Correlation between myocardial enzyme serum levels and markers of inflammation with severity of coronary artery disease and Gensini score: A hospital-based,prospective study in Greek patients

Background

Our objective was to associate serum levels of myocardial enzymes and inflammatory biomarkers with severity of coronary artery disease (CAD).

Patients and methods

123 patients participated in our study, including 65 cases of acute myocardial infarction (MI), 27 cases of newly diagnosed CAD – without MI – and 31 controls. In all subjects, myocardial serum enzyme levels (creatine phosphokinase, aspartate aminotransferase, lactate dehydrogenase) and inflammatory indices (C-reactive protein, fibrinogen, white blood cells, and erythrocyte sedimentation rate) were measured. Patients were all submitted to coronary angiography and CAD severity was evaluated by Gensini score.

Results

Significant differences concerning enzyme serum levels and inflammatory indices were found to exist between the three study groups, being highest among patients with acute MI (p < 0.001). A significant association was demonstrated between Gensini score and serum enzyme levels as well as inflammatory biomarkers.

Conclusions

Our findings suggest that serum levels of myocardial enzymes and inflammatory indices correlate with CAD severity in Greek patients.     

Double versus single cervical cerclage for the prevention of preterm births

Objective: To evaluate the effectiveness double cervical cerclage in reducing antenatal complications and improve perinatal outcomes.

Methods: We searched Medline, Scopus, Clinicaltrials.org, The Cochrane Central Register of Controlled Trials and Google Scholar search engines.

Results: Six studies were included that involved 880 women. Double cerclage was significantly superior to single cerclage in reducing preterm births <34?weeks (734 cases, OR 0.59, 95% CI 0.40, 0.86) and preterm births <28?weeks (645 cases, OR 0.43, 95% CI 0.26–0.73). It also significantly increased the gestational age (380 cases, MD 2.63, 95% CI 0.87, 4.39). However, as a technique, it failed to improve the rates of preterm births <37?weeks (740 cases, OR 0.98, 95% CI 0.72, 1.34) the incidence of chorioamnionitis (740 cases, OR 0.83, 95% CI 0.51, 1.36) and the occurrence of preterm premature rupture of the membranes (796 cases, OR 1.32, 95% CI 0.95, 1.82).

Conclusions: It seems that double cerclage effectively increases the gestational age at delivery and decreases the rates of extremely premature births. However, as a procedure, it does not reduce the incidence of antenatal morbidity or the neonatal death rates. Further research is needed in the field as our meta-analysis is limited by the small number of enrolled studies.     

Burnout Evaluation and Potential Predictors in a Greek Cohort of Mental Health Nurses

Background

Job burnout is one of the most serious occupational health hazards, especially, among mental health nurses. It has been attributed among others to staff shortages, health service changes, poor morale and insufficient employee participation in decision-making.

Diabetic nephropathy and antihypertensive treatment: what are the lessons from clinical trials?

Diabetic nephropathy is the most serious problem among current issues in nephrology, as 40% of the cases of end-stage renal disease are due to this entity. The close relationship between type 2 diabetes and hypertension makes the problem even more severe. The knowledge of the intrarenal effects of angiotensin II and the greater effect of angiotensin converting enzyme inhibitors (ACEI) on reducing albuminuria suggested in the past a trend toward preferable use of these drugs in diabetic nephropathy. The first relevant clinical trials yielded rather poor conclusions because of lack of blind randomization and short duration. Subsequent double-blind studies with adequate numbers of patients and sufficient duration underlined the importance of blood pressure (BP) control as well as the rather poor response of diabetic nephropathy to any treatment. In most of these studies, the changes in albuminuria or microalbuminuria were a substitute end point for the renal function. Three clinical trials using angiotensin II receptor blockers (ARB), planned specifically to monitor the progression of renal damage, have been recently published. They showed better renal protection by ARB, as compared with placebo or calcium channel blockers (CCB), beyond or independently of the BP reduction. Nevertheless, these recent trials, like the previous ones with similar results, invariably demonstrate slightly better control of BP in the groups of the active drug. Another issue is that the vast majority of the patients need so many nonstudy drugs to keep their pressure under control, that the isolation of advantageous effects of certain drugs seems unrealistic.     

Serotonergic modulation of suicidal behaviour: integrating preclinical data with clinical practice and psychotherapy

Many studies have provided important information regarding the anatomy, development and functional organization of the 5-HT system and the alterations in this system that are present within the brain of the suicidal patient. There is also a growing interest in genetic factors associated with suicide, since these may lead to the emergence of personality traits that prove to be long-term predictors of suicidal behaviour. This review will focus on presenting the scientific literature on the role of the serotonergic system in suicidal behaviour as well as dysfunctional attitudes and personality traits associated with the suicidal patient. The association of the serotonin transporter gene, the 5-HT2 receptors and its metabolite 5-hydroxyindoleacetic acid with suicidal behaviour and animal models that may capture the complexity of suicidal behaviour will be discussed. Finally, the relationship between neurobiological models and psychotherapeutic interventions for suicide prevention will be considered with a focus on Schema Therapy (an approach that has shown particular promise in the treatment of suicidal individuals with personality disorders), aiming to invite the reader to integrate some aspects of the neurobiology of human suicidal behaviour into a model of suicide that can be used in a clinical encounter.     

Systems biology in systemic lupus erythematosus: Integrating genes,biology and immune function

Overactive B cells, abnormally activated T cells and inappropriate handling of cellular debris by the innate immune system are central in the pathogenesis of systemic lupus erythematosus (SLE). Genetic studies in SLE patients have unraveled allelic variations in genes encoding key molecules that control inter- and intra-cellular signaling and play a role in the abnormal handling of apoptotic material. Despite recent breakthroughs though, it is still unclear how exactly genes and environment interact to produce the characteristic immune dysregulation in SLE.     

Internet Gaming Disorder: Compensating as a Draenei in World of Warcraft

The diagnosis of Gaming Disorder (GD) has been recently proposed in the beta draft of the 11th revision of the International Classification of Diseases (ICD-11) by the World Health Organization (WHO). This follows the inclusion of Internet Gaming Disorder (IGD), as a condition requiring additional research in the Diagnostic Statistical Manual for Mental Disorders (DSM-5), issued by the American Psychiatric Association (APA). Further research has been recommended to enhance understanding of excessive gaming, especially in the context of user-avatar (in-game figure representing the gamer) relationships. The association between selecting the Draenei race, compensation of real-life deficits through gaming, and the gamer’s gender were investigated as IGD risk factors among players of the online game, World of Warcraft (WoW). A normative online sample of WoW gamers (N = 404 M_age = 25.56; 13–75; males = 299; 74%) completed the Internet Gaming Disorder Scale–Short-Form (IGDS9-SF) and the compensation subscale of the User-Avatar Questionnaire. Regression, mediation, and moderated mediation analyses were conducted. Overall, players with higher levels of compensation exhibited greater levels of IGD symptoms. Interestingly, choosing the Draenei race was associated with increased compensatory behavior, which in turn linked to higher IGD risk. These associations were mildly stronger among females. Findings suggest that virtual demographics, such as the Draenei race, and their interplay with compensatory behaviors should be carefully considered when creating prevention and intervention policies targeting excessive gaming, especially when it involves the use of avatars.

     

Future Interventional Radiologists and Where to Find Them–Insights from Five UK Interventional Radiology Symposia for Junior Doctors and Medical Students

CardioVascular and Interventional Radiology - The interventional radiology (IR) trainee recruitment in the UK is lagging behind the pace of service expansion and is potentially hindered by...     

Antimicrobial and physicochemical characterization of endodontic sealers after exposure to chlorhexidine digluconate

ObjectivesAssess the antibacterial, physical and chemical properties of AH Plus, BioRoot RCS and Pulp Canal Sealer (PCS) in contact with 2% chlorhexidine digluconate (CHX) used as final irrigant prior to root canal obturation.MethodsThe antimicrobial properties were investigated by direct contact tests for planktonic and biofilm growth of E. faecalis, S. mutans, S.epidermidis and S.aureus in vitro. The setting time, wettability, microhardness and surface roughness were also assessed. The sealers were studied in no contact, 1-minute (short-term) and continuous contact (long-term) with CHX. Chemical characterization of sealers was performed by scanning electron microscopy, X-ray diffraction analysis and Fourier-transform infrared spectroscopy after CHX or saline used as the last irrigant in an ex vivo tooth model and in endo training blocks.ResultsCHX increased the antibacterial activity of all the sealers investigated against planktonic bacteria and biofilms with PCS exerting the highest antimicrobial activity with and without the presence of CHX. The setting of AH Plus and BioRoot RCS was retarded, while for PCS accelerated in the presence of CHX. AH Plus and PCS were more hydrophilic after contact with CHX, whilst BioRoot RCS was hydrophobic in a time-dependent manner. The microhardness of sealers was compromised and the surface roughness increased after CHX exposure for AH Plus and BioRoot RCS, and decreased for PCS. CHX did not affect the sealers’ chemistry, but PCS that exhibited two extra phases.SignificanceCHX improved the antibacterial efficacy of endodontic sealers but further evidence is needed to confirm its suitability as a final irrigant prior to root canal obturation.