ObjectiveThe goal of this study is to evaluate the long-term outcomes of patients with takotsubo syndrome and assess factors associated with death or recurrence.MethodsThis is a retrospective population-based cohort study of consecutive patients who presented to an integrated health system in Southern California with takotsubo syndrome between 2006 and 2016. Medical records were manually reviewed to confirm diagnosis and to identify predisposing factors, medication treatment and long-term outcomes. Factors associated with death or recurrent takotsubo syndrome were tested using Cox regression models.ResultsBetween 2006 and 2016, there were 519 patients with a confirmed diagnosis of takotsubo syndrome. Patients were followed for 5.2 years (IQR 3.0–7.2). During the follow-up period, 39 (7.5%) had recurrent takotsubo syndrome and 84 (16.2%) died. In multivariate modelling, factors associated with higher risk of recurrence or death were age (HR 1.56 per 10-year increase, 95% CI 1.29 to 1.87), male sex (HR 2.52, 95% CI 1.38 to 4.60), diabetes (HR 1.6, 95% CI 1.06 to 2.43), pulmonary disease (HR 2.0, 95% CI 1.37 to 2.91) and chronic kidney disease (HR 1.58, 95% CI 1.01 to 2.47). Treatment with beta-blockers were associated with lower risk of recurrence or death (HR 0.46, 95% CI 0.29 to 0.72). No association was observed between treatment with ACE inhibitors or angiotensin-receptor blockers and recurrence or death (HR 0.92, 95% CI 0.59 to 1.42).ConclusionsRecurrent takotsubo syndrome occurred in a minor subset of patients. Treatment with beta-blocker was associated with higher event-free survival.

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Objective:The cardioprotective effects of activation of the A2A adenosine receptor (A2AAR) on ischemia/reperfusion injury in the heart remain controversial. We investigated whether ATL 313, a new selective A2AAR agonist, could reduce myocardial infarct size in a rat ischemia/reperfusion model.Methods:Sprague-Dawley rats were subjected to a 40 minute occlusion of the left coronary artery followed by 3 hours reperfusion. Hemodynamics were monitored during the procedure. The rats were divided into 3 groups: Group 1 received continuous intravenous infusion of saline given 10 min prior to ischemia and throughout reperfusion (n=8); Group 2 received continuous intravenous infusion of 10 ng/kg/min of ATL 313 given 10 min prior to ischemia, and throughout reperfusion (n=8); and group 3 received an intravenous bolus of ATL 313 (900 ng/Kg body weight) given 10 min prior to ischemia, and continuous intravenous infusion of 10 ng/kg/min of ATL 313 started at 20 min after ischemia and throughout reperfusion (n=8). After euthanasia of the rats, the hearts were harvested for the assessment of risk zone and zone of necrosis of the left ventricle.Results:The percentage of risk zone in the left ventricle was similar among group 1 (47 ± 3.7 %), group 2 (41.5 ± 4.2 %) and group 3 (42.4 ± 3.8 %). However, the infarct size, expressed as a percentage of the risk zone, was significantly decreased in group 3 (30.6 ± 5 %, P=0.01) compared with group 1 (53.8 ± 6.2 %) and group 2 (52.1 ± 4.8 %). In group 3, the bolus injection of ATL 313 caused a reduction in blood pressure during the procedure, and decreased heart rate and LV ±dp/dt before coronary artery occlusion; but increased LV +dp/dt at the end of reperfusion compared to the other 2 groups.Conclusion:A2AAR agonist ATL313 significantly reduced infarct size and improved LV contractility at the end of reperfusion assessed by LV dp/dt at a dose of 900 ng/Kg. The mechanisms for the observed cardioprotection effect of ATL313 remain to be determined.

In gynecologic oncology, surgical and adjuvant therapy rely heavily on correct pathologic diagnosis. Thus, in-house review of outside pathologic slides and specimens has become routine within large tertiary referral centers. We sought to determine the impact of outside pathologic slide review on gynecologic oncology patient care and treatment. Gynecologic oncology cases between January 2007 and January 2012 were evaluated. Clinical information was gathered from comprehensive chart reviews and reports created after multidisciplinary treatment planning conferences. Discrepancies in diagnosis were identified as major if they resulted in a treatment alteration and minor if they did not impact care. Data were analyzed using descriptive statistics and the Fisher exact test. A total of 279 cases were identified and reviewed as part of the study--126 (45.2%) biopsy/cytology specimens and 153 (54.8%) surgical excision specimens. Minor discrepancies were noted in 25 reviewed cases (9%) and major discrepancies in 19 cases (6.8%). Among those patients in whom management was changed based on specialized pathologic review, 50% underwent additional surgery, 16% had their surgical plan modified, and 16% received adjuvant treatment or had their adjuvant treatment modified. In 235 cases (84.2%), institutional rereview of the outside slides/specimens did not result in a change in diagnosis. Diagnostic discrepancies were evenly distributed across all primary sites evaluated. The cost of outside pathologic review was estimated at $2,936 US dollars per change in diagnosis. Mandatory slide review in gynecologic oncology is important and results in diagnostic changes in approximately 16% of cases, with 43% of those changes impacting treatment.

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Qualitative methods involving pediatric patients with diverse CFCs and their parents in the item development process support the content validity for this bilingual and bicultural HRQoL instrument. The items developed in this study will now undergo psychometric testing in national multisite studies for validation.

Background and Objectives: Kapalbhati is among one of the cleansing act (shatkarma) in yogic philosophy. It is one of the popular Pranayama which has several benefits. It is highly recommended for those who have to do great deal of study and need a clean, clear mind. This study was conducted among nursing students at Janaki medical college, Janakpur, Nepal.Material and Methods: This analytical study was conducted among PCL Nursing students of Janaki Medical College, Janakpurdham, Nepal. Total 40 nursing student who gave consent and performed Kapalbhati correctly were included in the study. A detailed demographic profile with a structured questionnaire and observational checklist was filled for data collection. HR, SBP, DBP were the cardiac parameters taken. Those parameters were taken before, during, immediately after and after 1 minute, 2 minutes, 3 minutes and 5 minutes Pranayama. The data were entered in SPSS and Statistical analysis was done using version 20.Results: As in usual exercises, the HR, SBP and DBP increases significantly during Kapalbhati session but immediate post effect was surprisingly significantly fall in those parameters when compared with the value during exercises. The basal (pre-Kapalbhati) mean HR, SBP and DBP were 88.25 ± 9.02, 111.43 ± 11.28 and 73.9 ± 7.70 which increases upto 133.58 ± 35.70, 89.63 ± 23.31 and 118.55 ± 19.08 respectively during exercises and fall immediately after exercises value being 114.48 ± 21.94, 76.43 ± 15.34 and 88.6 ± 17.25 respectively.Conclusion: There is no significant difference between pre and post value of HR, SBP and DBP as in other study. There is significant rise between Pre-value and during-value of all parameters and significant fall of all parameters if compared between during-value and post-value.Janaki Medical College Journal of Medical Sciences (2015) Vol. 3 (2): 43-49

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