Influence of aerobic treadmill exercise on blood glucose homeostasis in noninsulin dependent diabetes mellitus patients.

The role of treadmill exercise on blood glucose homeostasis in noninsulin dependent diabetes mellitus (NIDDM) were studied using males between age of 45 and 60 years (X-52), who wereclinically and biochemically-confirmed cases of NIDDM were taken into study group. Control group comprised of 10 males between age group of 45 to 60 (X-53) years. All the subjects were assessed by physician and were investigated to confirm diabetic status. The whole study period was extendedfor 6 weeks. The significant decrease in postprandial blood sugar (44.4mg per cent for the study group and 32.2mg per cent for the control group) with a significant inter group difference (P<0.05) was observed. The mean decrease in fasting blood sugar 39.4mg per cent for the study group and 27.4mg per cent for the control group), with a marginal inter group difference (P<0.05) was observed. The treadmill exercise was found to be a definite tool in addition to drug and diet in glycemic control.

Percutaneous transluminal coronary angioplasty (PTCA) in Jamaica: preliminary results

This is the first detailed report from the Anglophone Caribbean of percutaneous transluminal coronary angioplasty (PTCA). The procedure resulted in complete dilatation of the occluded vessels in the five patients in whom it was undertaken, with significant improvement in exercise duration in the Bruce protocol (p<0.001; 95 percent CI 2.5 to 4.1 minutes) in the four patients who were studied. PTCA can be undertaken in developing countries with limited resources, and should be offered to selected patients with symptomatic coronary artery disease who need a revascularisation procedure.(AU)

Myocardial perfusion scintigraphy using Tc99m labelled compounds: correlation with coronary angiography

The increasing incidence of ischaemic heart disease with high mortality rate and the recent introduction of Tc99m labelled myocardial perfusion imaging agents, along with the advent of a coronary angiography programme in Trinidad and Tobago, prompted the comparison of the sensitivity and specificity of myocardial perfusion scintigraphy (MPS) with coronary angiography (CA). Using a standard one-day code-differential imaging protocol single photon emission computed tomography (SPECT), images of the left ventricular myocardium of 30 patients were obtained at rest and following exercise: These images were analyzed for perfusion defects to assess each of the three main coronary arteries; the left anterior descenting artery (LAD), the right coronary artery (RCA) and the left circumflex artery (LCx). The data were then correlated with the angiographic findings. MPS yielded an overall sensitivity of 97.5 percent and a specificity of 83.6 percent when compared to CA. Discordant data were obtained in the analysis of nine vascular territories with scintigraphy producing eight false positive and one false negative. The false positive cases were seen in two males and four females. Of the males, one was discovered to have intramyocardial tunnelling of the LAD artery and the other demonstrated differential perfusion between the LAD and LCx arteries. Of the females, one was classified as having Syndrome X and another demonstrated differential perfusion between the LAD and LCx arteries; the other two cases were attributed to breast attenuation. The one false negative was obtained in a patient who demonstrated good collateral circulation on angiography. MPS thus compares very well with CA in assessing the three main myocardial vascular territories (AU)

Prevalence of exercise-induced asthma in schoolchildren in Kingston, St. Andrew and St. Catherine, Jamaica

A cross-sectional study was done, focusing on the prevalence of exercise-induced asthma in Jamaica and variables that may account for this rate. No previous study of this nature had been undertaken, and the investigators contend that there is a need to identify children who suffer from this condition but are unaware of it. A sample of 214 students from primary and secondary schools in the corporate area were chosen and given questionnaires to complete. Eighty-four of the children reported a history consistent with that of exercise-induced asthma and were further subjected to stress testing for a definitive diagnosis of this condition. A prevalence of 20.8 percent [C.I ñ 5.35] was identified which reflected a rate comparable to that recorded in North America. There was a significantly higher prevalence in children of primary school ages, but all other variables considered for significance testing to determine associations between these and the prevalence of EIA proved not significant. A recomendation has been made for opportunity screening by medical practitioners (AU)

The necessity for a screening programme in schools for exercise-induced asthma in children in Kingston and St. Andrew

A cross-sectional study was done focussing on the prevalence of exercise-induced asthma in Jamaica and variables that may account for this rate. A sample of 214 students from primary and secondary schools were chosen from parishes in the corporate are and were given questionnaires to complete. Eighty-four of the children reported a history consistent with that of exercise-induced asthma and were furthur subjected to stress testing for a definitive diagnosis of this condition. A prevalence of twenty per hunderd was identified which reflected a rate in excess of that recorded worldwide. There was a significantly higher prevalence in children of primary school ages, but all other variable considered for significance testing to determine associations between these and the prevalence of EIA proved not significant. The necessity for a screening programme was reviewed and found to be justifiable taking into account he standard criteria. Recommendations were made for its institutions (AU)

Clinical exercise testing: its application to Trinidad and Tobago

Exercise treadmill testing has gone far beyond its initial application to the diagnosis of chest pain. Consequently test results can no longer be interpreted by the unqualified designation of "positive" or "negative". If utilized in a thoughtful manner it can provide useful answers to specific questions concerning most ambulatory patients and so provide information which may be used to customize individual management plans. (AU)

Treadmill exercise stress testing in the assessment of severity and management of ischaemic heart disease - abstract

Patients with definite ischaemic heart disease were subjected to treadmill exercise stress testing to assess the severity of their disease. Twelve lead electrocardiographic recordings were done and Standard Bruce Protocol used. Critical disease was diagnosed with profound ST segment depression beginning within three minutes, at low heart rates, with angina, and attenuated or hypotensive blood pressure response. Disease was considered severe with marked ST depression beginning within 6 minutes and persisting the full duration was regarded as moderate positivity. Mild disease showed mild definite significant ST depression persisting for longer than 4 minutes with or without angina. Thirty six patients (32 M, 4 F) were studied over a six month period, Thirteen (36 percent) showed critical disease by the above criteria and urgent coronary angiography (C.A.) with a view to aorto-coronary bypass surgery (A.C.B.S.) was recommended. So far six had C.A. (ages 44-68); all showed critical left main equivalent disease. Five necessitated urgent A.C.B.S., a total of 16 gragts being used. There were six severly positive tests and C.A. has also been recommended for this group. One had myocaridal infarction 3 months after assessment. Medical therapy was regarded as optimal therapy for eight with moderate, and nine with mild disease. One had thallium stress test which did not show significant myocardium in jeopardy. Treadmill exercise stress testing is a useful non-invasive tool in selecting patients who will benefit from C.A. and A.C.B.S. as opposed to continuing medical therapy (AU)

Reappraisal of cardiovascular surveys in Jamaica: use of submaximal exercise tests for clinical investigation

Assertions that idiopathic cardiomegaly or an obscure form of ischaemic heart disease are common in Jamaica have been based on a high prevalence in community surveys of unexplained electrocardiographic abnormalities and of positive responses to a questionnaire for ischaemic heart pain. Thirty-one men, aged 42-62 years, in whom these abnormalities had been found in a previously surveyed rural community, were recalled for clinical examination and exercise tests and compared with 18 control subjects. No clinical abnormalities were found. The heart rates during standard work and maximum oxygen uptake of subjects and controls were similar, and indicated, on average, excellent exercise performance consistent with their heavy physical activity in daily life. None complained of chest pain at near maximal exertion, and the previous diagnosis of angina pectoris was judged to have been mistaken. Most of the electrocardiographic abnormalities at rest were minor or isolated and did not change on exercise. Significant changes in exercise occurred in 4 subjects, in whom inverted T waves and ST depression became less obvious than at rest, but the cause of these abnormalities was not found. Though idiopathic cardiomegaly and ischaemic heart disease do not occur in Jamaica, their incidence is not known but there is no evidence that they are as widespread as has been previously asserted. Interpretations of answers to questionnaires and of electrocardiograms obtained in population surveys should be made with caution. From this study we have no evidence on whether the electrocardiographic changes were related to ethnic or environmental factors. (AU)