Long on QT and low on calcium

Acquired lengthening of the QT interval due to hypocalcaemia is a rare cause of arrhythmia in childhood. Early recognition, rapid institution of appropriate cardiac monitoring, and replacement therapy are essential. An endocrinal work-up may be necessary to exclude primary disorders of calcium metabolism. We report four cases documenting the varied clinical spectrum in which hypocalcaemic-induced prolongation of the QT interval and arrhythmia can occur in childhood.     

Influence of Smoking on Basal and on Vagally and Maximally Stimulated Gastric Acid and Pepsin Secretion

Published data show that smokers have greater basal or peak acid and pepsin outputs, but the mechanisms underlying these effects are unknown. To confirm this and to determine whether these findings extend to, and implicate, any vagal overactivity, gastric secretions collected for 1 h basally, 1 h after 15 min of modified sham feeding (MSF), and 1 h after pentagastrin (6 μg/kg subcutaneously) were analyzed for acid and pepsin content in 204 subjects, 104 with duodenal ulcer (66 smokers) and 101 without (57 smokers). Maximal acid outputs (MAO, μeq/kg/h, x + SEM) were higher in smokers than in non-smokers in both duodenal ulcer (DU) (623 + 35 versus 491 + 35, p < 0.005) and non-DU (502 + 32 versus 376 + 20, p < 0.005). Basal and MSF secretions were generally increased in smokers but, when expressed as a percentage of MAO, were not different in smokers and non-smokers (18% versus 17% and 43% versus 39%, respectively, in DU, and 13% versus 16% and 40% versus 36% in non-DU). Maximal pepsin outputs (units + 10 ²/kg/h) were also higher in smokers than in non-smokers (DU, 129 + 7.9 versus 105 + 9.5, p = 0.05, and non-DU, 101 + 7.5 versus 77 + 10, p = 0.05). Basal and MSF secretions as a percentage of maximal pepsin output were not different in smokers versus non-smokers. Multivariate logistic regression shows that smoking was most strongly associated with MAO and sham feeding outputs, but the duration-intensity (pack-years) of smoking was associated only with elevated MAO. We conclude that smoking is associated with increased maximal acid and pepsin output in both DU and non-DU populations. Smoking does not seem to affect independently vagal stimulation of gastric secretion.     

Effects of therapeutic paracentesis on systemic and hepatic hemodynamics and on renal and hormonal function

Thirteen patients with cirrhosis and tense ascites (six with and seven without peripheral edema) underwent 4- to 15-liter paracentesis without intravenous "colloid" replacement. Cardiac output increased from 6.6 +/- 0.7 liters per min at baseline to 8.2 +/- 0.7 liters per min (p less than 0.003) 1 hr after large-volume paracentesis completion and fell to 7.5 +/- 0.69 liters per min (p less than 0.05 vs. baseline, p less than 0.02 vs. 1 hr) 24 hr after large-volume paracentesis completion. There was no change in mean arterial pressure or mean pulmonary artery pressure. Central venous pressure fell from 9.1 +/- 0.8 mm Hg at baseline to 8.6 +/- 1.4 mm Hg 1 hr post-large-volume paracentesis to 6.8 +/- 1.0 mm Hg (p less than 0.005 vs. baseline, p less than 0.02 vs. 1 hr value) at 24 hr, and pulmonary capillary wedge pressure fell from 13.1 +/- 0.9 to 11.1 +/- 1.3 mm Hg 1 hr after large-volume paracentesis and to 9.89 +/- 1.2 (p less than 0.01 vs. baseline, p less than 0.03 vs. 1 hr after large-volume paracentesis) at 24 hr. Heart rate fell from 90 +/- 3.0 to 85 +/- 2.9 beats per min (p less than 0.01) 1 hr after large-volume paracentesis completion, but increased to 89 +/- 2.5 beats per min (p less than 0.02 vs. 1 hr after large-volume paracentesis) at 24 hr.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of particle size on quartz-induced hemolysis and on lung inflammation and fibrosis

To assess the role of crystal size in biologic responses, we quantitated red blood cell lysis and lung inflammation and fibrosis in the mouse using 4 alpha-quartz preparations with average diameters of 1, 5, 7.8, and 11.2 microns. When compared on the basis of identical crystal surface areas, the 1-micron fraction was more hemolytic than the other 3 fractions. The three larger fractions had equivalent membranolytic activities. After 6 weeks of postintratracheal instillation of the crystals into mice, the 1-micron-diameter crystal fraction increased wet lung weights by 1.25 x that of saline controls, while a 1.75 x increase was found for the three larger crystal fractions. A similar response was found when evaluating fibrosis development by determining lung hydroxyproline levels. Measurement of the percentage of the crystal dose remaining in the lungs revealed that the biologic differences observed were not due to a difference in the clearance of the smaller crystal fraction. Thus, larger crystals of alpha-quartz produce a greater degree of inflammation and fibrosis when instilled into the lung than those of 1 micron diameter, even though the smaller crystals are more membranolytic in vitro and appear to be cleared from the lung at the same rate as the larger crystals.     

Epidemiological study on Chlamydia trachomatis infection in pregnant housewives and investigation on its influence on outcome of pregnancy and on their newborns

We surveyed Chlamydial infection with Chlamydiazyme for 3010 pregnant housewives in Hokkaido. Four hundred and fourty six out of the 3010 pregnant housewives were also be retrospectively investigated for the influence of C. trachomatis on outcome of pregnancy and on their newborns. The results were as follows. 1) Of the 3010 pregnant housewives, 217 (7.2%) were C. trachomatis-antigen positive, when their endocervical specimens were tested. There was no difference in the positive rate of C. trachomatis among the six cities where our investigation was performed. 2) A high C. trachomatis-positive rate (21.9%) was achieved in the pregnant teen-aged housewives with a significant decrease as age increased. 3) As for placenta previa, threatened abortion, preterm delivery and small for date infants, the incidence was higher in the untreated C. trachomatis positive group than in the C. trachomatis negative group. 4) The weeks of gestation and birth weight of newborns in the untreated C. trachomatis positive group were significantly lower than those of the C. trachomatis negative group. 5) No statistical significance was found in the incidence of premature rupture of membrane, fatal distress, spontaneous abortion nor postpartum fever between the C. trachomatis negative group and the untreated C. trachomatis positive group. These results suggest that Chlamydial infection in pregnant housewives is widely spread in Hokkaido and gives some disadvantage to pregnancy outcome and newborns. Consequently, Chlamydial infection in pregnant women must be appropriately diagnosed and treated in the early stage of pregnancy.     

缬沙坦和培哚普利对大鼠肝纤维化模型肠通透性的影响

目的 观察血管紧张素受体阻滞剂缬沙坦和血管紧张素转换酶抑制剂培哚普利对四氯化碳诱导大鼠肝纤维化模型的疗效及对其肠通透性的影响。方法 将大鼠分为A组(正常对照组)、B组(模型对照组)、C组(缬沙坦治疗组)和D组(培哚普利治疗组)，于造模第4周C组开始用缬沙坦(10mg／kg)，D组开始用培哚普利(0.5mg／kg)治疗，共4周，进行肝组织及小肠组织苏木精-伊红染包，检测血浆D乳酸、DAO和内毒素浓度。结果经治疗后肝纤维化大鼠肝小叶结构趋于正常，纤维间隔变薄，血浆D-乳酸、DAO和内毒素浓度下降。结论 培哚普利和缬沙坦能有效地减轻四氯化碳诱导肝纤维化大鼠的损伤及纤维化程度，减轻肠源性内毒素血症和肠通透性增加。     

Impact of COVID-19 and comorbidities on health and economics: Focus on developing countries and India

Background and aimsPresence of comorbidities in patients with Coronavirus disease 2019 (COVID-19) have often been associated with increased in-hospital complications and mortality. Intriguingly, several developed countries with a higher quality of life have relatively higher mortality with COVID-19, compared to the middle- or low-income countries. Moreover, certain ethnic groups have shown a higher predilection to contract COVID-19, with heightened mortality. We sought to review the available literature with regards to impact of COVID-19 and comorbidities on the health and economics, especially in context to the developing countries including India.MethodsA Boolean search was carried out in PubMed, MedRxiv and Google Scholar databases up till August 23, 2020 using the specific keywords, to find the prevalence of comorbidities and its outcome in patients with COVID-19.ResultsAll available evidence consistently suggests that presence of comorbidities is associated with a poor outcome in patients with COVID-19. Diabetes prevalence is highest in Indian COVID-19 patients, compared to other countries. Majority of the patients with COVID-19 are asymptomatic ranging from 26 to 76%.ConclusionsUniversal masking is the need of hour during unlock period. Low-income countries such as India, Brazil and Africa with less resources and an average socio-economic background, must adopt a strict policy for an affordable testing programs to trace, test, identify and home quarantine of asymptomatic cases. Despite the huge number of COVID-19 patients, India still has low volume research at the moment.     

锌、铜对染砷小鼠肝及肾毒作用的干预研究

为观察补充锌、铜对染砷小鼠的肝、肾脏组织超氧化物歧化酶 (SOD)水平、丙二醛 (MDA)含量并初步探讨其作用机制 ,对染砷小鼠同步进行锌、铜干预试验 ,同时作肝脏、肾脏组织SOD活性及MDA含量测定和病理学观察。干预后 ,与阳性对照组相比 ,锌干预组肝脏、肾脏SOD活性升高 ,MDA含量下降 (P <0 .0 1) ,锌加铜组仅肾脏SOD活性升高 (P <0 .0 1) ,铜组肝、肾脏SOD活性及MDA含量均无显著性差异 (P >0 .0 5 )。病理学观察可见 ,锌干预组效果最好 ,其次为锌加铜组 ,而铜组无干预效果。提示补充一定剂量锌对染砷小鼠的脂质过氧化程度、抗氧化能力以及组织病理改变均有一定的干预效应。铜在该剂量下与锌起拮抗作用。     

Impact of adiponectin and ghrelin on incident glucose intolerance and on weight change

Objectives Adiponectin and ghrelin are associated with adiposity and type 2 diabetes in several studies. We sought to prospectively determine the interaction of adiponectin and ghrelin in the development of adiposity and hyperglycaemia. Design Prospective observational study. Participants 393 community‐dwelling Afro‐Jamaicans (mean age 47 ± 13 years; BMI 27·3 ± 6·3 kg/m²; 63% women) without glucose intolerance at baseline. Measurements Anthropometry, fasting plasma glucose, 2‐h plasma glucose, insulin resistance (HOMA‐IR), adiponectin and ghrelin concentrations were measured at baseline and 4·1 ± 0·9 years later. Multivariate analyses were used to explore the associations of HOMA‐IR, adiponectin and ghrelin with weight change and glycaemia. Results The mean weight change was 2·6 ± 5·5 kg. There were 114 incident cases of impaired glucose tolerance (IGT) and 35 cases of diabetes mellitus. Adiponectin was positively correlated with age and female sex (P‐values < 0·01). After adjusting for age and sex, adiponectin and ghrelin were significantly correlated with weight at baseline and follow‐up. However, they were not associated with weight change even after further adjustment for baseline weight. Adiponectin, but not ghrelin, was associated with 2‐h glucose concentrations at follow‐up even after adjusting for age, sex, HOMA‐IR and BMI (P = 0·04). In the fully adjusted logistic regression model, adiponectin predicted incident IGT (OR 0·93; 95% CI: 0·87–0·99) and attenuated the effect of BMI on incident IGT. Conclusions These longitudinal data show that adiponectin and ghrelin may not be causally involved in the development of obesity. However, adiponectin is independently associated with decreased risk of incident IGT.