Type D Personality and Myocardial Infarction: A Case-Control Study.

BACKGROUND: Coronary heart disease (CHD) is an impending global pandemic in developed countries as well as developing countries and economies in transition, such as India. A significant increase in the incidence of myocardial infarction (MI), one of the most common types of CHD, is being reported in India, and the incidence and severity of the disease are more among the youth in Kerala. Studies assessing the association between psychological factors and MI are few in India. METHODS: We adopted a case-control study design. A total of 150 cases (with MI) and 150 controls (without MI and matched for age and gender) from a tertiary care hospital in Trivandrum, Kerala, India, were selected using convenient sampling method, between September 2016 and August 2017. RESULTS: As compared to 33.3% of the controls, 50.7% of patients with MI had type D personality characteristics. Multivariate logistic regression analysis after adjusting for the confounders indicated a positive and statistically significant association between type D personality and MI: OR = 4.14, 95% CI = 2.19-8.85, P = 0.003. CONCLUSION: Type D personality is associated with MI.

Preoperative needle biopsy as a potential quality measure in breast cancer surgery.

Preoperative needle diagnosis (PND) is being considered as a quality measure in breast cancer surgery. This criterion has not been thoroughly evaluated in the literature. The purpose of this study is to assess ease of access to these data and rate of compliance in a tertiary care center. We retrospectively reviewed all our breast cancer cases between July 2006 and July 2007. The data were queried for preoperative needle diagnosis. Charts of patients who did not meet this criterion were reviewed to determine the cause for noncompliance. In the year 2006-2007, 396 breast cancer operations were performed (age range 19-96 years). Of 396 cases, 43 (11%) underwent a surgical procedure without diagnosis of cancer. In 19/396 (5%) cases PND was not feasible due to technical reasons. In 22/396 (5.5%) cases, preoperative needle biopsy did not render a malignant diagnosis: the pathology report was discordant with the radiological or clinical findings, or the needle biopsy result necessitated surgical resection. In only 2 of 396 cases (0.5%) was PND not attempted: an 80-year-old woman with a radiologically and clinically malignant mass, and a 43-year-old woman with a clinical and ultrasonographic suggestion of fibroadenoma. We conclude that data for preoperative needle diagnosis were easily accessible in our center. If this criterion is used as a quality measure in breast cancer surgery, 100% compliance may not be an achievable goal.

The effects of potassium channel agonists, cromakalim and adenosine, in diabetic rat hearts

INTRODUCTION: This study was designed to look at ATP sensitive potassium channels (KATP-sc) in diabetic male Sprague-Dawley rat hearts. Diabetes mellitus was induced using streptozocin (ip). KATP-SC can be found in pancreatic B-cells, cardiac muscle, skeletal muscle, neurones, hypothalamus and smooth muscle. Cromakalim and adenosine were used to construct concentration-response curves. These drugs are KATP-SC openers that cause shortening of action potential duration and hyperpolarisation. This is a novel study as there is a sparsity of information on the effect of KATP-SC openers on the hearts of diabetic animals. We therefore hypothesised that cromakalim and adenosine may have both an effect on the electrical activity as well as the contractility in the diabetic myocardium. METHODS: Male Sprague-Dawley rats (150-250 gm) were treated with streptozotocin (STZ) (60 mg/Kg i.p.). All animals were kept under identical living conditions and allowed free access to food and water for 1 week. Animals were then sacrificed after being anaesthetised with 60 mg/Kg pentobarbital containing 1000 Units/ml heparin. Hearts were being rapidly excised, placed in 4 degrees C. Krebs-Henseleit buffer and mounted in a Langendorff system. Concentration-response curves were constructed for cromakalim (0.01nM-0.1uM), and adenosine (0.1uM-100uM). Parameters measured were heart rate (HR), P-R and QRS intervals, systolic pressure (SP), diastolic pressure (DP) and developed pressure (Dev. Pre.). RESULTS: The results found for cromakalim in diabetic rats and adenosine in normal rats mirrored what has been found in previous studies for these drugs in non-diabetic animals, namely, a decrease in HR, an increase in P-R and QRS and a decrease in SP and Dev. Pre. However, adenosine in diabetic rats showed some unexpected results such as a decrease in P-R, and an increase in SP and Dev. Pre. It is possible that the diabetic state interferes significantly with the actions of adenosine but not as significantly with those of cromakalim. Conclusion: The results indicate that adenosine may not be cardioprotective in diabetic animals. This conclusion may be drawn from the fact that P-R interval decreased with increasing concentrations of adenosine. This may lead to the production of arrhythmias such as life threatening ventricular tachycardia or fibrillation (AU)

Hemopump left ventricular support in the peripartum cardiomyopathy patient.

The Hemopump temporary cardiac assist system underwent clinical trials within the United States from 1988 to 1991. Use of the device proved life-saving in providing left ventricular assistance for failing hearts. Presentation of a case study demonstrating the effects of Hemopump support is provided along with a detailed nursing care plan. A brief discussion of peripartum cardiomyopathy is also included.