Objective: The aim of the study was to identify predictors of heart-focused anxiety in patients with heart failure. A better understanding of such predictors may help in detecting the comorbidity ...underlying heart-focused anxiety and identifying patients who need psychological help. Methods: In order to account for multiple sources of heart-focused anxiety, we included psychological, lifestyle, and medical/laboratory predictors. The study involved 148 patients, of whom 74 had a leading diagnosis of worsening heart failure and were hospitalized during the COVID-19 epidemic. A second group of 74 patients suffering from cardiovascular diseases without a diagnosis of acute heart failure, were examined in various out-patient cardiology clinics. The sample consisted of 37.8% females and 62.2% males, with an average age of 63.35 years. The patients completed the Cardiac Anxiety Questionnaire, the Generalized Anxiety Disorder scale, the Patient Health Questionnaire, and the Intolerance of Uncertainty Scale. Results: Patients with heart failure with higher levels of depression and intolerance of uncertainty had higher overall levels of heart-focused anxiety, higher levels of fear about chest and heart sensations. Older patients with higher levels of depression had higher levels of activity avoidance, especially activities believed to elicit cardiac symptoms. Cardiac patients with higher level of anxiety and with anaemia as comorbidity had higher levels of heart-focused attention and monitoring of cardiac activity. Conclusion: In patients with heart failure, the presence of heart-focused anxiety significantly reduces the quality of life, leads to avoidant behaviours, and is associated with anxiety and depressive symptoms. These patients are more likely to seek medical help and specialist services, but the need for psychological help is very rarely recognized.
Aim To identify the risk factors of a repeated episode of severe
febrile neutropenia (FN) and to build an accurate and
easy-to-use predictive model.
Methods This single-center retrospective cohort ...study
conducted at the Clinical Hospital Center Children’s Hospital
Rijeka from January 1, 2008 to December 31, 2016
included pediatric patients with malignant diseases who
experienced at least one FN episode. The association of
the second severe FN episode appearance with relevant
clinical and laboratory data was analyzed by logistic regression Results Out of 45 patients with one FN episode, 25 (56%)
had severe FN and 11 (24%) had repeated severe FNs. Significant
predictors of a repeated severe FN episode were
the first FN episode duration of 9 or more days and red
blood cells ≤3.0 × 1012/L. The predictive model constructed
by crossing these two indicators had the accuracy of
87% (95% confidence interval CI 73%-94%), sensitivity
of 82% (95% CI 53%-97%), and specificity of 88% (95% CI
79%-93%).
Conclusion The first FN episode duration and anemia are
significantly associated with the risk for severe FN re-occurrence.
These factors may be useful in the identification of
children with cancer who are at high risk for adverse outcome
at any future fever onset and may benefit from early
intensive treatment.
Abstract Chronic heart failure (CHF) is a clinical syndrome resulting from interaction of different structure and functional disturbances leading to decreased heart ability to ensure adequate supply ...of oxygenized blood to tissues and ensure adequate metabolic needs in the cases of normal or increased afterload. Endothelial dysfunction (ED) is a pathological condition characterized by general imbalance of all major endothelial mechanisms with key role in development and progression of atherosclerotic disease. ED has been associated with most cardiovascular risk factors. There is increasing interest in assessing endothelial function non-invasively, leading to development and evaluation of new diagnostic methods. We suggest that MRI is safe and reliable test that offers important advantages over ultrasound for the detection of ED and monitoring of the expected therapeutic effect. We believe that ED plays a pivotal role in chronic heart failure development and progression, regardless of its etiology, and that MRI should be introduced as a “gold standard” in diagnostic procedure and treatment.
Nove europske smjernice za zatajivanje srca objavljene u svibnju 2016. donose važne novosti u odnosu prema prethodnom izdanju iz 2012. Prema ejekcijskoj frakciji lijevog ventrikula, bolesnici sa ...zatajivanjem srca sada se dijele u tri, a ne u dvije skupine. Osim već poznate kategorije zatajivanja srca s reduciranom i one s očuvanom sistoličkom funkcijom sada je uvedena nova grupa koja obuhvaća bolesnike s ejekcijskom frakcijom srednjeg raspona. Prevencija razvoja simptoma i znakova zatajivanja srca, kao i prevencija smrtnog ishoda prije pojave ovih kliničkih manifestacija, novosti su kojima prijašnje smjernice nisu pridavale važnost. Uz jasan algoritam za dijagnosticiranje zatajivanja srca napretke nalazimo i u području terapije. Ključna novìna je uvođenje potpuno novog lijeka: LCZ696 ili sakubitrila/valsartana. U ovim smjernicama promijenjen je i algoritam za resinkronizacijsku terapiju, a znatno su obogaćeni i sadržaji vezani uz akutno zatajivanje srca.
Breast cancer (BC) is the most common malignancy in women.
To assess the impact of HER2 status on axillary lymph node (ALN) involvement in patients with invasive ductal carcinoma of no special type ...(IDC-NST) both at diagnosis and during the 4-year postoperative period.
We retrospectively included 375 women with an early clinical stage of non-luminal IDC-NST who between 2007 and 2013 underwent breast surgery at a clinical hospital. They were divided into phenotype-based groups: HR+HER2-, HR+HER2+, HR-HER2+ and HR-HER2-. Only patients with sentinel lymph node (SLN) macrometastases underwent ALN dissection. If > 3 ALNs were positive, radiotherapy was delivered. All patients were treated with chemotherapy, HER2+ BC patients received trastuzumab, and hormone receptor (HR)-positive BC patients received hormonal therapy.
Larger tumor size, higher grade, HR+, HER2+ status, and lymphovascular invasion (LVI) were predictive for ALN metastases at diagnosis. The poorest overall, disease-free, and distant recurrence-free survival (OS, DFS, DRFS) were found in the HR-HER2- group, while the poorest locoregional recurrence-free survival (LRFS) was observed in HR-HER2+ and HR-HER2- groups. HER2 status was not predictor of survival.
HER2+ status was predictive for ALN involvement at diagnosis but had no effect on 4-year LRFS in these patients.
Endothelial dysfunction (ED) is a syndrome characterized by impairment of endothelium dependent vasodilatation,altered anticoagulant, anti-inflammatory and vascular remodeling properties. The ...dysfunctionalendothelium represents an interim stage between risk factors and atherosclerosis, and is activelyinvolved in the occurrence and development of the majority of cardiovascular diseases. As ED is reversibleand has significant prognostic impacts, there is a growing body of evidence supporting the need forED assessment to become a part of the routine medical practice, however there are still no appropriatemethods available to introduce it. The purpose of this paper is to provide fundamental principles in vascularbiology for clinical cardiologists and to propose some priorities for the future research activities.
Summary Many diseases, different nutritional, metabolic and hormonal changes, ageing and drugs can alter cognitive functions. Anemia via cerebral hypoxia and other possible mechanisms has been ...suggested to have a great influence on cognition. Iron deficiency anemia, the most common form of anemia, has been suggested to result in cognitive deterioration and alteration of neurological functions. Previous studies resulted in significant discrepancies considering correlation between anemia and cognitive achievement mainly because different or not sensitive enough tests used to measure cognition. We suggest a significant influence of iron deficiency anemia on dynamic properties and functional features of the central nervous system activity. Cognitive achievement is strongly related to hemoglobin level and could be expected in all patients. Higher hemoglobin level results in better CNS function. As a first step in confirming or refuting our hypotheses we suggest standardization of the method used to measure cognition, such as a very sensitive apparatus like Complex reactiometer Drenovac (CRD).
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