com idades entre 6 e 18 anos, submetidos à avaliação clínica e ao cálculo dos escores, sem o conhecimento do TI. Este foi feito a 70º sob monitoramento para análise da VFC. Valor-p < 0,05 foi considerado como o critério de significância estatística. Resultados A mediana de idade foi de 14,0 anos, sendo que 52% eram no sexo feminino, 72 apresentaram Calgary ≥ -2 (média 1,80) e 69 com Calgary modificado ≥ -3 (média 1,38). Ocorreram pródromos em 59 pacientes, recorrência em 50 e trauma em 19. A resposta ao TI foi positiva em 54 (49 vasovagal, com 39 vasodepressora), com aumento do componente de baixa frequência (BF) e diminuição da alta frequência (AF) (p < 0,0001). Na posição supina, o BF foi de 33,6 no sexo feminino e 47,4 em unidades normalizadas no sexo masculino (p = 0,02). Aplicando-se a curva de operação característica para TI positivo, não houve significância estatística para VFC e os escores. Conclusões A maioria das crianças e adolescentes com diagnóstico presumido de SVV apresentaram um cenário clínico típico, com escore de Calgary ≥ -2, e resposta vasodepressora predominante ao TI. Verificou-se uma maior ativação simpática na posição supina no sexo masculino. Os escores de Calgary e a ativação simpática não permitiram predizer a resposta ao TI.

Abstract Background In the pediatric population, syncope is mainly from vasovagal (VVS) origin. Its evaluation must be done by clinical methods, and the tilt test (TT) can contribute to the diagnosis. Objectives To analyze the clinical profile, Calgary and modified Calgary scores, response to TT and heart rate variability (HRV) of patients aged ≤ 18 years with presumed VVS. To compare the variables between patients with positive and negative responses to TT. Method Observational and prospective study, with 73 patients aged between 6 and 18 years, submitted to clinical evaluation and calculation of scores without previous knowledge of the TT. It was done at 70º under monitoring for HRV analysis. P-value < 0.05 was the statistical significance criterion. Results Median age was 14.0 years; 52% of participants were female, 72 had Calgary ≥ -2 (mean 1.80), and 69 had modified Calgary ≥ -3 (mean 1.38). Prodromes were observed in 59 patients, recurrence in 50 and trauma in 19. The response to TT was positive in 54 participants (49 vasovagal, with 39 vasodepressor responses), with an increase in the low frequency (LF) component and a decrease in the high frequency (HF) component (p < 0,0001). In the supine position, LF was 33.6 in females and 47.4 in normalized units for males (p = 0.02). When applying the operating characteristic curve for positive TT, there was no statistical significance for HRV and scores. Conclusion Most children and adolescents with a presumed diagnosis of VVS presented a typical clinical scenario, with a Calgary score ≥ -2, and a predominant vasodepressor response to TT. Greater sympathetic activation was observed in the supine position in males. Calgary scores and sympathetic activation did not predict the response to TT.

Utilidad de la midodrina para controlar el síncope vasovagal: ¿la recomienda la evidencia? / Usefulness of Midodrine for the Control of Recurrent Vasovagal Syncope: Does the Evidence Recommend it? / Utilidade da midodrina no controle da síncope vasovagal: as evidencias a recomendam?

Introducción:El síncope vasovagal es la principal causa de pérdida transitoria de la conciencia, y es un motivo de consulta cada vez más frecuente en pediatría y medicina del adulto. La midodrina es un agonista de los recepto-res alfa, de acción periférica, empleada principalmente en el manejo de la hipotensión ortostática; sin embargo, también se ha evaluado en el síncope vasovagal, con resultados prometedores.Objetivo:Analizar la evidencia más reciente sobre la utilidad de la midodrina para el control y la prevención del síncope vasovagal.Materiales y métodos: Se realizó una búsqueda bibliográfica utilizando términos de búsqueda como Vasovagal Syncope y Midodrine, así como sinónimos, que se combinaron con operadores booleanos, en cinco bases de datos, hasta octubre del 2022. Se incluyeron estudios originales, revisiones sistemáticas y metanálisis, publicados tanto en inglés como en español.Resultados:Ensayos controlados aleatorizados y revisiones sistemáticas y metanálisis difieren ligeramente entre resultados, pero estos demuestran un efecto global protector. La evidencia más reciente y completa indica que utilizar este agente reduce significativamente la positividad al realizar la prueba de la mesa inclinada y que previene la aparición de episodios sincopales.Conclusiones:Aunque la evidencia actual sobre la eficacia de la midodrina respecto a la prevención y control del síncope vasovagal es limitada, se observa un efecto protector significativo, porque disminuye el riesgo de sufrir un episodio sincopal, aproximadamente hasta en un 50 %.Palabras clave: midodrina; síncope vasovagal; síncope; adrenérgicos; medicina basada en la evidencia

Introduction: Vasovagal syncope is the main cause of transient loss of consciousness, being an in-creasingly frequent reason for consultation in pediatrics and adult medicine. Midodrine, a periphe-rally acting alpha-receptor agonist, is mainly used in the management of orthostatic hypotension. However, it has also been evaluated in vasovagal syncope, with promising results. Objective: To analyze the most recent evidence on the usefulness of midodrine for the control and prevention of vasovagal syncope. Materials and Methods: A literature search was performed using search terms such as "Vasovagal Syncope" and "Midodrine," as well as synonyms, which were combined with Boolean operators, in 5 databases until October 2022. Original studies, systematic reviews and meta-analyses, published in both English and Spanish, were included. Results: Randomized controlled trials and systematic reviews and meta-analyses differ slightly between results, but these demonstrate an overall protective effect. The most recent and complete evidence shows that using this agent significantly reduces the probability of positivity when performing the tilt table test and prevents the occurrence of syncopal episodes. Conclusions: Although current evidence on the efficacy of midodrine with respect to the prevention and control of vasovagal syncope is limited, a significant protective effect is observed, reducing the risk of suffering syncopal episode by approximately up to 50%

Introdução: a síncope vasovagal é a principal causa de perda transitória de consciência e é um motivo cada vez mais comum de consulta em pediatria e medicina de adultos. A midodrina é um agonista do receptor alfa de ação periférica usado principalmente no tratamento da hipotensão ortostática; no entanto, ela também foi avaliada na síncope vasovagal, com resultados promissores. Objetivo: Revisar as evidências mais recentes sobre a utilidade da midodrina para o controle e a pre-venção da síncope vasovagal. Materiais e métodos: Foi realizada uma pesquisa na literatura usando termos de pesquisa como Va-sovagal, Syncope e Medodrine, bem como sinônimos, que foram combinados com operadores boo-leanos, em cinco bancos de dados, até outubro de 2022. Foram incluídos estudos originais, revisões sistemáticas e metanálises, publicados em inglês e espanhol. Resultados: Os ensaios clínicos randomizados, as revisões sistemáticas e as metanálises diferem ligei-ramente entre os resultados, mas demonstram um efeito protetor geral. As evidências mais recentes e abrangentes indicam que o uso desse agente reduz significativamente a positividade no teste de inclinação da mesa e evita a ocorrência de episódios de síncope. Conclusões: Embora as evidências atuais sobre a eficácia da midodrina em relação à prevenção e ao controle da síncope vasovagal sejam limitadas, observa-se um efeito protetor significativo, pois ela diminui o risco de sofrer um episódio sincopal em aproximadamente 50%

Reflex cardioinhibitory syncope potentially related to SARS-CoV-2 infection: a case report / Síncope cardioinibitória reflexa potencialmente relacionada à infecção por SARS-CoV-2: um relato de caso

Autonomic dysfunction related to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is increasingly described in the literature. We report the case of a 30-year-old male with a background of asthma and migraine who experienced a second episode of SARS-CoV-2 infection characterized by mild respiratory symptoms. Twenty-four days after the symptom onset, he developed acute syncope. A tilt test revealed a neuromediated cardioinhibitory response with asystole (Vasovagal Syncope International Study ­ VASIS type 2B). The temporal association between SARS-CoV-2 infection and syncope seems to indicate a probable causal relationship, which requires corroboration by future studies.

Disfunção autonômica relacionada à infecção por coronavírus-2 da síndrome respiratória aguda grave (SARS-CoV-2) vem sendo cada vez mais descrita na literatura. Relatamos o caso de um homem de 30 anos de idade, com histórico de asma e enxaqueca, que apresentou um segundo episódio de infecção por SARS-CoV-2 caracterizado por sintomas respiratórios leves. Vinte e quatro dias após o início dos sintomas, desenvolveu um quadro agudo de síncope. Um teste de inclinação revelou uma resposta cardioinibitória neuromediada com assistolia (Vasovagal Syncope International Study ­ VASIS tipo 2B). A associação temporal entre infecção por SARS-CoV-2 e síncope parece indicar uma provável relação causal, a qual requer corroboração por estudos futuros.

Crisis hipertensiva y bradicardia secundaria a intoxicación por midodrina / Hypertensive crisis and bradycardia secondary to midodrine intoxication

Resumen El síncope, definido como una pérdida transitoria de la conciencia que cursa con recuperación espontánea y completa, es secundario a un amplio grupo etiológico, incluido el de origen vasovagal desencadenado por una descarga adrenérgica u ortostatismo. El tratamiento de esta entidad incluye medidas no farmacológicas y farmacológicas, como la administración de midodrina, un agonista de los receptores a de acción periférica, usada en el control de la hipotensión ortostática y cuyo empleo ha demostrado mejoría en los síntomas de esta alteración. Se presenta el caso de una mujer de 18 años, con antecedente de síncope vasovagal en tratamiento con medidas no farmacológicas y midodrina desde seis meses antes, quien consultó al servicio de urgencias de un centro de atención de nivel IV por cuadro clínico consistente en ingestión intencionada de una sobredosis de midodrina. En el ingreso se documentaron crisis hipertensiva, bradicardia extrema y compromiso hepático y renal. Se indicó tratamiento sintomático con resolución de las alteraciones clínicas y paraclínicas e intervención del equipo de salud mental.

Abstract Syncope, defined as a transitory loss of consciousness characterised by its rapid onset, short duration, and spontaneous complete recovery, is secondary to a wide ethiological group, such as the vasovagal origin triggered by an adrenergic discharge or orthostatism. The management of this entity includes both non-pharmacological measures and pharmacological treatment such as the use of midodrine, a peripherally acting alpha receptor agonist, used in the management of orthostatic hypotension, whose use has shown improvement in the symptoms of this condition. We present a clinical case of an 18-year-old woman, with a history of vasovagal syncope under treatment with midodrine and non-pharmacological measures for 6 months, who was admitted to the emergency department of a level IV care center due to an intentional intake of midodrine overdose. Upon admission, a hypertensive crisis with extreme bradycardia, and liver and kidney involvement were documented. Symptom´s management was started with resolution of clinical and paraclinical alterations, and intervention by the mental health team.

Etiology and Age Distribution of Syncope in Delta Area Patients

Background: Syncope is a Total Loss of Consciousness (TLOC) due to cerebral hypo-perfusion, characterized by a rapid onset, short duration, and spontaneous complete recovery. It shares many clinical features with other disorders; it therefore presents in many differential diagnoses. This group of disorders is labelled TLOC. The aim of the present study was to determine the etiologies and the age distribution of patients with syncope in Delta area. Methods: This study included thirty patients who had at least one episode of syncope. All patients in this study were subjected to history taking, clinical examination, laboratory investigations, standard 12-lead Electrocardiogram (ECG), Resting Transthoracic Echocardiography (TTE). Some patients were subjected to Prolonged ECG monitoring (Holter, Event, ILR), Brain computed tomography (CT) and Magnetic resonance imaging (MRI), Tilt table test and Electrophysiology study (EP study). Results: Most common ECG rhythm was normal sinus rhythm, complete heart block, left ventricular hypertrophy, Slow Atrial fibrillation (AF), Left bundle branch block (LBBB), ventricular tachycardia. The most common diagnosis of syncope was vasovagal syncope, idiopathic syncope then cardiac syncope. Incidence of idiopathic syncope in populations under 40 years was significantly higher than in populations over 40 years, meanwhile regarding cardiac-related etiology for syncope in patients under age 40 was significantly lower than those patients over age 40. Conclusion: For age distribution, the incidence of idiopathic syncope in populations under 40 years was significantly higher than in populations over 40 years, meanwhile cardiac-related etiology for syncope in patients under age 40 was significantly lower than those patients over age 40.

Cuestionario de reacciones vasovagales a la donación de sangre en una institución de salud / Questionnaire of vasovagal reactions to blood donation in a health institution

Resumen: Objetivo: Identificar mediante un cuestionario de signos y síntomas vasovagales a donadores de sangre, con el fin de registrar los antecedentes que aumentan la probabilidad de presentar reacciones vasovagales. Materiales y Métodos: Se aplico un cuestionario a donadores de sangre, durante tres meses, en el banco de sangre en una institución de salud de tercer nivel. Resultados: El 100% de los donadores respondió negativamente a las preguntas del cuestionario, pero el 1.3% de ellos presentaron reacción vasovagal, siendo el mareo, palidez y náusea el signo y síntomas más frecuentemente mostrados. Al comparar dos grupos con y sin reacción vasovagal pareados por sexo, edad e índice de masa corporal, no hubo diferencias entre ellos. Conclusiones: Los donadores en nuestro país son fundamentalmente de reemplazo, por lo que se debe considerar esta circunstancia además de sus motivaciones, para el diseño de encuestas dirigidas a esta población.

Abstract: Objective: Identify, trough a vasovagal signs and symptoms questionnaire, blood donors in order to record the antecedents that increases the probability of presenting vasovagal reactions. Materials and Methods: A questionnaire was applied to blood donors, for three months, in the blood bank in a third-level health institution. Results: 100% of the donors answered negatively to the questions in the questionnaire, but 1.3% of them presented vasovagal reaction, with dizziness, pallor and nausea being the most frequently shown sing and symptoms. When comparing two groups with and without vasovagal reaction matched by sex, age and body mass index, there were no differences between them. Conclusions: Donors in our country are fundamentally replacement donors, so this circumstance plus their motivations should be considered for the design of surveys aimed at this population.

The outcome of head up tilt test in older adults with typical versus atypical features of syncope

Background: Syncope is usually a benign condition preventable by simple measures. Its diagnosis by history and inexpensive tests like head-up tilt table (HUTT) test save the patient unnecessary expenditure and stress. Objectives: To determine the outcome of head-up tilt test in older adult patients aged 60 years and more who present with typical versus atypical history of syncope, along with a study of the prodromal symptoms, association with comorbid burden, medications, grip strength, and cognitive function. Materials and Methods: An observational study of the patients presenting to the department of geriatrics with a history of neurocardiogenic syncope from May 2017 to October 2017 undergoing HUTT test looked at the association of the type of syncope based on the history and outcome of their HUTT test and association with prodromal symptoms, comorbidities, medications, triggering factors, electrocardiography, and Holter. Conclusions: The HUTT positivity rate for patients with a history of syncope was 31.8% with no association between typical or atypical syncope and HUTT positivity. Dizziness, lightheadedness, blurred vision, and sweating were significantly associated with typical syncope. No comorbidity or medication had an association with syncope or HUTT response but the comorbid burden had a significant association with positive HUTT response.