No-Reflow Phenomenon: A Major Issue Concerning Revascularization in Acute Coronary Syndromes

The no-reflow phenomenon (NRp), a dreaded complication of primary and also of any complex percutaneous coronary intervention (PCI), is characterized by insufficient myocardial perfusion in a territory of a coronary artery without evidence of mechanical obstruction. Microvascular injury is the underlying mechanism of NRp and its manifestation is not only impaired TIMI flow (<3), but also impaired TIMI myocardial perfusion grade (TMPG) which should be assessed in case of chest pain, persistent ST segment elevation or hemodynamic compromise despite the presence of TIMI III flow. The NRp mechanism is multifaceted, the evidence base for its treatment is inconsistent and limited, but its predictors are well known. The armamentarium against NRp consists of preventive and therapeutic strategies, both mechanical and pharmacological. A brief overview of all the above issues concerning NRp is attempted herein. Rhythmos 2019;14(2):27-30

The Clinical and Radiological Spectrum of Hippocampal Pathology in Amyotrophic Lateral Sclerosis

Hippocampal pathology in Amyotrophic Lateral Sclerosis (ALS) remains surprisingly under recognized despite compelling evidence from neuropsychology, neuroimaging and neuropathology studies. Hippocampal dysfunction contributes significantly to the clinical heterogeneity of ALS and requires structure-specific cognitive and neuroimaging tools for accurate in vivo evaluation. Recent imaging studies have generated unprecedented insights into the presymptomatic and longitudinal processes affecting this structure and have contributed to the characterisation of both focal and network-level changes. Emerging neuropsychology data suggest that memory deficits in ALS may be independent from executive dysfunction. In the era of precision medicine, where the development of individualized care strategies and patient stratification for clinical trials are key priorities, the comprehensive review of hippocampal dysfunction in ALS is particularly timely

Double–blind control of the data manager doesn't have any impact on data entry reliability and should be considered as an avoidable cost

<p>Abstract</p> <p>Background</p> <p>Database systems have been developed to store data from large medical trials and survey studies. However, a reliable data storage system does not guarantee data entering reliability.</p> <p>We aimed to evaluate if double-blind control of the data manager might have any effect on data-reliability. Our secondary aim was to assess the influence of the inserting position in the insertion-sheet on data-entry accuracy and the effectiveness of electronic controls in identifying data-entering mistakes.</p> <p>Methods</p> <p>A cross-sectional survey and single data-manager data entry.</p> <p>Data from PACMeR_02 survey, which had been conducted within a framework of the SESy-Europe project (PACMeR_01.4), were used as substrate for this study. We analyzed the electronic storage of 6446 medical charts. We structured data insertion in four sequential phases. After each phase, the data stored in the database were tested in order to detect unreliable entries through both computerized and manual random control. Control was provided in a double blind fashion.</p> <p>Results</p> <p>Double-blind control of the data manager didn't improve data entry reliability. Entries near the end of the insertion sheet were correlated with a larger number of mistakes. Data entry monitoring by electronic-control was statistically more effective than hand-searching of randomly selected medical records.</p> <p>Conclusion</p> <p>Double-blind control of the data manager should be considered an avoidable cost. Electronic-control for monitoring of data-entry reliability is suggested.</p

Screening chest radiography: results from a Greek cross-sectional survey

BACKGROUND: Public health authorities worldwide discourage the use of chest radiography as a screening modality, as the diagnostic performance of chest radiography does not justify its application for screening and may even be harmful, since people with false positive results may experience anxiety and concern. Despite the accumulated evidence, various reports suggest that primary care physicians throughout the world still prescribe chest radiography for screening. We therefore set out to index the use of chest radiography for screening purposes among the healthy adult population and to analyze its relationship with possible trigger factors. METHODS: The study was designed as a cross-sectional survey. Five thousand four hundred and ninety-nine healthy adults, coming from 26 Greek provinces were surveyed for screening practice habits in the nationwide anticancer study. Data were obtained for the use of screening chest radiography. Impact of age, gender, tobacco exposure, family history positive for malignancies and professional-risk for lung diseases was further analyzed. RESULTS: we found that 20% (n = 1099) of the surveyed individuals underwent chest radiography for screening purposes for at least one time during the previous three years. Among those, 24% do so with a frequency equal or higher than once yearly, and 48% with a frequency equal or higher than every three years. Screening for chest radiography was more commonly adopted among males (OR 1.130, 95% CI 0.988–1.292), pensioners (OR 1.319, CI 1.093–1.593) and individuals with a positive family history for lung cancer (OR 1.251, CI 0.988–1.583). Multivariate analysis confirmed these results. CONCLUSION: Despite formal recommendations, chest radiography for screening purposes was a common practice among the analyzed sample of Greek adults. This practice is of questionable value since the positive predictive value of chest radiography is low. The implementation of even a relatively inexpensive imaging study on a national scale would greatly burden health economics and the workload of radiology departments

Determination of the association of urine prostate specific antigen levels with anthropometric variables in children aged 5-14 years

PURPOSE: Calculation of PSA is possible in human fluids even if it presents in very low concentrations with the help of hypersensitive immunodiagnostic methods. The periurethral glands represent one of the potential sources of urine prostate specific antigen (uPSA) in both sexes but the purpose of studying PSA levels in children is still unclear in the literature. In this pilot study we studied uPSA in a small cohort of normal, pre and post pubertal children, in relation to standard anthropometric variables. MATERIALS AND METHODS: The study cohort consisted of 58 children 5-14 years old (42 boys/16 girls). Height, weight, body mass index (BMI) and the respective stature-for-age, weight-for-age and BMI-for-age percentiles of the sample were determined. uPSA levels were measured using a third generation immunodiagnostic method (DPC Immulite®) that has a lower limit of detection of 3 ng/L. When levels of PSA were above the upper limit of detection, uPSA levels were assessed using the ROCHE technique. RESULTS: uPSA levels tend to be higher in male than female children (p = 0.091, linear regression analysis). uPSA was measurable only in 3/16 girls (18.75%). Measurable uPSA was found in 18/42 boys (42.8%). The range of urine PSA in boys was 0-161000 ng/L (mean 10561.9 ± 31830.48 ng/L). Statistical analysis with linear regression showed correlation with height and age in boys. CONCLUSIONS: The use of hypersensitive assays allows calculation of uPSA in childhood. The values of this variable are measurable in both sexes and related with gender. In boys, uPSA was correlated with age and height but not with other variables tested. Further studies are required to clarify this field

Executive Dysfunction, Social Cognition Impairment, and Gray Matter Pathology in Myotonic Dystrophy Type 2: A Pilot Study

International audienc

A case-control study of hopelessness and suicidal behavior in the city of Athens, Greece. The role of the financial crisis

This study aimed to examine the psychometric properties of Beck Hopelessness Scale (BHS) in Greek patients with a recent suicide attempt, the predictive ability of BHS especially in terms of age and the possible effect of the financial crisis on hopelessness as it has been identified as a significant suicide risk factor. The study included a total of 510 individuals, citizens of Athens, Greece. Three hundred and forty individuals (170 attempted suicide patients, and 170 -age and gender- matched healthy individuals used as controls) completed BHS before the financial crisis onset (from 2009 to 2010). A sample of 170 healthy individuals also completed the BHS after the financial crisis onset (from 2013 to 2014), when the impact of the austerity measures was being felt by the Greek society. The Greek BHS version demonstrated good psychometric properties and a sufficient degree of internal consistency. Attempted suicide patients (M=9) presented higher hopelessness than the controls (M=3). The patients&apos; age positively correlated with hopelessness (r(s)=.35, p&lt;.001), and the ROC curve revealed that the BHS ability to discriminate the individuals with pathological rates of hopelessness from those without, strengthened as age increased. No significant differences were found between the individuals evaluated before (M=3) and after (M=3, p&gt;.05) the crisis onset. Nevertheless, regarding the latter group, the women, the younger individuals, the less educated, the unemployed and the participants with low or mediocre self-reported financial status presented increased hopelessness. Our findings suggest that BHS could be a useful instrument especially when screening for suicide risk in people of older age, and that the financial crisis in Greece had a greater impact on subgroups of the population regarding hopelessness