The widow maker warning sign or wellens' syndrome: A case report

Wellens' syndrome, also known as LAD (left anterior descending) coronary T-wave syndrome, widow maker or warning sign, is a potentially unrecognized critical proximal LAD stenosis with possible fatal consequences. It can be associated with extensive acute anterior wall myocardial infarction, with left ventricular dysfunction and a lethal outcome within a few days after the onset of symptoms. It usually consists of a typical ECG finding in the precordial leads that represents a significant proximal LAD stenosis in patients with unstable angina pectoris. Although this syndrome is not indicated for PCI (the patient is usually pain-free at the time of electrocardiography registration), it is necessary to recognize the characteristic pattern and perform an emergency coronary angiography and percutaneous or surgical revascularisation of the affected blood vessel. Here we present the case report of a 47 year-old woman without previous anamnesis of coronary disease. On admission to the Coronary Care Unit she was chest pain-free and had all the indicators of Wellens' syndrome

Fractional flow reserve of intermediate lesions on collateral donor coronary arteries after myocardial infarction

Fractional flow reserve (FFR) is the gold standard for the functional assessment of coronary arteries. The aim of this study was to evaluate the relation between angiography, QCA and FFR in borderline lesions on collateral donor coronary arteries. In addition, FFR is compared with the angiographic appearance of collaterals to infarction-related arteries and echocardiographically assessed viability of infarct related the LV wall. In 60 patients with previous IM and occluded IRA, functional assessment of borderline coronary stenosis (30-70% DS) on collaterals donor artery was performed. We have not found statistically significant differences in these parameters between groups with different angiographic appearances of collaterals and different viability of distal myocardium. However, we found higher FFR values in diabetic patients (p=0.018). Higher FFR values in diabetic patients reveal the negative effects of diabetes on collateral growth and myocardial viability

Influence of ZnO nanoparticles on slow release of essential oil from polimeric matrix

Biopolymer emulsions were processed in the form of thin films for application in active food packaging. Active packaging is defined as material designed to release active components into food or absorb them from food in order to extend durability or to maintain/improve packaging conditions and extend shelf-life of food. We synthesized emulsion based on biodegradable polymers (pectin, gelatin, chitosan) with addition of active components -essential oils and ZnO nanoparticles (NPs). By introducing essential oils in the polymer matrix, with the addition of certain emulsifiers, it comes to encapsulation of oil droplets and the formation of a homogeneous emulsion. Thin films were fabricated by mold casting or spraying of the emulsions on a substrate. The slow release of an essential oil from the polymeric matrix was determined by UV-vis spectrophotometry. It was shown that polymers with addition of nanoparticles provided a prolonged action of active components. Surface morphology of the films was characterized by atomic force microscopy (AFM), and it was noticed that nanoparticles were mainly accumulated around oil droplets, which additionally contributed to a slow release of the active components

Is Balint training associated with the reduced burnout among primary health care doctors?

The aim of our study was to examine whether the participation in Balint group is associated with the reducing burnout syndrome among primary health care doctors. This investigation was conducted on a population of 210 doctors employed in primary health centers in Belgrade. Out of 210 doctors, 70 have completed Balint training for a period of at least 1 year, whereas 140 doctors have never attended this training (the Non-Balint group). The level of burnout among physicians was assessed with the Serbian translation of the original 22- item version of the Maslach Burnout Inventory – Human Services Survey which defines burnout in relation to emotional exhaustion, depersonalization and personal accomplishment. We found that 45.0% of the Non-Balint participants and 7.1% of the Balint-trained participants responded with symptoms of high level of emotional exhaustion, with a statistically significant difference (p < 0.001). In relation to depersonalization, 20% of the Non-Balint subjects were highly depersonalized compared to 4.4% of the Balint-trained subjects, with a statistically significant difference (p < 0.001). Regarding the personal accomplishment, 21.4% of the Non-Balint subjects and 7.1% of the Balint-trained subjects had a perception of low personal accomplishment, with a statistical significance (p < 0.001). In the multiple ordinal logistic model, with emotional exhaustion as a dependent variable, statistically significant predictor was female gender (OR = 2.51; p = 0.021), while Balint training was obtained as a protective factor (OR = 0.12; p < 0.001). Non-specialists were detected as a risk factor for depersonalization (OR = 2.14; p = 0.026) while Balint group was found as a protective factor (OR = 0.10; p < 0.001), according to the multiple ordinal logistic regression analysis. Regarding the reduced personal accomplishment, our results indicated that nonspecialists were at risk for this subdimension (OR = 2.09; p = 0.025), whereas Balint participants were protected (OR = 0.18; p < 0.001). Participation in Balint groups is associated with the reduced burnout syndrome among primary health care doctors.Keywords: Doctor-patient relationship; Balint groups; burnout; primary health care; patientcentered; approac

Intracerebral hemorrhage as a first sign of pheochromocytoma: case report and review of the literature

Pheochromocytomas and sympathetic paragangliomas are rare catecholamine-secreting tumours that represent very rare causes of intracerebral haemorrhage in the young, with only a few cases reported. A 32-year-old man presented to our emergency department because of sudden onset of severe headache. He had a six-month history of paroxysmal headache, palpitations, and sweating. During examination he became somnolent and developed left-sided hemiplegia. A computed tomographic (CT) scan of the brain showed a right temporoparietal haematoma. He was admitted to the Clinic for Neurosurgery and the haematoma was evacuated. The patient was comatose, on assisted respiration, with frequent hypertensive crises. An examination for possible secondary causes of hypertension was undertaken. Plasma metanephrine value was elevated (414 pg/mL, reference values < 90 pg/mL). Abdominal CT scans revealed a large mass (6 cm) in the right adrenal gland. After adequate control of the hypertension was achieved with nonselective alpha- and beta-adrenergic blockers the tumour was excised. The histopathologic findings confirmed the diagnosis of pheochromocytoma. The genetic analysis demonstrated a duplication in exon 1 of the VHL gene. We reported a rare, potentially fatal complication of pheochromocytoma — an intracerebral haemorrhage. This case and review of similar rare cases in the literature illustrate the importance of early recognition of the characteristic symptoms of catecholamine excess in young patients with hypertension

Structural, optical and photocatalytic properties of BiFeO3 nanoparticles

BiFeO3 (BFO) precursor powder was synthesized by ultrasound asissted sol–gel route at relatively low temperature, starting from Bi-nitrate, Fe-nitrate, and ethylene glycol. Structural, optical, and photocatalytic properties of the obtained powder were investigated. X-ray diffraction analysis confirmed that thermal treatment of precursor powder at 500 °C led to formation of pure phase BiFeO3. BFO is p-type semiconductor where determined band gap was 2.20 eV, indicating its potential application as visible-light-response photocatalyst. Mott-Schottky measurements were performed to determine flat band potential and position of valence and conduction bands. Obtained BFO powder is used for photocatalytic degradation of typical organic azo dye Mordant Blue 9 in concentration of 50 mg/l. Measurements were performed for different times of irradiation and pH of the dye solution. Photodegradation products were analyzied by HPLC technique, and mechanism of photocatalytic degradation of organic dye was proposed

Pilomyxoid astrocytoma of the thoracic spinal cord: Extremely rare case report of over 70‐year‐old patient

Abstract The Pilomyxoid is rare tumor in elderly population, in addition to the occurrence of an isolated lesion in spinal cord is extremely rare in non‐pediatric population. Taking biopsy and subtotal resection is the starting point in essential approach for the treatment. After defining the histopathological nature of the tumor and specified that is Pilomyxoid, the next step is the combination of reoperation and adjuvant therapy

Effects of the silver nanodots on the photocatalytic activity of mixed-phase TiO2

We present the synthesis and photocatalytic properties of mixed-phase TiO2 nanoparticles decorated with silver nanodots obtained by environmental-friendly wet chemical method using low molecular weight chitosan as the silver reducing agent. Structural analysis of synthesized Ag nanoparticles revealed that they crystallized in a rare hexagonal modification. High-resolution transmission electron microscopy study shows that lt 3-nm hexagonal-Ag nanoparticles are implanted on the surface of lt 20-nm anatase grains. Compared to Ag-free TiO2 powders, implantation with Ag results in important increase in visible light absorption. The photocatalytic activity of the samples was measured by monitoring decolorization of concentrated textile dye solution (50 mg L-1 of Reactive Orange 16) under simulated solar irradiation of 280 W m(-2). The optimum photocatalytic properties are achieved with 5 wt% of silver. Based on the collected results, the operating mechanism of the degradation process is suggested, and the effects of the silver addition are explained

Mesoporous films prepared from synthesized TiO2 nanoparticles and their application in dye-sensitized solar cells (DSSCs)

In this paper, we propose a novel method for preparation of high surface area titania nanoparticles, and investigate their photovoltaic performance in dye sensitized solar cells (DSSCs). The precursor compound titanium(IV)-isopropoxide is hydrolyzed in the presence of nonionic surfactant (Triton X100) and ethylenediaminetetraacetic acid sodium salt (EDTA-Na-2) and thermally transformed into gel. The gel is autoclaved, resulting in submicronic micelles which are further processed into mesoporous films. The films are deposited from paste, composed of ultrasonically broken micelles and the organic ingredients. The crack-free film structures, composed of sub-25 nm pure anatase particles are observed using the appropriate instrumental techniques: scanning electron microscopy (SEM), field-emission scanning electron microscopy (FE-SEM), transmission electron microscopy (TEM), X-ray diffractometry (XRD), UV-VIS-NIR spectroscopy. The large surface area of 158 m(2) g (1) and mesoporosity are confirmed using the data obtained from the nitrogen adsorption-desorption isotherm. The photovoltaic performance of the operating N719-sensitized solar devices are tested using electrochemical impedance spectroscopy (EIS), open-circuit voltage decay (OCVD) and by recording current density-voltage (J-V) curves. The cell exhibits promising photocurrent density up to 11.7 mA cm (2), and the photo-to-electric power efficiency of 5.22%, for cell area of 0.24 cm(2), under 100 mW cm (2) halogen light source

Trio Clinical Exome Sequencing in a Patient With Multicentric Carpotarsal Osteolysis Syndrome: First Case Report in the Balkans

Exome sequencing can interrogate thousands of genes simultaneously and it is becoming a first line diagnostic tool in genomic medicine. Herein, we applied trio clinical exome sequencing (CES) in a patient presenting with undiagnosed skeletal disorder, minor facial abnormalities, and kidney hypoplasia; her parents were asymptomatic. Testing the proband and her parents led to the identification of a de novo mutation c.188C>T (p.Pro63Leu) in the MAFB gene, which is known to cause multicentric carpotarsal osteolysis syndrome (MCTO). The c.188C>T mutation lies in a hotspot amino acid stretch within the transactivation domain of MAFB, which is a negative regulator of RANKL-induced osteoclastogenesis. MCTO is an extremely rare autosomal dominant (AD) disorder that typically arises spontaneously and causes carpotarsal osteolysis, often followed by nephropathy. To the best of our knowledge, this is the first study reporting genetically diagnosed MCTO in the Balkans