Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous autonomic disorder. All patients have exaggerated tachycardia upon standing, but the pathophysiology may be diverse. We present a young adult Thai male with a chief complaint of palpitations while in an upright posture since childhood. The patient underwent a modified Ewing test battery which included standing test, deep breathing, and Valsalva maneuver. His heart rate increased more than 30 beats per minute (bpm) during repeated active stand tests (65 to 110 bpm and 77 to 108 bpm), while upright diastolic blood pressure increased more than 10 mmHg. Normal Valsalva ratio (2.01 and 1.86) and baseline heart rate variability (HFRRI = 4030.24 ms2 and 643.92 ms2) indicated intact vagal function. High low-frequency systolic blood pressure variability (LFSBP = 20.93 mmHg2), increased systolic blood pressure overshoot in phase IV of Valsalva (42 mmHg), and increased upright diastolic blood pressure indicated a hyperadrenergic state. In conclusion, the overall autonomic profile was compatible with hyperadrenergic POTS. Thus, we confirmed the first male POTS case reported in Thailand. We demonstrated the importance of autonomic function testing with continuous measurements to confirm POTS. There is a need for further research in POTS in Thailand.

BACKGROUND: Post-Coronavirus disease 2019 (Post-COVID-19) syndrome has neurological symptoms related to the dysfunction of the autonomous nerve system. However, a pathogenic relationship between post-COVID-19 syndrome and dysautonomia still remains to be demonstrated. Establishing a pathogenic relationship between paresthesia and the presence of cardiac dysautonomia in patients with post-COVID-19 syndrome is the objective of this study.
METHODS: This observational study was carried out in the neurophysiology service wing of the Juan Bruno Zayas Hospital, Santiago de Cuba, in Cuba. The patients were recruited through a post-COVID-19 clinic at the same hospital. A variability study of cardiac frequency and a test of autonomic cardiovascular reflexes was carried out, which is composed of deep breathing, orthostatism, and the Valsalva maneuver.
RESULTS: The variability parameters of the cardiac frequency, the expiration-inspiration ratio between deep breaths, and the Valsalva Index showed no statistically significant differences between healthy participants and those with post-COVID-19 syndrome. During the Valsalva maneuver, there was a greater cardiac frequency response in participants with post-COVID-19 syndrome than in healthy subjects. The difference in supine and standing blood pressure was significantly minor in patients with post-COVID-19 syndrome. The logarithm of high frequency (log HF) increased significantly in patients with paresthesia when compared to patients without paresthesia.
CONCLUSIONS: In the autonomic function tests, no signs of dysautonomia were found in patients with post-COVID-19 syndrome. The presence of paresthesias is associated with differences in cardiac vagal activity, which may suggest that damage to peripheral sensory nerve fibers could be associated with an affectation to autonomic fibres.

Background and Objectives: One of the most challenging tasks in a clinical setting is to differentiate between complex regional pain syndrome (CRPS) type II and traumatic neuropathic pain (NeP). CRPS is characterized by several dysautonomic manifestations, such as edema, hyper/hypohidrosis, skin color change, and tachycardia. This study compared the outcomes of autonomic function screening tests in patients with CRPS type II and traumatic NeP for diagnostic differentiation. Materials and Methods: CRPS type II was diagnosed according to the Budapest research criteria, while NeP was diagnosed according to the updated grading system suggested by the International Association for the Study of Pain Special Interest Group on Neuropathic Pain in 2016. Twenty patients with CRPS type II and twenty-five with traumatic NeP were investigated. Results: Twelve patients with CRPS type II presented abnormal results for the quantitative sudomotor axon reflex test (QSART). Abnormal QSART results were more common in the CRPS type II group. Conclusions: Analysis of QSART combined with other ancillary tests can help in the differential diagnosis of CRPS type II and traumatic NeP if factors influencing abnormal QSART are sufficiently controlled.

In today\'s world, science has progressed significantly, yet most people are still unaware of diabetes. Lack of obesity, physical work, and lifestyle changes are the main factors. Diabetes is becoming more common all around the globe. Type 2 diabetes may go unnoticed for years, resulting in serious consequences and high healthcare expenses. The goal of this study is to look at a wide range of studies in which the autonomic function of diabetic people has been studied with the help of various autonomic function tests (AFTs). AFT is a non-invasive approach to assessing patients for testing sympathetic and parasympathetic responses to stimuli. AFT findings give us comprehensive knowledge of the autonomic physiology reactions in normal and in autonomic diseases like diabetes. This review will concentrate on AFTs that are scientifically valid, trustworthy, and clinically beneficial, according to experts.

UNASSIGNED: Normative data for autonomic function tests (AFT) is not available for Indian population.
UNASSIGNED: The aim of the study was to establish normative data in AFT and its correlation with age, gender, and body mass index.
UNASSIGNED: The study was done on 254 healthy subjects of age ≥18 years. All AFTs were done in autonomic laboratory at the Department of Neurology, Christian Medical College and Hospital, Ludhiana. Cardiovascular tests (heart rate response to deep breathing, HR changes in Valsalva maneuver and head-up tilt test (HUT)) and quantitative sudomotor axon reflex testing (QSART) were performed in all the subjects. Fifty subjects underwent thermoregulatory sweat test (TST).
UNASSIGNED: The mean age (SD) of study participants was 43 (16.0) years (range 20-84), and 129 (50.8%) were men. The normative value range (2.5-97.5 percentile) for HR difference, E: I ratio, and Valsalva ratio (VR) was 3.5-47.0, 1.05-1.93, and 1.11-2.64, respectively, for all the subjects. HR difference and E: I ratio showed an significant inverse relation with age (r = -0.623 and r = -0.584, respectively). VR also showed an inverse relation with age (r = -0.575, P =< 0.001), and female had a lower value than male (1.63 vs 1.78, P =< 0.001). In QSART, mean (SD) sweat volume was higher in males 0.630 (0.230) compared to females 0.513 (0.132) for all sites, P < 0.001, and similar trend was noticed for sweat area in TST.
UNASSIGNED: Normative AFT data has been established for Indian population for the first time. The values are comparable to previously published studies.

UNASSIGNED: Patients with psychiatric disorders are at an increased risk of developing cardiovascular disease, reducing life expectancy. Autonomic dysfunction has been linked to this increased risk; many studies have found reductions in heart rate variability (HRV). Only a few studies have systematically explored the relationship between obsessive-compulsive disorder (OCD) and autonomic function, and they have found contradicting results. The present study is intended to explore comprehensive autonomic functions in OCD patients and compare them with healthy controls.
UNASSIGNED: A total of 18 OCD patients meeting Diagnostic and Statistical Manual of Mental Disorders - 5 (DSM-5) criteria were enrolled to undergo comprehensive autonomic function testing, and the results were compared with 25 age- and sex-matched healthy controls.
UNASSIGNED: Time-domain parameters of HRV such as standard deviation of the RR intervals, coefficient of variance of RR intervals, standard deviation of differences between adjacent RR intervals, root square of the mean of the sum of the squares of differences between adjacent RR intervals, and percentage of number of RR interval differences ≥ 50 ms were significantly lower in OCD patients, indicating lesser parasympathetic tone. Frequency-domain parameters such as total power and very low frequency were significantly lower in OCD patients, indicating a significant decrease in autonomic tone. Nonlinear parameters such as dispersion of points perpendicular to the line of identity and dispersion of points along the line of identity were significantly lower in OCD patients, indicating altered vagal and sympathetic tone. In autonomic reactivity tests, the fall in systolic blood pressure during the lying to standing test and change in diastolic blood pressure during the cold pressor test were significantly altered in OCD patients, indicating abnormal sympathetic reactivity. There was no significant correlation between autonomic parameters and the severity of OCD.
UNASSIGNED: OCD is characterized by a decreased parasympathetic tone and abnormal sympathetic reactivity compared to normal controls.

UNASSIGNED: The high temperature in the working environment could be one of the risk factors for cardiovascular diseases in steel plant workers. The excessive high temperature at the working place leads to altered autonomic activity and is related to more cardiovascular risk.
UNASSIGNED: The effect of high temperature on cardiovascular autonomic function tests in steel plant furnace worker.
UNASSIGNED: This was a case-control study for which 50 steel plant furnace workers and 50 controls were selected. The cardiovascular sympathetic function status in worker and control were analyzed by three tests: (i) Blood pressure (BP) response to sustained isometric handgrip test, (ii) BP response to the cold pressor test, and (iii) BP response to standing from a supine position (orthostasis). Statistical analysis was done by using an independent t-test.
UNASSIGNED: Diastolic BP (DBP) response to sustained isometric handgrip and systolic BP (SBP) and DBP response to the cold pressor test showed that the increase BP in workers were more than controls but the difference was not statistically significant (P > 0.05). SBP response to standing from the supine position showed statistically significant (P < 0.001) greater fall in steel plant workers.
UNASSIGNED: The sympathetic autonomic dysfunction was seen in steel furnace workers in response to environmental stressor-excessive heat.

UNASSIGNED: Cardiovascular disease (CVD), the leading cause of death worldwide is responsible for over 17 million deaths globally, of which 10 per cent deaths have been expected due to consumption of tobacco. The association between CVD and chewing of tobacco is limited and remains arguable. The aim of this study was to find out the correlation between urinary cotinine level and cardiovascular autonomic function tests of tobacco chewers.
UNASSIGNED: In the present study, 600 participants, 300 smokeless tobacco chewers (STC) and 300 non-tobacco chewers (NTC), between 18 and 65 yr were selected. Various parameters such as anthropometric, systolic blood pressure (SBP), diastolic blood pressure (DBP), autonomic function tests and urinary cotinine levels were measured.
UNASSIGNED: Significant difference (P<0.001) was noted in STC and NTC for anthropometric parameters, SBP, DBP and urinary cotinine levels. Sympathetic and parasympathetic autonomic function test showed significant difference on comparison in STC and NTC groups, except in Valsalva ratio. Correlations with urinary cotinine levels were significant for sympathetic autonomic functions, SBP fall (r=0.138, P=0.016), DBP rise (r=-0.141, P≤0.014); parasympathetic autonomic function, heart rate (HR) response to standing (r=-0.208, P≤0.003), deep breathing (r=-0.473, P≤0.001) and Valsalva ratio (r=-0.396, P≤0.0001).
UNASSIGNED: Correlation between urinary cotinine levels and autonomic function tests elucidates the linkage involving autonomic nervous system damage which can be considered as an important associated relationship for early diagnosis of CVD health risk factors among smokeless tobacco (ST) users.

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Gastric emptying tests (GET) are the gold standard for diagnosing gastroparesis, but many patients do not have delayed emptying. We aimed to examine the combination of autonomic nervous system testing (ANS) and the enteric measure (ENS) of electrogastrography (EGG) to predict disordered GET. Seventy-six patients (47 F, 29 M mean age 40 years) with diabetes mellitus underwent evaluation for end-organ failure including gastroparesis. ANS testing assessed autonomic function by finger capillary pulse to positional changes (PAR), vasoconstriction to cold (VC), and EKG R-R interval change (RRI) with deep breathing; the ENS measures of cutaneous EGG assessed gastric myoelectrical activity. Solid (S) GET subgroups were based on 50% emptying (TS50). Via linear regression analysis: VC, PAR, and EGG had a significant inverse correlation with GET TS50 and decreased in response to a delay in gastric emptying (p < 0.05). Via ordinal logistic regression RRI and EGG-predicted gastric emptying (p < 0.01). Patients with a higher RRI and EGG value were 0.93 and 0.14 times more likely to be diagnosed with rapid gastric emptying. The areas under the curve for receiver operator characteristics (AUROC) for all measures were 0.72 in comparison to 0.59 with EGG. Based on the results, four components (RRI, VC, PAR, and EGG) quantitatively describe gastric emptying in patients with signs of diabetic gastropathy better than EGG alone.