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The hemodialysis patients have a wide variety of electrocardiographic [ECG] abnormalities and, in certain instances; hemodialysis itself seems to be a cause of ECG changes and different kinds of dysrhythmias. The purpose of the study was to assess the effect of hemodialysis on QT and corrected QT [QTc] interval and QTc interval dispersion in patients with end-stage renal failure 10 min before [pre-HD] and 10 min after each hemodialysis [post-HD]. An observational cross-section study was conducted on 30 patients 'admitted to the dialysis unit in Abou El Ressh pediatric hospital along a period of 6 months starting from October 2008. The total number of cases on regular hemodialysis throughout the year was: 60 cases. 30 cases were picked at random to be included in the present work. Clinical examination, history taking and laboratory analysis were offered to all patients, 12 lead ECG was done before and after hemodialysis. The results showed that after hemodialysis there were significant changes for the QTc and QT dispersion with 3.3% of cases had prolonged QT interval after hemodialysis and 43.3% had prolonged QTc after dialysis and 50% had abnormal QTd after dialysis. After dialysis there was significant negative correlation between Na level and QTc, also between K level and QTc
Subject(s)
Humans , Male , Female , Renal Dialysis/adverse effects , Myocardium , Electrocardiography , Arrhythmias, Cardiac , ChildABSTRACT
To evaluate the usefulness and validity of the exercise-induced T wave normalization for prediction and diagnosis of ischemic heart disease and to assess and quantify its correlation to autonomic dysfunction. A cohort study Department of Medicine, Farwania Hospital, Kuwait One hundred and twenty-one patients with history of exertional chest pain with inverted T wave in the resting ECG but without history of myocardial infarction and 67 patients with T wave inversion during exercise test were included in the study. All patients underwent treadmill exercise ECG test and stress thallium scintigraphy in the course of their management. Exercise induced T-wave There was no significant difference between patients from both groups as regards the resting heart rate, the time of the exercise test, peak heart rate, heart rate recovery after exercise and QT dispersion after exercise, [p = NS]. Predictive indices revealed that exercise induced T wave normalization is sensitive but not a specific indicator for prediction of ischemic heart disease, as the sensitivity was 71%, specificity = 49.2%, accuracy = 63.2%, positive predictive value = 74.4% and negative predictive value = 44.8%. A significant relation between age, smoking status, diabetes mellitus status and exercise induced T wave normalization [p < 0.05] was observed. Exercise induced T wave normalization is a sensitive but not specific marker of exercise induced myocardial ischemia and this may be due to autonomic dysfunction with impaired parasympathetic function and unopposed sympathetic action
ABSTRACT
Objectives: To evaluate usefulness of the recovery time after a treadmill exercise ECG test for assessment of autonomic system function in hypertensive patients using Holter-based heart rate variability as a reference
Methods: Sixty untreated hypertensive patients were included in the study. Echocardiography was done to assess left ventricular mass index and function. Exercise ECG test was given for all patients. The heart rate recovery was calculated as reduction in heart rate from the peak to one minute of the recovery time and a cutoff value of 12 beats/minute or less was considered abnormal. The patients were classified into two groups: group I: included 40 patients with impaired heart rate recovery after exercise test and group II: included 20 patients with normal heart rate recovery. Holter 24-hour ECG monitoring was done for all patients for assessment of heart rate variability
Results: There was a significant impaired heart rate variability in the hypertensive patients with impaired heart rate recovery than those with normal heart rate recovery [p< 0.05]. Predictive indices of heart rate recovery after exercise ECG test for assessment of cardiac autonomic function revealed that sensitivity = 94%, specificity = 81%, positive predictive value = 90%, negative predictive value = 90% and accuracy = 90%. Stepwise logistic analysis revealed a significant relation between the maximal heart rate during exercise test, time-domain heart rate variability variables [r-MSSD and p-NN50] and impaired heart rate recovery after exercise ECG test in hypertensive patients [p< 0.05]. There was a significant correlation between Holier based vagal dependent r-MSSD and the heart rate recovery after exercise test [p <0.05]
Conclusion: Incorporation of heart rate recovery after exercise may eventually be considered the usefull diagnostic test for assessment of autonomic nervous system function in hypertensive patients
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Objectives: To evaluate the role of autonomic nervous system in determining the appearance of diastolic ventricular dysfunction in patients with previously unrecognized and untreated essential hypertension
Methods: We studied 60 middle aged and pharmacologically untreated hypertensive subjects [45 men and 15 women] and 30 normotensive subjects [24 men and 6 women] as a control group [group I]. All patients were referred from outpatient clinic with blood pressure more than 140/90 mmHg as detected by ambulatory blood pressure monitoring with an ausculatory device. Echocardiography was done to assess left ventricular diastolic function. Exercise ECG test was done to exclude patients with ischaemic heart disease. Holter ECG monitor was done for all subjects to assess heart rate variability. Hypertensive patients were classified into two groups: group II: included 30 patients with diastolic dysfunction and group III: included 30 patients with normal ventricular systolic function
Results: In regard of age, gender, left ventricular mass index and left ventricular systolic function there was no significant difference between all groups of study [p = NS], but the hypertensive patients of group II had a significant decreased E/A ratio [p <0.05], a significant decrease in r-MSSD and p-NN50 [p < 0.05] and a significant increase in daytime and nighttime heart rate [p < 0.05] than subjects and patients of groups I and II. There was a significant correlation between vaeal dependent parameter [r-MSSD] and E/A ratio [r = 0.875, p < 0.05]. Stepwise logistic analysis revealed that no significant relation between age, gender and ambulatory systolic and diastolic blood pressure and the presence of left ventricular diastolic dysfunction in hypertensive patients
Conclusion: It is concluded that left ventricular diastolic dysfunction in hypertensive patients without left ventricle hypertrophy is related to reduced parasympathetic activity and this supports the use of non-pharmacologic treatments that increase vagal tone
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Twelve puppies were used to study the effeciency of bone cement as a mean of fi ationofan induced mandibular fracture. It gave adequate fixation and complete bony union was evident within two months. The general condition of the dogs was satisfactory. The permanent tooth germ adjacent to the cement showed irrigularities both in shape and structure. The treatment of jaw fracture in chddren with such material should be carried our with caution. The absence of soft tissue break down on the cement encouragous its intraoral use but complete asepsis is mandatory. Thank's are due to the Dean of the Faculty of Veterinary Medicine Cairo University, Chairman of Veterinary Surgery department and his Staff members amd Chairmen of VeLerinary Pathology department and his staff members for their valuable aids