Evaluation of Sinus and Atrioventricular Nodes Function in Patients with Vasovagal Syncope

Aim: Evaluation of sinus and atrioventricular nodes function as a potential factor responsible for prolonged bradycardia, asystole, or both in patients with cardioinhibitory and non-cardioinhibitory vasovagal syncope (VVS). The study included 258 patients (mean age = 47.7 ± 17.2 years; range 18–62; 147 females) with a history of VVS. They were divided among four groups, according to results of head-up tilt test (HUTT).
Methods: All patients underwent standard HUTT, carotid sinus massage (CSM), and rapid transesophageal atrial pacing for evaluation of total sinus node recovery time (SNRT), and corrected sinus node recovery time (CNRT), resting and intrinsic heart rate (IHR), and Wenckebach point (WP). Values of SNRT > 1,500 ms, CNRT > 525 ms, WP < 130 bpm, and CSM-induced pause >3 seconds were considered abnormal.
Results: SNRT, CNRT, and WP before and after pharmacological blockade, resting heart rate, and IHR did not differ significantly among the study groups. The prevalence of mild sinus node dysfunction (SND), decreased value of WP, and cardioinhibitory carotid sinus hypersensitivity was similar among all study groups.
Conclusions: The prevalence of mild SND, abnormal atrioventricular conduction, and carotid sinus hypersensitivity (CSH) was similar among patients with VVS regardless of the type of vasovagal reaction. SND and CSH do not seem to play an important role in the pathogenesis of cardioinhibitory vasovagal reaction.     

Patients with endoscopic gastritis and/or duodenitis improve markedly following eradication of Helicobacter pylori,although less so than patients with ulcers

BACKGROUND: It is well documented that dyspepsia in patients with peptic ulcer disease (PUD) improves markedly after eradication of Helicobacter pylori, while rarely does it improve in patients with functional dyspepsia. There is a large group of H. pylori-infected patients who do not qualify for either diagnosis, but in whom eradication may be considered. The aim of this study was to compare symptom severity, change in gastrointestinal symptoms 1 year after eradication and satisfaction with therapy between PUD patients and patients with endoscopic diagnoses of gastritis and/or duodenitis (G/D patients). METHODS: The patients were randomized to one of four triple regimens containing ranitidine bismuth and metronidazole, and either oxytetracycline or spiramycine. Eradication was assessed with the 14C-urea breath test. GI symptoms were evaluated using the Gastrointestinal Symptom Rating Scale (GSRS) and the Ulcer Esophagitis Subjective Symptoms Scale (UESS) questionnaires. RESULTS: One-hundred-and-eighty-three patients were recruited from GI outpatient clinics. Patients with PUD and G/D had similar severity of symptoms before eradication therapy. One year after H. pylori eradication, 99% of the PUD patients and 75% of the G/D patients felt better regarding their main upper GI complaint. Abdominal pain score decreased by 48% as measured by GSRS and by 78% as measured by UESS in the PUD group and by 25% and 47%, respectively, in the G/D group. Reflux symptoms decreased by 41% and 63% in PUD patients and by 28% and 45% in G/D patients; indigestion by 30% and 47% in PUD and by 20% and 34% in G/D; eating discomfort by 60% in PUD and by 35% in G/D. Sleep quality score improved by 68% in PUD and by 41% in NU patients. Constipation decreased by 22% in the PUD group. All these differences in symptoms were highly significant compared to baseline. Diarrhoea was unchanged. CONCLUSIONS: Abdominal pain, reflux symptoms, indigestion and the ability to eat and sleep improved in both PUD and G/D patients 1 year after H. pylori eradication. Chronic diarrhoea was not induced. Abdominal pain improved significantly more in PUD than in G/D patients. Further study of the effect of H.pylori eradication in G/D patients is warranted.     

Detection of canine echinococcosis by coproantigen ELISA

ObjectiveTo study the canine echinococcosis by coproantigen ELISA method.MethodsDuring the present investigation experimental infection was established using evaginated worms of Echinococcus granulosus (E. granulosus). To check cross reactivity two pups were infected with Taenia hydatigena (T. hydatigena). In order to detect the presence of antigen, hyperimmune sera were raised against excretory-secretory products of adult worms E. chinococcus granulosus. Faecal sample collected either from experimentally infected pups or from other sources were heated at 70 °C to detect heat stable soluble antigen.ResultsPups harbouring less than 104 worms showed negative results. Samples collected from 14 days onwards from experimentally infected animals harbouring more than 104 worms showed positive value. The maximum positive samples were detected in samples collected from in and around slaughter house and the least number of samples were detected positive maintained by dog squad.ConclusionsThe affinity purified IgG exhibited promising results for detection of canine echinococcosis by indirect ELISA.     

Insulin-induced hypoglycemia stimulates gastric vagal activity and motor function without increasing cardiac vagal activity

BACKGROUND/AIMS: We investigated whether increasing the efferent vagal activity by insulin-induced hypoglycemia would enhance gastric emptying and volumes in healthy subjects. METHODS: Twenty healthy volunteers (10 males) were examined with and without vagal stimulation by insulin-induced hypoglycemia using a glucose clamp technique. Stomach function was tested by drinking meat soup (0.04 kcal ml(-1)) at a rate of 100 ml min(-1) until maximal capacity. Intragastric volume at maximal drinking capacity was determined by three-dimensional ultrasound. Respiratory sinus arrhythmia (RSA) was used as an index of cardiac vagal activity and plasma pancreatic polypeptide (PP) as a measure of gastric vagal activity, and skin conductance (SC) as a measure of sympathetic tone. RESULTS: Insulin-induced hypoglycaemia increased drinking capacity (p = 0.002), gastric emptying (p = 0.02), PP (p = 0.004) and SC (p = 0.004), while intragastric volume was unchanged (p = 0.7) and RSA decreased (p = 0.03). CONCLUSION: Enhancement of gastric vagal activity by insulin-induced hypoglycemia increased drinking capacity and gastric emptying similarly, resulting in an unchanged intragastric volume. Enhanced efferent vagal activity to the stomach (as measured by PP) was not associated by enhanced cardiac vagal activity (as measured by RSA), possibly a consequence of stress-induced sympathetic activation during the procedure.     

pH-Activated Phospholipase A 2 : an Important Mucosal Barrier Breaker in Peptic Ulcer Disease

Abstract

Objective. Hyperlipidemia, overweight, insulin resistance and hypertension are associated with non-alcoholic fatty liver disease. The knowledge about these conditions as etiologic factors in liver cirrhosis is, however, limited. In this study, we examined the relation between overweight and hypertriglyceridemia, and development of liver cirrhosis in a general population. Material and methods. An epidemiological, longitudinal study was conducted involving men at the age of 50 with 40 years of follow-up. Baseline data were collected in 1963 and 1967. Cases of liver cirrhosis were identified by searching the Swedish Hospital Discharge Register and death certificates of the Central Bureau of Statistics. The independent effect of BMI, triglyceride levels and alcohol habits for cirrhosis of the liver was calculated by using multiple logistic regression analysis. Results. Elevated BMI and triglycerides were significant independent risk factors for the development of liver cirrhosis (OR 1.27 and 1.99, respectively, p < 0.01). Conclusions. Overweight and hypertriglyceridemia are independent risk factors for liver cirrhosis in Swedish men.     

Atypical respiratory complications of dengue fever

In last decade, dengue has emerged as one of the most important vector born disease. With increasing cases, uncommon presentations and complications are now commonly recognized. Here, we report two cases of rare pattern of respiratory involvement in dengue: acute respiratory distress syndrome and bronchiolitis with respiratory failure.     

Synergistic inhibition of platelet activation by plasmin and prostaglandin I2

Endothelial cell prostacyclin (PGI2) inhibits platelet activation by raising platelet cyclic AMP. Previously, platelet activation was also shown to be blocked by plasmin formed by endothelium-derived tissue plasminogen activator (TPA). We have now studied interactions between PGI2 and plasmin in the control of platelet function. PGI2 and plasmin cause synergistic inhibition of thrombin- and ADP-induced aggregation of washed platelets. Inhibition by PGI2 is similarly potentiated by TPA added to platelet-rich plasma to generate plasmin. Thrombin-stimulated rise in platelet cytosolic Ca2+, measured by fura2 fluorescence, and thromboxane A2 formation, measured by radioimmunoassay (RIA), are likewise synergistically inhibited by PGI2 and plasmin. Plasmin neither increases nor potentiates PGI2-stimulated increases in platelet cyclic AMP. Thus, PGI2 and plasmin cause synergistic inhibition of platelet activation by both cyclic AMP-dependent and independent mechanisms. This interaction between two different endothelium-derived products may play an important role in localizing the hemostatic plug to a site of vascular injury by preventing further thrombin-mediated accrual of platelets.     

Oral and general health-related quality of life among young patients with haemophilia

Summary.  The clinical diagnosis of dental diseases may indicate their cause and prognosis, however it gives little information about resulting levels of impairment from the patients' perspective. In this study, we aimed to investigate oral and general health-related quality of life (OHRQoL-HRQoL) in patients with haemophilia; and to test whether haemophiliacs would have worse or better OHRQoL compared with the general population. Data were collected from haemophiliacs (age range 14–35; mean 23 ± 6.58, n  = 71) and age/sex-matched controls (age range 14–35; mean 21.00 ± 6.45, n  = 60) through face-to-face interviews including nine questions and using oral health impact profile (OHIP)-14, oral health-related quality of life-UK (OHQoL-UK), short-form general measure of health (SF)-36 to measure self-rating oral health status, perceived dental treatment needs, tooth brushing frequencies, OHRQoL-HRQoL. In the field of self-rating oral health status, perceived dental treatment needs, tooth brushing frequencies and OHIP, OHQoL-UK, SF-36 scores – except the subscales including vitality, role emotional and mental health – the control group is in better conditions compared with the haemophilia group. At the same time, both the two groups are in good conditions in dental attendance, vitality, role emotional and mental health. Life quality is related with the perceived discrepancy between the reality of what a person has and the concept of what that person wants, needs or expects. In order to eliminate the dilemma in the field of health, we should facilitate the haemophiliacs' lives by serving the health care in a multidisciplinary view.     

Strain during gastric contractions can be measured using Doppler ultrasonography

This study was undertaken to explore if strain of the muscle layers within the gastric wall could be measured by transabdominal strain rate imaging (SRI), a novel Doppler ultrasound (US) method. A total of 9 healthy fasting subjects (8 women, 1 man; ages 22 to 55 years) were studied and both grey-scale and Doppler US data were acquired with a 5- to 8-MHz linear transducer in cineloops of 97 to 256 frames. Rapid stepwise inflation (5 to 60 mL) of an intragastric bag was carried out and bag pressure and SRI were measured simultaneously. SRI enabled detailed studies of layers within the gastric wall in all subjects. Great variations in strain distribution of the muscle layers were found. Radial strain was much higher in the circular than in the longitudinal muscle layer. Strains derived from SRI correlated well with strains obtained with B-mode measurements (r = 0.98, p < 0.05). During balloon distension, we found an inverse correlation between pressure and radial strain (r = -0.87, p < 0.05). Intraobserver correlation of strain estimation was r = 0.98 (p < 0.05) and intraobserver agreement was 0.2% +/- 18.6% (mean difference +/- 2SD, % strain). Interobserver correlation was r = 0.84 (p < 0.05) and interobserver agreement was 6.9% +/- 56.8%. SRI enables detailed mapping of radial strain distribution of the gastric wall and correlates well with B-mode measurements and pressure increments.     

Effect of Glyceryl Trinitrate on Gastric Accommodation and Symptoms in Functional Dyspepsia

The purpose of this study was to investigatewhether sublingual glyceryl trinitrate influences thesize of the proximal stomach and postprandial symptomsin patients with functional dyspepsia. Twenty patients with functional dyspepsia were included in adouble-blind, placebo-controlled crossover study withsublingual glyceryl trinitrate. All patients werescanned twice on consecutive days, receiving eitherplacebo or 0.5 mg glyceryl trinitrate randomly 5 minprior to ingestion of 500 ml meat soup. Total symptoms,pain, nausea, and bloating were scored on a visualanalog scale before and after the meal. Standardized ultrasonograms were obtained 1, 10, and 20 minpostprandially of the proximal and distal stomach. Theproximal stomach was larger in the sagittal section at1 min postcibally (26.5 ± 3.9 vs 24.8 ±4.9 cm², P = 0.036) and 10 min postprandially (22.0± 5.1 vs 19.8 ± 5.3 cm², P =0.009) after administration of glyceryl trinitratecompared with placebo, whereas a tendency was observedafter 20 min (18.7 ± 5.5 vs 17.3 ± 5.7 cm², P = 0.076). The correspondingchanges in the frontal diameters were 8.3 ± 1.1vs 7.8 ± 1.2 cm (P = 0.067) after 1 min, 7.2± 0.9 vs 6.4 ± 0.8 cm (P = 0.001) after 10min, and 6.3 ± 1.1 vs 5.6 ± 1.2 cm (P =0.016) after 20 min. The area of the distal stomach was notdifferent (P = 0.31) in the two groups. Afteradministration of glyceryl trinitrate, the patientsreported less pain (P = 0.048) and nausea (P = 0.023) 5min postprandially, but this effect was reduced 15min later. Total symptom score was improved by glyceryltrinitrate treatment (P = 0.042). Sublingual glyceryltrinitrate improves accommodation of the proximal stomach to a meal and reduces postprandialsymptoms in a group of patients with functionaldyspepsia.