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Hypertension, Autonomic Storm, Increased Counter Regulatory Hormones and Suppressed insulin in Acute Myocarditis in Scorpion Envenoming Syndrome

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World Journal of Cardiovascular Diseases 2014年第4期4卷 189-210页

作者： Kari Radha Krishna Murthy Department of Physiology Santhiram General Hospital & Santhiram Medical College Kurnool India

Death due to scorpion envenoming syndrome is a common event in many of the tropical and non-tropical counties. Initial transient hypertension is commonly observed in scorpion sting victims. Scorpion envenoming causes autonomic storm resulting in initial transient hypertension followed by hypotension, cold clammy skin, hypothermia, cardiovascular disturbances, acute myocarditis, sarcolemmal defects, pulmonary oedema, acute pancreatitis, disseminated intravascular coagulation (DIC), Adult respiratory distress syndrome (ARDS), and many other clinical manifestations. All these manifestations could be due to sudden increase in catecholamines, angiotensin II, glucagon, Cortisol and either due to suppressed insulin secretion or insulin resistance and death. The sudden increase of metabolic A in counter-regulatory hormones along with either suppressed insulin secretion/or insulin resistance results in glycogenolysis in liver, cardiac and skeletal muscles causing hyperglycemia and a sudden increase in free fatty acid levels. Free Fatty Acids increase the susceptibility of the ventricles to the disorganized electrical behavior, inhibit cardiac sarcolemmal Na+-K+ ATPase activity, increase the tendency to intravascular thrombus, increase myocardial oxygen consumption, interfere with tropomyosin-troponin activation of Actin-Myosin coupling, show detergent effects on cell membranes and they could alter the stabilization of lysosomal membranes and probably become toxic to the myocardium. Based on our animal experiments in which insulin administration reversed the metabolic and ECG changes induced by scorpion envenoming and treating the poisonous scorpion sting victims with insulin, we consider that insulin has a primary metabolic role in preventing, counter-acting and reversing all the deleterious effects of FFA by inhibiting the catecholamine induced by lipolysis, and increasing intra-cellular K+, facilitating glucose transport to the myocardium and glucose metabolism through different pathways. Administration of insulin-gluco

关键词： Hypertension Autonomic Storm Angiotensin II Adult Respiratory Distress Syndrome (ARDS) Multi-System Organ Failure (MSOF) insulin-glucose Infusion

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Is nonlinear model predictive control with fuzzy predictive model proper for managing the blood glucose level in typeI diabetes?

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Journal of Biomedical Science and Engineering 2012年第2期5卷 63-74页

作者： Maryam Ahmadi Amir Homayoon Jafari Department of Biomedical Engineering Tehran University Tehran Iran Young Researcher Club Central Tehran Branch Islamic Azad University Tehran Iran

In recent decades, due to the increasing risk of diabetes, the measurement and control of the blood sugar is of great importance. In typeI diabetes, because of the lack of insulin secretion, the cells cannot absorb glucose, and thus have a low level of glucose. To control blood glucose, the insulin must be injected to the body. In fact, the injection must be in a completely controlled environment. If the level of the insulin exceeds the physiological limits, it may cause death. This paper presents an online approach to control the blood glucose level using a nonlinear model predictive control. This method, maintains the level of blood glucose concentration within a normal range. Thus, the blood glucose level is measured in each minute and predicted for the next time interval. If that is not in the normal range, amount of the insulin which must be injected will be determined. The proposed control approach includes important features such as model uncertainties and prevents acute decrease in the blood glucose level, and instability. In order to assess performance of the proposed controller, computer simulations have been carried out in Matlab/Simulink. Simulation results will reveal the effectiveness of the proposed nonlinear model predictive controller in adjusting the blood glucose level by injecting required insulin. So if the nutrition of the person decreases instantly, the hypoglycemia does not happen.

关键词： Diabetes Delay of insulin-glucose Regulatory System Blood glucose Level Nonlinear Model Predictive Control

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