QT interval prolongation in people treated with bedaquiline for drug-resistant tuberculosis

Background: Bedaquiline (BDQ) is indeed recommended for treating multidrug-resistant tuberculosis (MDR-TB). However, it's essential to monitor patients receiving bedaquiline therapy closely because it has been associated with prolongation of the QTc interval. This study aimed to assess the association of bedaquiline to QT interval prolongation in DR-TB patients. Methods: This was an observational longitudinal study conducted in the Department of Respiratory Medicine in Chest Disease Hospital, Rajshahi, from August 2020 to February 2023. A total of 44 MDR-TB patients were included in the study. Data analyses were done by using Statistical Package for Social Sciences (SPSS) version 25.0. Results: Out of 44 patients the majority 30(68.2%) patients belonged to age >40 years with a mean age of 49.3±15.6 years, and all patients were male. All MDR patients were detected by sputum Gene-Xpert, 44 (100%), and sputum for AFB culture was done in all patients, 44 (100%). QT level and QT changes were statistically significant for baseline and 24 weeks. Only one patient died in 2 weeks of follow-up (Table 3). Changes of QT >60 ms was found in 6 (13.6%) and ?60 ms was 38 (86.4%). Age, sex, marital status, residence, educational status, occupational status, monthly income, chief complaints, co-morbidities, and using drug-causing QT prolongation were not statistically significant (p>0.05). Conclusions: Prolonged QT interval is in DR-TB patients who receive treatment using the bedaquiline regimen. We observed that with a moderate prolongation of QTc, there were no arrhythmias recorded and 1 death occurred due to acute MI.

Participation of clinical pharmacists in QTc interval prolongation induced by gilteritinib / 药学实践与服务

Objective To explore the role of clinical pharmacists involved in the case of a patient with acute myeloid leukemia whose QTc interval prolongation was induced by gilteritinib, and to provide reference for drug treatment and monitoring of those patients. Methods The abnormal electrocardiogram （ECG） of a patient with acute myeloid leukemia was found in time by clinical pharmacists, who participated in clinical diagnosis and treatment by analyzing the patient’s underlying diseases, diagnosis and treatment process, therapeutic drugs and their potential interactions. Results Clinical pharmacists suspected that the prolonged QTc interval was likely to be an adverse reaction caused by gilteritinib, and recommended immediate discontinuation of the drug and re-examination of the electrocardiogram.The physician took the suggestion to stop the suspected drug therapy with gilteritinib promptly, and ECG was rechecked 3 d later, and the QTc value returned to the normal range. Conclusion Clinical pharmacists participating in clinical diagnosis and treatment could provide better pharmaceutical care for patients.

Relationship of the T-wave Tpeak-Tend interval with conduction system disorders in arterial hypertension / Relación del intervalo Tpico-Tfinal de la onda T con trastornos del sistema de conducción en hipertensión arterial

Abstract Purpose: The Tpeak-Tend interval of the T wave has emerged as a new electrocardiographic marker of increased transmural dispersion of ventricular repolarization. We aimed to determine the presence of cardiac conduction system disorders in patients with systemic arterial hypertension (SAH) who have altered Tpeak-Tend interval of the T wave. Methods: The 67 patients with SAH were divided into two groups. Those with prolonged (≥ 77 ms) Tpeak-Tend intervals, 21 (31%) patients were in the study group. Those with normal (< 77 ms) Tpeak-Tend intervals, 46 (69%) patients were in the control group. Alteration of ventricular repolarization manifested as a prolongation of the Tpeak-Tend interval was detected by computerized electrocardiographic analysis tools. Results: The median value of QRS complex duration was significantly wider in the study group as compared to the control group (110 ± 12 ms vs. 94 ± 8 ms p < 0.001). There was a significantly greater incidence of left anterior hemiblock in the study group (14% vs. 0% p < 0.04). The median value of the QTc interval was significantly greater in the study group (440 ± 26 vs. 422 ± 15 p < 0.01). There was a significantly greater incidence of patients with prolonged QTc interval in the study group (33% vs. 11% p < 0.02). The median value of the Tpeak-Tend interval was significantly greater in the study group (84 ± 5 ms vs. 65 ± 4 ms p < 0.001), as well as, the Tpeak-Tend/QTc ratio in the study group (0.19 ± 0.1 vs. 0.16 ± 0.1 p < 0.001). Conclusion: There is a significantly greater ventricular repolarization disorders and abnormalities of the cardiac conduction system in SAH patients who possess altered Tpeak-Tend interval of the T wave.

Resumen Objetivo: El intervalo Tpico-Tfinal de la onda T es un marcador electrocardiográfico de la dispersión transmural aumentada de la repolarización ventricular. Investigamos la presencia de trastornos del sistema de conducción cardíaca en pacientes con hipertensión arterial sistémica (HA) que poseen alterado el intervalo Tpico-Tfinal de la onda T. Métodos: Los 67 pacientes con HA fueron divididos en dos grupos. Aquellos con intervalos de Tpico-Tfinal prolongados (≥ 77 ms), 21 (31%) pacientes (grupo de estudio). Aquellos con intervalos normales (< 77 ms) Tpico-Tfinal, 46 (69%) pacientes (grupo control). Los intervalos Tpico-Tfinal fueron medidos por herramientas de análisis electrocardiográfico computarizado. Resultados: El valor mediano de la duración del complejo QRS fue significativamente más amplio en el grupo de estudio (110 ± 12 ms vs. 94 ± 8 ms p < 0.001). Hubo una incidencia significativamente mayor de hemibloqueo anterior izquierdo en el grupo de estudio (14% vs. 0% p < 0.04). El valor mediano del intervalo QTc fue significativamente mayor en el grupo de estudio (440 ± 26 vs. 422 ± 15 p < 0.01). Hubo una incidencia significativamente mayor de pacientes con intervalo QTc prolongado en el grupo de estudio (33% vs. 11% p < 0.02). El valor mediano del intervalo Tpico-Tfinal fue significativamente mayor en el grupo de estudio (84 ± 5 ms vs. 65 ± 4 ms p < 0.001), así como el cociente Tpico-Tfinal/QTc (0.19 ± 0.1 vs. 0.16 ± 0.1 p < 0.001). Conclusión: Existe una alteración de la repolarización ventricular significativamente mayor y anomalías del sistema de conducción cardíaca en pacientes con HA que poseen alteración del intervalo Tpico-Tfinal de la onda T.

Association of endemic arsenic poisoning and abnormal electrocardiogram: Meta-analysis / 中华地方病学杂志

Objective:To evaluate the correlation between endemic arsenic poisoning and abnormal electrocardiogram (ECG).Methods:PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), Wanfang data, VIP and other databases were used for literature retrieval, and epidemiological literatures related to abnormal ECG of endemic arsenic poisoning published in domestic and abroad were included in the study. The time limit was from the establishment of the database to December 1, 2020. RevMan 5.3 was used for Meta-analysis of binary variables. Random effect model was selected according to the results of heterogeneity, and odds ratio ( OR) was used as the effect index. Characteristic changes were found by subgroup analysis. Bias was published by funnel plot. Results:Nine articles were included in this Meta-analysis, with 6 articles in Chinese and 3 articles in English, respectively. The abnormal ECG changes included QTc prolongation, ST-T segment change, left axis deviation and arrhythmia. Finally, 1 975 cases were included in the exposure group, including 575 cases of abnormal ECG; 750 cases of control group, including 145 cases of abnormal ECG. Meta-analysis showed that the combined OR value [95% confidence interval ( CI)] of abnormal ECG changes was 4.41 (2.83 - 6.87), with statistical significance between the two groups ( Z = 6.56, P < 0.05); the results of subgroup analysis showed that the combined OR values (95% CI) of QTc prolongation, ST-T segment change, left axis deviation and arrhythmia were 12.30 (5.91 - 25.59), 2.74 (1.39 - 5.41), 2.93 (0.89 - 9.62) and 4.13 (2.38 - 7.17), respectively. Conclusions:Endemic arsenic poisoning may cause abnormal ECG. Prolongation of QTc caused by arsenic exposure may be the characteristic change of abnormal ECG.

Electrocardiographic effect of artemisinin-piperaquine, dihydroartemisinin-piperaquine, and artemether-lumefantrine treatment in falciparum malaria patients

Abstract INTRODUCTION: Artemisinin-based combination therapy (ACT), such as artemisinin-piperaquine (AP), dihydroartemisinin-piperaquine (DP), and artemether-lumefantrine (AL), is the first-line treatment for malaria in many malaria-endemic areas. However, we lack a detailed evaluation of the cardiotoxicity of these ACTs. This study aimed to analyze the electrocardiographic effects of these three ACTs in malaria patients. METHODS: We analyzed the clinical data of 89 hospitalized patients with falciparum malaria who had received oral doses of three different ACTs. According to the ACTs administered, these patients were divided into three treatment groups: 27 treated with AP (Artequick), 31 with DP (Artekin), and 31 with AL (Coartem). Electrocardiograms and other indicators were recorded before and after the treatment. The QT interval was calculated using Fridericia's formula (QTcF) and Bazett's formula (QTcB). RESULTS: Both QTcF and QTcB interval prolongation occurred in all three groups. The incidence of such prolongation between the three groups was not significantly different. The incidence of both moderate and severe prolongation was not significantly different between the three groups. The ΔQTcF and ΔQTcB of the three groups were not significantly different. The intra-group comparison showed significant prolongation of QTcF after AL treatment. CONCLUSIONS: Clinically recommended doses of DP, AL, and AP may cause QT prolongation in some malaria patients but do not cause torsades de pointes ventricular tachycardia or other arrhythmias.

Detailed ECG analysis in type 2 diabetes mellitus: a predictor of multitude of complications

Background: Type 2 diabetes mellitus is a systemic disease with life-threatening complications and morbidity. The 12 lead ECG, an easily available investigation, when studied in detail can give a lot of information and predict various microvascular and macrovascular complications apart from coronary artery disease.Methods: A random cross sectional study involving 100 patients of type 2 diabetes mellitus, in the age group of 18-80 years were included in study after applying various inclusion and exclusion criteria. They were subjected to ECG, 2D echocardiography and laboratory tests. Data were collected and analysed.Results: Arrythmia was not detected in any patient. A resting tachycardia (HR >100) in 30 patients correlated with Prolonged QTc (>440 miliseconds) (p=0.04). QRS amplitude was reduced in 26 patients. Prolonged QTc also correlated with presence of diabetic complications, retinopathy of NPDR type and nephropathy (p=0.004). Hence about 30% of the study group did show signs of early diabetic cardiac autonomic neuropathy and cardiomyopathy.Conclusions: The statistically significant utility of electrocardiogram in predicting various complications of diabetes apart from coronary artery disease.

Effect of wheat-grain moxibustion at Yinbai (SP 1) on the menstrual period prolongation after IVF-ET down-regulation treatment / 中国针灸

OBJECTIVE@#To compare the clinical effect between wheat-grain moxibustion at Yinbai (SP 1) and oral administration of dydrogesterone tablet for menstrual period prolongation after down-regulation treatment of in vitro fertilization embryo transfer (IVF-ET).@*METHODS@#A total of 54 patients with prolonged menstrual period after down-regulation treatment of IVF-ET were randomly divided into an observation group and a control group, 27 cases in each one. In the observation group, when the menstrual period delayed more than 7 days, the wheat-grain moxibustion at Yinbai (SP 1) was performed, once a day, with an interval of 1 day between two 3-day treatments; when the menstrual blood was cleaned, the ovulation was continued and the eggs were taken. In the control group, when the menstrual period delayed more than 7 days, the oral administration of dydrogesterone tablet was provided, 10 mg each time, twice a day; when the menstrual blood was cleaned, the ovulation was continued and the eggs were taken. The number of days for menstrual blood to be cleaned, the area change of uterine cavity hemorrhage, the morphology of endometrium, the blood supply of endometrium, the number of oocytes obtained, the grade of frozen embryo and the clinical effect were observed between the two groups after treatment.@*RESULTS@#Compared with the control group, the number of days for menstrual blood to be cleaned was shorter in the observation group after treatment (0.05). The cured rate in the observation group was 100.0% (27/27), higher than 33.3% (9/27) in the control group (<0.05).@*CONCLUSION@#The wheat-grain moxibustion at Yinbai (SP 1) could more effectively treat prolonged menstrual period after IVF-ET down-regulation treatment, which is beneficial to the preparation of the endometrium, and has no effect on the oocyte collection and embryo culture.

Determination of the increased risk of developing atrial fibrillation in fibromyalgia syndrome

Abstract Introduction: Atrial fibrillation (AF) is the leading cause of ischemic stroke and is one of the most common arrhythmias. Previous studies have shown that impaired diastolic functions, P wave dispersion (Pd), and prolonged atrial conduction times (ACT) are associated with increased incidence of atrial fibrillation (AF). The aim of this study was to evaluate diastolic functions, Pd, and ACT in fibromyalgia syndrome (FMS) patients to determine whether there is an increase in the risk of developing AF. Methods: The study included a total of 140 female patients (70 FMS group, 70 healthy control group). Pd was evaluated using 12 lead electrocardiography (ECG), and diastolic functions and ACT with echocardiography. The ECG and echocardiographic evaluations were performed by different cardiologists blinded to the clinical information of the subjects. Results: There was no difference between the two groups in laboratory and clinical parameters. Patients with FMS had significantly higher echocardiographic parameters of ACT known as left-sided intra-atrial (13.9 ± 5.9 vs. 8.1 ± 1.8, p < 0.001), right-sided intra-atrial (21.9 ± 8.2 vs. 10.4 ± 3.5, p < 0.001) and interatrial [40 (25-64) ms vs. 23 (14-27) ms p < 0.001] electromechanical interval (EMI) compared with the control group. Pd was significantly greater in the FMS group compared with the control group [46 (29-62) ms vs. 32 (25-37) ms, p < 0.001]. In the FMS group, there was no significant relationship of the echocardiographic parameters of ACT, Pmax and Pd with age, E/A ratio and deceleration time (DT); while all these five parameters were significantly correlated with left atrial dimension, isovolumetric relaxation time (IVRT), fibromyalgia impact questionnaire (FIQ) and visual analogue scale (VAS). There was a strong correlation between FIQ and VAS and echocardiographic parameters of ACT, Pmax and Pd. Conclusions: Impaired diastolic functions, an increase in Pd, and prolongation of ACT were observed in FMS. Current disorders are thought to be associated with an increased risk of AF in FMS. The risk of developing AF increases with the severity of FMS and clinical progression.(AU)

Study of cardiac manifestations in patients with chronic liver disease

Background: Chronic liver disease is a common cause of mortality and morbidity worldwide. This has pathological effects on various systems in the body including cardiovascular system which usually is unnoticed. In majority of cases of chronic liver disease, cardiovascular complications develop as a subclinical condition which manifests only during stressful situations. Hence early detection of cirrhotic cardiomyopathy by echocardiography and 2D-ECHO studies in all patients of chronic liver disease helps in reducing the morbidity and mortality.Methods: 100 cases of chronic liver disease were included in the study. Data was collected through a prepared proforma. All patients were subjected to cardiac evaluation by ECG and Echocardiography. Serum pro-BNP levels were done for selected patients. Severity of the liver disease was assessed by using Child-Pugh score. Cardiac abnormalities were noted and correlated with the severity of the liver disease.Results: Out of 100 patients studied, 83% were males. 80% of the patients had history of alcoholism. 59% of the patients had abnormal ECG finding. 40% of them had QT prolongation and was related to the severity of liver disease. 60% of the total patients studied had positive pro-BNP values in patients with significant cardiac dysfunction. 46% of the patients had normal echocardiographic finding; most common abnormal finding was diastolic dysfunction (43%) and positively correlated with severity of liver disease.Conclusions: In chronic liver disease patient’s QT prolongation is the most common ECG abnormality. Most common Echocardiographic finding was diastolic dysfunction which had strong correlation with the severity of the liver disease.

The Advance of Escitalopram's Drug-induced QTc Prolongation / 中国药学杂志

Escitalopram, a selective serotonin re-uptake inhibitor (SSRI) antidepressant which is the (S)-enantiomer of citalopram, is worldwide used for the treatment of depressive and anxious disorders in clinical practice, however, recent data have indicated that high therapeutic escitalopram doses may cause the potential of QTc prolongation effect, which is a predisposing factor for arrhythmia. Nevertheless, in March 2012, the Food and Drug Administration (FDA) issued a safety bulletin advising the daily dosage of escitalopram should be restricted to a maximum of 20 mg daily in healthy adults and 10 mg maximum in high risk patients (eg>60 years of age). In this review, we aimed to investigate what factors can affect and how escitalopram gives rise to QTc prolongation.

Analysis of Selective Serotonin Reuptake Inhibitors Associated with QT Prolongation and Torsade de Pointes Adverse Events Based on Data Mining Methods / 中国药学杂志

OBJECTIVE: To excavate and evaluate the risk signals of QT prolongation and torsade de pointes(TdP) induced by selective serotonin reuptake inhibitors(SSRIs), provide references for clinical use. METHODS: Data from FDA adverse event reporting system (FAERS, from January 2004 through June 2018) were analyzed for each SSRIs, including fluoxetine, sertraline, citalopram, escitalopram, paroxetine, and fluvoxamine. When QT prolongation and TdP cases were identified using preferred terms (PT) and standardised MedDRA queries (SMQ), three different data mining algorithms were used to detect signalsreporting odds ratio (ROR), medicines and healthcare products regulatory agency (MHRA), and bayesian confidence popagation neural network (BCPNN), if all the three algorithms were positive, suggesting the generation of signals. RESULTS: A total of 3 912 reports of QT prolongation and TdP associated with SSRIs were retrieved through the SMQ. Among which, more females than males(2 349 vs. 1 150), mainly aged 18-44 and 45-64 years, and 90.64% were serious adverse events. The signals were found for fluoxetine, sertraline, citalopram, escitalopram, paroxetine and fluvoxamine at the SMQ level, the RORs (95%CI) were 5.25(4.79-5.76), 2.08(1.79-2.27), 2.86(6.32-7.44), 3.41(3.03-3.84), 2.09(1.84-2.37) and 10.44(8.17-13.33) respectively; the PRRs (X2) were 5.20(1 494.43), 2.01(140.41), 6.77(2 911.71), 3.93(462.34), 2.09(136.58) and 10.21(538.26) respectively; the Ics (IC-2SD) were 2.15(2.12), 1.54(1.52), 2.67(2.65), 2.34(2.31) 1.14(1.12) and 3.16(3.10) respectively. Analysis of the PT included in the SMQ for TdP/QT prolongation, except paroxetine was only detected electrocardiogram QT prolonged signal, all the other SSRIs were detected electrocardiogram QT prolonged and TdP signals. CONCLUSION: QT prolongation may be a SSRIs class effect, but TdP just for fluoxetine, sertraline, citalopram, escitalopram and fluvoxamine. Clinical staff should pay more attention to the differences in adverse drug reaction related to SSRIs, and take pertinence measure to prevent.

Clinical analysis of 8 cases of connective tissue disease complicated with acquired hemophilia A / 中华风湿病学杂志

Objective To analyze the clinical features and treatment of connective tissue disease (CTD) complicated with acquired hemophilia A (AHA).Methods A retrospective analysis of 8 cases of CTD [5 cases of systemic lupus erythematosus (SLE),2 cases of Sj(o)gren's syndrome (SS),1 case of rheumatoid arthritis (RA)] related to clinical manifestations,diagnostic methods,treatment options and outcomes.Results At the onset of AHA,active disease was shown in 7 patients with CTD,and 5 cases had bleeding symptoms in different parts.There were 3 cases of anti-phospholipid syndrome in 5 cases of SLE,2 of which had thrombosis.In 8 patients,the activated partial thromboplastin time (APTF) was prolonged by 1.7 to 3.times,FⅧ∶ C was 9.2％ to 21％ (50％ to 150％),and the factor Ⅷ inhibitor titer was increased by 7.6 to 56 BU/m1 (Bethesda method).Seven patients were treated with sufficient hormones,immunosuppressive agents,human immunoglobulin (IVIG),and blood products.Five patients had clinically improved bleeding tendency and APIT,and one patient was ineffective.Conclusion CTD is easy to combine with AHA.Glucocorticoid combined with immunosuppressive agent can effectively treat CTD-related AHA.For refractory patients,rituximab can be an alternative.

Cambios electrocardiográficos en pacientes con VIH con y sin inhibidores de proteasa vs NNRTI / Differences in electrocardiographic changes in HIV patients with and without treatment with protease inhibitors vs NNRTI

Resumen ANTECEDENTES La infección por el virus de inmunodeficiencia humana (VIH) incrementa la prevalencia de prolongación del intervalo QT corregido (QTc), lo que es un factor independiente de eventos de enfermedad cardiovascular en esta población. En la bibliografía mundial se asocia este cambio con la administración de los antirretrovirales inhibidores de proteasa y efavirenz. Sin embargo, no se conocen datos de estos cambios en la población mexicana. MATERIAL Y MÉTODO Estudio prospectivo observacional en el que se seleccionaron expedientes de marzo de 2015 a mayo de 2016 de la consulta externa del Instituto Nacional de Enfermedades Respiratorias (INER); se dividieron en dos grupos: sin tratamiento, por reciente diagnóstico, y con tratamiento antirretroviral. Se registraron datos clínicos, tratamiento farmacológico, electrocardiograma y química sanguínea. RESULTADOS No se encontraron diferencias entre ambos grupos respecto a edad ni electrólitos séricos. Tampoco se encontró relación entre la prolongación del QTc con efavirenz o los inhibidores de proteasa. Raltegravir disminuyó la duración del QTc (p = 0.001) mientras que la coinfección por molusco contagioso se asoció con prolongación del QTc (p = 0.02). CONCLUSIÓN En nuestro estudio no logramos demostrar en población mexicana relación de la prolongación del QTc con los antirretrovirales de primera ni segunda línea. Se requieren más estudios para determinar la importancia clínica del efecto de raltegravir y molusco contagioso en el QTc.

Abstract BACKGROUND Human immunodeficiency virus (HIV) infection increases the prevalence of QTc prolongation (QTc), which is an independent factor of cardiovascular disease events in this population. In the world literature this change is associated with the use of the protease inhibitors and efavirenz antiretrovirals. However, no data are available on these changes in the Mexican population. MATERIAL AND METHOD A prospective observational study was done selecting records from March 2015 to May 2016 of the external consultation of the National Institute of Respiratory Diseases (INER), Mexico City; they were divided into two groups, those without treatment, because recent diagnosis, and with antiretroviral treatment. We recorded clinical data, pharmacological treatment, electrocardiogram and blood chemistry. RESULTS We found no differences between the two groups regarding age or serum electrolytes. We found no association between QTc prolongation and efavirenz or protease inhibitors. Raltegravir decreased QTc duration (p = 0.001) while molluscum contagiosum coinfection was associated with QTc prolongation (p = 0.02). CONCLUSION In our study, we failed to demonstrate in Mexican population association of QTc prolongation with first- and second-line antiretrovirals. More studies are needed to determine the clinical significance of the effect of raltegravir and molluscum contagiosum on QTc.

Signification and Challenges of the Act on Life-Prolongation Determination - With focus on Patient-Oriented Medical Care / 의료커뮤니케이션

BACKGROUND: The Purpose of this study is to look into the signification and challenges of the Act on life prolongation determination of a patient who is going under hospice palliative medical care and a deathbed process (hereinafter referred to as “the Well-Dying Act”) from a position of a patient.METHODS: To improve the problems exposed in the process of enforcement of the Well-Dying Act, it's important to find a solution point after looking into improvements from a position of a patient through communication in line with the intent of law enactment. Hereupon, this study intended to look into improvements through the interviews with family members of a patient, and doctors.RESULTS: it was found that improvements include reduction in the domain of family for consent to an interruption of life prolongation medical care, necessity of establishment of a medical institution ethics committee for implementing the Well-Dying Act, simplification of the relevant form, abolition of a criminal penalty clause, and introduction of an authorized agent, etc.CONCLUSION: This study thinks that it stands to reason to limit the domain of family for consent to an interruption of life prolongation medical care to a patient's spouse, parents and children in principle; nevertheless, when all these persons are not existent, reasonable is the way to impose a duty of getting unanimous consent to a patient's well-dying from all direct lineal ascendants and descendants of the patient on a relevant medical institution.

Association between metabolic syndrome with QTc interval prolongation in physical examination subjects / 重庆医学

Objective To explore the relationship between metabolic syndrome(MS) and corrected QT(QTc) interval prolongation.Methods A total of 1 260 participants having electrocardiogram examinations,aged over 18 years old from June 2015 to June 2016 were included and divided into the MS group and non-MS group.QTc was calculated according to the Bazett formula.The Logistic regression model was established for exploring the association between MS and QTc.Results There were 63 cases of QTc interval prolongation in the MS group,however,40 cases in the non-MS group(P＜0.01).In the unadjusted model,MS was a risk factor of QTc interval prolongation[OR =6.36,95 ％ CI(2.34,8.67),P＜ 0.01].After further adjusting confounders,MS was still correlated with QTc interval prolongation[OR =4.11,95 ％ CI(2.09,7.13,P＜ 0.01].In the study of the relationship between the MS groups with QTc interval prolongation,after adjusting confoundingfactors,only abdominal obesity[OR=2.76,95％ CI(1.43,7.56),P＜0.01] and hypertriglyceridemia[OR=1.75,95％CI(1.22,4.31),P=0.013)] were closely correlated with QTc interval prolongation.Conclusion MS is an independent risk factor of QTc interval prolongation.It is especially important to strengthen the management of blood lipid and abdominal circumference.

Strategies of Using Antipsychotics in Patients with Bipolar Disorders / 신경정신의학

Bipolar disorder is a recurrent chronic condition and patients usually continue long-term medication from young age to prevent the recurrence of mood episodes. Antipsychotics play an important role in acute and maintenance treatment of bipolar disorder, even when patients experience no psychotic symptoms. Antipsychotics are also used in monotherapy and combination therapy involving mood stabilizers such as lithium or valproate. However, limited antipsychotics are currently approved by the US Food & Drug Administration ; 10 kinds of antipsychotics were approved for manic or mixed episodes, 3 for bipolar depression, and 5 for maintenance therapy. Before and after the use of antipsychotics, psychiatrists should carefully monitor baseline weight, pulse, blood pressure, fasting blood glucose or HbA1c, blood lipid profile, and electrocardiogram to evaluate QTc prolongation. During manic episodes or mixed features, antipsychotics rapidly control agitation, aggression, and impulsivity. Repetitive injections of typical antipsychotics are not implemented in bipolar patients as this practice is not evidence-based. However, long-acting injectable atypical antipsychotics are approved and feature support on maintenance therapy for bipolar patients. Although recent studies have shown the benefits of aripiprazole and olanzapine on rapid-cycling bipolar patients, few studies support the effectiveness of antipsychotics in suicide prevention. Moreover, while there is extensive evidence on the effectiveness of lithium in suicide or self-harm prevention. In conclusion, antipsychotics, especially aripiprazole, quetiapine, olanzapine, and risperidone, are effective to manage bipolar disorder in clinical settings. But weight gain and cardiac conductance should be carefully monitored before and during the use of antipsychotics.

Prolongation of survival time of incurable terminal cancer patients with herbal medicines

Background: The purpose of present study was to know the relation between the four blood groups (A, B, AB, and O) and high academic scores among students of Government medical colleges of North India. Materials and methods: Study was conducted in Department of Physiology, Dr BSA Medical College, Delhi and UCMS, Delhi on 247 medical students both males and females of age group 18-20 years. Blood groups were collected from past medical records during the time of admission and Confirmation was done during the blood grouping practical classes. Blood group, completion test marks, internal assessment marks (theory, practical and viva-voce) in percentage were tabulated. Statistical analysis was done by SPSS 16.0 software. Results: Out of 247 students 98 students were B group, 76 students were O group, 57 students were A group and 16 students were AB group. Total number of Blood group B students (N=22) who scored high marks were more than the other blood group students. While the %age of students of A blood group (29.8%) were more than other blood groups. Conclusion: Though our study showed that there was a variation in the academic scores between the blood groups A, B, O and AB, there was no significant association (p < 0.05) found between any blood group and academic scores. So, the conclusion of our study was that there was no real correlation between blood groups and academic scoring

QT-interval prolongation due to medication found in the preoperative evaluation

QT prolongation is an electrocardiographic change that can lead to lethal arrhythmia. Acquired QT prolongation is known to be caused by drugs and electrolyte abnormalities. We report three cases in which the prolonged QT interval was improved at the time of operation by briefly discontinuing the drugs suspected to have caused the QT prolongation observed on preoperative electrocardiography. The QTc of cases 1, 2, and 3 improved from 518 to 429 ms, 463 to 441 ms, and 473 to 443 ms on discontinuing the use of a gastrointestinal prokinetic agent, a proton pump inhibitor, and a molecular targeted drug, respectively. These cases were considered to have drug-induced QT prolongation. We reaffirmed that even drugs administered for conditions unrelated to cardiac diseases can have adverse side effect of QT prolongation. In conclusion, our cases indicate that dental surgeons should be aware of the dangerous and even potentially lethal side effects of QT prolongation. For safe oral and maxillofacial surgery, cooperation with medical departments in various fields is important.

Introduction of ICH E14 Clinical Evaluation of QT Prolongation Caused by Non-Antiarrhythmic Drug: Q&As (R3) / 药物评价研究

To detect and determine the QT interval prolongation caused by non antiarrhythmic drugs,ICH released the E14 Clinical Evaluation of QT/QTc Interval Prolongation and Proarrhythmic Potential for Non-Antiarrhythmic Drugs and released E14's questions and answers (ICH E14 Q&As) in 2008 which explained some specific questions.Subsequently,This Q&As were revised third times and in June 2017 forwarded by FDA.The number of questions and answers in the revised edition doubled compared with the original.This article introduces the details of this revised edition,and hopes to be helpful to the research and supervision in China.

Pharmaceutical Care for Sotalol-induced QT Prolongation in Aged Patient with Heart Failure / 中国药房

OBJECTIVE:To explore the role of clinical pharmacists participating in the prevention and treatment of sotalol-in-duced QT prolongation in aged patient with heart failure. METHODS:Clinical pharmacists participated in the treatment for a aged patient with heart failure,and assisted physicians to identify and assess the risk of sotalol-induced QT prolongation. According to the clinical symptoms and laboratory indexes,it was suggested to continue to use sotalol for antiarrhythmic,adjust the hepatoprotec-tive drug,given pharmaceutical care of ECG,electrolyte level monitoring,drug education and so on. RESULTS:Physicians adopt-ed the suggestions of clinical pharmacists to relive the illness without malignant arrhythmia and discharged after 11 d. CONCLU-SIONS:The patient with heart failure should be dominated by improving cardiac function and maintaining hemodynamic stability;combined with related guidelines and documentation,clinical pharmacists can assist physicians to identify the drug that induced QT prolongation,asses the risk of torsades de pointes ventricular tachycardia and other bad consequences,develop and optimize the regimen and strengthen pharmaceutical care to ensure the safe and effective treatment.