Investigation of the discomforts of the medical staff in COVID-19 isolation room / 上海交通大学学报（医学版）

Objective: To investigate the occurrence of medical staff leaving the COVID-19 isolation room due to discomforts and to provide reference for clinical prevention and treatment. Methods: Stratified sampling method was used to investigate the occurrence of medical staff from Shanghai medical team leaving isolation room earlier due to discomforts, as well as the main symptoms and signs of theirs. Logistic regression was used for risk factor analysis. Results: Among the 227 medical staff working in Leishenshan Hospital in Wuhan, Hubei Province, who were assisted by Shanghai, 69 (30.4%) staff left earlier due to discomforts while working in the isolation room. Two of them had syncope, and sixty-seven of them had symptoms and signs related to presyncope. Symptoms of presyncope include headache, nausea, sweating, dyspnea, and palpitations, etc. Univariate analysis revealed statistically significant differences in occupation (P=0.002), gender (P=0.006), and standing time (P=0.002). Logistic regression analysis showed that occupation (P=0.000), standing time (P=0.025), and hunger (P=0.029) were statistically significant. Conclusion: Different occupation, gender and standing time have different effects on the situation of medical staff leaving the isolation room due to discomforts. Occupation, standing time and feeling of hunger are the influencial factors for medical staff leaving the isolation room earlier.

Syncope in children clinicoetiological correlation

Background: Syncope is the abrupt cessation of cerebral blood flow leading to temporary loss of consciousness. Identification of etiology is utmost important as any syncopal event may be life threatening. Aim was to correlate the clinical and etiological causes of syncope in children and to note their investigational profile.Methods: Among 40 patients presenting with syncope and presyncope were studied. History of the event, precipitating factors were noted. They were investigated with the help of blood pressure, Electrocardiogram (ECG), 2D Echocardiogram and Electroencephalogram (EEG).Results: Out of the 40 patients of syncope 65% were above the age of 10 years with male preponderance (60%). Vasovagal syncope (57%) was the most common cause of syncope followed by orthostatic hypotension (15%), neurological (15%), and cardiac etiology (6%). In the neurological etiology the EEG showed diffuse slow background with occasional sharp bursts in right frontal area in 2 patients while in 4 patients sharp bursts were present in the centero-temporal region. 17% were classified as presyncope, 60% as mild and 22% as having severe syncope. There was a significant correlation of etiology of syncope with duration of hospitalization of more than 4 days and with recurrence of syncope. There was significant correlation of Evaluation of Guidelines in Syncope (EGSYS) score >3 with cardiogenic syncope. On follow up, neurological syncope patients had significant decrease in the number of syncopal episodes as they were immediately started on antiepileptics.Conclusions: Electrocardiogram, 2D Echocardiogram and Electroencephalogram are important tools for the early management and treatment of cardiac and neurological etiology of syncope.

Hallazgos electrocardiográficos y clínicos durante la prueba de inclinación (tilt test) en pacientes con sospecha diagnóstica de síncope neurocardiogénico / Electrocardiographic and clinical findings during a trial of inclination (tilt test) in patients with suspected neurocardiogenic syncope

El Tilt test es reconocido como una herramienta diagnóstica para evaluar pacientes con síncope neuromediado. No se discutido como se puede predecir el síncope de una manera sencilla en vista de que no hay descripción de parámetros precisos que permitan predecir un Tislt test positivo. Se desea con este trabajo observar los parámetros electrocardiográficos o clínicos que permitan predecir el resultado de la prueba. Se evaluaron 275 pacientes con sospecha diagnóstica de síncope neuromediado a quienes se les realizó Tilt test (enero de 2000-2006. 108 pruebas fueron positivas (39%), y con respuesta vasodepresora un 94,5%. Edad promedio fue 32 años, sexo femenino 68%; un 74% tenían un electrocardiograma (EGC) normal al inicio del tilt test y 41% presentó arritmia sinusual durante la prueba. Los cambios en el ECG más frecuentes fueron la taquicardia sinusal (19%) y ritmo de la unión (9,5%). Hubo descenso de la presión arterial sistólica (PAS), desde la fase basal hasta el final de la prueba, la PAD tuvo un incremento inicial y luego descendió, La respuesta positiva sin droga en el grupo de escolares y adolescentes fue predominante. Los hallazgos clínicos más frecuentes fueron; mareo, presíncope y síncope. Existen hallazgos clínicos y electrocardiográficos como el pre síncope y la arritmia sinusal que por su alto valor predictivo negativo, pudieran predecir una alta probabilidad de un resultado negativo del tilt test.

Tilt testing is recognized as a valuable diagnostic tool for the evaluation of patients with neuromediated syncope. To date, it is not possible to predict syncope in a simple manner in view of the fact that there is no description of precise parameters that may predict a positive tilt test. To observe electrocardiographic and clinical features that may predict the outcome of testing. For this, 275 patients with a suspected diagnosis of neurocardiogenic syncope were evaluated with a tilt-test from January 2000 to January 2006. A total of 108 test were positive (39%) and a vasodepressor response was seen in 94.5%. The mean age was 32 years (range: 7 to 92 years). Women accounted for 68%; 74% of the patients had a normal electrocardiogram at the beginning of the test and 41% developed sinus arrhymia during the test. The most common electrocardiographical changes durint the test were sinus tachycardia (19%) and junctional rhythm (9.5%). A drop in systolic blood pressure between the start and the end of the test was observed. The diastolic blood pressure showed an initial increase followed by a decrease. There were more positive responses without drugs in the group of students and adolescents. The most frequent clinical features were dizziness, presyncope and syncope. There are clinical and electrocardiographical fundings such as presyncope and sinus arrhythmia that because of their high negative predictive value, could predict a high probability of a negative tilt test result.

The Effect of Beta-blocker Assessed by Repeat Head-up Tilt Test in Adults with Vasovagal Syncope or Presyncope

BACKGROUND: Oral beta-blocker is initially used to prevent the symptons in patients with vasovagal syncope or presyncope. But, beta-blocker treatment may actually cause worsening of symptoms in some patients. The purpose of the present study was to evaluate the efficacy of oral beta-blocker in preventing symptoms during repeat head-up tilt test in patients who had a positive response in initial head-up tilt test. METHOD: Patients. Among the 150 patients with unexplained syncope or presyncope who underwent head-up tilt from October 1994 to January 1996, forty-three patients, who were taking beta-blocker and underwent repeat head-up tilted test, were included in this study. Initial head-up tilt test. Each patients was tilted to the 70 degree upright position for 30 minutes. If the test was negative in the baseline tilt, intravenous isoproterenol was started at 1 (micro)g/min and then increased by 1 (micro)g/min every three minutes to al maximum of 5 (micro)g/min while maintaining 70 degree upright position. Repeat head-up tilt test. The test was repeated while each patients was taking atinolol. The repeat test was continued until reaching at the stage where each patient had a positive response in initial test. RESULTS: 1) In initial head-up tilt test, most (91%) of a positive response occured during isoproterenol provocation. 2) In repeat head-up tilt test on atenolol, thirty-four patients(79%) had a negative response. But nine patients(21%) still had a positive response. 3) Nonresponsive group showed younger age and shorter time period to a positive response in initial head-up tilt test than responsive group. CONCLUSION: It may be useful to assess the effectiveness of beta-blocker by repeat head-up tilt before deciding long term treatment, especially younger age group.

Usefulness of Head-up Tilt Test in Adults with Syncope or Presyncope of Unexplained Origin

BACKGROUND: Vasovagal syncope is a common cause of syncope. In some cases, syncopal episode is recurrent, resulting in physical injury. Head-up tilt test with or without isoproterenol provocation has been a tool to diagnose vasovagal syncope. But the protocol of head-up tilt test has not been settled. In this study, we evaluate the usefulness of a head-up tilt test with isoproterenol provocation in patients with syncope or presyncope of unexplained origin. METHODS: Head-up tilt test was performed with patients in the fasting state in the morning. After supine heart rate and blood prewwure were obtained, each patient was tilted to the 70 degree upright position for 30 minutes using a motorized tilt table with a footboard. If the test was negative in the baseline tilt, intravenous isoproterenol was started at 1 microg/min and then increased by 1 microg/min every three minutes to a maximum of 5 microg/min while maintaining 70 degree upright position. The end points of test were positive response, intolerance of isoproterenol, heart rate>150 beats/min, and completion of the protocol. When an end point reached, the patient was rapidly returned to the horizontal position. RESULTS: 1) Of 122 patients with syncope or presyncope, 113 patients(93%) had prodromal symptoms. 2) 23 patients(19%) had physical injury during episode. 3) 93 patients(76%) experienced episodes while they were standing or sitting. 4) A total of 83 patients(68%) had a positve response during head-up tilt test ; 7 patients(8%) of these 83 patients had a positive response during the baseline tilt. But, 76 patients(92%) required isoproternol provocation to elicit this response. 5) The pattern of positive response showed vasodepressive pattern in 55 patients(67%), mixed pattern in 26 patients(31%), and cardioinhibitory pattern in 2 patients(2%). 6) No significant side effect of isoproterenol was noted. 7) There were no significant differences between positive response group and negative response group in terms of clinical characteristics and hemodynamic findings during head-up tilt test. CONCLUSION: A head-up tilt test with isoproterenol provocation could be an useful tool for diagnosing vasovagal syncope or presyncope in adults.