Adverse Cardiovascular Effects from the Use of Anabolic-Androgenic Steroids as Ergogenic Resources

This review evaluates the documented cardiovascular functioning among anabolic-androgenic steroid (AAS) users. AAS users manifest a reduction in HDL cholesterol, increased inflammatory markers, and oxidative stress. Strong evidence associating AAS use with blood pressure at hypertensive levels, as well as hypertrophy and cardiac dysfunction has also been reported. Both epidemiological and autopsy studies attest the relationship between AAS use and early mortality. The review's limitations are noted.     

基于乌斯坦因模式的心肺复苏研究报告

目的 心肺复苏Utstein评价模式已被许多国家广泛用于心肺复苏评价研究.本文以心肺复苏结果Utstein评价模式设计心肺复苏注册登记表,以评价中国海南海南省人民医院心搏骤停患者流行病学特征、心肺复苏效果与影响因素.方法 应用心肺复苏Utstein模式注册登记表,对海南省人民医院急诊科511例心肺复苏患者进行前瞻性观察研究,评价本组患者心搏骤停流行病学特征及心肺复苏结果.结果 注册登记的511例心肺复苏患者纳入研究.本研究患者以40 ～ 70岁等年龄段心搏骤停发生率较高.既往史中,心血管系统疾病(190例,37.2％)、脑血管疾病(48例,9.4％)及呼吸系统疾病(39例,7.6％)等慢性疾病较为常见.173例(33.9％)为心源性心搏骤停,其中109例(21.3％)为急性心肌梗死.80例(15.7％)患者首次监测心律为心室纤颤.院内心搏骤停患者自主循环恢复率及成活出院率分别为47.0％和13.5％,院外心搏骤停患者为16.7％和4.7％.结论 本研究表明心血管系统疾病、脑血管疾病及呼吸系统疾病为最常见慢性疾病.急性心肌梗死、中风及创伤为最常见心搏骤停病因.院内心搏骤停组自主循环恢复率及成活出院率均高于院外心搏骤停组,两组差异具有统计学意义.     

Role of omega-3 ethyl ester concentrate in reducing sudden cardiac death following myocardial infarction and in management of hypertriglyceridemia: An Indian consensus statement

IntroductionSudden cardiac death (SCD) is the most lethal manifestation of heart disease. In an Indian study the SCDs contribute about 10% of the total mortality and SCD post ST elevation myocardial infarction (MI) constitutes for about half of total deaths.ObjectiveGiven the limitations of existing therapy there is a need for an effective, easy to use, broadly applicable and affordable intervention to prevent SCD post MI. Leading cardiologists from all over India came together to discuss the potential role of n-3 acid ethyl esters (90%) of eicosapentaenoic acid (EPA) 460 mg & docosahexaenoic acid (DHA) 380 mg in the management of post MI patients and those with hypertriglyceridemia.RecommendationsHighly purified & concentrated omega-3 ethyl esters (90%) of EPA (460 mg) & DHA (380 mg) has clinically proven benefits in improving post MI outcomes (significant 15% risk reduction for all-cause mortality, 20% risk reduction for CVD and 45% risk reduction in SCD in GISSI-Prevenzione trial) and in reducing hypertriglyceridemia, and hence, represent an interesting option adding to the treatment armamentarium in the secondary prevention after MI based on its anti-arrhythmogenic effects and also in reducing hypertriglyceridemia.     

Current management of isolated sternal fractures in the UK: Time for evidence based practice? A cross-sectional survey and review of literature

Routine admission of patients with isolated sternal fractures for observation is still widespread in the UK. However, the evidence appears to suggest that this is unnecessary. We undertook a cross-sectional telephone survey of management of isolated sternal fractures in the UK. We contacted 85 acute admitting units over a three-month period and were able to get a response from 67 units. Most of the hospitals were district general hospitals (52) and situated in England (49). The orthopaedic department was the most common admitting department. 51 units indicated that they regularly admit isolated sternal fractures for observation. Other indications for admission included pain control (33), abnormal cardiac enzymes (28), social circumstances (23), abnormal electrocardiogram (6), and low oxygen saturation (5). Chest X-ray was performed on admission in all hospitals. 57 hospitals performed ECG and cardiac enzyme tests prior to admission and 6 hospitals carried out echocardiogram following admission on a regular basis. Patients were not followed up on discharge. 2 hospitals with on-site cardiothoracic unit followed-up patients on discharge, and 1 hospital advised GP follow-up. A review of the literature indicated that patients with isolated sternal fractures are at low risk of significant cardiac, pulmonary or mediastinal complications and do not need extensive investigations or routine admission. The current practice of management of isolated sternal fractures in the UK does not appear to conform to available evidence. In order to decide on management plans based on more rigorous evidence, there is a need for a prospective double blind randomised study of patients with isolated sternal fractures, comparing those discharged to those admitted over a longer follow-up period.     

Cardiovascular safety of low-dose fenfluramine in Dravet syndrome: a review of its benefit-risk profile in a new patient population

Objective: Dravet syndrome (DS) is a rare, treatment-resistant epilepsy syndrome for which current treatment regimens are often ineffective. Fenfluramine is currently in development for treatment of DS, based on reports in the 1980s and 1990s of its anti-epileptic activity in pediatric patients with intractable epilepsy. However, fenfluramine was withdrawn from global markets in 1997 following reports of its association with pulmonary hypertension and heart valve disease in adult patients treated for obesity. This review was conducted to assess cardiac safety of fenfluramine when used at lower doses for treatment of DS.

Methods: Pubmed was searched for clinical studies of fenfluramine in obese adults who reported incidence of heart valve disease. These data were reviewed against published results from Belgian patients with DS who have been treated with low-dose fenfluramine for up to 28 years.

Results: Nine controlled studies of fenfluramine and related compounds (dexfenfluramine and/or phentermine) which assessed incidence and severity of cardiac valve disease in 3,268 treated patients and 2,017 control subjects have been reported. Mild or greater aortic valve regurgitation was found in 9.6% of treated patients compared with 3.9% of control subjects, and moderate or greater mitral valve regurgitation was found in 3.1% of treated patients and 2.5% of control subjects. Nineteen DS patients have been treated for up to 28 years with 10–20?mg/day fenfluramine, with no clinical signs or symptoms of cardiac valve disease or pulmonary hypertension. Slight and clinically unimportant changes in valve structure have been seen on echocardiography in five patients at some time during the observation period.

Conclusions: A different benefit-risk relationship appears to be emerging when fenfluramine is used at low doses for extended periods in young patients with DS. Continued cardiac assessments during ongoing Phase 3 clinical trials will provide additional safety information for this potential new and effective treatment.     

影响创伤骨科患者术后疼痛的相关因素研究

目的探讨创伤骨科患者术后疼痛的影响因素。方法回顾性分析2011年9月—2015年9月武汉市东西湖区人民医院收治的224例创伤骨科患者行外科手术治疗的临床资料,根据患者术后主诉情况分为疼痛组(n=89)与非疼痛组(n=135)。采用多元Logistic回归模式对创伤骨科患者术后疼痛的相关影响因素进行观察、分析。结果疼痛组患者平均年龄较低、女性、性格外向、高学历、心理状态不佳、体位不当,治疗过程中牵引、外固定等,医护人员对疼痛评估知识缺乏比例均显著高于非疼痛组(P0.05),但两组患者骨折部位及骨折原因方面的差异均无统计学意义(P0.05);经多元Logistic回归模型分析,最终得出影响创伤骨科患者术后疼痛相关因素包括:年龄、性别、性格、文化程度、心理状态、体位、治疗中的因素以及医护人员自身因素(P0.05)。结论影响创伤骨科患者术后疼痛相关因素较多,应注意对这些因素的密切观察,并采取相关处理措施,以改善患预后状况。