Eleven type-I (insulin-dependent) diabetic patients with abnormal changes in left ventricular function in response to cold stress (CS) were investigated to try and determine the cause of these abnormal responses. Resting M-mode echocardiography demonstrated that all 11 patients had normal left ventricular dimensions and wall motion, thereby excluding overt cardiomyopathy. Thallium-201 scintigraphy was used to assess myocardial perfusion during CS and eight patients were found to have perfusion defects during stress which persisted in four. It is possible that CS unmasks evidence of myocardial ischemia but it is also possible that the abnormal responses to CS reflect altered vasomotor reactivity in the diabetic patient, producing coronary spasm. Left ventricular function may be influenced by many factors in diabetes and an abnormal CS test may not necessarily indicate structural disease. Such tests, however, may help in the further understanding of the pathophysiology of heart disease in diabetes.

Adult↗

PubMedDate not supplied

Cardiac function during stress testing in long-standing insulin-dependent diabetics.

Four dynamic tests of cardiac function were compared in a group of 13 long-standing insulin-dependent diabetics who had no clinical evidence of cardio-respiratory disease. One patient developed abnormal features during 24 hour ambulatory electrocardiograms while all 13 patients had normal exercise electrocardiograms. The change in left ventricular ejection fraction during dynamic supine exercise as measured by gated blood-pool scintigraphy was not significantly different from control subjects (p less than 0.1) while during cold stimulation testing the change in left ventricular ejection fraction in the diabetics was highly significantly different from the control subjects (p less than 0.01). Five of the patients had one or more abnormal tests of autonomic function. The cold stimulation test may be a sensitive index of cardiac dysfunction in diabetics but as the mechanism is unclear alternative explanations are possible. While the etiology of heart disease in such patients is uncertain it is likely to be multifactorial and this test may prove useful in investigating the natural history and pathogenesis of cardiac disease in diabetics.

Adolescent↗

PubMedDate not supplied

Bedside prediction of neonatal pulmonary maturity by single step gastric aspirate shake test.

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False Negative Reactions↗

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Seroepidemiology of hepatitis A infection in India: changing pattern.

OBJECTIVE: Recent changes in the epidemiology of hepatitis A virus (HAV) infection and the availability of effective vaccines have renewed interest in this infection. We determined the age-related prevalence of anti-HAV antibodies in India and looked for differences by known risk factors for HAV infection. METHODS: In this prospective study, serum samples obtained from 1612 subjects aged 1 to 60 at six centers in five cities (Calcutta, Cochin, Indore, Jaipur and Patna) during the period February to August 1998 were tested for anti-HAV antibodies. Demographic and socio-economic information was obtained by questionnaire. RESULTS: The overall seroprevalence rate was 65.9%, varying from 26.2% to 85.3% in various cities; there was no difference between males and females. Seropositivity increased with age from 52.2% in the 1-5 year age group to 80.8% in those aged 16 years or more. Seroprevalence rates were significantly lower in those aged 1-5 years compared with other age groups (p<0.0001). There was no difference in seroprevalence between those with monthly family income Rs 5001. Multivariate analysis showed that anti-HAV seroprevalence varied significantly by source of water supply, being highest when the supply was municipal. CONCLUSION: Our results indicate an epidemiological pattern of intermediate endemicity. This finding has public health implications as it indicates that a significant proportion of the Indian adolescent and adult population is at risk of HAV infection.

Adolescent↗