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Background: Myocardial diastolic tissue velocities are reduced already in newly onset Type 2 diabetes mellitus (T2D). Poor disease control may lead to left ventricular (LV) systolic dysfunction and heart failure. The aim of this study was to assess the effects of exercise training on myocardial diastolic function in T2D patients without ischemic heart disease.

Aims: To investigate whether exposure to cobalt in cobalt plants has any measurable effect on the cardiovascular system. Methods: Occupational, cross sectional study, using a self administered questionnaire, blood pressure measurement, electrocardiography, and laboratory tests in which 203 male workers with at least one year of exposure to cobalt and 94 unexposed controls participated. Echocardiography was performed on a subset of 122 most highly exposed cobalt workers, of which 109 were analysed, and on 60 controls, of which 57 were analysed. Analysis of covariance and a multiple regression analysis were used to evaluate the data. Results: Two of the echocardiography parameters measured were associated with cobalt exposure. In the higher exposure group the left ventricular isovolumic relaxation time (mean 53.3, 49.1, and 49.7 ms in the high exposure, low exposure, and control groups respectively) and the deceleration time of the velocity of the early rapid filling wave (mean 194.3, 180.5, and 171.7 ms for those in the high exposure, low exposure, and control groups respectively) were prolonged, indicating altered left ventricular relaxation and early filling. Conclusion: Cumulative exposure to cobalt was found to be associated with the results of Doppler echocardiography measurements, indicating altered diastole. This finding supports the hypothesis that cobalt accumulation in the myocardium could affect myocardial function. Whether this finding has clinical implications remains to be evaluated.A n epidemic of cardiomyopathy occurred in the 1960s in Canada, the United States, and Belgium among persons who drank large amounts (that is, several litres per day) of beer containing cobalt.1-3 The disease was severe, and almost half of the diseased persons died. According to postmortem analyses, the patients' hearts were dilated and the walls of the left chamber had thickened. It was assumed that heavy drinking and dietary deficiencies, in addition to exposure to cobalt, played a role in causing the disease. 4 Single cardiomyopathy cases have been reported among persons exposed to cobalt at work. 5 6 Exposure levels have been high in these cases (that is, 0.1-5 mg Co/m 3 ). These workers have been diagnosed as having a cardiac condition similar to dilative cardiomyopathy.In a study among hard metal workers, a weak but still significant inverse correlation was found between exposure time and the left ventricular ejection fraction, as measured by radionuclide ventriculography. 7 The study group consisted of 30 men, and the exposure levels were not mentioned. In a second echocardiogram and radionuclide study (31 men, exposure levels 0.09-13.6 mg Co/m 3 ), men who had been diagnosed with hard metal disease (n = 12) were found to have a significantly lower left ventricular ejection fraction during both rest and exercise than persons who had not been diagnosed with hard metal disease. 8 In the study group, the left ventricular peak filling rate at rest was lower than the average of the general population. The researchers a...

An epidemic of respiratory tract diphtheria began in Russia in 1989. In 1994 more than 2,500 cases occurred in St. Petersburg alone. We describe clinical findings in the 1,860 adult patients treated in Botkin's Hospital. The study is based on a retrospective review of patient records. In 98% of the patients the diagnosis was confirmed by a positive throat culture growing a toxin producing strain of Corynebacterium diphtheriae. A catarrhal disease without membranes was present in 1,256 (67.5%) patients, 150 patients had membranes on tonsils only, 268 patients on tonsils, the uvula, soft palate and posterior pharynx and 35 patients on larynx or in the lower respiratory tract. 42 patients (2.3%) died. Among the deceased patients 26 were alcoholics, whereby the death rate for non-alcoholics was probably around 1%. 151 patients (8.1%) had a toxic form of the disease with swelling of the neck. This form of the disease carried a high mortality, 25.7%. In a subgroup of 1,045 patients the protective efficacy of vaccination could be evaluated. A 2.2-fold protection was found, but the study may underestimate the efficacy. We conclude, that if a wide diphtheria epidemic affects an industrialized country, it would probably not any more be the big killer that it was in Europe and in the United States in the 1950's and 1960's.