Algorithm for diagnosing stable coronary artery disease

The aim of the study was to develop simple algorithm for non-invasive estimating probability of the presence of CAD to optimize indications for cardiac catheterization. A prospective collection of clinical, electrocardiography (ECG), exercise electrocardiography (EE), dobutamine stress echocardiography (SE) and catheterization data was performed. All patients (n = 551, 65% male) complaining of chest pain, without prior history of myocardial infarction undergone EE (regarded as positive on the basis of > or = 1 mm ST-depression) SE (ischemia was defined as new or worsening wall motion abnormalities using a 16-segment model) and coronary angiography (CA): CAD was defined as > or = 50% narrowing of at least one major vessel. Two algorithms were developed with the use of probability analysis by computer program which employs Bayes' theory. They incorporated pretest variables: (age, gender, chest pain classification according to Diamond), ECG and results of one or two non-invasive test: EE and (or) SE. The studied population was divided into 3 groups on the basis of pretest likelihood of CAD: 1. low (< 10%), 2. intermediate (10-70%, in man divided into intermediate--low.: 10-29% and intermediate--high: 30-70%) and 3. high (> 70%). RESULTS: The prevalence of CAD in studied population was 61%. The sensitivity of the algorithm is 96% and specificity was 44%. Sensitivity and specificity of EE and SE was respectively: 93%, 21% and 85%, 69%). CONCLUSIONS: 1. An algorithm derived in our study is simple and may be useful in decision making that relates to CA. 2. We showed that when the likelihood of CAD is high on the basis of initial evaluation, diagnostic non-invasive testing is not indicated before CA, when the probability is intermediate or low, implementation of first choice test should be different in women (SE) and men (EE).     

Platelets in idiopathic thrombocytopenic purpura are increased in size but are of normal density

To determine whether platelet size and volume are related to one another or to platelet age, subpopulations of platelets from patients with idiopathic thrombocytopenic purpura (ITP) have been produced on the basis of density using Percoll gradients. The density distribution of platelets from patients with ITP and from patients with other forms of thrombocytopenia (thought to be nonimmune in nature) was the same as in normal controls. However, the platelets in each density subpopulation from ITP patients were increased in size. beta-thromboglobulin (beta TG) content of platelets from each patient group and the normals increased with density and tended to be higher in ITP than in normal controls. beta TG concentration per unit platelet volume and its level in plasma were similar in ITP patients and in normal controls. This suggests that the apparently normal density of ITP platelets was not a result of degranulation of large, dense platelets. Thus platelet size and density are independently determined and the increased size of platelets in immune thrombocytopenia may be the result of abnormalities in their production.     

Laughter as a social rejection cue: Gelotophobia and transient cardiac responses to other persons' laughter and insult

Other persons' laughter, normally perceived as a signal that persons are friendly and inviting others to approach, can also be perceived as a cue of social rejection. In this study, prerecorded laughter was placed in a realistic and personally relevant context, and participants' responses were related to gelotophobia, a trait predisposing to perceiving laughter as a cue of social rejection. Individuals with gelotophobia showed marked heart rate deceleration in response to the laughter stimulus, possibly indicating a “freezing‐like” response. Moreover, cardiac responses to anger provocation by overtly insulting statements indicated heightened aggressive anger in response to cumulated social threat. The study adds to recent research showing specific cardiac responses to social rejection and to the literature on social rejection sensitivity by demonstrating the value of using well interpretable physiological measures in this research context.     

Ulcerated plaques of the aorta as a cause of ischaemic stroke

Stroke is a second cause of mortality worldwide and a leading cause of acquired disability in adults. Approximately 20% of all ischaemic strokes are of cardioembolic origin. We present a case of a 60-year-old man with a history of stroke without changes in carotid and vertebral arteries. Echocardiography exam revealed patent foramen ovale (PFO) and abnormal echos in the aorta that were verified as advanced complex atheromas by computed tomography. Due to small size PFO was deemed insignificant and the source of embolism were most probably aortic atheromas. Patient was put on acenocumarol, aspirin and statin.     

Insecticide-Treated Plastic Sheeting for Emergency Malaria Prevention and Shelter among Displaced Populations: An Observational Cohort Study in a Refugee Setting in Sierra Leone

Abstract. A double-blind phase III malaria prevention trial was conducted in two refugee camps using pre-manufactured insecticide-treated plastic sheeting (ITPS) or untreated polyethylene sheeting (UPS) randomly deployed to defined sectors of each camp. In Largo camp the ITPS or UPS was attached to inner walls and ceilings of shelters, whereas in Tobanda the ITPS or UPS was used to line only the ceiling and roof. In Largo the Plasmodium falciparum incidence rate in children up to 3 years of age who were cleared of parasites and monitored for 8 months was 163/100 person-years under UPS and 63 under ITPS (adjusted odds ratio [AOR] = 0.40, 95% confidence interval [CI] = 0.33-0.47). In Tobanda incidence was 157/100 person-years under UPS and 134 under ITPS (AOR = 0.85, 95% CI = 0.75-0.95). Protective efficacy was 61% under fully lined ITPS and 15% under roof lined ITPS. Anemia rates improved under ITPS in both camps. This novel tool proved to be a convenient, safe, and long-lasting method of malaria control when used as a full shelter lining in an emergency setting.     

A Sensitive Microtitre Plate Enzyme Immunoassay of Oestradiol-17β in the Cow and Mare

Abstract

Microtitre plates were coated with antiserum against oest-radiol-17β-6-(0-carboxymethyl)-oxime bovine serum albumin raised in sheep. The plasma samples (0.2–1.0 ml) were extracted with peroxide-free dlethyl ether prepared daily by treatment with Al₂O₃. The enzyme conjugate was prepared by coupling oestradiol-17β-6-(0-carboxymethyl)-oxime to horse-radish peroxidase. The conjugate was chromatographed on a Sephadex G-25 column. The standard curve ranged from 0.37 to 18.40 fmol/well of oestradiol-17β. The amount of oestradiol-17β causing a 50% reduction of maximum binding was 4.4 fmol/well.

Standards and samples were Incubated overnight at 4°C. The conjugate solution was added followed by further incubation for 2 h at 4°C. Tetramethylbenzidine was used as a chromogen, and the optical density was measured at 450 nm. The patterns of oestradiol-17β during a normal oestrus cycle in the cow and mare are presented.