The effect of therapy on electrocardiography parameters in children with iron deficiency anemia and minor thalassemia compared with the healthy children

Aim Treatment of iron deficiency anaemia in patients undergoing colon cancer resection improves outcome defined by length of stay, recurrence, and requirement for blood transfusions. Method Retrospective analysis of patients with anaemia and colonic cancer between January 2018 - August 2019. Anaemia categorised as – Iron Deficiency Anaemia and non- Iron Deficiency anaemia. IDA was defined as hypochromic microcytic anaemia. Patient demographics, tumour location, pre- and post-operative haemoglobin, length of stay, recurrence and requirement for blood transfusions were collected plus treatment for anaemia. Comparisons made between IDA and non-IDA groups in relation to treatment for anaemia with iron (oral/IV). Non-parametric statistical tests used (median, 2-way ANOVA, Kruskal-Wallis) with significance at P <0.05. Results 150 patients with colonic cancer identified: 77 in IDA group, 46 treated (42 oral, 4 iv iron). 11 in non- IDA group, 8 treated (oral iron). IDA oral and IV treatment versus non-IDA: Median age 74, 80 and 78 years (P = 0.814), Pre- and post op Hb IDA vs non-IDA: 107, 97; 109, 101 (P 0.007 significant), Requirement for blood transfusion (units) 0.77, 0.50;0.90 (P 0.596) Length of Stay (days) 6, 5; 7 (P 0.113), Tumour location: mean of right colon and transverse colon 24.33, 3.667 (P >0.1), and Recurrence P >0.1. Conclusions In our series, iron treatment does not influence recurrence, length of stay, requirement for blood transfusions. Tumour location is not significantly different between IDA and non-IDA group. Patients treated with oral iron therapy are seen to have a larger drop in haemoglobin post operatively than the other groups.

A Homoharringtonine-Based Protocol Is Superior to Daunorubicin and Idarubicin-Based Protocols in Elderly Patients with Newly-Diagnosed Acute Myeloid Leukemia with Comparable Effects and Low Toxicities: Experience in a Chinese Center.

Noise, defined as any sound that is unpleasant, is one of the most important environmental problems. Prolonged exposure to noise has been shown to be associated with the development of cardiovascular diseases. No study investigated the effect of noise on surface electrocardiography (ECG). The aim of our study is to investigate the effect of noise on surface ECG parameters including P-wave dispersion (PWD), QT intervals, corrected QT interval (QTc), T-wave peak to end (Tp-e) interval, and Tp-e/QT and Tp-e/QTc ratios. A total of 51 people working in the textile factory affected by the noise and 43 volunteers without any disease and who were not exposed to noise were included in this study. The average noise level in the textile factory was 112dB. A 12-lead ECG was obtained from all individuals. PR interval, PWD, QRS duration, QT interval, QTc interval, Tp-e interval, and Tp-e/QT and Tp-e/QTc ratios were calculated for all individuals. The noise group had significantly increased PWD [35 (28-40) vs. 28 (22-36) p = 0.029], QT interval ( 373.5 ± 27.3 vs. 359.3 ± 2.74, p = 0.001), QTc interval [(409 ± 21 vs. 403 ± 13 p = 0.045)], Tp-e interval [(90.6 ± 6.0 vs. 83.5 ± 7.3 p < 0.001)], Tp-e/QT [(0.24 ± 0.03 vs. 0.23 ± 0.02, p = 0.015)] and Tp-e/QTc [(0.22 ± 0.02 vs. 0.21 ± 0.02 p < 0.001)] compared to control group. Also, duration of working was positively correlated with PWD (r = 0.468, p = 0.001) and Tp-e/QTc ratio (r = 0.328, p = 0.019). In multiple linear regression linear regression analysis, noise was the independent predictor of both PWD (β = 0.244, p = 0.032) and Tp-e/QTc (β = 0.319, p = 0.003) CONCLUSION: We showed that noise significantly increased PWD, QT and Tp-e interval measurements. Also, noise was the independent predictor for both PWD and Tp-e/QTc.

Background and objectiveIntra-corporeal delta-shaped anastomosis (IDA) is an important development in laparoscopic digestive-tract reconstruction. We applied it in laparoscopic right hemicolectomy for right colon cancer and compared the short-term outcomes between the patients treated with IDA and conventional extracorporeal anastomosis (EA).MethodsBetween 1 January 2016 and 1 October 2017, 36 and 50 patients who underwent IDA and EA, respectively, were included. Data on clinicopathological characteristics, surgical outcomes, post-operative recovery and complications were collected and compared between the two groups.ResultsSurgical outcomes and clinicopathological characteristics were similar between the two groups except the length of incision, which was significantly shorter in the IDA group than in the EA group (4.6 ± 0.6 vs 5.6 ± 0.7 cm, P < 0.001). The time to ground activities, fluid diet intake and post-operative hospitalization did not differ between the groups; however, the time to first flatus was significantly shorter in the IDA group than in the EA group (2.8 ± 0.5 vs 3.2 ± 0.8 days, P = 0.004). The post-operative visual analogue scale for pain was lower in the IDA group than in the EA group on post-operative Day 1 (4.0 ± 0.7 vs 4.5 ± 1.0, P = 0.002) and post-operative Day 3 (2.7 ± 0.6 vs 3.4 ± 0.6, P < 0.001). The surgical complication rates were 8.3 and 16.0% in the IDA and EA groups (P = 0.470), respectively. No complications such as anastomotic bleeding, stenosis and leakage occurred in any patient.ConclusionsIDA is safe and feasible and shows more satisfactory short-term outcomes than EA.

Hemodialysis (HD) patients are known to have high cardiovascular mortality rate. Sudden cardiac death (SCD) due to arrhythmias causes most of the cardiac deaths. HD per se may lead to ECG abnormalities and ventricular arrhythmias. Monitoring ECG parameters such as corrected QT interval, QT dispersion (QTd), Tpe interval may be useful to stratify the patients with high risk of arrhythmia and SCD. Herein we aimed to investigate the effects of changes in serum electrolyte levels and pH on ECG parameters before and after the HD. A total of 50 chronic HD patients (mean age 58±19; male 27) were enrolled. Patients with unmeasurable T waves; atrial fibrillation; bundle branch block; use of class I or class III antiarrhythmic drugs were excluded. Serum potassium, magnesium, calcium, urea, creatinine and pH were measured before and after HD treatment. Standard surface 12-lead ECGs were recorded before and after HD. QTc, QTd, Tpe, JT interval, P-wave-duration, P-wave dispersion were determined. Serum potassium and magnesium decreased, and calcium, pH and bicarbonate levels increased; QRS and Tpe interval were increased after HD. Basal Tpe was correlated with urea (r=0.31, p=0.02). Tpe interval was higher in hypocalcemic compared to normocalcemic patients (77±11 vs 70±9ms, p=0.02). ∆Tpe was correlated with ∆calcium (r=-0.32, p=0.02). Basal QTc was correlated with calcium (r=-0.62, p<0.001). ∆QTc was correlated with basal calcium (r=0.39, p=0.005) and ∆calcium (r=-0.46, p<0.001). Basal JT was correlated with calcium (r=-0.55, p<0.001). ∆JT was correlated with pH (r=0.35, p=0.01), ∆calcium (r=-0.53, p<0.001) and ∆magnesium (r=-0.30, p=0.03). Before HD, 12 patients (12%) were hypermagnesemic of whom JT intervals were lower (314±20 vs 332±23ms, p=0.02). Ultrafiltration per body weight was associated with ∆QTc (r=-0.40, p=0.007) and ∆JT (r=-0.36, p=0.01). QRS and Tpe intervals were increased after HD. Tpe interval was longer in hypocalcemic patients. Change in Tpe was negatively associated with the change in calcium. Ultrafiltration was associated with ∆QTc and ∆JT. Calcium and ultrafiltration seem to be the most important determinants of ECG parameters of HD-induced repolarization abnormalities.

Background: Atrioventricular nodal reentry tachycardia (AVNRT) is known to be associated with increased risk of susceptibility for ventricular arrhythmias and sudden death. Studies indicate that prolongation of the interval between the peak and end of the T wave (Tpeak to Tend, Tp-e) on the 12-lead ECG, is a marker of ventricular arrhythmogenesis. The aim of this study was to assess ventricular repolarization in patients with AVNRT by using Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio. Method: Patient records were retrospectively analyzed. Electrocardiogram of 62 patients, who were diagnosed as AVNRT by electrophysiological study, were obtained and scanned. T wave peak to end interval, QT and corrected QT intervals were measured. Electrocardiograms of age and sex matched 34 healthy control individuals were also analyzed for comparison. Patients with critical coronary stenosis, moderate or severe valve disease, left and/or right heart failure, left and/or right ventricle hypertrophy, atrial fibrillation, right or left bundle block or patients who got pacemaker or ICD implanted were excluded. Results: Both groups did not differ in patient demography. Mean values for AVNRT patients and control group were: QT (362.7±43.7 vs 364.1± 34.1), QTc (417.8±43.2 vs 438.3±44.2) and Tp-e interval (83.5±16.6 vs 77.0±9.7). Tp-e/QT and Tp-e/QTc ratio were also higher in AVNRT group. Discussion: Tp-e is a measure of transmural dispersion of repolarization in the left ventricle and accepted as a surrogate for increased ventricular arrhythmogenesis risk. Tp-e/QT and Tp-e/QTc are relatively new markers which also indicate repolarization defects. Our results show that Tp-e (p=0.018), Tp-e/QT (0.23 vs 0.21; p=0,008) and Tp-e/QTc (0.20 vs 0.17; p=0.000) were significantly higher in AVNRT group which correspond to prior studies about strong relationship between AVNRT and ventricular arrhythmia. | Parameter | Patient group | Control group | p value | |:------------------- | ------------- | ------------- | ------- | | QT interval (msn) | 362.7±43.7 | 364.1± 34.1 | 0.870 | | QTc interval (msn) | 417.8±43.2 | 438.3±44.2 | 0.030 | | Tp-e interval (msn) | 83.5±16.6 | 77.0±9.7 | 0.018 | | Tp-e/QT | 0.23±0.0 | 0.21±0.0 | 0.008 | | Tp-e/QTc | 0.20±0.0 | 0.17±0.0 | <0.001 | * Tp-e: T wave peak to end interval QTc: corrected QT interval ECG measurements of both groups.

Is there a significant transmural gradient in repolarization time in the intact heart?

The effect of moderate altitude on Tp-e interval, Tp-e/QT, QT, cQT and P-wave dispersion

BackgroundChronic kidney disease (CKD) patients are at higher risk for cardiac arrhythmias. The risk of arrhythmia may change with different treatment modalities. We proposed to compare the effects of varied therapy methods on myocardial repolarization parameters (Tp‐e, QT, QTc intervals, Tp‐e/QT, Tp‐e/QTc ratios) and P‐wave dispersion (PWD) in patients with CKD.MethodsThree groups were formed from the patients aged between 18 and 65 years, as Group 1 consisting of CKD patients receiving hemodialysis (HD) three times a week, Group 2 consisting of predialysis CKD patients and Group 3 consisting of CKD patients who underwent successful transplantation. All patients’ basic demographic data, risk factors, and echocardiographic parameters were recorded, and electrocardiographic repolarization parameters and PWD were analyzed.ResultsThe PR, QT, and QTc intervals were significantly shorter in the transplantation group compared to the other groups (P = .020, P < .001, P = .035; respectively). Tp‐e interval, Tp‐e/QT, and Tp‐e/QTc ratios were significantly higher in the predialysis group compared to the other groups (P < .001, P < .001, P = .001; respectively), while there was no significant variation between the HD and transplantation groups (P > .05). PWD was significantly increased in the predialysis group compared to other two groups (P < .001), while no significant variation between the HD and transplantation groups was observed.ConclusionWe found that the Tp‐e interval, Tp‐e/QT, Tp‐e/QTc, and PWD were significantly higher in the predialysis CKD group, but the PR, QT, and QTc intervals were significantly shorter in the transplantation group compared to the other groups. The prognostic significance and prediction of these parameters in arrhythmic events in CKD patients requires further evaluation with long‐time follow‐up.

Dual diethylcarbamazine and albendazole (DA) therapy is the standard mass drug administration (MDA) regimen for lymphatic filariasis in Kenya. Following the recent World Health Organization recommendation, Kenya piloted triple therapy with ivermectin, diethylcarbamazine, and albendazole (IDA) in MDA. We conducted a community-based, observational, cohort event monitoring study to compare the types, frequency, severity, and predictors of adverse events following dual versus triple therapy in 20,421 eligible residents. Residents in Kilifi (n = 10,010) and Mombasa counties (n = 10,411) received DA and IDA through MDA campaigns, respectively. Adverse events were actively monitored through house-to-house visits on days 1, 2, and 7 after MDA. Any clinical events reported before and after MDA were cross-checked and verified to differentiate pre-existing events from MDA-associated adverse events. Overall, 5807 and 3102 adverse events were reported by 2839 and 1621 individuals in the IDA and DA groups, respectively. The incidence of experiencing one or more adverse events was significantly higher (p < 0.0001) in the IDA group (27.3%; 95% confidence interval [CI] 26.4-28.2) than in the DA group (16.2%; 95% CI 15.5-16.9). Dizziness (15.9% vs 5.9%) and drowsiness (10.1% vs 2.6%) were the most common adverse events and significantly higher in the IDA group compared with the DA group (p < 0.0001). Most adverse events were mild or moderate with a few severe cases (IDA = 0.05%; 95% CI 0.35-0.78, DA = 0.03%; 95% CI 0.14-0.60). Female sex, obesity, taking three or more diethylcarbamazine or ivermectin tablets, and having pre-existing clinical symptoms were significant predictors of adverse events following IDA treatment. Ivermectin, diethylcarbamazine, and albendazole as a combination is as safe and well tolerated as DA to use in MDA campaigns with no serious life-threatening adverse events. Systemic mild-to-moderate adverse events with a few severe cases and transient adverse events are more common with IDA treatment than with DA treatment. Hence, integrating pharmacovigilance into a MDA program is recommended for the timely detection and management of adverse events.

Objective To evaluate the effect of oxytocin on Tp-e and QTc interval during caesarean section under spinal anesthesia in healthy puerperas. Methods Forty ASA Ⅰ puerperas were selected and allocated to receive oxytocin intravenous bolus group (group-IB) or oxytocin continuous infusion group (group-CI) with 20 puerperas in each by random digits table. An intravenous bolus of 5% glucose 5 ml and 5 U oxytocin was administered after delivery a 55-60 s period. A continuous infusion of 5% glucose 5 ml and 5U oxytocin was administered after delivery a 10 min period. Measured the QTc interval,Tp-e interval,mean arterial pressure (MAP) and beart rate ( HR ) pre-operatively, then 1,3 and 5 ain after spinal anesthesia, and at least 1,3,5 and 10 min after oxytocin injection. Results In group-IB:HR was fast 1 min after oxytocin injection compared with pre-operatively [(89 ± 13) beats/min vs. (73 ± 12) beats/min] ,MAP was decreased [(69 ± 12 ) mm Hg ( 1 mm Hg= 0. 133 kPa ) vs. ( 82 ± 13 ) mm Hg] and QTc interval was prolonged [(426 ±21 ) ms vs. (405 ± 18 ) ms] (P ＜ 0.01 ); but Tp-e interval was prolonged 1,3,5 min after oxytocin injection compared with pre-operatively (P ＜ 0.01 or ＜ 0.05 ). Conclusions Single large dose of oxytocin intravenous bolus (5 U) can prolong QTc interval and Tp-e interval in healthy puerperas, and Tp-e interval can exact predict the occurrence of ventricular arrhythmias. The risk-benefit balance of oxytocin bolus during caesarean delivery should be discussed with women with a history of long QT syndrome. Key words: Casarean section; Oxytocin; Tp-e interval; QTc interval

To assess the feasibility of 12-lead electrocardiographic (ECG) measures such as P wave dispersion (PWd), QT interval, QT dispersion (QTd), Tp-e interval, Tp-e/QT and Tp-e/QTc ratio in predicting poor outcome in patients diagnosed with sepsis in pediatric intensive care unit (PICU). Ninety-three patients diagnosed with sepsis, severe sepsis or septic shock and 103 age- and sex-matched healthy children were enrolled into the study. PWd, QT interval, QTd, Tp-e interval and Tp-e/QT, Tp-e/QTc ratios were obtained from a 12-lead electrocardiogram. PWd, QTd, Tp-e interval and Tp-e/QT, Tp-e/QTc ratios were significantly higher in septic patients compared with the controls. During the study period, 41 patients had died. In multivariate logistic regression analyses, only Tp-e/QT ratio was found to be an independent predictor of mortality. The ECG measurements can predict the poor outcome in patients with sepsis. The Tp-e/QT ratio may be a valuable tool in predicting mortality for patients with sepsis in the PICU.

Objective: Type 1 diabetes mellitus is the most common endocrine-metabolic disease in childhood, which progresses with insulin deficiency and can cause serious cardiovascular complications. Atrial and ventricular arrhythmias are important cardiovascular complications of diabetes. In this study, cardiac repolarization inhomogeneity in children with Type 1 diabetes mellitus was evaluated electrocardiographically. Method: Between February 2021 and April 2021, 48 patients with Type 1 diabetes mellitus and an equal number of healthy control groups were included in the study. Demographic characteristics of all cases were analyzed. P wave dispersion (PWd), QT interval (QT), QT dispersion (QTd), QTc interval (QTc), QTc dispersion (QTcd), Tpeak-Tend interval (Tp-e), Tp-e dispersion (Tp-ed) were evaluated with 12-lead electrocardiography, Tp-e/QT, Tp-Te/QTc ratios were calculated, and parameters were compared between both groups. Results: The mean age of the patient group was 11.44 ± 4 years, and the mean age of the control group was 9.97 ± 4.5 years. The study group consisted of 18 girls (37.5%) and 30 boys (62.5%). In the control group, there were 21 girls (43.7%) and 27 boys (56.3%). There was no significant difference between the patient and control groups in terms of age and gender. The disease duration of the cases was 35.10±30.7 months, and the HbA1c value was 8.4±1.75%. When heart rates, P wave duration, and PWd, QT, QTd, QTc, QTcd, Tp-e, Tp-ed values were compared between the patient and control groups, there was no statistically significant difference between the PWd, QT and QTc intervals, QTd, QTcd, Tp-e interval, Tp-e dispersion, Tp-e/QT, Tp-e/QTd measurements and ratios of the two groups (p&gt;0.05). Conclusion: In our study, ventricular repolarization parameters of children with Type 1 diabetes and healthy children were found to be similar. Although we think the data we have obtained will contribute to the literature due to the limited number of studies on this subject in children, we believe that long-term and prospective studies involving more patients are needed.

BackgroundLimited data are available regarding hydroxychloroquine (HCQ) and moxifloxacin (MOX) in patients with possible coronavirus disease 2019, (COVID-19). Both drugs may increase risk of malignant ventricular arrhythmias associated with prolongation of QT interval.MethodsA total of 76 subjects with chest tomography findings compatible with COVID-19 pneumonia were enrolled in the study. Standard 12-lead electrocardiogram (ECG) was repeated on days 2 and 5 in patients receiving a combination of HCQ + MOX. Heart rate, QT interval, Tp-e interval, and Tp-e/QT ratio were measured.ResultsThe mean age of the patients was 61.7 ± 14.8 years and 54% had hypertension. Compared to day 2, ECG on day 5 showed significant increases in QT interval (370.8 ± 32.5 vs. 381.0 ± 29.3, respectively, P = 0.001), corrected QT (QTc) interval (424 (403 - 436) vs. 442 (420 - 468), respectively, P < 0.001), Tp-e interval (60 (55 - 70) vs. 65 (57 - 75), respectively, P < 0.001), cTp-e interval (72.2 ± 12.9 vs. 75.4 ± 12.7, respectively, P < 0.001). Moreover, a slight decrease in Tp-e/QT ratio was observed (0.17 ± 0.03 vs. 0.17 ± 0.02, P = 0.030). QTc was > 500 ms in 5% of the patients, and 8% of patients had an increase in QTc interval > 60 ms. Tp-e/QT ratio was > 0.23 in 4% of patients. Five patients died due to pulmonary failure without evidence of ventricular arrhythmia. No ventricular arrhythmia events, including torsades de pointes (TdP), were observed.ConclusionsHCQ + MOX combination therapy led to increases in QTc interval, Tp-e interval, and cTp-e interval. However, this therapy did not cause ventricular arrhythmia in the short-term observation.

Dear editor We read with great interest the article entitled “P-wave and QT dispersion in patients with conversion disorder” by Izci et al1 in Therapeutics and Clinical Risk Management. In this well designed research, Izci et al studied QT dispersion (QTd) and P-wave dispersion (Pd) in patients with conversion disorder (CD). In conclusion, they reported that corrected QT (QTc) and QTd values were significantly altered in patients with CD when compared to healthy controls, but that there was no significant difference in terms of Pd. It has been postulated that the relationship between somatoform disorders and CD is related to altered autonomic functions.2 These changes may affect the refractory period and conduction velocity of the heart. In line with these assumptions, heterogeneity in the duration of the ventricular repolarization phase leading to arrhythmias may also be seen in patients with CD. As in this study, QTd is the most frequently used parameter to detect ventricular inhomogeneity. However, reproducibility of QT interval measurements is low in both manual and automatic measurements and interobserver and intraobserver variability of QTd is very high.3,4 Quantifying the inhomogeneity of the myocardium, transmural dispersion of repolarization (TDR) has also been used since the beginning of the 2000s in addition to QTd.5 There are three types of myocyte, ie, endocardial, epicardial, and midmyocardial M cells, each having different electrophysiological properties in the ventricular myocardium. Mid-myocardial M cells have typically the longest repolarization phase. The repolarization phase of the midmyocardial M cells continues until the end of the T-wave. However, the repolarization phase of the epicardial cells ends at the peak of the T-wave. The time between the peak and end of the T-wave is known as the Tp-e interval, and is an index of the TDR.5 In addition, the Tp-e/QT ratio has also been used as an electrical dispersion index for the myocardium, showing arrhythmic risk. The role of the TDR in evaluation of arrhythmic risk has been demonstrated in coronary artery disease and in the Brugada, short QT, and long QT syndromes. Previously, we showed that the Tp-e interval was increased in patients with obstructive sleep apnea.6 On the other hand, the basic electrophysiological characteristics of the atrium that predispose to atrial arrhythmias are prolongation of intra-atrial and interatrial conduction times and heterogeneous propagation of sinus impulses. Pd is an accepted marker of atrial depolarization heterogeneity and the altered propagation of sinus impulses found to be associated with increased risk of atrial fibrillation. Although prolonged Pd values were found to be correlated with atrial fibrillation, it is controversial whether Pd is related to heterogeneity of atrial conduction or to other factors. Furthermore, reproducibility of P-wave measurements is low in both manual and automatic measurements and interobserver and intraobserver variability is very high. Atrial electromechanical coupling (AEC) can be assessed by electrocardiography-integrated tissue Doppler imaging and provides a means to determine the atrial mechanical and electrical event. Analysis of AEC by tissue Doppler imaging allows precise analysis of AEC between different regions. Moreover, measurement of AEC may suggest an inhomogeneous propagation of sinus impulses in different cardiac sites. Autonomic dysregulation and altered sympathovagal balance, as in somatoform disorders, may account for heterogeneity in atrial conduction properties. Measurement of AEC has been done in patients with psoriasis, ankylosing spondylitis, hyperthyroidism, end-stage renal disease, and hypertension.7–9 Regarding these observations, autonomic imbalance may cause atrial depolarization and sinus impulse propagation abnormalities leading to altered AEC. Our opinion is that, if AEC intervals had been measured in this study, they may have been found to be altered in patients with CD. Further, regarding the forementioned observations, if Izci et al had measured the Tp-e interval and Tp-e/QT ratio in their study, they might have found an increased TDR in their patients with CD. Considering all the data about Pd, AEC, QTd, and TDR, their study might have revealed the effects of CD on electrical heterogeneity of the myocardium more completely in many respects.