Procalcitonin in acute heart failure

Acute heart failure (AHF) isa time critical disease and it is of outmost importance to identify the underlyingprecipitating factors as soon as possible as this can improve patient outcomes. Infection is such a significant factor. Procalcitonin (PCT), as a biomarker of bacterial infection, can be used in AHF patients to establish the diagnosis of concomitant bacterial infection. PCT can guide the early initiation of antibiotic therapy and provide prognostic information regarding AHF patients. This short review summarizes the current evidence on PCT use in AHF including the preliminary results of the IMPACT-BIC-18 trial.&nbsp

The adverse reactions to contrast media during percutaneous coronary interventions; keep in mind the non-idiosyncratic reactions.

Background: Iodinated contrast media (ICM) have been among the most commonly used agents in the modern era of medicine and have become of paramount importance in the field of interventional cardiology. Although ICM have an overall good safety profile, severe or life-threatening reactions can occur as well. Description of case: Herein, we report the case of a 74-year-old female patient who presented with a non-ST elevation myocardial infarction and underwent a successful percutaneous coronary intervention (PCI). At completion of the procedure, the patient complained of dizziness and a metallic taste. She became severely hypotensive with simultaneous bradycardia, simulating a vasovagal reaction. The persistence, however, of the reaction despite initial appropriate measures, guided our thought to a non-idiosyncratic reaction to the contrast media. The patient was hemodynamically stabilized with administration and up-titration of vasopressors and transferred to the coronary care unit, where she developed the full-blown clinical picture of an ICM adverse reaction. She was discharged 8 days later with no further complications.        Conclusion: Non-idiosyncratic reactions to contrast media during a PCI can be misinterpreted as a complication of the procedure per se or as a vasovagal reaction. A high level of clinical suspicion is warranted to ensure prompt recognition and appropriate management

Acute post cardiac injury syndrome occurring immediately after a demanding percutaneous coronary intervention.

Postcardiac injury syndrome (PCIS) occurs as a complication of myocardial infarction (Dressler's syndrome), of cardiac surgery (post-pericardiotomy syndrome), or post-traumatic (either iatrogenic or non-iatrogenic) and involves a pericardial or myocardial injury. There is scarce data regarding occurrence and pathogenesis of PCIS after invasive procedures. Herein, we describe a unique case of acute PCIS with typical clinical, laboratory, echocardiographic findings that occurred one hour after a demanding multi-stenting percutaneous coronary intervention. Possible pathogenetic mechanisms and treatment options are being discussed

Dietary sugar intake and its association with obesity in children and adolescents

Sugar intake has been associated with increased prevalence of childhood overweight/obesity; however, results remain controversial. The aim of this study was to examine the probability of overweight/obesity with higher sugar intakes, accounting for other dietary intakes. Data from 1165 children and adolescents aged ≥2–18 years (66.8% males) enrolled in the Hellenic National Nutrition and Health Survey (HNNHS) were used; specifically, 781 children aged 2–11 years and 384 adolescents 12–18 years. Total and added sugar intake were assessed using two 24 h recalls (24 hR). Foods were categorized into specific food groups to evaluate the main foods contributing to intakes. A significant proportion of children (18.7%) and adolescents (24.5%) exceeded the recommended cut-off of 10% of total energy intake from added sugars. Sweets (29.8%) and processed/refined grains and cereals (19.1%) were the main sources of added sugars in both age groups, while in adolescents, the third main contributor was sugar-sweetened beverages (20.6%). Being overweight or obese was 2.57 (p = 0.002) and 1.77 (p = 0.047) times more likely for intakes ≥10% of total energy from added sugars compared to less <10%, when accounting for food groups and macronutrient intakes, respectively. The predicted probability of becoming obese was also significant with higher total and added-sugar consumption. We conclude that high consumption of added sugars increased the probability for overweight/obesity among youth, irrespectively of other dietary or macronutrient intakes

Socioeconomic Crisis and Incidence of Acute Myocardial Infarction in Messinia, Greece

In the last 5 years Greece is facing the worst socioeconomic crisis since the end of the Second World War. The purpose of the current study was to gather all the incident cases of acute myocardial infarction (AMI) that were hospitalized in the General Hospital of Kalamata during the last 10 years. Our results suggest that the prolonged financial crisis may have led to a higher incidence of AMI in the population of Messinia, Greece

Prevalence of Overweight and Obesity Among Greek Army Recruits

OBJECTIVE Obesity poses a major public health issue whose prevalence is reaching epidemic proportions, especially among younger ages. Our aim was to determine the prevalence of overweight and obesity among Greek men recruited in the army, and to evaluate potential associations with place of residence and educational level. SUBJECTS &amp; METHODS Height and weight were measured in 3,684 men, aged 23.2±2.8 (mean ± standard deviation) years. Body mass index (BMI, kg/m2) was used as measure of adiposity. Associations between BMI categories and level of education (≤9 school years, &gt;9 years) and between BMI categories and place of residence (urban, rural) were evaluated using chi-square test. RESULTS Average BMI was 25.2±4 kg/m2. The prevalence of overweight (25&lt;BMI&lt;30) was 33.7% and associated positively with a higher educational level (p&lt;0.001), whereas the prevalence of obesity (BMI&gt;30) was 10.0% and was not associated with educational level. Obesity was associated with place of residence; individuals from rural areas were more obese than those from urban areas (p=0.04). Our results, when compared to those of similar studies conducted in 1969, 1990, and 2006 showed a significant increase in mean BMI. CONCLUSION Overall, we documented a high and increasing prevalence of overweight and obesity (43.7%) among younger Greek men

The “Elpis” Registry on Percutaneous Coronary Interventions: A Three-Year Experience

The advent of percutaneous coronary intervention (PCI) transformed the treatment of obstructive coronary artery disease (CAD) by creating a less invasive revascularization option to coronary-artery bypass grafting (CABG).1 Although, randomized controlled clinical trials (RCTs) are the gold standard in medical research, there is not always the possibility to conduct properly designed RCTs. The gap between evidence from RCTs and clinical practice can be filled by epidemiological studies and properly designed registries.2 The results of the Hellenic Heart Registry on Percutaneous Coronary Interventions (HHR-PCI), a national registry of patients with stable angina or acute coronary syndromes who underwent PCI, were only recently published.3 The purpose of the current study is to report the experience of a newly formed Catheterization laboratory at a tertiary hospital of Athens and to compare its findings to those reported by the HHR-PCI... (excerpt

Presence of Hypertension Is Reduced by Mediterranean Diet Adherence in All Individuals with a More Pronounced Effect in the Obese: The Hellenic National Nutrition and Health Survey (HNNHS)

Hypertension is a major risk of cardiovascular diseases. This study's aim was to examine associations between hypertension and a priori known lifestyle risk factors, including weight status and Mediterranean diet adherence. The study included a representative sample of the adult population (N = 3775 (40.8% males)), from the Hellenic National Nutrition and Health Survey (HNNHS), which took place from September 2013 to May 2015. Demographic and anthropometric data were collected using validated questionnaires, and blood pressure (BP) measurements were performed for the two main metropolitan areas (N = 1040; 41.1%). Hypertension diagnosis was according to the International Classification of Diseases (ICD-10) guidelines. Weighted proportions, extended Mantel-Haenszel (M-H) analyses, and multiple logistic regressions (for the survey data) were performed. Mean systolic BP (SBP) and diastolic BP (DBP) were 118.6 mmHg and 72.2 mmHg respectively, with both values being higher in males compared to females in all age groups (p < 0.001). Study participants with hyperlipidemia or diabetes, and those overweight, were almost twice as likely to be hypertensives, with the odds increasing to 4 for those obese (p for all, < 0.05). Stricter Mediterranean diet adherence significantly decreased the likelihood of hypertension by 36% (OR: 0.64; 95% CI: 0.439, 0.943), and a significant interaction was found between Mediterranean diet adherence and weight status on hypertension. The presence of hypertension is clustered with comorbidities, but is significantly associated with modifiable risk factors, including Mediterranean diet and weight status, underlining the need for personalized medical nutritional treatment

Η επίδραση των γλυκοκορτικοειδών και της αφυδρογονάσης τύπου Ι των 11β - υδροξυστεροειδών στα λεία μυϊκά κύτταρα των αγγείων

The actions of glucocorticoids are mediated, in part, by 11β-hydroxysteroid dehydrogenase 1 (11β-HSD1), which amplifies their effects at the pre-receptor level by converting cortisone to cortisol. Glucocorticoids, such as dexamethasone, inhibit vascular smooth muscle cell proliferation; however, the role of 11β-HSD1 in this response remains unknown. Accordingly, human coronary artery smooth muscle cells (HCSMC) were treated with dexamethasone (10-9 – 10-6 mol/L) and was found that after 72 h, dexamethasone increased 11β-HSD1 expression (14.16 ± 1.6 fold, p<0.001) and activity (6.21 ± 1.2 fold, p<0.001) in a dose- and time-dependent manner, which was dependent upon glucocorticoid receptor (GR) activation and C/EBPβ and C/EBPδ signaling. As glucocorticoids are known to negatively regulate GR expression, the effect of decreasing 11β-HSD1 expression on GR expression was examined. In HCSMC transfected with 11β-HSD1 siRNA, GR expression was increased; this effect was associated with protein kinase A activation and CREB phosphorylation. To examine the role of 11β-HSD1 in HCSMC proliferation, 11β-HSD1 expression was decreased and cells were stimulated with platelet derived growth factor (PDGF) (10 ng/ml). Decreased 11β-HSD1 expression was associated with increased cell proliferation in the absence of PDGF compared to scrambled control-transfected cells (236.10 ± 13.11 %, n=4, p<0.001) and this effect was augmented by PDGF. Furthermore, the inhibitory effect of dexamethasone on cellular proliferation was abrogated in 11β-HSD1 siRNA-transfected HCSMC. Downregulation of 11β-HSD1 was associated with decreased p27kip1 expression and increased phosphorylated retinoblastoma protein, consistent with a proliferative response. These ABSTRACT 7 findings suggest that 11β-HSD1 plays a role in the effects of glucocorticoids on vascular smooth muscle cell phenotyp