Effect of mineral-vitamin premix supplementation on behavioral, performance, hormonal, oxidative stress, and serum biochemical profiles on rutting male Camelus dromedarius in Egypt.

Introduction: The rutting period imposes a stressful condition on male camels, which results in elevated serum cortisol levels and alterations in their sexual behavior. Therefore, the current work was carried out to investigate the effect of mineral-vitamin premix supplementation on behavior, reproductive performance, hormones, serum oxidative stress profile, and other serum biochemical parameters of Camelus dromedarius during the breeding season. Methods: Fourteen mature, fertile male Camelus dromedarius were divided into two groups, a control group (n = 7) and a mineral-vitamin premix group (n = 7). The present study lasted for 95 days during the rutting period (1st February to 5th May). Each camel in the premix group received a daily diet of 50 g of mineral-vitamin premix throughout the whole rutting period, during which the frequencies and durations of the following behaviors: maintenance, posture, aggressiveness, and sexual activity were collected every 20 min. At the end of the study, blood samples were collected. Results: Results revealed that the premix group showed higher (P < 0.05) maintenance (feeding and rumination), standing, and overall sexual desire-related behavior frequency, besides more times (P < 0.001) for rumination, standing, walking, and lying while showing lower (P < 0.001) frequencies of overall aggressive behaviors than the control group. The serum concentration of malondialdehyde, nitric oxide, cortisol, blood glucose, and urea evidenced a significant decrease in the premix group compared with the control one, while significantly elevated levels of reduced glutathione, testosterone, total antioxidant capacity, triiodothyronine, and thyroxin, total protein, albumin, globulin, calcium, phosphorus, potassium, and magnesium were recorded in the premix group in comparison with the control. Conclusion: It could be concluded that daily dietary supplementation of 50 g of mineral-vitamin premix to male camels during the breeding season is necessary to overcome the oxidative stress and serum cortisol concentration with a subsequent decrease in aggressive behavior and improvement to testosterone level in blood, body condition score and body weight gain.

Modulation of Immunity, Antioxidant Status, Performance, Blood Hematology, and Intestinal Histomorphometry in Response to Dietary Inclusion of Origanum majorana in Domestic Pigeons' Diet.

This experiment was conducted to evaluate the effect of adding Origanum majorana (OM) powder to domestic pigeon diets on growth performance, feeding and drinking behaviour, blood hematology, blood biochemical parameters, blood inflammatory and oxidative markers, carcass characteristics, the weights of lymphoid organs, and and intestinal cecal, and bursa of Fabricius histology. A random distribution of fifty-four unsexed pigeon squabs (30 days old, average body weight; 321 g ± 7.5) into three groups was done. The first group was fed the grower basal diet without adding OM powder, while OM powder was added at levels of 0.5 and 1% to the basal diets of the second and third groups, respectively. The changes in growth performance parameters and feeding and drinking behavior under OM powder's effect were insignificant. However, the lymphoid organs (spleen and thymus) significantly increased in weight (p < 0.05) in the OM-fed groups. Moreover, blood examination showed positive responses to OM powder in terms of blood cell counts (RBCs andWBCs), and the values of hemoglobin, hematocrit, mean corpuscular volume, lymphocyte numbers, levels of globulin, and glutathione peroxidase enzyme were significantly increased. The numbers of heterophils, the ratio of heterophil to lymphocyte, malondialdehyde levels were reduced (p < 0.05). Histomorphometry examination revealed increases in intestinal villi height, cecal thickness, and bursal follicle area and number. These results indicated that adding OM powder to the pigeon diet may improve their immunity, increase their antioxidant status, and correct some hematological disorders.

Cell detachment rates and confluence of fibroblast and osteoblast cell culture using different washing solutions.

The advancements in the cell culture studies have led to the development of regenerative medicine concept. The aim of this study is to compare the effectiveness of some washing solutions, including phosphate buffered saline (PBS), sodium chloride (NaCl), and ringer's lactate (RL) on the rate of detachment and confluency in fibroblast and osteoblast cell culture. Baby Hamster Kidney 21 clone 13 (BHK21/C13) fibroblast cells and 7F2 osteoblast were cultured on T25 flasks for 3-4 days. Three treatment groups were classified on the basis of different washing solutions used in the moment before trypsinization: PBS, 0.9% NaCl, and RL. Each group was measured for the detachment rate and cell confluence. The measurement was done in 2 passage numbers. The use of PBS, NaCl, and RL washing solution showed that detachment time was less than 5 minutes for the fibroblasts and 3 minutes for the osteoblasts. There was a significant difference in the rate of fibroblast cell detachment (p=0.006) and osteoblast (p=0.016). The capability of fibroblasts and osteoblasts to achieve a confluence of 106 cells/well on the first and second measurements was almost the same between the washing solution groups. The use of physiological 0.9% NaCl solution as a washing solution in fibroblast and osteoblast cell culture has almost the same effectiveness as PBS to help accelerate cell detachment in less than 5 minutes without influencing the capability of cells to proliferate.

Effect of Dietary Microalgae (Spirulina platensis) on Growth Performance, Ingestive Behavior, Hemato-Biochemical Parameters, and Economic Efficiency of Fayoumi Broilers.

This study was conducted to evaluate the effect of dietary supplementation with Spirulina platensis (SP) on the productive performance, carcass characteristics, behavior, blood serum metabolites, hematological indices, and economic efficiency of Fayoumi broiler chickens for a 56-day. In total, 120 one-day-old broiler chicks were randomly distributed among four dietary treatments with three replicates (n = 10/group) for 8 weeks. The dietary treatments were a control basal diet without SP and the same basal diets supplemented with 0.25, 0.5, or 1.0% SP. Birds fed 1% Spirulina-supplemented diets recorded significantly (p < 0.05) higher body weight, weight gain, and feed conversion ratio and less overall feed intake and feeding behavior than those in the control group. No significant changes (p > 0.05) were recorded in the dressing percentage or the relative weights of internal organs among the different experimental groups, except for the thymus. Diets containing 0.5 or 1.0% SP saw an increase (p < 0.05) in serum total protein and globulin and a reduction (p < 0.05) in serum cholesterol concentration. The lymphocyte percentage in birds fed SP diets was significantly (p < 0.05) higher than in birds fed the control diet. These results suggest that adding SP up to 1% to the broiler diets could positively affect some important blood biochemical parameters, enhance their immunity response, and improve their growth performance. However, from an economic point of view, supplementation with 0.25% of SP is recommended for Fayoumi broiler chickens.

Recessive white plumage color mutation of Japanese quail (Coturnix coturnix japonica) revealed morphological variations in the oropharyngeal roof structures, accompanied by behavioral differences.

Genetic background of experimental animals contributes mainly to the variations in the experimental outcomes. Therefore, quails of two lines of plumage color (brown and recessive white) were studied to investigate the impact of plumage color mutations on the morphological structures of the oropharyngeal roof and also on the ingestive behavior and quail performance. Feeding intake and feed conversion ratio were higher in the brown quails, associated with nonsignificant increase of the live body weight and body weight gain. In the recessive white quails, ingestive behaviors revealed significant declines. The roof of the oropharynx roof was significantly longer in the recessive white quails; however, the upper beak was significantly longer and narrower in the brown ones. The length of the palate and pharynx showed nonsignificant increase in the recessive white quails. The median palatine ridge was formed of rostral continuous and caudal interrupted parts, and the lengths of these parts were slightly higher in the recessive white quails, meanwhile the lateral palatine ridge length showed a slight increase in the brown birds. Openings of intraepithelial glands were more numerous in the recessive white quails. The brown quails demonstrated more detectable and larger caudally directed conical shaped palatine and pharyngeal papillae, in addition to more considerable palatine salivary glands openings. The infundibular cleft was significantly wider in the recessive white quails, where its edges were characterized by lack of the pharyngeal papillae. The findings of this study will be beneficial for the breeders during selection the suitable quail lines for meat production purposes.

Zinc oxide nanoparticles prevent multidrug resistant Staphylococcus-induced footpad dermatitis in broilers.

The current experiment was designed to evaluate the effects of dietary supplementations of zinc oxide nanoparticles (ZONPs) on some behavioural, performance, welfare and histopathological changes in broilers exposed to multidrug resistant Staphylococcus aureus (MRSA)-induced footpad dermatitis (FPD). Eighty-four male Indian River (IR) broilers were randomly allotted to six different dietary treatments as follows: C-ve, C+ve, 10, 20, 30 and 40 ppm ZONPs from 7 to 49d of age. At day 28, broilers (n = 70) were sub-cutaneously injected with 0.5 ml of saline containing 5.3 × 107 CFU/ml of S. aureus (MRSA) in each metatarsal foot pad. Control (non-infected) broilers were given 0.5 ml of saline (n = 14). Results clarified that non-infected birds and ZONPs-fed birds had significantly higher standing and feeding activities and lower resting activities in comparison with the infected group. Also, the S. aureus infected group had significantly lower body weight gain (BWG) and higher feed conversion ratio (FCR) than the non-infected group. In addition, the non-infected birds and ZONPs groups had significantly lower object crossing and tonic immobility times (TI) and gait scores (GS) in comparison with the S. aureus group. Only ZONPs 30, 40 ppm and non-infected groups had a significantly higher latency to lie time (LLT) and lower serum cortisol level in comparison with the S. aureus group. Moreover, there were significant changes in the gross lesion score and histopathological lesions between the different groups. In conclusion, the dietary supplementation of ZONPs can reduce S. aureus-induced negative effects of FPD in broilers.

Housing Management of Male Dromedaries during the Rut Season: Effects of Social Contact between Males and Movement Control on Sexual Behavior, Blood Metabolites and Hormonal Balance.

The current study aimed to evaluate the effect of different housing management systems on behavior, blood metabolites and hormonal balance in male dromedaries during the rutting season. Forty-eight adult male dromedaries were stratified in a two by three factorial experiment design, testing effects of social contact (single and group) and movement control (tied, fenced and exercise). During a ten-week experimental period, male dromedaries were filmed weekly for 20 min three times per day to evaluate their behaviors. Blood samples were collected and analyzed for serum metabolites and hormones. Both animal social contact and movement control significantly affected maintenance, posture and sexual behaviors. Male dromedaries housed in groups expressed higher frequencies of sexual desire-related behaviors (teeth grinding, open legs, tail flapping, dulla "soft palate exteriorization", blathering and urination) than those individually housed. Animal movement control significantly affected sexual behavior; fenced and exercised male dromedaries expressed higher frequencies of sexual desire-related behaviors than tied ones. Male dromedaries housed in groups and allowed to walk around had significantly higher frequencies of ruminating, standing, walking and sexual-related behaviors than those housed individually or tied. Movement control had significant effects on blood serum metabolites and hormone concentrations. Fenced and exercised male dromedaries had higher (p < 0.05) concentrations of blood serum transaminases, free radicals, glucose, cholesterol and testosterone (2.91 and 2.09 ng/mL, respectively) and lower (p < 0.05) concentrations of cortisol (44.12 and 53.52 nmol/L, respectively) and triiodothyronine (1.68 and 1.91 ng/mL, respectively) than tied male dromedaries. In conclusion, animal social interaction is of particular importance for maintaining physical, psychological and sexual behaviors. Allowing walking-around exercise for captive animals improves their metabolic status and decreases captive stress effects. Housing systems that guarantee social interaction and physical activity are the most suitable housing management systems for captive male dromedaries during the rutting season.

Adrenocortical tumors in children: a Kuwait experience.

INTRODUCTION: Adrenocortical tumors (ACT) are rare tumors of childhood. The majority of these tumors is hormone-producing and cause virilization and Cushing syndrome or feminization. METHODOLOGY: The authors describe 6 cases of adrenal cortical tumors treated at the Kuwait Cancer Center which were presented over a period of 20 years (1989-2009). RESULTS: The mean age was 5.5 years (range 15 months - 12 years). All had signs of virilization. One child had hypertension, while 2 had a metastatic disease at presentation. The diagnosis was made by clinical signs and symptoms, high levels of relevant adrenal hormones and imaging. Two children were not fit for surgery; one was too sick for any treatment and died shortly after diagnosis, while the other died after receiving one cycle of palliative chemotherapy. Four patients underwent complete surgical resection and achieved complete remission, three of whom later had recurrence (distant in one and local in two patients) and succumbed due to progressive disease. Mitotane was used in two children. Only one patient is currently surviving and well nearly 13 years after her surgery. In our series, the long-term outcome of children with adrenocortical tumors was very poor. CONCLUSIONS: Virilization is an important clue to the diagnosis of ACT. Early diagnosis and complete surgical resection are important for survival. Metastasis at presentation or as recurrence carries very dismal prognosis.

Efficacy and safety of two doses of low molecular weight heparin (enoxaparin) in pregnant women with a history of recurrent abortion secondary to antiphospholipid syndrome.

The aim of this randomised controlled trial was to compare efficacy and safety of two doses of low molecular weight heparin (enoxaparin) in pregnant women with a history of recurrent abortion secondary to antiphospholipid syndrome. A total of 60 women with a minimum of three consecutive abortions before 10 weeks' gestation and positive lupus anticoagulant and/or anticardiolipin antibodies on at least two occasions at least 12 weeks apart were randomised into two groups based on computer generated randomisation list concealed in opaque envelopes. Pregnant women were treated with enoxaparin 40 mg plus low dose aspirin (LDA) (n = 30) or enoxaparin 20 mg plus LDA (n = 30). The live birth rate was 76.67% in enoxaparin 40 mg group and 70% in enoxaparin 20 mg group (p value = 0.559). There were no significant differences between both groups with respect to neonatal outcome, obstetric and maternal complications during pregnancy or puerperium. No cases of severe bleeding, thrombocytopenia or spontaneous fractures were reported in both groups.

Lactic acidosis and developmental delay due to deficiency of E3 binding protein (protein X) of the pyruvate dehydrogenase complex.

Pyruvate dehydrogenase deficiency is an important cause of primary lactic acidosis. Most cases occur as a result of mutations in the gene for the E1 alpha subunit of the complex, with a small number resulting from mutations in genes for other components, most commonly the E3 and E3-binding protein subunits. We describe pyruvate dehydrogenase E3-binding protein deficiency in two siblings in each of two unrelated families from Kuwait. The index patient in each family had reduced pyruvate dehydrogenase activity in cultured fibroblasts and no detectable immunoreactive E3-binding protein. Both were homozygous for nonsense mutations in the E3-binding protein gene, one involving the codon for glutamine 266, the other the codon for tryptophan 5.

Persistent hyperinsulinaemic hypoglycaemia of infancy (nesidioblastosis): a report from Kuwait.

We report nine Bedouin children from Kuwait with persistent hyperinsulinaemic hypoglycaemia (PHHI) seen over a 13-year period in two regional hospitals. The incidence of PHHI in this inbred community is high (1:20,000); five of them came from two families. All the children presented with seizures associated with severe and recurrent hypoglycaemia, eight presenting in the neonatal period and one at the age of 2 months. One child died soon after birth. All the others received diazoxide initially, which achieved remission in one while two siblings remain dependent on the drug. Long-acting somatostatin analogue (octreotide) was successfully used in one child. Four children underwent pancreatectomy, two showed diffuse and two had localized nesidioblastosis. Two children achieved normal neurodevelopmental milestones, four suffered mental retardation of varying degrees and three died. Early diagnosis and prompt treatment are essential to avoid the neurological damage associated with hypoglycaemia. In some cases, this condition is due to an autosomal recessive pattern of inheritance and it is therefore important to offer genetic counselling to families with one or more affected siblings.

[Spiral CT and MRT of the operated Stanford-type-A aortic dissection: its course and complications]. / Spiral-CT und MRT der operierten Stanford Typ A-Aortendissektion: Verlauf und Komplikationen.

PURPOSE: To demonstrate normal postoperative spiral CT and MRI findings and typical complications in patients with aortic repair after Stanford type A aortic dissection. METHODS: 24 patients with aortic repair after Stanford type A aortic dissection were followed up by spiral CT and MRI (0.5 Tesla). Presence of persistent dissection, progressive or new dissection, proximal and distal anastomosis, periprosthetic space, supraaortic vessels, thrombosis and dilatation of the true and false lumen were evaluated. RESULTS: The following postoperative complications were seen: three pseudoaneurysms which developed at the proximal anastomoses of the Dacron prosthesis in two cases and at the insertion site of the reimplanted left coronary artery after implantation of a composite graft (Bentall procedure) in one case; one re-dissection; one perforation of the false lumen; periprosthetic flow in one patient after surgical repair of type A dissection by the graft inclusion technique; progressive dilatation of the false lumen in 4 cases; dilatation of the aortic root in a Marfan patient after replacement of the ascending aorta. CONCLUSION: Precise knowledge of the surgical technique performed is crucial to accurate postoperative imaging evaluation. MRI is the method of choice in the postoperative follow-up of clinically stable patients with aortic dissections.

Kenny-Caffey syndrome is part of the CATCH 22 haploinsufficiency cluster.

We report four sibs with Kenny-Caffey syndrome in a consanguineous Bedouin family. The first two died in the neonatal period while the remaining affected brother and sister had all the characteristic clinical, biochemical, and radiological abnormalities of the syndrome. These included severe pre- and postnatal growth retardation, cortical thickening of the tubular bones with medullary stenosis, eye abnormalities, facial dysmorphism, hypocalcaemia, and low levels of parathyroid hormone. The children also showed intracranial calcification, impaired neutrophil phagocytosis, increased proportion of B lymphocytes, reduced CD4 and CD8 subpopulations of T lymphocytes, and inhibited transformation in response to Candida antigen. Fluorescence in situ hybridisation (FISH) was applied to blood lymphocyte metaphase spreads from these two Bedouin sibs and their parents using probe D22S75 (Oncor), specific for the DiGeorge critical region on chromosome 22q11.2. The presence of 22q11.2 haploinsufficiency was identified in the affected sibs, which was transmitted from the phenotypically normal mother. The present report widens the spectrum of CATCH 22 microdeletion to accommodate Kenny-Caffey syndrome.

Definition of predicted effective antiarrhythmic drug therapy for ventricular tachyarrhythmias by the electrophysiologic study approach: randomized comparison of patient response criteria.

OBJECTIVES: We sought to compare efficacies of therapy for ventricular tachyarrhythmias selected by programmed stimulation using two different patient response efficacy criteria: <5 versus <16 repetitive ventricular responses. BACKGROUND: Therapy selection for ventricular tachyarrhythmias by programmed stimulation requires definition of a patient response that predicts long-term efficacy. Such definitions have not been previously compared prospectively. METHODS: Patients with sustained ventricular tachyarrhythmias were randomized to therapy selection using either the <5 or <16 repetitive response criterion of predicted effective therapy. The primary end point was sudden death or recurrence of ventricular tachyarrhythmia requiring intervention. RESULTS: Predicted effective drug therapy was found for 23 (34%) of 68 patients randomized to the <5 criterion and 29 (36%) of 81 patients randomized to the <16 criterion (p = NS). Definition of therapy required 3.0 +/- 1.6 drug trials (mean +/- SD) in patients randomized to the <5 criterion and 2.9 +/- 1.8 trials in patients randomized to the <16 criterion (p = NS). Patients randomized to the <5 criterion had a lower 2-year probability of the primary end point (0.20 +/- 0.05) than did patients randomized to the <16 criterion (0.33 +/- 0.05, one-tailed p = 0.004). The advantage of the <5 criterion was also seen in subgroup analyses involving patients with and without an initial drug efficacy prediction. CONCLUSIONS: The programmed stimulation approach to the selection of antiarrhythmic therapy for ventricular tachyarrhythmias using a patient response criterion of <5 repetitive ventricular responses results in a lower probability of recurrence of ventricular tachyarrhythmia than does use of a <16 repetitive response criterion.

[Intramural hematoma of the thoracic aorta: diagnostic imaging and differential diagnosis]. / Das intramurale Hämatom der thorakalen Aorta: Bildgebende Diagnostik und Differentialdiagnose.

PURPOSE: Aortic wall thickening due to intramural hemorrhage may be the only sign of aortic dissection. The aim of this study was to evaluate the incidence, imaging features and differential diagnoses of intramural hemorrhage (IMH) of the thoracic aorta. METHODS: 98 patients with clinically suspected aortic dissection were investigated via Spiral-CT and MRT. Diagnosis of IMH based on the presence of smooth crescentic or concentric wall thickening over a longer segment of the thoracic aorta without flow visualization and without compression or distortion of the aortic lumen. RESULTS: 69 patients had classic aortic dissections and 7 patients were diagnosed to have IMH of thoracic aorta. One patient with IMH of the ascending aorta died of aortic rupture and subsequent pericardial tamponade 12 hours after onset of symptoms. In one patient with IMH of the descending aorta on initial examination, there was a progression of overt aortic dissection at follow-up after three weeks. In two patients with IMH of the descending aorta, wall thickening decreased in size at follow-up (10-15 weeks), whereas in one patient it remained unchanged. CONCLUSION: IMH of the aorta should be considered a precursor of aortic dissection. At follow-up IMH may decrease in size, rupture or progress to overt aortic dissection.

Febrile urinary tract infection in children: Role of 99MTc-dimercaptosuccinic acid (DMSA) scan and other imaging techniques.

Fifty children (37 females and 13 males) with first febrile urinary tract infections were studied to assess the value of 99MTc-dimercaptosuccinic acid (DMSA) scan in detecting inflammatory changes of acute pyelonephritis (APN). These findings were compared with renal ultrasonography (US). We also evaluated the reliability of clinical and laboratory observations in diagnosing acute pyelonephritis (APN). All children had micturating cystourethrography (MCUG). DMSA-documented acute pyelonephritis was present in 29 (58%) patients. Only four children (8%) demonstrated changes suggestive of APN on renal ultrasonography. Vesicoureteric reflux (VUR) was documented in 17 (47%) of the total group and in 13 (45%) of those with abnormal DMSA scan. Follow-up DMSA scan in 15 children with initial abnormal findings showed complete recovery in seven (47%). Our data have shown that DMSA renal scan is the most useful investigational procedure in children with febrile UTI. The diagnosis of APN, depending on clinical and laboratory data, is unreliable. Renal US alone can miss serious renal defects. MCUG remains the most sensitive procedure to detect VUR and it should be performed in all children with UTI and abbormal DMSA scan. Early detection of acute pyelonephritis allows the prompt introduction of antimicrobial agents in those children and can prevent or decrease renal damage and its complications.

Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and MR imaging.

PURPOSE: To compare the usefulness of spiral computed tomography (CT), multiplanar transesophageal echocardiography (TEE), and magnetic resonance (MR) imaging in the diagnosis of thoracic aortic dissection and arch vessel involvement. MATERIALS AND METHODS: Forty-nine symptomatic patients with clinically suspected aortic dissection were examined with contrast material-enhanced spiral CT, multiplanar TEE, and 0.5-T MR imaging (T1-weighted, cardiac-gated, spin-echo sequences). Imaging results were confirmed at autopsy (five patients), intraoperative exploration (23 patients), angiography (nine patients), and follow-up (12 patients). RESULTS: Sensitivity in the detection of thoracic aortic dissection was 100% for all techniques. Specificity was 100%, 94%, and 94% for spiral CT, multiplanar TEE, and MR imaging, respectively. In the assessment of aortic arch vessel involvement, sensitivity was 93%, 60%, and 67%, respectively, and specificity was 97%, 85%, and 88%, respectively. CONCLUSION: Spinal CT and multiplanar TEE are as valuable as MR imaging in the detection of thoracic aortic dissection. In the assessment of the supraaortic branches, spiral CT is superior (P<.05).

A randomized clinical trial of the noninvasive and invasive approaches to drug therapy for ventricular tachycardia: long-term follow-up of the Calgary trial.

Individualized antiarrhythmic drug therapy for patients with ventricular tachyarrhythmias may be selected by the noninvasive approach (suppression of spontaneous ventricular premature beats) or the invasive approach (suppression of ventricular tachyarrhythmias induced at an electrophysiologic study). There is controversy over which approach is superior. From a screened population of 124 patients with symptomatic ventricular tachycardia or ventricular fibrillation, 57 patients with both frequent ventricular premature beats and inducible ventricular tachycardia at baseline were randomized to have chronic therapy selected by either the noninvasive or invasive approach. These patients have now been followed up for a minimum event-free period of 6.5 years. By intention-to-treat, therapy selected by the invasive approach prevented subsequent ventricular tachyarrhythmias better than that selected by the noninvasive approach (6-year probabilities of freedom from symptomatic sustained ventricular tachyarrhythmia recurrence; noninvasive approach, 0.45 +/- 0.10; invasive approach, 0.73 +/- 0.09; p=.02). This advantage of the invasive approach was also evident for the outcome of any ventricular tachyarrhythmia recurrence and for efficacy analyses involving only those patients with a drug-efficacy prediction. We hypothesize that the difference between these results and those of the ESVEM trial are caused, in part, by differences in the characteristics of the enrolled patients and differences in criteria used to define a predicted-effective therapy.

The patient with recurrent atrioventricular nodal reentrant tachycardia or chronic atrial fibrillation or atrial flutter.

Atrioventricular nodal reentry tachycardias, atrial fibrillation, and atrial flutter are common symptomatic arrhythmias encountered in clinical practice. The reentry mechanisms and pathophysiology of atrioventricular nodal reentrant tachycardias, atrial fibrillation, and atrial flutter are described. This article outlines the therapeutic approaches used in the acute phases of presentation. Nursing implications for patients admitted to intensive care/telemetry units are discussed.