Atrial fibrillation is the most common arrhythmia worldwide with increasing frequency noted with age. Hyperthyroidism is a well-known cause of atrial fibrillation with a 16%–60% prevalence of atrial fibrillation in patients with known hyperthyroidism Ross et al. (2016). While hyperthyroidism as a causative factor of atrial fibrillation is well established, this literature review aims to answer several questions on this topic including:1. The relationship of atrial fibrillation to hyperthyroidism2. Atrial fibrillation as a predictor of hyperthyroidism3. The pathophysiology of thyrotoxic atrial fibrillation4. Subclinical hyperthyroidism and the relationship with atrial fibrillation5. Cardioversion and Catheter ablation of hyperthyroid patients with atrial fibrillation6. Thrombotic risk of hyperthyroid patients with atrial fibrillation7. Management of Thyrotoxic Atrial fibrillation8. Pharmacological rhythm control in patients with hyperthyroidism and atrial fibrillation9. Treatment of Hyperthyroidism to prevent atrial fibrillation10. Clinical Implications of Hyperthyroidism and Atrial Fibrillation
ABSTRACT. Objectives. Bone mass increases throughout childhood, with maximal bone mass accrual rate occurring in early to mid-puberty and slowing in late puberty. Prevention of osteoporosis and its morbidities depends primarily on the establishment of adequate peak bone mass. Physical activity, calcium intake, and vitamin D stores (from sunlight conversion of precursors of vitamin D and to a lesser degree from dietary intake) are vital determinants of bone mineral density (BMD). BMD is further controlled by genetic and environmental factors that are poorly understood.Observance of ultra-Orthodox Jewish customs may have a negative effect on the factors that promote bone health, and there have been anecdotal reports of higher fracture rates in this population. The ultra-Orthodox Jewish lifestyle encourages scholarly activity in preference to physical activity. Additionally, modest dress codes and inner-city dwelling reduce sunlight exposure. Orthodox Jews do not consume milk products for 6 hours after meat ingestion, leading to potentially fewer opportunities to consume calcium. Foods from the milk group are some of the best sources of dietary calcium.Our aims are to examine BMD in a group of healthy ultra-Orthodox Jewish adolescents in an urban community and to attempt to correlate it to physical activity and dietary factors.Design and Methods. We recruited 50 healthy, ultraOrthodox Jews, ages 15 to 19 years (30 males and 20 females). None were taking corticosteroids or had evidence of malabsorption. All girls were postmenarchal and nulliparous. Pubic hair Tanner stage for boys and breast Tanner stage for girls were determined. Weight and height standard deviation scores were calculated. Calcium, phosphorus, protein, vitamin D, and calorie intake were assessed using a comprehensive food questionnaire referring to what has been eaten over the last year. Hours per week of weight-bearing exercise and walking were determined. Lumbar spine (L) BMD was assessed by dual energy radiograph absorptiometry. The pediatric software supplied by Lunar Radiation Corporation, which contains gender-and age-specific norms, provided a z score for the lumbar BMD for each participant. L2 to L4 bone mineral apparent density (BMAD) was calculated from L2 to L4 BMD.Results. BMD of L2 to L4 was significantly decreased compared with age/sex-matched normative data: mean z score was ؊1.25 ؎ 1.25 (n ؍ 50). The mean L2 to L4 BMD z score ؎ standard deviation was ؊1.71 ؎ 1.18 for boys and ؊0.58 ؎ 1.04 for girls. Eight boys (27%) had L2 to L4 BMD z scores <؊2.5, which defines osteoporosis in adulthood. Twenty-seven adolescents (54%), 16 boys and 11 girls, had Tanner stage V. Two participants (4%) had delayed development of Tanner stage V. Mean consumption of calcium by participants under 19 years old was 908 ؎ 506 mg/day (n ؍ 46), which is lower than the adequate intake of 1300 mg/day for this age. The consumption of phosphorus was 1329 ؎ 606 mg/day, and the consumption of vitamin D was 286 ؎ 173 IU/day (n ؍ 50).The mean serum 25(OH)D level...
Fast ice is often used by coastal communities in the James Bay area for transportation in winter using snowmobiles. Therefore, the extent of fast ice along the James Bay coastline is important for land use and any changes to these extents may have significant impacts on the lifestyles of local communities. The eastern coastline has experienced changes in recent decades that might have affected the ice processes, namely hydrologic modifications due to hydroelectric development by Hydro-Québec along with climatic changes that have been observed worldwide. A statistical analysis in the form of summarized ice charts of the ice extents in the middle of winter have been compiled for the past four decades to highlight any recent changes in ice coverage using data from satellite imagery and ice charts produced by the Canadian Ice Service (CIS). A statistical analysis has also been carried out on the freeze-up and breakup dates using historical data. Moreover, a statistical analysis of hydrological data and climatic data has been carried out to determine the long-term and short-term trends in the parameters influencing the ice processes. After testing sensitivity of the past ice regime to climatic and hydrological parameters, the trends detected in the extents of fast ice, as well as freeze-up and breakup conditions, have been correlated with climatic parameters. Using the dominant parameters, a simplified model of the extents of fast ice has been developed, as well as criteria to determine freeze-up and breakup dates. Air temperature projections have also been obtained for two greenhouse gas emissions scenarios using global climate model results to establish future climatic conditions. Finally, projections of the fast ice regime around the year 2050 have been developed to determine a longterm trend covering both historical changes and future conditions. We expect around the year 2050 a recession of the landfast ice coverage of several kilometers, a delay of 1-3 weeks of the freeze-up dates and an advance of 2-10 days of the breakup dates in comparison to the period of 1998-2016 in the James Bay area.
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