Eventual role of myocardial muscular «bridges» in the pathogenesis of acute coronary syndrome

Aim of the study was to investigate the role of myocardial muscular «bridges» (MMB) in the pathogenesis of acute coronary syndrome (ACS). Material and methods. The study comprised of 27 patents with ACS: 21 (77,8 %) with diagnosed unstable angina pectoris (UA) and 6 (22,2 %) with acute anterior myocardial infarction with ST elevation (STEMI). Results. All patients with STEMI had positive qualitative troponin test. The serum level of creatine phosphokinase (CPK) was 857.7 ± 495.5 U/l, the CPK MB level was 46.5 ± 42.4 U/l. The patients’ age varied from 32 to 68 years (on average, 52.4 ± 4.6 years). Selective coronary angiography (CAG) revealed systolic functional obstruction of the LAD with vessel’s lumen recovery to the norm during diastole in all 27 patients, which is typical for MMB. In all cases with UA, the clinical aggravation was associated with ECG signs of transitory or permanent myocardial hypoxia in the territory supplied by the LAD, while the patients with STEMI had ECG, biochemical and EchoCG signs of myocardial damage and kinetics disturbances in the left ventricular areas supplied by the LAD. All patients underwent intravascular instrumental investigation. During in-hospital stage all patients received conservative therapy including β-adrenergic receptors or CA-channels blockers; ACE inhibitors; disaggregants. Upon 12 months all patients underwent repeated outpatient examination. In all cases, the conducted therapy resulted in the improvement of the patients’ condition. Conclusion. This study allows concluding that MMB play an essential role in the pathogenesis of ACS, including STEMI

HIV pre-test information, discussion or counselling? A review of guidance relevant to the WHO European Region

Objectives In the context of a shift from exceptionalism to normalisation, this study examines recommendations/evidence in current pan-European/global guidelines regarding pre-test HIV testing and counselling practices in health care settings. It also reviews new research not yet included in guidelines.Methods Comparative content analysis of one global and three pan-European guidelines; systematic literature review.Results There is consensus that verbal informed consent must be gained prior to testing, individually, in private, confidentially, in the presence of a health care provider. All guidelines recommend pre-test information/discussion delivered verbally or via other methods (information sheet). There is agreement about a minimum standard of information to be provided before a test, but guidelines differ regarding discussion about issues encouraging patients to think about implications of the result. There is heavy reliance on expert consultation in guideline development. Referenced scientific evidence is often more than 10 years old and based on US/UK research. Eight new papers are reviewed.Conclusions Current HIV testing and counselling guidelines have inconsistencies regarding the extent and type of information that is recommended during pre-test discussions. The lack of new research underscores a need for new evidence from a range of European settings to support the process of expert consultation in guideline development