The effects of thrombolytic therapy on the high-resolution electrocardiogram after myocardial infarction.

The effects of thrombolytic treatment was studied in 109 consecutive patients 9-11 days after their first acute myocardial infarction by high-resolution electrocardiography (ECG), 24 h Holter monitoring, exercise test and radionuclide ventriculography. Thirty-seven patients were treated with intravenous thrombolytic agents. Thrombolytic treatment was assessed by clinical criteria to be successful in 22 patients and probably successful in 12 patients. Thrombolysis failed in three patients and 72 patients did not receive thrombolytic treatment (control group). Measurements made on the high-resolution and filtered (60 Hz high-pass) vectormagnitude complex included the total duration, the duration of the potential less than 40 microV, the root mean square (RMS) voltage in 10 ms intervals over the first 50 ms and RMS voltage of the last 40, 50 and 60 ms. The filtered QRS duration was significantly shorter in reperfused patients compared with the control group (83 +/- 10 vs 89 +/- 12 ms; P = 0.017). In inferior infarcts (n = 57) the filtered QRS duration was 83 +/- 11 ms in reperfused and 89 +/- 10 ms in non-reperfused patients (P = 0.044), but in anterior infarcts (n = 52) there was no difference. The RMS voltage of the initial 50 ms of the QRS was higher in the reperfused than in non-reperfused anteroseptal infarcts (38 +/- 14 v 23 +/- 10 microV; P = 0.022). Patients successfully treated with thrombolytic agents within the first 2 h had higher RMS voltage of the terminal 40 ms of the QRS than patients treated within 2-4 h (38 +/- 17 vs 27 +/- 17 microV; P = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)     

Tuberculosis as an occupational hazard for health care workers in Estonia.

SETTING: Tuberculosis incidence has been increasing in the Baltic states since the 1990s, accompanied by the emergence of drug resistance, including multidrug resistance (MDR). In this changing situation, the potential threat of nosocomial spread of tuberculosis to other patients and health care workers (HCW) has remained unrecognised. OBJECTIVE: To investigate the risk of tuberculosis in health care workers in Estonia. DESIGN: Cases of tuberculosis registered among HCWs from 1994 to 1998 were evaluated. The case records were analysed retrospectively and combined with bacteriological data including data on drug resistance. RESULTS: Sixty-seven HCWs (23 physicians, 23 nurses and seven laboratory technicians, 12 assistant nurses and two cleaners), all of whom tested negative for human immunodeficiency virus, were diagnosed as having active tuberculosis. The incidence of tuberculosis among HCWs (mean 91/100,000/year) was 1.5 to three times higher than in the general population. In a chest hospital in charge of regional tuberculosis care, the incidence was 30 to 90 times higher, and was highest among physicians. In 49 HCWs tuberculosis was confirmed by culture. Among these, drug resistance was detected in 23 (49%), 18 (38%) of whom had MDR tuberculosis. CONCLUSIONS: Health care workers, especially those working in a chest hospital where tuberculosis patients were treated, were found to be at an elevated risk of tuberculosis. MDR tuberculosis poses a particular threat which is difficult to combat.     

Adiponectin and stress hormone responses to maximal sculling after volume-extended training season in elite rowers

The purpose of this study was to investigate the resting and short-duration exercise-induced hormone responses of male rowers as a result of 6 months of volume-extended training season. Body composition, maximal aerobic capacity, and on-water 2000-m sculling performance were assessed before and after a 24-week training in elite rowers (n = 11; 193.1 +/- 5.2 cm; 91.6 +/- 5.8 kg; maximum oxygen consumption [VO2max], 6.2 +/- 0.5 L x min(-1)). Six rowers were selected (SEL; 192.0 +/- 6.3 cm; 93.5 +/- 7.1 kg; VO2max, 6.4 +/- 0.4 L x min(-1)) and 5 were not selected (N-SEL; 194.8 +/- 4.1 cm; 89.6 +/- 4.0 kg; VO2max, 6.0 +/- 0.5 L x min(-1)) for the national team. Resting adiponectin did not change as a result of prolonged training. Adiponectin did not change after 2000-m rowing at baseline either. No responses were also observed 24 weeks later in SEL rowers, whereas a significant decrease (P < .05) was observed in N-SEL rowers. At the same time, leptin also decreased after the first 30 minutes of recovery in N-SEL rowers. After the training period, immediate postexercise increases in growth hormone and testosterone were significantly higher in the whole group of rowers. No differences in cortisol responses were observed before and after the training period in SEL and N-SEL rowers. In conclusion, it appears that resting adiponectin does not change as a result of prolonged training. Training may modify adiponectin response to an short-duration exercise depending on the performance level of athletes. Decreased postexercise adiponectin and leptin values in rowers with lower performance capacity may be indicative of the inadequate recovery of these athletes.