Ischaemic cardiogenic shock

Ischaemia is the most common underlying cause of cardiogenic shock. Cardiogenic shock occurs in up to 10% of patients presenting with acute myocardial infarction and is the leading cause of death. Myocardial ischaemia results in both systolic and diastolic dysfunction and triggers a maladaptive feedback loop that can ultimately result in tissue hypoxia, multi-organ dysfunction and death. Myocardial dysfunction can be complicated by a systemic inflammatory response syndrome (SIRS) as a result of systemic hypoxia. Echocardiography is key to diagnosis and to exclude conditions requiring urgent surgical intervention. Serial assessment can be used to monitor response to interventions and/or complications. Resuscitative aims are immediate cardiorespiratory stabilization to facilitate urgent revascularization. Both pharmacological and mechanical supportive techniques are used. Mortality rates for patients who develop ischaemic cardiogenic shock remain high, and further research into strategies to prevent and treat the condition is required.     

(iv) The initial assessment and early management of patients with severe pelvic ring injuries

Pelvic fractures account for up to 8% of all musculoskeletal injuries and 90% of patients with pelvic fractures will have other injuries. Major haemorrhage is well recognized in severe pelvic fractures and is one of the leading causes of death in this patient group. The reported mortality rate in patients with pelvic fracture presenting with haemorrhagic shock ranges from 36.4 to 54%. 5% of all pelvic fractures are open fractures and although the mortality in this particular group has recently improved, it still remains high.The reconfiguring of major trauma to establish major trauma centres in the UK has seen a 20% increase in patients surviving major trauma. Pelvic binders are the first line management to stabilize the pelvis for any patient presenting with hypotension and a suspicion of pelvic ring injury. Damage control resuscitation including permissive hypotension, haemostatic resuscitation and damage control surgery are strategies used to prevent hypothermia, coagulopathy and acidosis.Rapid and accurate assessment of the pelvic injury is essential and guides further management. Patients that fail to respond to initial aggressive resuscitation should undergo arterial embolization. Pelvic packing should be considered if embolization is not available, or in the rare situation of combined substantial abdominal and pelvic bleeding requiring immediate laparotomy. Patients with an open pelvic fracture require a multidisciplinary team approach to improve outcome.Future advances in haemorrhage control and resuscitation with techniques such as resuscitative endovascular balloon occlusion of the aorta (REBOA) and new classes of haemostatic adjuncts will further improve survival in these severely injured patients.     

Nutrition and oxidative stress: a systematic review of human studies

Oxidative stress (OS) – defined as the imbalance between free radical production and antioxidant defences – is a condition associated with chronic-degenerative disease, such as cancer, metabolic and disease cardiovascular diseases (CVDs). Several studies have shown that diet and some of its components could influence the intensity of OS damage. The aim of this review was to critically examine some pieces of evidence from observational and intervention study in human beings to assess whether diet and its components can really modify OS in vivo. Furthermore, we tried to find out the possible mechanism behind this association. We considered all studies in MEDLINE which fitted with the following criteria: (1) adult subjects who were healthy or affected by metabolic disease and CVDs; (2) no food supplements, pillows, powder but only common foods and beverages and (3) OS assessment with well-known and validated in vivo biomarkers.     

Lumiracoxib,a highly selective COX-2 inhibitor

Lumiracoxib (Prexige^®, Novartis AG) is a highly selective inhibitor of cyclooxygenase-2 that has been approved in 22 countries including the UK for analgesic therapy in chronic and acute pain. For patients with osteoarthritis, the recommended initial dose is 100 or 200 mg once daily, in one or two divided doses. In patients with primary dysmenorrhea, or following dental or orthopedic surgery with moderate-to-severe acute pain, the recommended dose is 400 mg once daily. The Therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET) tested the efficacy and gastrointestinal safety of the drug against two traditional nonselective nonsteroidal anti-inflammatory drugs, naproxen and ibuprofen. The results from this trial demonstrated that lumiracoxib reduces gastrointestinal ulcer complication rates by 66% overall and 79% among nonaspirin users in a population without gastroprotection. Lumiracoxib was not associated with a statistically significant difference in cardiovascular morbidity and mortality compared with nonselective nonsteroidal anti-inflammatory drugs. However, in view of the ongoing debate about the safety of cyclooxygenase-2 inhibitors, the use of this drug class should be limited to patients with increased risk of gastrointestinal complications until results of randomized trials in cardiovascular high-risk populations are published.     

Catalase has a key role in protecting cells from the genotoxic effects of monomethylarsonous acid: A highly active metabolite of arsenic

Although it is widely known that arsenic‐contaminated drinking water causes many diseases, arsenic's exact mode of action (MOA) is not fully understood. Induction of oxidative stress has been proposed as an important key event in the toxic MOA of arsenic. The authors' studies are centered on identifying a reactive species involved in the genotoxicity of arsenic using a catalase (CAT) knockout mouse model that is impaired in its ability to breakdown hydrogen peroxide (H₂O₂). The authors assessed the induction of DNA damage using the Comet assay following exposure of mouse Cat^+/+ and Cat^?/? primary splenic lymphocytes to monomethylarsonous acid (MMA^III) to identify the potential role of H₂O₂ in mediating cellular effects of this metalloid. The results showed that the Cat^?/? lymphocytes are more susceptible to MMA^III than the Cat^+/+ lymphocytes by a small (1.5‐fold) but statistically significant difference. CAT activity assays demonstrated that liver tissue has approximately three times more CAT activity than lymphocytes. Therefore, Comet assays were performed on primary Cat^+/+, Cat^+/?, and Cat^?/? hepatocytes to determine if the Cat^?/? cells were more susceptible to MMA^III than lymphocytes. The results showed that the Cat^?/? hepatocytes exhibit higher levels of DNA strand breakage than the Cat^+/+ (approximately fivefold) and Cat^+/? (approximately twofold) hepatocytes exposed to MMA^III. Electron spin resonance using 5,5‐dimethyl‐1‐pyrroline‐N‐oxide as the spin‐trap agent detected the generation of ·OH via MMA^III when H₂O₂ was present. These experiments suggest that CAT is involved in protecting cells against the genotoxic effects of the ·OH generated by MMA^III. Environ. Mol. Mutagen. 54:317–326, 2013. © 2013 Wiley Periodicals, Inc.     

Cardiac Autonomic Function and Global Left Ventricular Performance in Autoimmune Eauthyroid Chronic Thyroiditis: Is Treatment Necessary at the Euthyroid Stage?

Objective: Autoimmune chronic thyroiditis (ACT) is characterized by lymphocyte infiltration in the thyroid gland and the presence of antithyroid antibodies in serum. Medical treatment does not affect antibody levels and treatment decision is not definite yet for the euthyroid patients. We aimed to evaluate cardiac autonomic function and global left ventricular performance in autoimmune euthyroid chronic thyroiditis and determine the need for medical treatment. Method: We studied 30 ACT patients and 25 healthy control subjects. Cardiac autonomic function is evaluated by heart rate recovery (HRR). Global left ventricular performance is evaluated by two‐dimensional echocardiography and pulsed‐wave tissue Doppler echocardiography. Results: There was no difference between patients and controls with respect to clinical and biochemical parameters except hemoglobin (13.67 ± 1.25 g/dL, 14.51 ± 1.35 g/dL, p:0.047) and low density lipoprotein (120.71 ± 24.91 mg/dL, 100.55 ± 14.73 mg/dL, p: 0.003). Tei index was significantly higher in ACT group (0.521 ± 0.074, 0.434 ± 0.034, P < 0.0001). E′/A′ was found to be significantly lower (1.234 ± 0.42, 1.750 ± 0.291, P < 0.0001) and E/E′ was found to be higher than the controls (8.482 ± 0.449, 6.039 ± 0.209, P < 0.0001). HRR was significantly lower than the controls (20 ± 4 BPM, 30 ± 8 BPM, P < 0.0001). Conclusion: Although left ventricular performance is found to be normal by conventional echocardiographic methods, it is found to be impaired when Tei index and tissue Doppler parameters are used. Cardiac autonomic function is also impaired in ACT patients. As a result of these cardiac changes, medical treatment may be considered earlier, even at the euthyroid stage. (Echocardiography 2011;28:15‐21)     

The link between radiofrequencies emitted from wireless technologies and oxidative stress

Wireless communication such as cellular telephones and other types of handheld phones working with frequencies of 900 MHz, 1800 MHz, 2100 MHz, 2450 MHz have been increasing rapidly. Therefore, public opinion concern about the potential human health hazards of short and long-term effect of exposure to radiofrequency (RF) radiation. Oxidative stress is a biochemical condition, which is defined by the imbalance between reactive oxygen species (ROS) and the anti-oxidative defense. In this review, we evaluated available in vitro and in vivo studies carried out on the relation between RF emitted from mobile phones and oxidative stress. The results of the studies we reviewed here indicated that mobile phones and similar equipment or radars can be thought as a factor, which cause oxidative stress. Even some of them claimed that oxidative stress originated from radiofrequencies can be resulted with DNA damage. For this reason one of the points to think on is relation between mobile phones and oxidative stress. However, more performance is necessary especially on human exposure studies.