Ultrasound evaluation of the fetal heart: Is it possible?

Ultrasound evaluation of the fetal heart can be performed. Knowledge of the embryology, anatomy, and function of the heart have led us to understand the pathophysiology of congenital heart disease. In this review we discuss the indications as well as some basic principles of fetal echocardiography.     

Galectins testing: New promises for the diagnosis and risk stratification of chronic diseases?

Galectins are carbohydrate binding proteins involved in several biological functions such as intracellular signaling, cell to cell interaction and exchanges between cells and the extracellular matrix. Galectins are therefore participating to the control of gene expression, the regulation of immune response and the control of cell growth and viability. Galectins have stimulated in one hand a great interest for their potent contribution to the physiopathology of several diseases and cancers and may represent in another hand relevant biomarkers to support the diagnosis and prognosis of several disorders.     

Limiting reductive stress for treating in-stent stenosis: the heart of the matter?

Restenosis after balloon angioplasty and stenting (BAS) remains an unsolved clinical dilemma for patients with coronary artery disease. A better understanding of the mechanisms that drive this phenomenon is likely to lead to more effective treatments. In this issue of the JCI, Ali et al. uncover a critical redox axis with the antioxidant enzyme glutathione peroxidase-1 (GPX1) at its hub and identify potential new therapeutic targets, such as ROS1 tyrosine kinase. This study represents a potential new approach to finding a treatment for BAS, with implications that may extend beyond BAS to other vasculopathies involving vascular remodeling.     

Triphasics: have they fulfilled their promise?

Triphasic oral contraceptives (OCs) were designed to use the least amount of drugs for the desired effect and to imitate the physiology of the menstrual cycle, resulting in good cycle control and minimal side effects. Yet, studies indicate that triphasic OCs cause only marginally better cycle control than monophasic OCs with reduced frequency of withdrawal bleeding. In fact, the triphasic OCs in Australia do not mimic the normal menstrual cycle. Theoretically, the lowered total steroid doses more gently inhibits the hypothalamic-pituitary function via the absence of a midcycle surge of estradiol and luteinizing hormone and the absence of a rise in luteal progesterone, allowing a more rapid return to functional fertility. 2 triphasic OCs contain the progestogen norethisterone, and the other one contains levonorgestrel. Triphasic OCs appear to have a somewhat lower effect on lipid and carbohydrate metabolism than do current monophasic OCs. Clinicians have not conducted longterm prospective studies on triphasic OCs, so no evidence exists to support the contention that they are less likely to have cardiovascular effects than monophasic OCs. Further, triphasic and monophasic OCs have basically the same effect on blood coagulation factors. OCs have basically the same effect on blood coagulation factors. Many large-scale clinical trials show that the pregnancy rate is around .06. The low dose of levonorgestrel in the beginning of the cycle may reduce effectiveness, however, if women make mistakes. Further, the more complicated packaging of triphasic OCs may make it easier for women to make a mistake. Triphasic OCs may reduce the severity of acne. Most women find triphasic OCs to be quite acceptable, but, in a small group of women, its phasic formulation causes some side effects, including premenstrual syndrome, breast tenderness, excessive bleeding, or painful menstruation.     

Functional MRI of the human amygdala?

In view of an increasing number of publications that deal with functional mapping of the human amygdala using blood oxygenation-level-dependent (BOLD) magnetic resonance imaging, we reevaluated the underlying image quality of T2*-weighted echoplanar imaging (EPI) and fast low angle shot (FLASH) sequences at 2.0-T with regard to susceptibility-induced signal losses and geometric distortions. Apart from the timing of the gradient echoes, the degree of susceptibility influences is controlled by the image voxel size. Whereas published amygdala studies report voxel sizes ranging from 22 to 125 microl, the present results suggest that reliable imaging of the amygdala with BOLD sensitivity requires voxel sizes of 4 to 8 microl or less. Preferentially, acquisitions should be performed with a coronal section orientation. Although high-resolution BOLD MRI is at the expense of temporal resolution and volume coverage, it seems to provide the only solution to this physical problem.     

Is advocacy at the heart of professional practice?

This article considers the meaning of advocacy and the various forms of advocacy in existence. The author discusses whether the nursing profession sees advocacy as being at the heart of professional practice. Some of the risks that may result from advocacy are also outlined.     

Is the right to information fulfilled in an emergency department? Patients' perceptions of the care provided

Rationale, aims and objective In an emergency department (ED), the effective exchange of information between patients and health care providers is recognized as being critically important to patient care. The aims of this study were to evaluate the extent to which the right to information is fulfilled in the ED, to ascertain the degree of patient satisfaction with the attention received and to evaluate the relation between satisfaction and the information received, waiting time and seriousness of the emergency. Methods This is a cross‐sectional survey that involved 300 patients who consulted an ED during a period of 3 months. The data were obtained by means of a self‐administered validated questionnaire: sociodemographic characteristics, variables related with the treatment received and overall satisfaction were obtained. Medical records were also analysed. Results The percentages of patients who received information about the reason for a complementary test, discomfort and complications were: 90.4%, 68.3% and 37%, respectively. In all, 98.3% claimed to have understood diagnosis, but when their written answers were analysed only 37.7% were exactly correlated. The percentages of patients who received information about posology, duration and side effects on medication were: 89.9%, 85.7% and 53%, respectively. Overall, 66% of the patients considered the attention they received as ‘good’ or ‘excellent’. There is a statistically significant relation between patient perceptions of received information and overall satisfaction of care and perceived waiting time. Conclusion Providing the patients with information in all phases of the care process, giving the opportunity to ask questions, resolving doubts and providing legible and easily understood discharge instructions all contribute to increasing patient satisfaction in ED.     

Tako-Tsubo syndrome: dying of a broken heart?

Aim  

The aim of the article is to review the etiology, pathology and epidemiology of a disease entity named Tako-Tsubo syndrome, receiving this name according to the picture obtained during ventriculography resembling a Japanese octopus trap. The Tako-Tsubo syndrome is a diagnosis encountered in patients with acute coronary syndrome and, therefore, is important to consider.