A Combined Approach for Health Assessment in Adolescent Endurance Runners

Background: It has been shown that prolonged exhaustive exercise, such as half-marathon running, could lead to transient post-exercise elevation of cardiac troponins, increase in oxidative stress, and mild decline in renal function in adolescent athletes. With increases in sports participation involving young people, there has been much interest in pre and post health evaluations following exercise. Evaluations can be used to identify pre-existing health confounders and to examine any detrimental responses that may occur post exercise. Study purpose & Methods: The purpose of this study was to evaluate pre and post exercise measures of cardiac function, serum albumin, systemic immunoglobulin (Serum IgA and IgG), cortisol and testosterone in adolescent (age: 16.2 ± 0.6) male endurance runners performing in 21-km maximal run. Results: Results revealed that cortisol, IgA and IgG levels significantly decreased 2, 4, and 24 h post exercise compared to pre-exercise levels (p < 0.05). Testosterone levels reduced 4 h post exercise (p < 0.05) but were restored to baseline values following 24 h. There were no changes recorded for albumin levels post exercise (p > 0.05). ECG assessments did not show any abnormalities at the T wave axis, ST segments and Q wave pre or post exercise. Conclusions: The findings from this study suggest that a single bout of prolonged maximum running is not likely to induce abnormal electrical activity in the heart, but does decrease serum immunoglobulin, and homeostasis of anabolic and catabolic hormones in trained adolescent endurance runners.

Variability Inter-observer between Three Methods of Electrocardiographic (Conventional, Computerized and Computerized Printed) on Healthy Cats

Background: Electrocardiography is an exam widely used in feline medicine. It consists of recording the electrical activity of the heart in waves representing myocardial depolarization and repolarization. Two electrocardiographic evaluation methods are employed in dogs and cats: computerized and conventional. However, possible differences in ECG results performed by the different methods have been reported. This paper aims to evaluate the observer's interference in the interpretation of the electrocardiographic exams and possible differences between the methods: conventional single channel, computerized screen and computerized printed of healthy cats.Materials, Methods & Results: Electrocardiographic tracings were obtained from 58 healthy cats, aged between 1 and 10 years-old, of both sexes, of the Persian and mixed breed and therefore interpreted by four observers with similar degree of experience. The examinations were performed in a sequential manner, the computerized method first, and then the conventional method. The animals were gently contained in the right lateral decubitus position. The tracings obtained by the conventional method were printed on thermally sensitive graph paper. The computerized method was performed in computer by means of specific software (TEB® ECGPC version 6.2), being the waves delimited by the observer. The tracings were also printed by means of a jet printer, and also interpreted. The morphology of P waves, QRS complexes and T waves were analyzed in the derivations: I, II, III, aVR, aVL and aVF. Heart rate, amplitude and duration of the P, QRS and T waves, PR, QT and heart rate (HR) intervals were calculated in derivation II. Mean electric axis was determined in leads I and III. Comparing the methods, there was a difference observed in the values of P and R waves, QRS complex, QT and PR intervals and T wave polarity. The interpretation of the evaluators presented statistical differences in the duration of the P wave, QRS, QT and HR. The three methods used presented differences during the mean of the interpretation of the evaluators.Discussion: Some factors such as the positioning of the animal and the use of chemical containment may influence the electrocardiographic tracings, as well as variations between electrocardiographic devices. In our study, the non-use of sedation and the use of the same equipment in all animals reduced the variability of the results. The interpretation of the computerized method printed and on the screen presented different results which can be explained by the reduced human visual capacity when compared to the computers. It is known that the interpretation of different tracings by the observers might influence the results of the examination. The evaluators of the present study evaluated the same tracings, but there was a difference in the interpretation of the observers. Regarding the methods, there was a difference between the three methods evaluated in relation to the ST segment. The computerized on-screen method demonstrated in its totality isoelectric ST segments that represent normal pattern for the species. The conventional and computerized printed methods presented results of elevation in ST segments that represent alterations in the diagnosis. There was a difference between the measurements performed by different observers, however this fact did not influence the results of the tests, since the parameters remained within the normality standards for species. It can be concluded that the variation between observers and among the three methods evaluated suggests that the ST segment interpretation is subtle and less influenced when performed in the computerized method.

Description of ST Segments Elevation of Myocardial Infarction on Patients Undergoing Primary Percutaneous Coronary Intervention in dr. M. Djamil Hospital Padang

Myocardial infarction is influenced by various risk factors consist of gender, age, family history, smoking, hypertension, dyslipidemia, diabetes mellitus and menopause. The aim of this study was to describe the description of sex, age and risk factors possessed by patients with ST segments Elevation Myocardial Infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI) procedures at Dr. M. Djamil hospital Padang. Amount of 40 people were obtained specifically for STEMI patients who underwent PPCI and were treated at the integrated heart services installation of RSUP dr. M. Djamil Padang from July-September 2019. The research variables measured were age, sex, risk factors for hypertension, diabetes mellitus, smokers, dyslipidemia, family history and menopause. Data was analyzed in the form of univariate analysis, which explained each research variable according to the proportion and frequency values. The results were found in 40 patients with acute ST segments elevation myocardial infarction, all aged > 40 years, most were male (85%) and the most risk factor was smoking (82,5%). We conclude that STEMI patients who underwent PPCI in dr.M. Djamil hospital Padang from July-September 2019 were all > 40 years old, most were male, with the most risk factors were smokers.

Weight loss supplement causing acute heart block in a child

A 16-year-old male was admitted to the paediatric ICU with acute onset of vomiting, somnolence, and chest pain, and electrocardiogram showing 2nd degree heart block after ingesting an Aleurites moluccana (Candlenut) seed as a herbal weight loss supplement. Electrocardiogram showed progressively worsening heart block with down-sloping of the ST segments, resembling digoxin toxicity. After 2 days of ICU observation, his symptoms began to improve and eventually resolved. The side effects of herbal supplements are often unknown but by analysing cases such as these, physicians can develop a better understanding of these substances to help guide management.

Statistical and spectral analysis of ECG signal towards achieving non-invasive blood glucose monitoring

Background Globally, the cases of diabetes mellitus (diabetes) have increased in the past three decades, and it is recorded as one of the leading cause of death. This epidemic is a metabolic condition where the body cannot regulate blood glucose, thereby leading to abnormally high blood sugar. Genetic condition plays a significant role to determine a person susceptibility to the condition, a sedentary lifestyle and an unhealthy diet are behaviour that supports the current global epidemic. The complication that arises from diabetes includes loss of vision, peripheral neuropathy, cardiovascular complications and so on. Victims of this condition require constant monitoring of blood glucose which is done by the pricking of the finger. This procedure is painful, inconvenient and can lead to disease infection. Therefore, it is important to find a way to measure blood glucose non-invasively to minimize or eliminate the disadvantages encountered with the usual monitoring of blood glucose. Method In this paper, we performed two experiments on 16 participants while electrocardiogram (ECG) data was continuously captured. In the first experiment, participants are required to consume 75 g of anhydrous glucose solution (oral glucose tolerance test) and the second experiment, no glucose solution was taken. We explored statistical and spectral analysis on HRV, HR, R-H, P-H, PRQ, QRS, QT, QTC and ST segments derived from ECG signal to investigate which segments should be considered for the possibility of achieving non-invasive blood glucose monitoring. In the statistical analysis, we examined the pattern of the data with the boxplot technique to reveal the change in the statistical properties of the data. Power spectral density estimation was adopted for the spectral analysis to show the frequency distribution of the data. Results HRV segment obtained a statistical score of 81% for decreasing pattern and HR segment have the same statistical score for increasing pattern among the participants in the first quartile, median and mean properties. While ST segment has a statistical score of 81% for decreasing pattern in the third quartile, QT segment has 81% for increasing pattern for the median. From a total change score of 6, ST, QT, PRQ, P-H, HR and HRV obtained 4, 5, 4, 5 and 6 respectively. For spectral analysis, HRV and HR segment scored 81 and 75% respectively. ST, QT, PRQ have 75, 62 and 68% respectively. Conclusions The results obtained demonstrate that HR, HRV, PRQ, QT and ST segments under a normal, healthy condition are affected by glucose and should be considered for modelling a system to achieve the possibility of non-invasive blood glucose measurement with ECG.

Pneumomediastinum, ST elevation and urgent cardiac catheterisation: a crucial triad?

Pneumomediastinum (PNMD) entails the presence of air or other gas in the mediastinum and is also known as mediastinal emphysema. PNMD may cause a wide variety of signs and symptoms, as well as ECG abnormality, including ST segment changes. We present a 56-year-old man admitted to our hospital after a facial trauma. After undergoing tracheostomy, he complained of chest discomfort. A chest X-ray in the posteroanterior view showed PNMD, and an ECG was suggestive of inferior-lateral wall myocardial infarction. An urgent cardiac catheterisation identified a critical obstruction at the origin of the right coronary artery. Following a balloon angioplasty, chest discomfort continued; and the ECG ST segments did not show any dynamic change during the subsequent 72 hours. We urge clinicians to perform a comprehensive workup for every patient presenting with PNMD and ST segment changes, to prevent unnecessary invasive procedures.