Comparison of the diagnostic accuracy of ischemia-modified albumin and echocardiography in patients with acute chest pain.

BACKGROUND: Several imaging tests and biomarkers have been proposed for the identification of patients with unstable angina among those presenting to the emergency department with acute chest pain. Preliminary data suggest that ischemia-modified albumin (IMA) may represent a potentially useful biomarker in these patients. OBJECTIVE: To compare IMA and echocardiography in excluding unstable angina in patients with acute chest pain. METHODS: Thirty-three patients (mean [± SD] age 59.8±10.8 years; 28 men) presenting to the emergency department with acute chest pain lasting <3 h suggestive of acute coronary syndrome, with normal or non-diagnostic electrocardiograms, and creatine kinase MB and troponin levels within the normal range, were included in the present study. RESULTS: After further diagnostic evaluation, five patients (15.2%) were diagnosed with unstable angina. The sensitivity, specificity, positive predictive value and negative predictive (NPV) value of echocardiography for diagnosing unstable angina was 60.0%, 89.3%, 50.0% and 92.6%, respectively. The area under the ROC curve for diagnosing unstable angina based on the serum IMA levels was 0.193 (95% CI 0.047 to 0.339; P<0.05). Based on ROC curve analysis, serum IMA levels ≥31.95 IU/mL yielded the optimal combination of sensitivity and specificity for diagnosing unstable angina. The sensitivity, specificity, positive predictive value and NPV of serum IMA levels ≥31.95 IU/mL for diagnosing unstable angina was 40.0%, 28.6%, 9.1% and 72.7%, respectively. CONCLUSIONS: Measurement of serum IMA levels appears to represent a useful tool for excluding unstable angina in patients presenting to the emergency department with acute chest pain. Moreover, IMA shows an NPV that is comparable with echocardiography.

A case of successful management with splenectomy of intractable ascites due to congenital dyserythropoietic anemia type II-induced cirrhosis.

The congenital dyserythropoietic anemias comprise a group of rare hereditary disorders of erythropoiesis, characterized by ineffective erythropoiesis as the predominant mechanism of anemia and by characteristic morphological aberrations of the majority of erythroblasts in the bone marrow. Congenital dyserythropoietic anemia type II is the most frequent type. All types of congenital dyserythropoietic anemias distinctly share a high incidence of iron loading. Iron accumulation occurs even in untransfused patients and can result in heart failure and liver cirrhosis. We have reported about a patient who presented with liver cirrhosis and intractable ascites caused by congenital dyserythropoietic anemia type II. Her clinical course was further complicated by the development of autoimmune hemolytic anemia. Splenectomy was eventually performed which achieved complete resolution of ascites, increase of hemoglobin concentration and abrogation of transfusion requirements.

Novel approaches for medication compliance and effectiveness analysis and support in cardiovascular disease patients.

HeartCycle is an integrated project aiming to provide a disease management solution for cardiovascular disease patients, by developing technologies, algorithms to interpret data and services to facilitate the remote management of patients at home. In this paper an overview of part of the algorithmic work package, oriented at motivating the patients to be compliant to treatment regimes and to adopt a beneficial lifestyle, will be given. A concept allowing further education of the patient on the effect of medication on their vital signs, as well as the prediction of medication effect and a possible way to check compliance using vital signs measurements will be presented.

Seasonal variation in the occurrence of stroke in Northern Greece: a 10 year study in 8204 patients.

OBJECTIVE: The effect of seasonal variation on the occurrence of stroke remains controversial. The objective of this study was to determine whether there is a seasonal variation in the occurrence of stroke in Northern Greece. METHODS: We recorded the seasonal stroke rates over a 10 year period (from January 1997 to December 2006) in 8204 patients in Northern Greece. The findings were analysed separately for ischemic stroke (IS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and transient ischemic attack (TIA). RESULTS: In patients with IS, there was a significant seasonal variation (p<0.001), with the peak incidence in spring (8.4% above average) and the lowest rate in summer (10.4% below average). There was no significant seasonal variation in the occurrence of the other stroke subtypes (ICH, SAH and TIA) when they were considered individually. DISCUSSION: The seasonal effect on stroke incidence needs to be defined so as to improve the provision of preventive measures.