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Biomedical subjects

B Ibrahim

Publications and source records attributed to B Ibrahim.

At least 19 recordsLinked to original sources
PubMed2001

Initial clinical experience with implantable loop recorders.

The purpose of this study was to review the initial experience of a university hospital with Implantable Loop Recorders (ILR) for diagnosis of recurrent unexplained syncope or presyncope. Twelve patients with syncope or presyncope of unknown etiology (who had a negative tilt table test, electrophysiologic study, and neurologic work-up) underwent implantation of ILR. All implants were performed using the Reveal ILR (Medtronic AVE, Santa Rosa, California). The 8 cc device is 61 mm long, 19 mm wide, 8 mm thick and weighs 17 grams. It has 18 months of battery life and has 2 electrodes with 38.5 mm spacing. The device is nonvascular and is implanted approximately 2 fingerbreadths below the clavicle in a subcutaneous pocket (1.5 inches long) and is secured via polydacron suture to the pre-pectoral fascia/pectoralis muscle. Twelve patients with a mean age of 61 +/- 22 years received the ILR. Ten patients had syncope and 2 had presyncope. Three patients had coronary artery disease and 2 had dilated cardiomyopathy. ILRs were implanted for a mean follow-up period of 7.2 +/- 5.8 months (range, 1 day to 18 months). Two patients still continue to be monitored at the time of this report. The mean number of events prior to ILR was 6.0 +/- 5.4. Eight patients (66%) had recurrent syncope after implantation. One patient was not available for follow-up. There were no significant complications from the implant. In 5/12 patients (42%), the ILR helped to diagnose the etiology of the syncopal episode. Syncope was secondary to asystole in three patients, junctional bradycardia in another patient, and seizure activity in a fifth patient (high-frequency noise recorded on the electrocardiogram during sinus rhythm). The 4 patients with ILR-documented bradyarrhythmias underwent permanent pacemaker implantation and are alive and well. ILR implantation is a simple, useful and safe method in assisting with the diagnosis of recurrent unexplained syncope or presyncope after an inconclusive electrophysiologic and neurologic evaluation.

Adult↗
PubMed2000

Effect of Tephrosia vogelii and Justicia extensa on Tilapia nilotica in vivo.

According to our and other ethnobotanic studies (Walker, R., 1951. Une Nouvelle Légumineuse du Gabon servant à narcotiser le poisson. Rev. Bot. Appl. 31, 327; Walker, R., Sillans, R., 1961. Les plantes utiles du Gabon. Encyclopédie Biologique. P. Chevalier, Paris; Halle, N., 1970. Flore du Gabon 17, Famille des Rubiacées. Museum National d'Histoire Naturelle, Paris; Mounzeo, H., et al., 1997. Quelques plantes utilisées comme poisons de pêches chez les Punu du Gabon. Le Flamboyant 44. Décembre, Bulletin de Liaison des membres du réseau 'Arbres Tropicaux'), Tephrosia vogelii and Justicia extensa are two plants whose leaves are particularly used for the catching of fish in Gabonese rivers. The leaf extracts of those plants have been tested on Tilapia nilotica in order to observe their toxicity. At a given dose, the small fish are the first to be poisoned. This toxicity is more important for J. extensa and increased in a dose-dependent manner. After boiling for 90 min, those leaf extracts and rotenone (10(-6) M) taken as a control retain their toxicity at high dose (625 mg/l), although the latency period is higher. With the same temperature condition, at weak doses (37.5 and 62.5 mg/l), T. vogelii loses its toxicity, whereas J. extensa preserves it at 62.5 mg/l. As shown in our results, the fact that the extracts preserve their toxicity at high dose after boiling requires particular attention be given to the doses used for fishing and to the type of plants used.

Animals↗
PubMed2000

An association between anxiety and neurocardiogenic syncope during head-up tilt table testing.

To study the association between anxiety and neurocardiogenic syncope as determined by head-up tilt table testing (HUT) in men and women with presyncope or syncope, patients with unexplained syncope or presyncope undergoing HUT were asked to complete the Burns Anxiety Inventory (BAI), a validated inventory of 33 questions with responses graded from 0 to 3. HUT consisted of a 30-minute tilt to 60 degrees, which if negative, was repeated with an isoproterenol infusion. A positive HUT was defined as symptomatic hypotension and/or bradycardia. Of the 66 patients who completed the BAI and underwent HUT, 33 were men and 33 were women. The mean age was 57 +/- 18 years (17-91 years). Patients with a positive HUT had a higher BAI score than those with a negative HUT (22 +/- 12 vs 14 +/- 13, P = 0.017). This association was stronger in women with a BAI score of 24 +/- 11 in those with a positive HUT versus 13 +/- 8 in those with a negative HUT (P = 0.005). In contrast, the mean BAI score for men with a positive HUT was 19 +/- 13, as compared to 15 +/- 16 for a negative HUT (P = 0.5). In conclusion, the present study demonstrates a statistical association between anxiety (as determined by BAI) and HUT result. Gender-based analysis revealed a more statistically significant relationship between anxiety and HUT outcome for women as compared to men.

Adult↗
PubMed2000

Revealing data retrieved from an implantable loop recorder.

This patient is an 80-year-old man with a history of recurrent syncope of unknown etiology who underwent an extensive cardiac and neurologic evaluation which was essentially negative. The patient subsequently received an implantable loop recorder (Reveal , Medtronic, Inc., Minneapolis, Minnesota). Eight months after implantation, this device was activated by the patient following a syncopal episode. The episode revealed over 30 seconds of sinus arrest with only 3 ventricular escape complexes observed during that time. The patient activated this device and was subsequently referred for a dual chamber permanent pacemaker, which was implanted without complications. This case illustrates the advantages of a non-vascular, implantable loop recorder for helping to define the etiology of recurrent unexplained syncope.

Aged↗
PubMed1999

Calcium channels, potassium channels and membrane potential of smooth muscle cells of human allantochorial placental vessels.

The membrane potential (Um), the main factor of the excitation-contraction coupling, of human allantochorial placental vascular smooth muscle cells (VSMCs) has been previously shown to depend on voltage-sensitive K+ channels. These channels were blocked by high external K+. To characterize other channels which regulated Um, various constrictor or/and vasodilators and channel blockers were used. Serotonin depolarized VSMCs, in normal medium, but induced a more marked depolarization in VSMCs predepolarized by high external K+. This depolarization was inhibited by nifedipine, a blocker of voltage-gated Ca2+ channels. Acetylcholine, sodium nitroprusside (without effect on Um in normal medium), hyperpolarized the predepolarized-high K+ medium VSMCs. This hyperpolarization was inhibited after addition of charybotoxin (a blocker of Ca2+-activated K+ channels) or/and glibenclamide (a blocker of ATP-sensitive K+ channels). A similar effect was obtained with isoproterenol. These results indicated that membrane potential of human placental allantochorial VSMCs was regulated by voltage-gated, Ca2+- and ATP-sensitive K+ channels and by voltage-dependent Ca2+ channels.

Acetylcholine↗
PubMed1999

Utility of intracardiac echocardiography (ICE) in electrophysiology: ICEing the CAKE (catheter ablation knowledge enhancement).

PURPOSE: Previous studies have demonstrated the utility of intracardiac echocardiography (ICE) during electrophysiologic procedures including radiofrequency catheter ablation. The purpose of this study was to analyze the initial learning experience with ICE during invasive electrophysiologic procedures. METHODS: During a 1-month ICE trial, patients scheduled for radiofrequency catheter ablation underwent concurrent imaging using a 9 French, 9 MHz catheter in the right atrium proximal to important endocardial structures and diagnostic/ablation catheters. The procedure length, fluoroscopy and ICE times were systematically recorded during each procedure. In addition, the images were analyzed and recorded and their utility was evaluated after each case. A case control analysis was also performed. RESULTS: Seven patients underwent ICE (as part of an ICE trial period) during their electrophysiology study between July 21 and August 13, 1998. This study demonstrated the utility of ICE in identifying radiofrequency catheter tip stability and intracardiac and endocardial structures, including the crista terminalis, coronary sinus, and foramen ovale. CONCLUSION: ICE contributes to the electrophysiology arsenal for both diagnostic and therapeutic procedures. In particular, this technique demonstrated a decrease in fluoroscopy time as compared to a case control population. This technique limits radiation to the patient and operator. In addition, endocardial structures, which may be pivotal in diagnosing and treating cardiac arrhythmias, were easily identified. Radiofrequency catheter stability can also be assessed with this technique.

Adult↗
PubMed1999

The effects of intrinsic sympathomimetic activity on beta-blocker efficacy for treatment of neurocardiogenic syncope.

To compare the efficacy and side effects of beta-blockers with intrinsic sympathomimetic activity (ISA) to those without ISA, we retrospectively reviewed patients diagnosed with neurocardiogenic syncope (NCS) as determined by head-up tilt table testing. Four hundred and thirty-one patients (mean age of 57 +/- 25 years) underwent head-up tilt table testing for syncope of unknown etiology, of which 120 patients were diagnosed with NCS; 87 of these patients were treated with beta-blocker therapy. Only 56 patients could be contacted during follow-up. Twenty-eight patients were treated with beta-blockers with ISA (acebutolol or pindolol) and 28 received beta-blockers without ISA (atenolol or metoprolol) based on physician preference and followed for up to 2 years. During the follow-up period, beta-blockers with or without ISA had comparable clinical efficacy in suppressing recurrent syncope in patients with NCS. However, beta-blockers with ISA were better tolerated and caused less fatigue (32% side effects) as compared to those without ISA (50% side effects; p = 0.23). The benefits of beta-blockers with ISA were more pronounced in patients less than 60 years old (19% side effects with beta-blocker with ISA as compared to 85% side effects with beta-blocker without ISA; p = 0.0004). Beta-blockers without ISA appear to be better tolerated and caused less fatigue in patients 65 years old or greater (20%) than in patients less than 65 years old (85%; p = 0.0002).

Acebutolol↗
PubMed1997

Implantable Cardioverter-Defibrillator Implantation in the Electrophysiology Laboratory by Electrophysiologists.

Recent developments in implantable cardioverter-defibrillator (ICD) technology have helped simplify the surgical implantation technique of these devices. There has been a marked reduction in the size of these devices making them easier to implant pectorally. In addition ICDs have enhanced longevity and a more facile transvenous lead system. Surgical implantation is almost identical to the procedure used for permanent pacemaker implantation in conjunction with the performance of a short electrophysiologic/arrhythmia induction protocol. In general, the average implant time is approximately one hour and in our series minimal morbidity and no mortality was identified. In conclusion, ICDs can be safely and effectively implanted in the electrophysiology laboratory by electrophysiologists in a timely and cost-effective manner. These implant procedures can help to shorten the length of stay and improve the operating room utilization for more critical procedures.

Journal Article↗
PubMed1997

Implication of external Mg2+ ions in the depolarization of smooth muscle cell membrane of the human chorionic placental vessels: an hypothesis.

The membrane potential (MP) of the smooth muscle cells of human allantochorial placental vessels is the major factor which explains the excitation-contraction coupling. Indeed, the smooth muscle cells of these vessels may be considered as tonic because they only respond to excitatory stimuli with graded depolarization. On the contrary, the phasic smooth muscles generate action potentials and some generate electrical slow waves as well. The depolarization of smooth muscle cell membranes may be a consequence of various factors, particularly the secretion of endothelium-derived depolarizing factors (EDDF). The modifications of the ionic composition of external medium interfere with the membrane potential values. The increase of [Mg2+]o (Cl- or SO4[2-]) depolarizes the membrane. This effect in vitro seems inconsistent with the known vasodilator action of external Mg2+. To explain this result, an hypothetical scheme is proposed on the probable targets of local and systemic Mg2+ effects: a direct action of external Mg2+ ions on the membrane potential by secretion of depolarizing endothelial factors which depolarize the membrane; an indirect action on the membrane potential by regulation of K+ and Ca2+ channels; an action on the concentration of internal Mg2+; an interaction with internal Ca2+ concentration and regulation of the Na+/Ca2+ exchanger. A data review of Mg2+ ions effects on smooth muscles is realized to corroborate this scheme.

Animals↗
PubMed1996

Cardiac arrest caused by trigeminal neuralgia.

A 67-year-old man with a 12-year history of trigeminal neuralgia experienced multiple fainting episodes preceded by right facial pain. One episode resulted in cardiac arrest with successful resuscitation. Pacemaker insertion prevented further episodes of syncope despite the occurrence of pain. The fainting episodes and cardiac arrest are believed to be unusual manifestations of trigeminal neuralgia.

Aged↗
PubMed1995

Dual chamber pacing: how many patients remain in DDD mode over the long term?

OBJECTIVE: DDD pacing is better than VVI pacing in complete heart block and sick sinus syndrome but is more expensive and demanding. In addition, some patients have to be programmed out of DDD mode and this may have an important impact on the cost-effectiveness of DDD pacing. The purpose of this study was to determine how many patients remain in DDD mode over the long term (up to 10 years). DESIGN: A retrospective analysis of the outcome over 10 years of consecutive patients who had their pacemakers programmed initially in DDD mode. SETTING: A district general hospital. PATIENTS: 249 patients with DDD pacemakers. Sixty two patients (24.9%) had predominantly sick sinus syndrome and 180 (72.3%) had predominantly atrioventricular conduction disease. Mean (range) complete follow up for this group of patients was 32 months (1-10 years). RESULTS: Cumulative survival of DDD mode was 83.5% at 60 months. Atrial fibrillation was the commonest reason for abandonment of DDD pacing. Atrial fibrillation developed in 30 patients (12%), with atrial flutter in three (1.2%). Loss of atrial sensing or pacing, pacemaker mediated tachycardia, and various other reasons accounted for reprogramming out of DDD mode in eight patients (3.2%). Overall, an atrial pacing mode was maintained in 91% and VVI pacing was needed in only 9%. CONCLUSIONS: With careful use of programming facilities and appropriate secondary intervention, most patients with dual chamber pacemakers can be maintained successfully in DDD or an alternative atrial pacing mode until elective replacement, although atrial arrhythmia remains a significant problem. There are no good reasons, other than cost, for not using dual chamber pacing routinely as suggested by recent guidelines and this policy can be achieved successfully in a district general hospital pacing centre.

Aged↗
PubMed1995

Membrane potential of smooth muscle cells of human placental chorionic vessels. Comparative effects of MgCl2 and MgSO4.

Magnesium has been shown to produce various effects on vascular smooth muscle, in that its absence elicits an increase in muscle tone and increases sensitivity to a number of stimulatory agonists. In the present study, the influence of MgCl2 and MgSO4 was investigated in human placental chorionic muscle cells (from arteries and veins with or without endothelium), especially on the membrane potential, Um. Classically, Um was obtained from microelectrodes inserted into smooth muscle cells through the endothelium or directly. In arteries with endothelium, the smooth muscle cells were depolarized by MgSO4 (threshold: 6 mM) and MgCl2 (threshold: 8 mM). In endothelium-free arteries, the smooth muscle cells were also depolarized by MgSO4 (threshold: 8 mM) and MgCl2 (threshold: 6 mM). Identical results were obtained with veins, but thresholds were different. The different thresholds may indicate that MgCl2 influences the cell membrane potential directly, while MgSO4 interferes first with the endothelial cells, which may act as an intermediary between the Mg2+ ions and the membrane of the smooth muscle cells.

Dose-Response Relationship, Drug↗
PubMed1995

Influence of magnesium salts on the membrane potential of human endothelial placental vessel cells.

Magnesium salts have been shown to depolarize the membrane of the smooth muscle cells of human placental arteries and veins with and without endothelial cells. In the present study, the influence of MgCl2 and MgSO4 was investigated on the membrane potential, Um, of the endothelial cells of the same vessels. Um was classically recorded with microelectrodes. The endothelial cell membrane of arteries was depolarized by MgCl2 (depolarization threshold, d th: 4 mM) and by MgSO4 (d th: 8 mM). A depolarization was also observed with the endothelial cell membrane of veins. The depolarization threshold with MgCl2 and 4MgSO4 was respectively 6 mM and 8 mM. The different thresholds indicate that the influence of MgCl2 on the endothelial cell membrane potential is higher and more direct than that of MgSO4, and confirm previous hypothesis on the effects of magnesium salts on the vascular smooth membrane cells.

Electric Stimulation↗
PubMed1994

Incidence and prediction of induced ventricular tachyarrhythmias in idiopathic dilated cardiomyopathy.

The value of time-domain and spectral turbulence analyses of the signal-averaged electrocardiogram (SAECG) for predicting induction of sustained monomorphic ventricular tachycardia (VT) was prospectively investigated in 70 patients with idiopathic dilated cardiomyopathy. Sustained VT was induced in 9 patients (13%). The prevalence of abnormal time-domain and spectral analyses was 16 and 37%, respectively. The total predictive accuracy of time-domain and spectral analyses for VT induction was 86 and 67%, respectively (p < 0.01). The predictive accuracy of time-domain and spectral analysis was similar in patients without an intraventricular conduction defect (94 and 84%, respectively). However, the predictive accuracy of time-domain was higher than that of spectral analysis in patients with an intraventricular conduction defect (65 vs 25%; p < 0.05). The poor concordance between spectral analysis and programmed stimulation results was mainly due to the high number of false-positive recordings in the presence of an intraventricular conduction defect (9 of 20 cases). With the use of stepwise discriminant function analysis, an abnormal time-domain SAECG was the only variable predicting the induction of sustained VT (p < 0.0003). In dilated cardiomyopathy, an abnormal time-domain SAECG and induced sustained VT are rare, both time-domain signal-averaged electrocardiography and spectral analysis have a high predictive accuracy for VT induction in patients without an intraventricular conduction defect, and spectral analysis does not improve VT prediction in those with a conduction defect.

Analysis of Variance↗
PubMed1994

Transcriptional and posttranscriptional mechanisms modulate creatine kinase expression during differentiation of osteoblastic cells.

Enhancement of energy metabolism is fundamental to the developmental programs of many cell types. This work examines the molecular mechanisms that mediate changes in energy metabolism during differentiation of osteoblastic cells. When the rat osteoblastic cell line, ROS 17/2.8, is induced to differentiate with 1,25-dihydroxyvitamin D3, expression of creatine kinase-b (ck-b), a pivotal enzyme in energy metabolism, is enhanced. Maximum enhancement occurs at 48 h of induction with 10 nM 1,25-dihydroxyvitamin D3 when creatine kinase activity is 2.1-fold over uninduced cells. This is associated with a 2-fold increase in transcription rate and the formation of a second protein-DNA complex on the ck-b gene promoter that is supplementary to the one present in undifferentiated cells. In addition, the contribution of posttranscriptional regulatory mechanisms is suggested by (1) the increase in ck-b mRNA abundance exceeds that of transcription rate, indicating an increase in message stability, (2) the increase in ck-b mRNA precedes and exceeds that of protein activity, indicating translational modulation, and (3) RNA mobility-shift assays indicate that a cytosolic factor in ROS 17/2.8 cells interacts specifically with the highly conserved 3'-untranslated region of the ck-b mRNA. We have previously reported that such an interaction mediates translational control (Ch'ng, J. L. C., Shoemaker, D. L., Schimmel, P., and Holmes, E.W. (1990) Science 248, 1003-1006). The physiological roles of these regulatory mechanisms during osteoblast differentiation are discussed.

Animals↗
PubMed1994

Combined time-domain and spectral turbulence analysis of the signal-averaged ECG improves its predictive accuracy in postinfarction patients.

The predictive accuracy of time-domain (TD) late potential analysis of the signal-averaged electrocardiogram in postmyocardial infarction (MI) is limited by the high incidence of false positives in inferior MI. However, frequency-domain spectral turbulence (ST) analysis suffers from a high incidence of false positives, especially in anterior MI. A prospective study was conducted of 262 patients with acute MI to investigate the hypothesis that combined TD and ST analyses of the signal-averaged electrocardiogram could improve its predictive accuracy for serious arrhythmic events in the post-MI period. Abnormal TD criteria were RMS40 less than 25 microV at 25 Hz plus RMS40 less than 16 microV at 40 Hz, and abnormal ST criteria were a turbulence score of 3 or 4. Seventeen patients had arrhythmic events during 10.5 +/- 2.4 months of follow-up evaluation (13 sudden cardiac death judged to be due to arrhythmia and 4 nonfatal sustained ventricular tachycardia). The total predictive accuracy of combined TD and ST (92%) was higher than TD (87%), whereas ST had the lowest total predictive accuracy of 78%. The negative predictive accuracy of all three analyses was high (96-97%). However, the positive predictive accuracy of TD (28%) was higher than ST (14%). Combined TD and ST significantly improved the positive predictive accuracy of the test to 35% in the total group and to 40% in patients with first anterior or inferior MI. The best results were obtained in patients with first anterior MI, where the positive predictive accuracy of combined analysis was 50%.

Arrhythmias, Cardiac↗