Detection of ventricular thrombosis in acute myocardial infarction: Value of indium-111 platelet scintigraphy in relation to two-dimensional echocardiography and clinical course

In order to detect left ventricular (LV) thrombosis, ¹¹¹In-platelet scintigraphy and two-dimensional echocardiography were performed in 40 patients 15 days±6 days after acute myocardial infarction. A dual isotope subtraction method, using ¹¹¹In-platelet scintigraphy and ^99mTc-blood pool scintigraphy, was used to assess LV platelet deposition expressed as LV counts per pixed. Seven patients (group A) had a positive ¹¹¹In-platelet scintigram and 33 patients (group B) had a negative ¹¹¹In-platelet scintigram (LV counts per pixel: 0.56±0.23 and 0.28±0.19, respectively, P<0.05). Three group A patients but no group B patients had a positive echocardiogram. Arterial embolism was noted in four patients, of whom two showed both positive echocardiogram and platelet scintigram. LV counts per pixel were 0.57±0.13 and 0.31±0.21, respectively (P<0.02) in patients with and without arterial embolism. Thus, both ¹¹¹In-platelet scintigraphy and two-dimensional echocardiography can detect LV thrombosis. ¹¹¹In-platelet scintigraphy may help to define patients at risk for embolization and may be used in conjunction with echocardiography to study the effect of antithrombotic therapy.     

Renal effects of cyclosporin A in children treated for idiopathic nephrotic syndrome

Little data have been published on tubular renal function during cyclosporin A treatment in children without transplants. We studied 12 young subjects (mean age 10 years) with steroid-responsive idiopathic nephrotic syndrome and with signs of steroid toxicity. After achieving remission with prednisone 60 mg/m², 8 children started cyclosporin A therapy (6 mg/kg/day) (group A) and 4 children were given cyclophosphamide 2.5 mg/kg/day (group B). The latter were considered as controls together with 10 other children with idiopathic nephrotic syndrome in complete remission and off therapy (group C). We monitored creatinine clearance and tubular handling of β₂-microglobulin, sodium, phosphorus and uric acid for one year. Cyclosporin A induced a decrease in creatinine clearance with a decrease in fractional excretion of β₂-microglobulin; sodium excretion was similar in the two treated groups and a transient decrease in fractional excretion of uric acid was seen only in patients receiving cyclosporin A. Both groups showed an increased renal threshold phosphate concentration. Our results suggest that in children, cyclosporin A therapy induces a decrease in glomerular filtration rate associated with increased reabsorption activity of proximal tubular cells.     

Work engagement in health professions education*

Work engagement deserves more attention in health professions education because of its positive relations with personal well-being and performance at work. For health professions education, these outcomes have been studied on various levels. Consider engaged clinical teachers, who are seen as better clinical teachers; consider engaged residents, who report committing fewer medical errors than less engaged peers. Many topics in health professions education can benefit from explicitly including work engagement as an intended outcome such as faculty development programs, feedback provision and teacher recognition. In addition, interventions aimed at strengthening resources could provide teachers with a solid foundation for well-being and performance in all their work roles. Work engagement is conceptually linked to burnout. An important model that underlies both burnout and work engagement literature is the job demands-resources (JD-R) model. This model can be used to describe relationships between work characteristics, personal characteristics and well-being and performance at work. We explain how using this model helps identifying aspects of teaching that foster well-being and how it paves the way for interventions which aim to increase teacher’s well-being and performance.     

Male andropause: A myth or reality

Male andropause, male climacteric or viropause is a condition in which men suffer from complex symptomatology due to low androgen level with aging. After the age of 40 years testosterone level starts declining and andropause corresponds to the age at which a pathogenic threshold is reached. This review summarizes the etiology, consequences, screening, diagnosis, monitoring of androgen deficiency in aging male (ADAM). The pros and cons of testosterone replacement therapy (TRT) in elderly male have been discussed. Currently oral, transdermal, transbuccal, intramuscular, and subcutaneous implants are available for clinical use. The choice is made by physicians based on therapeutic indication and patient preferences.