effect of fasting on QT Interval

QT interval reflects the total duration of ventricular depolarization and repolarization in the ECG. Experimental hypoglycaemia and spontaneous clinical episodes of hypoglycaemia lead to the lengthening of the heart rate corrected QT interval or QTc. This is associated with elevated risk of sudden death. To find out the effect of fasting blood glucose levels on QT interval and the corrected QT interval [QTc]. Fasting and post prandial blood glucose levels and ECG of healthy young adults were studied and QT interval, RR interval and QTc were determined. The fasting QTc came out to be 0.408 +/- 0.020 as compared to the post prandial value of 0.380 +/- 0.019. The student's t test showed a highly significant value [p<0.0001]. There is significant prolongation of QT interval and QTc during fasting but within normal physiological limits

Empirical treatment for tuberculosis: surgery of cases treated over 2 years in London area

To determine factors influencing the decision to treat tuberculosis empirically and its outcome. A retrospective survey was done to assess the factors influencing the decision to treat tuberculosis empirically and the effectiveness of such treatment, within a London area. Data on tuberculosis cases treated during 1995-96 [n=218] was collected and analysed. One hundred and fifty-eight [72.5%] cases of tuberculosis were treated empirically, that is, in the absence of positive smear or histology. Factors suggesting tuberculosis were clinical suspicion, abnormal radiology, elevated Erythrocyte Sedimentation Rate [ESR] and/or C-reactive Protein [CRP], grade 3 or 4 Heaf test, contact or family history, and Heaf conversion. Significantly more Asian [79 of 105 [75,2%]; p<0.02] and African patients [61 of 81 [75.3%]; p<0.05] were treated empirically as compared to West European patients [14 of 28 [50%]]. Based on logistic regression, any non-European ethnicity carried a significant risk for being treated empirically [OR. 2.7, CI: 1.7-20.8; p<0.05]. Patients requiring revision of diagnosis [n=9] were older [55.7:!:.10.1 vs 32.8:!:.16.0 years; p<0.001]; 6 of them had neoplastic conditions. In this survey, frequent use of empirical treatment for tuberculosis in non-European patients reflects the physicians' high index of suspicion. Although such therapy is justifiable in selected cases, the proportion requiring revision of diagnosis may be reduced by more thorough investigation, especially in older patients

Chronic abdominal pain in children

Children in the age group of 5 to 12 years, attending a paediatric outpatient department, were evaluated to determine the prevalence, and also to elucidate the causes of chronic abdominal pain. 10.5% of the children were found to be suffering from chronic abdominal pain. The maxium affection was seen in the age group of 7 to 9 years. The proportion of affected girls was twice[14.7%] compared to boys [7.5%]. The location of pain was periumbilical in nearly half of the cases. 2.5% of the children had UTI and abdominal sonography carried out in 128 instances was abnormal in 3% of the cases. Nervous, excitable and apprehensive personality traits were strongly related with chronic abdominal pain, so also the presence of enuresis. Children with chronic abdominal pain had significantly more school absences compared to the controls. Out of six emotional problems analysed to assess their association with chronic abdominal pain, single parenting, chronic illness in the mother and father and excessively rigid parenting were found to have significant relationship. The results of this study suggest that chronic abdominal pain is a relatively common complaint in children. A good history, physical examination and minimal laboratory investigations usually provide a direction either towards an organic cause or a functional/psychological etiology

significance of reciprocal changes on electrocardiogram in acute myocardial infarction

Two hundred and fourteen patients admitted to the coronary care unit at Punjab Institute of Cardiology, Lahore with acute myocardial infarction [MI] were analysed of these, 130 had reciprocal ST segment depression and 84 did not have these changes. 46 [35.4%] patients with reciprocal ST segment depression and 14 [16.7%] without these developed left ventricular failure [P<.02]. The mortality was significantly higher in the group with reciprocal changes than without i.e. 21 patients [16%] versus 5 patients [5.9%] [P<.04]. The size of MI assessed by the peal levels of creative kinase [CK] was significantly larger in patients with reciprocal changes [2459 +/- 1611 IU/L] [% t S.Dl compared with 1542 +/- 123'7 IU/L for those without [P<.01], even when the anterior and inferior MI were analysed separately. The patients with no reciprocal changes developed significantly more non-Q MIs t. e 23 [27.4%] compared to 10 [7.7%] for those with reciprocal changes [P<.01]. We conclude that the patients with reciprocal segment depression on admission ECG develop more complications related to acute infarction. These patients should be aggressively treated