Guidelines for the management of acute coronary syndrome in patients presenting without persistent ST segment elevation. The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011;32:2999-3054. 5. Neumann FJ, Kastrati A, Pogatsa-Murray G, et al. Evaluation of prolonged antithrombotic pretreatment (“cooling-off” strategy) before intervention in patients with unstable coronary syndromes: a randomized controlled trial. JAMA 2003
Nikolay G. Dimitrov, Iana I. Simova, Hristo F. Mateev, Maria R. Kalpachka, Pavlin S. Pavlov and Iveta G. Tasheva
Valeria Ács, Hajnal Finta, Edith Simona Ianosi and Monica Sabău
Aim: Evaluation of the contribution of general practitioners to the early diagnosis of tuberculosis in the studied period. Analysis of cases not diagnosed as active TB, from those suspected by the general practitioner and the real cases with respiratory lesions.
Material and methods: We conducted an observational epidemiologic study aiming at evaluating the diagnosis of pulmonary TB at the level of primary care medicine.
Results: The difference between conformed TB patients that have been referred with the suspicion of TB and those without suspicion is significant (p <0.0001), and the risk of disease estimated by OR was 21.54. More than half of the patients (139), had positive microscopic examination and culturing, representing 62.61%. In 10.36% microscopic examination was positive and culturing was negative (13 patients). Negative microscopic examination and positive culturing were detected in 5.86% of the patients. The majority of suspected/confirmed new patients were living in urban environments. The urban/rural ratio was 1.27. The reasons why the general practitioner suspected tuberculosis, in the order of frequency, were the following: cough/dry cough, sweating/nocturnal sweating, fever/persisting fever. Among the TB types, we noted the large percentage of patients with infiltrating, nodular tuberculosis confined to the volume of one pulmonary segment (30.78%), and 19.87% of the cases were multicavity tuberculosis; also, we noted the presence of caseous tuberculosis with moderate volumes of infiltrates, confined to a pulmonary lobe (18.27%).
Conclusion: Early diagnosis of tuberculosis in the primary healthcare network is a continuous challenge for the general practitioner.
Raina G. Ardasheva, Mariana D. Argirova, Valentin I. Turiiski and Athanas D. Krustev
Background: Increased intra-abdominal pressure (IAP) causes tissue ischemia, subsequent hypoxia, and impairment of normal tissue metabolism. Elevation of IAP above 20 mmHg leads to progression of abdominal compartment syndrome (ACS) that is associated with organ dysfunction or failure not previously manifested. Aim: To evaluate the eff ects of diff erent grades and time of exposure to IAP on biochemical parameters and oxidative stress in organs aff ected by ischemia using previously developed rat model. Results: Three experimental groups exposed to diff erent IAP and time frames were tested for liver, kidney, and pancreas injury by measuring the activities of tissue specifi c enzymes in blood serum. Elevated activities of aspartate aminotransferase, pancreatic amylase, lipase, and higher concentrations of D-lactate, urea, and creatinine were found in some of the experimental groups compared to a control group of animals not subjected to increased IAP. Increased levels of biomarkers of oxidative stress as well as decrease in concentration of the major cellular antioxidant glutathione indicated the presence of oxidative injury as a result of elevated IAP. Conclusions: The developed rat model is appropriate to study the mechanism and manifestation of tissue injury during diff erent grades of elevated IAP but also to test approaches aimed to attenuate the detrimental eff ects of ACS. This study also underlines the necessity of using not a single but a set of biochemical parameters in order to assess the severity of tissue injury during elevated IAP and progression to ACS.
Jakó Beáta, Benedek Theodora, Suciu Zsuzsanna and Benedek I
Introduction: The association between a high calcium score at the level of the unstable coronary lesions and the different characteristic of culprit lesions which result in an acute coronary syndrome (ACS) has not been described yet. We aimed to study the correlation between the accumulation of calcium within the vessel wall of a coronary artery and the plaque burden of culprit lesions that develop an acute coronary event. Material and methods: A total of 45 patients with ACS (22 unstable angina, 23 nonST elevation myocardial infarction) underwent 64-slice CCTA. In all patients a complex CT analysis of the culprit plaques was performed and the calcium score for each coronary artery was computed. Results: We found a significant correlation between a calcium score higher than 100 and the plaque volume (r = 0.85. p = 0.01). Selecting a cut-off value of 100 HU for regional calcium score at the level of the coronary artery, we found that those arteries with Ca score higher than 100 presented significantly larger plaque volumes than the ones with calcium score below 100 (110.8 ml vs 82.4 ml, p <0.0001 for left anterior descending artery, 111.09 ml vs 82.5 ml, p = 0.0005 for circumflex artery, and 132.78 ml vs 76.23 ml for right coronary artery). Conclusion: Our data shows that in ACS, the severity of the culprit lesions correlates with regional accumulation of calcium within the vessel wall.
Jakó Beáta, Benedek Theodora, Suciu Zsuzsanna and Benedek I
Introduction: Coronary calcium score, as determined by Angio CT multislice, has been proved to represent a reliable parameter which reflects the global cardiovascular risk. We aimed to study the characteristics of culprit lesions in Acute Coronary Syndrome (ACS) patients with low versus high calcium score. Material and methods: A total of 45 patients with ACS underwent 64-slice CCTA. Group 1 - 19 patients with Ca score below 400HU, Group 2 - 26 patients with calcium score >400HU. In all patients a complex CT analysis of the culprit plaque was performed. Results: There were no significant differences between the groups at baseline as regard to age, gender, cardiovascular risk factors (p>0.2). In patients with high calcium score, culprit lesions presented a significantly larger amount of plaque burden than in patients with low calcium score (82.8ml versus 131.81ml, p <0.0001). This was also true when assessing in a subanalysis different cut-off points for definition of relatively higher calcium score (89.66ml versus 137.93ml, p <0.0001, for calcium score cut off 600HU, 97.88ml versus 137.57ml, p<0.0001 for calcium score cut-off of 1000HU). Conclusion: Our data shows that patients with high calcium score who develop an acute coronary syndrome present larger atheromatous plaque than those with low calcium scores, and theseverity of the culprit lesions correlates with global cardiovascular risk as expressed by a high calcium score
Olivera Andrejić, Rada Vučić, Svetlana Apostolović, Milan Pavlović, Dragana Stokanović, Valentina Nikolić, Tatjana Jevtović-Stoimenov and Stefan Momčilović
The aim of our study was to determine the factors influencing galectin-3 levels in patients with acute coronary syndrome and decreased left ventricular ejection fraction. We collected material from 37 successive patients with acute coronary syndrome and decreased left ventricular ejection fraction, of which 19 patients had atrial fibrillation, and 18 patients who were without atrial fibrillation constituted a control group. Blood samples used for the biochemical measurements were obtained on the third day from acute coronary syndrome. We used Statistical Package for Social Sciences for data analysis. A p-value less than 0.05 was considered to be a measure of statistical significance. Galectin-3 concentration is directly correlated with age and B-type natriuretic peptide level. Also, our results showed an inverse correlation between galectin-3 and total body weight, body mass index, body surface area and creatinine clearance. The following variables were found to be significant predictors of galectin-3 level: decreased left ventricular ejection fraction, total body weight, LDL concentration and body mass index. We identified factors that can predict a decrease in the left ventricular ejection fraction below 45% after acute coronary syndrome: atrial fibrillation increases the risk by almost six times, and urea concentration increases the risk by 1.2 times for each unit. Left ventricular ejection fraction below 45%, TBW, body mass index and LDL level are good predictors of galectin-3 concentration in patients with ACS and decreased left ventricular ejection fraction. Atrial fibrillation could be a predictive marker of decreased left ventricular ejection fraction.
Zoran Jovanovic, Vesela Radonjic, Ratomir Jelic, Narcisa Petrovic-Subic, Ivan Soldatovic, Vera Terzic, Sladjan Stojilkovic and Dusan Djuric
Apart from providing knowledge on the beneficial effects of drugs, practical psychopharmacotherapy also includes drug profiles of adverse effects, especially when medical comorbidity is present. The mechanism of action of many psychotropic drugs, mainly antipsychotics and antidepressants, is associated with prolongation of the QT interval and the occurrence of arrhythmias, specifically Torsade de pointes (TdP), which can be lethal. The aim of this pilot study was to confirm the prevalence of prolonged QTc interval in a sample of psychiatric patients taking psychopharmacs.
The present study included 41 patients who were already on psychopharmacs. The average value of the QTc interval in the observed sample was 413.8±23.3 ms. The most frequent psychopharmacotherapy was the combination of typical and atypical antipsychotics (24.4%), followed by monotherapy with antipsychotics (22%) and combined antidepressant and atypical antipsychotic therapy (22%). The average value of the QTc interval for male patients was 412.1±25.2 ms, whereas for female patients, it was 416.6±20.4 ms. No difference between sexes was confirmed (p=0.555). The correlation between the QTc interval and age of patients was positive but not statistically significant (p=0.072). The highest average (419.3±31.6 ms) and highest maximum (479 ms) values of the QTc interval were noted for patients undergoing combined therapy of antidepressants and atypical antipsychotics. Prolonged values of the QTc interval were observed for seven males and one female, and no patients exhibited pathological values.
This study confirmed previous research that found that prolongation of the QTc interval exists in patients in sample groups who take psychopharm acs, but not up to critical values.
Zorica Savovic, Violeta Iric-Cupic and Goran Davidovic
References 1. Fernandez-Berges D, Bertomeu-Gonzalez V, Sanchez PL, Cruz-Fernandez JM, Arroyo R, Barriales Alvarez V, Carrasco Sanchez FJ, Dalli E, Castro Beiras A, Kaski JC. (2011). Clinical scores and patient risk stratification in non-ST elevation acute coronary syndrome. Int J Cardiol. 146: 219-224. 2. De Aralijo Goncalves P, Fereira J, Aguiar C, Seabra-Gomes R. (2005). TIMI, PURSUIT and GRACE risk scores: sustained prognostic value and interaction with revascularisation in NSTE-ACS. Eur Heart J. 26: 865
Francesco Piscioli, Teresa Pusiol and Luca Roncati
References 1. Cerroni L, Barnhill R, Elder D, Gottlieb G, Heenan P, Kutzner H, LeBoit PE, Mihm M Jr, Rosai J, Kerl H. Melanocytic tumors of uncertain malignant potential: Results of a tutorial held at the XXIX Symposium of the International Society of Dermatopathology in Graz, October 2008. Am J Surg Pathol. 2010;34:314-26. 2. Abraham RM, Karakousis G, Acs G, Ziober AF, Cerroni L, Mihm MC Jr, Elder DE, Xu X. Lymphatic invasion predicts aggressive behavior in melanocytic tumors of uncertain malignant potential (MELTUMP). Am J
Ivan Simic and Vladimir Zdravkovic
investigation in ST-elevation acute coronary syndromes: The RIFLE STE ACS Study. J Am Coll Cardiol 2012;60:2481-9. 4. Karrowni W, Vyas A, Giacomino B, et al. Radial versus femoral access site for primary percoutaneus coronary interventions in ST-segment elevation myocardiali infarction patients. JACC Cardiovasc Interv 2013;6:814-23. 5. Widimsky P, Holmes DR Jr. How to treat patients with ST-elevation myocardiolo infarction and multi-vessel disease? Euro Heart J 2011;32:396-403. 6. Cavender MA, Milford-Beland S, Roe MT, et al