ESTRÉS ANTE ENFERMEDADES TRANSMISIBLES EN ESTUDIANTES DE PSICOLOGÍA DE UNA UNIVERSIDAD PÚBLICA DE ICA

The aim of this research was to know the stress levels for communicable diseases in university students of the psychology career of a public university in the Ica region. Thesample consisted of 84 participants between men and women between 18 and 60 years old. This study is of a non-experimental type and a comparative descriptive design. Thedata collection instrument used was the Stress Scale for Communicable Diseases prepared by Anicama et al. The results showed that 77.4% present average and high levels ofgeneral stress and 78.6% present average and high levels before the dimension of stress before communicable diseases. Likewise, it was found that there are no significantdifferences according to sex and age; however, statistically significant differences were found according to the contagion condition of a close relative

How do cardiologists select patients for dual antiplatelet therapy continuation beyond 1 year after a myocardial infarction? Insights from the EYESHOT Post-MI Study

Background: Current guidelines suggest to consider dual antiplatelet therapy (DAPT) continuation for longer than 12 months in selected patients with myocardial infarction (MI). Hypothesis: We sought to assess the criteria used by cardiologists in daily practice to select patients with a history of MI eligible for DAPT continuation beyond 1 year. Methods: We analyzed data from the EYESHOT Post-MI, a prospective, observational, nationwide study aimed to evaluate the management of patients presenting to cardiologists 1 to 3 years from the last MI event. Results: Out of the 1633 post-MI patients enrolled in the study between March and December 2017, 557 (34.1%) were on DAPT at the time of enrolment, and 450 (27.6%) were prescribed DAPT after cardiologist assessment. At multivariate analyses, a percutaneous coronary intervention (PCI) with multiple stents and the presence of peripheral artery disease (PAD) resulted as independent predictors of DAPT continuation, while atrial fibrillation was the only independent predictor of DAPT interruption for patients both at the second and the third year from MI at enrolment and the time of discharge/end of the visit. Conclusions: Risk scores recommended by current guidelines for guiding decisions on DAPT duration are underused and misused in clinical practice. A PCI with multiple stents and a history of PAD resulted as the clinical variables more frequently associated with DAPT continuation beyond 1 year from the index MI

Ventricular fibrillation after omeprazole treatment: a case control

Hydrogen-potassium adenosine triphosphatase (H+/K+-ATPase)-target of omeprazole family members- present in gastric parietal cells, plays an essential role in the formation of HCl. It belongs to a family of P-type cation-transporting ATPases also including Ca2+-ATPase and Na+/K+ -ATPase. A 54 years old woman with a mildly degree hypertension (not pharmacologically treated), familiarity for CAD (father deceased after an AMI at the age of 60) and Helicobacter pylori positive gastritis, previously treated with antibiotics and antacid drugs, had being suffering for about two weeks for a gastric pyrosis recurrence. She started oral therapy with omeprazole 20 mg/die, but, still symptomatic, she was treated i.v. with ranitidine and spasmolytics. However, 8 days later, aspecific thoracic pain sensitive to deep inspiration, movements and digital pressure occurred. The ECG didn\u2019t show any sign of acute ischemia and necrosis enzymes were normal. Furthermore, she was treated i.v. with 30 mg ketorolac, and 30 minutes later with 40 mg omeprazole. After few minutes, the patient had ventricular fibrillation, interrupted with a single 200 J DC-shock, and treated with magnesium sulphate in repolarizing solution i.v. The patient maintained always stable sinus rhythm: no further arrhythmias were recorded during her hospitalization and she kept asymptomatic. There were no signs of ischemia at ECG; all ematochemical parameters (CK, CK-MB, LDH, myoglobin and TnI), serum electrolytes, D-dimer and protein C reactive were always normal. In addition to routine laboratory tests, a peripheral blood sample for genetic analysis was taken with patient informed consent. To assess if clinical drugs-related side effects could be ascribe to genetic CYP-dependent drug metabolizing polymorphisms, DNA sample was analyzed. PCR-RFLP and sequencing of mutated CYP2C19 (variants: *2 and *3) and 3A4 (*1B, *2 and *3) alleles isoforms were performed. The homozygous mutations of both CYP isoforms recorded can be responsible of the abnormal omeprazole level and the consequent toxicity. In other words, high plasmatic level of this drug, not adequately metabolized, could target other receptors structurally similar the ones present in the stomach. So due the individual metabolic fingerprint when more than one principal metabolic pathway is \u201cdisrupted\u201d serious side effects could be expected

Ventricular fibrillation after omeprazole treatment: a case control

Hydrogen-potassium adenosine triphosphatase (H+/K+-ATPase)-target of omeprazole family members- present in gastric parietal cells, plays an essential role in the formation of HCl. It belongs to a family of P-type cation-transporting ATPases also including Ca2+-ATPase and Na+/K+ -ATPase. A 54 years old woman with a mildly degree hypertension (not pharmacologically treated), familiarity for CAD (father deceased after an AMI at the age of 60) and Helicobacter pylori positive gastritis, previously treated with antibiotics and antacid drugs, had being suffering for about two weeks for a gastric pyrosis recurrence. She started oral therapy with omeprazole 20 mg/die, but, still symptomatic, she was treated i.v. with ranitidine and spasmolytics. However, 8 days later, aspecific thoracic pain sensitive to deep inspiration, movements and digital pressure occurred. The ECG didn’t show any sign of acute ischemia and necrosis enzymes were normal. Furthermore, she was treated i.v. with 30 mg ketorolac, and 30 minutes later with 40 mg omeprazole. After few minutes, the patient had ventricular fibrillation, interrupted with a single 200 J DC-shock, and treated with magnesium sulphate in repolarizing solution i.v. The patient maintained always stable sinus rhythm: no further arrhythmias were recorded during her hospitalization and she kept asymptomatic. There were no signs of ischemia at ECG; all ematochemical parameters (CK, CK-MB, LDH, myoglobin and TnI), serum electrolytes, D-dimer and protein C reactive were always normal. In addition to routine laboratory tests, a peripheral blood sample for genetic analysis was taken with patient informed consent. To assess if clinical drugs-related side effects could be ascribe to genetic CYP-dependent drug metabolizing polymorphisms, DNA sample was analyzed. PCR-RFLP and sequencing of mutated CYP2C19 (variants: *2 and *3) and 3A4 (*1B, *2 and *3) alleles isoforms were performed. The homozygous mutations of both CYP isoforms recorded can be responsible of the abnormal omeprazole level and the consequent toxicity. In other words, high plasmatic level of this drug, not adequately metabolized, could target other receptors structurally similar the ones present in the stomach. So due the individual metabolic fingerprint when more than one principal metabolic pathway is “disrupted” serious side effects could be expected

Levosimendan e stress ossidativo

Lo stato di stress ossidativo (OSS) \ue8 stato di recente proposto come marker diagnostico per patologie cardiovascolari. \uc8 noto come l\u2019OS sia un mancato bilanciamento tra generazione di radicali liberi (o di specie reattive all\u2019ossigeno e all\u2019azoto) e disponibilit\ue0 di antiossidanti (di natura enzimatica e non) in un sistema biologico o compartimento. L\u2019OSS pu\uf2 essere influenzato da molteplici fattori tra cui: dieta, esercizio fisico, esposizione ambientale/occupazionale e stile di vita quali tabagismo ed alcolismo. Sulla base dello studio di singole specie radicaliche, \ue8 stato osservato come un elevato OSS sia coinvolto nella genesi di placche aterosclerotiche, e disfunzioni endoteliali, creando un vero circolo vizioso. Nei nostri laboratori \ue8 stato di recente sviluppato un metodo per la determinazione dell\u2019OSS direttamente su sangue periferico attraverso una metodica EPR basata sull\u2019uso di una sonda radicalica (Radical-Probe-EPR). La sonda radicalica, bis(1-idrossi-2,2,6,6-tetrametil-4-piperidinil)decandioato di-cloridrato, reagisce istantaneamente e quantitativamente con i radicali centrati sull\u2019ossigeno (inclusi il superossido e perossinitrito), generando un nitrossido sufficientemente stabile da poter essere misurato mediante spettroscopia EPR. Questa metodica minimizza le problematiche legate all\u2019invasivit\ue0, instabilit\ue0 e specificit\ue0 verso singole specie radicaliche riscontrate con i convenzionali \u201cspin-trap\u201d. Il Levosimendan, \ue8 un nuovo farmaco inotropo-vasodilatatore, usato nello shock cardiogeno che non aumenta il consumo di ossigeno, ha lunga durata d\u2019azione (metaboliti attivi) e una migliore tolleranza rispetto ad altri farmaci somministrati in simili condizioni cliniche (dobutamina). La terapia \ue8 iniziata in unit\ue0 coronarica sotto monitoraggio medico e laboratoristico; nell\u2019arco temporale di un anno solare nella nostra unit\ue0 coronarica sono stati trattati 15 pazienti con questo farmaco. In questo studio sono stati reclutati 5 pazienti (4 maschi ed 1 femmina), che, per la loro criticit\ue0 clinica, necessitavano di trattamento. Il Levosimendan \ue8 stato somministrato in bolo alla dose di 12 microgrammi/Kg/10 minuti e successivamente, in infusione per 24 ore, 0.1 microgrammi/Kg/minuto. Dopo 1, 6 e 24 ore sono stati effettuati prelievi di sangue venoso immediatamente esposti con la sonda per la successiva indagine EPR durante monitoraggio emodinamico con linea arteriosa e catetere di Swan-Ganz in arteria polmonare. Il miglioramento riscontrato in questi pazienti in termini di riduzione dell\u2019OSS andava da 30% ad un 55% alla ventiquattresima ora, e parallelo miglioramento dell\u2019emodinamica. Il guadagno, in termini di ripresa di funzionalit\ue0 ventricolare sinistra e condizioni cliniche generali, era gi\ue0 visibile alla sesta ora, anche se maggiore alla ventiquattresima ora. Questi risultati preliminari suggeriscono come il Levosimendan migliori la prognosi clinica dei pazienti sottoposti a trattamento anche attraverso una riduzione dello stress ossidativo

MDCT evaluation of the cardiac venous system.

PURPOSE: This study was undertaken to evaluate the usefulness of electrocardiographically (ECG)-gated multidetector-row computed tomography (MDCT) for the assessment of the coronary venous system and detection of its anatomical variants, in order to identify those suitable for lead placement in cardiac resynchronisation therapy (CRT). MATERIALS AND METHODS: We retrospectively examined the coronary MDCT studies of 89 patients (73 males, 16 females, average age 62.5 years, range 31-79) referred for suspected coronary artery disease. The cardiac venous system was assessed in all patients using three-dimensional (3D) postprocessing on a dedicated Vitrea workstation (five patients were excluded from the analysis). RESULTS: The coronary sinus, the great cardiac vein, the anterior interventricular vein and the middle cardiac vein were visualised in all cases. The lateral cardiac vein was visualised in 56/84 patients (67%) and the posterior cardiac vein in 63/84 patients (75%), never both missing. Along the postero-lateral wall of the left ventricle, only one branch was present in 44 cases, two branches in 21 cases and three or more branches in 19/84 cases (22%). Evaluation of the maximum diameter revealed that the lateral vein was dominant over the posterior vein in 20/40 cases. The small cardiac vein was visualised in 11/84 cases. CONCLUSIONS: MDCT provides good depiction of the cardiac venous system, enabling the study of the vessel course and the identification of anatomical variants. Hence, this imaging technique could be proposed for the preoperative planning of CRT in selected patients

Scheduled intermittent inotropes for Ambulatory Advanced Heart Failure. The RELEVANT-HF multicentre collaboration

Background: Ambulatory Advanced Heart Failure (AAHF) is characterized by recurrent HF hospitalizations, escalating diuretic requirements, intolerance to neurohormonal antagonists, end-organ dysfunction, short-term reduced life expectancy despite optimal medical management (OMM). The role of intermittent inotropes in AAHF is unclear. The RELEVANT-HF registry was designed to obtain insight on the effectiveness and safety of compassionate scheduled repetitive 24-hour levosimendan infusions (LEVO) in AAHF patients. Methods: 185 AAHF NYHA class III\u2013IV patients, with 652 HF hospitalizations/emergency visits in the previous 6 months and systolic dysfunction, were treated with LEVO at tailored doses (0.05\u20130.2 \u3bcg/kg/min) without prior bolus every 3\u20134 weeks. We compared data on HF hospitalizations (percent days spent in hospital, DIH) in the 6 months before and after treatment start. Results: Infusion-related adverse events occurred in 23 (12.4%) patients the commonest being ventricular arrhythmias (16, 8.6%). During follow-up, 37 patients (20%) required for clinical instability treatment adjustments (decreases in infusion dose, rate of infusion or interval). From the 6 months before to the 6 months after treatment start we found lower DIH (9.4 (8.2) % vs 2.8 (6.6) %, p < 0.0001), cumulative number (1.3 (0.6) vs 1.8 (0.8), p = 0.0001) and length of HF admissions (17.4 (15.6) vs 21.6 (13.4) days, p = 0.0001). One-year survival was 86% overall and 78% free from death/LVAD/urgent transplant. Conclusions: In AAHF patients, who remain symptomatic despite OMM, LEVO is well tolerated and associated with lower overall length of hospital stay during six months. This multicentre clinical experience underscores the need for a randomized controlled trial of LEVO impact on outcomes in AAHF patients

End-tidal carbon dioxide (ETCO2) and ventricular fibrillation amplitude spectral area (AMSA) for shock outcome prediction in out-of-hospital cardiac arrest. Are they two sides of the same coin?

Aim: Ventricular fibrillation amplitude spectral area (AMSA) and end-tidal carbon dioxide (ETCO2) are predictors of shock success, understood as restoration of an organized rhythm, and return of spontaneous circulation (ROSC). However, little is known about their combined use. We aimed to assess the prediction accuracy when combined, and to clarify if they are correlated in out of hospital cardiac arrest' victims. Materials and Methods: Records acquired by external defibrillators in out-of-hospital cardiac arrest patients of the Lombardia Cardiac Arrest registry were processed. The 1-min pre-shock ETCO2 median value (METCO2) was computed from the capnogram and AMSA (2\u201348 mV.Hz range) computed applying the Fast Fourier Transform to a 2-second pre-shock filtered ECG interval (0.5 1230 Hz). Support Vector Machine (SVM) predictive models based on METCO2, AMSA and their combination were fit; results were given as the area under the curve (AUC) of the receiver operating characteristic (ROC) curves. Results: We considered 112 patients with 391 shocks delivered. METCO2 and AMSA were predictors of shock success [AUC (IQR) of the ROC curve: 0.59 (0.56 120.62); 0.68 (0.65 120.72), respectively] and of ROSC [0.56 (0.53 120.59); 0.74 (0.71 120.78),]. Their combination in a SVM model increased the accuracy for predicting shock success [AUC (IQR) of the ROC curve: 0.71 (0.68 120.75)] and ROSC [0.77 (0.73 120.8)]. AMSA and METCO2 were significantly correlated only in patients who achieved ROSC (rho = 0.33 p = 0.03). Conclusions: AMSA and ETCO2 predict shock success and ROSC after every shock, and their predictive power increases if combined. Notably, they were correlated only in patients who achieved ROSC