Diagnostic criteria to differentiate pathological procrastinators from common delayers: a re-analysis

Detection and treatment of clinically relevant forms of procrastination would be greatly facilitated by diagnostic criteria as formulated for psychological disorders in the Diagnostic and Statistical Manual (DSM-5). In the present article, the steps for deriving and validating diagnostic criteria for pathological procrastination are described. In an online survey of a random sample of N = 10,000 German university students, 990 answered 13 items derived from the attempts in the literature to define procrastination, the Aitken Procrastination Inventory (API) and the Patient Health Questionnaire (PHQ-9). A subset of six items related to the first factor onset delay of the API was selected by Best Subset Multiple Regression (BSMR). A latent class analysis (LCA) of these six items sorted the students into six clusters. A cluster of pathological procrastinators (10%) was separated from the clusters of less impaired habitual, average, and occasional delayers. In addition, a cluster of unconcerned delayers (10%), with strong procrastination tendencies but little personal disadvantages, and a small cluster of fast performers (2%) emerged. The pathological procrastinators differed from all other clusters significantly on nine of the 13 items. They were older, had studied longer but had fulfilled less of their study obligations and were more depressed. The answer options of the six questions were collapsed into two categories (procrastination feature present for at least half a year or absent). These criteria were used for the clinical diagnosis of pathological procrastination. For a diagnosis, two fixed criteria (delaying important tasks needlessly and strong interference with personal goals) plus at least two of four additional criteria (time spent procrastinating, time pressure, physical and psychological complaints, below performance potential) must be met. This diagnostic rule captured 92% from the cluster of pathological procrastinators and 10% of the habitual delayers, but no one from the remaining clusters. Using these diagnostic criteria for clinical diagnosis and intervention decisions will facilitate the comparison and integration of the results from future studies of procrastination

Primary leiomyosarcoma of the right atrium: a case report and literature update

Leiomyosarcoma of the right atrium is a very rare cardiac tumor. Various combinations of treatments including resection or transplant surgery and Chemotherapy have been advocated. We report a case of a man who presented with pulmonary embolism secondary to right atrial leiomyosarcoma. He was managed by excision of the tumor and reconstruction of the right atrium with autologous pericardium. Postoperatively tumor dissemination was controlled with adjuvant chemotherapy

Isolated ventricular noncompaction: a case report

Isolated ventricular noncompaction is an extremely rare cardiomyopathy, not fully clarified

A Right Atrial Hemangioma Mimicking Thrombus In A Patient With Atrial Arrhythmias

Cardiac hemangiomas are rare tumors, accounting for only 2.8% of all benign primary cardiac tumors and occur at any age. Clinical presentations vary depending on the tumor location (myocardial, endocardial or pericardial). In many cases, this may be an incidental finding. We report the case of a patient with paroxysmal atrial fibrillation who had a right atrial hemangioma detected with transesophageal echocardiography prior to having percutaneous pulmonary vein isolation performe

Xanthine oxidase inhibition for the treatment of cardiovascular disease: an updated systematic review and meta-analysis

Background: Previous studies have shown that xanthine oxidase inhibitors (XOI) might improve outcome for patients with cardiovascular disease. However, more evidence is required. Methods and results: We published a meta‐analysis of trials conducted before 2014 examining the effects of XOI on mortality in patients with cardiovascular disease. At least two further trials (N = 323 patients) have since been published. Accordingly, we repeated our analysis after a further search for randomized controlled trials of XOI in PubMed/MEDLINE, EMBASE, and Cochrane Databases. We identified eight relevant trials with 1031 patients. The average age of the patients was 61 years and 68% were men (one study did not report gender). There were 57 deaths in these eight trials, 26 in those assigned to XOI, and 31 in those assigned to the control. The updated meta‐analysis could not confirm a reduction in mortality for patients assigned to XOI compared with placebo (odds ratio 0.84) but 95% confidence intervals were wide (0.48–1.47). Conclusions: This updated meta‐analysis does not suggest that XOI exert a large reduction in mortality but also cannot exclude the possibility of substantial harm or benefit

Isolated Left Ventricular Noncompaction Cardiomyopathy Accompanied by Severe Mitral Regurgitation

Isolated left ventricular noncompaction cardiomyopathy (IVNC) is a cardiomyopathy thought to be caused by arrest of normal embryogenesis of the endocardium and myocardium. This abnormality is often associated with other congenital cardiac defects. A 21-year-old man presented to the emergency department with worsening exertional dyspnea during the previous 2 months. Two-dimensional and Doppler echocardiography revealed an enlarged left atrium (LA) and a markedly dilated left ventricle (LV) with preserved LV systolic function, severe mitral valve regurgitation, and prolapse due to chordae rupture. The myocardium of the LV and right ventricle (RV) had excessively prominent trabeculations and deep intertrabecular recesses. He is the first patient in Korea who has undergone mitral valve replacement surgery because of severe mitral valve regurgitation and prolapse due to chordae rupture accompanied by IVNC

No relationship between left ventricular radial wall motion and longitudinal velocity and the extent and severity of noncompaction cardiomyopathy

<p>Abstract</p> <p>Background</p> <p>Noncompaction cardiomyopathy (NCCM) is characterized by a prominent trabecular meshwork and deep intertrabecular recesses. Although systolic dysfunction is common, limited information is available on differences in wall motion of the normal compacted and noncompacted segments. The purpose of this study was to assess radial wall motion and longitudinal wall velocity in patients with NCCM, according to the extent and severity of noncompaction.</p> <p>Methods</p> <p>The study comprised 29 patients in sinus rhythm (age 41 ± 15 years, 15 men), who fulfilled stringent diagnostic criteria for NCCM and compared to 29 age and gender matched healthy controls. Segmental radial wall motion of all compacted and noncompacted segments was assessed with the standard visual wall motion score index and longitudinal systolic (Sm) wall velocity with tissue Doppler imaging of the mitral annulus. For each LV wall a normalized Sm value was calculated. The extent and severity of NC in each LV segment was assessed both in a qualitative and quantitative manner.</p> <p>Results</p> <p>Heart failure was the primary clinical presentation in half of the patients. NCCM patients had a wall motion score index of 1.68 ± 0.43 and a normalized Sm of 82 ± 20%. The total and maximal noncompaction scores were not related to the wall motion score index and the normalized Sm. NCCM patients with and without heart failure had similar total and maximal noncompaction scores.</p> <p>Conclusions</p> <p>In NCCM patient's radial wall motion and longitudinal LV wall velocity is impaired but not related to the extent or severity of noncompaction.</p