Cardioprotective Heme Oxygenase-1-PGC1α Signaling in Epicardial Fat Attenuates Cardiovascular Risk in Humans as in Obese Mice.

OBJECTIVE: This study investigated whether levels of signaling pathways and inflammatory adipokines in epicardial fat regulate cardiovascular risks in humans and mice. METHODS: Epicardial fat was obtained from the hearts of patients with heart failure requiring coronary artery bypass surgery, and signaling pathways were compared with visceral fat. The genetic profile of epicardial and visceral fat from humans was also compared with genetic profiles of epicardial and visceral fat in obese mice. Left ventricular (LV) fractional shortening was measured in obese mice before and after treatment with inducers of mitochondrial signaling heme oxygenase 1 (HO-1)-peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1α). An RNA array/heat map on 88 genes that regulate adipose tissue function was used to identify a target gene network. RESULTS: Human epicardial fat gene profiling showed decreased levels of mitochondrial signaling of HO-1-PGC1α and increased levels of the inflammatory adipokine CCN family member 3. Similar observations were seen in epicardial and visceral fat of obese mice. Improvement in LV function was linked to the increase in mitochondrial signaling in epicardial fat of obese mice. CONCLUSIONS: There is a link between cardiac ectopic fat deposition and cardiac function in humans that is similar to that which is described in obese mice. An increase of mitochondrial signaling pathway gene expression in epicardial fat attenuates cardiometabolic dysfunction and LV fractional shortening in obese mice.

Acute myocardial infarction in the setting of left bundle branch block: Chapman's sign.

Acute myocardial infarction (AMI) diagnosis in patients with pre-existing left bundle branch block (LBBB) can be difficult. Undiagnosed or delayed diagnosis of AMI in these patients can put them at risk of having shock, mechanical complications, and death. We present a case of 77-year-old Caucasian male with a known LBBB and coronary artery bypass surgery for coronary artery disease who presented to the emergency department with a chief complaint of chest pain and shortness of breath. The patient had recurrent chest pain despite using aspirin, nitroglycerine, and morphine. An electrocardiogram (ECG) showed a new notch in the upslope of the R wave in leads I, AVL that indicated a positive Chapman's sign. Troponin levels were initially normal, but serial troponin showed elevated enzyme giving evidence of acute coronary syndrome (ACS). The patient was started on heparin drip and underwent subsequent coronary catheterization. Physicians should be aware of Chapman's sign on ECG in patients presenting with chest pain who have baseline LBBB as it might represent myocardial ischemia and warrant emergent treatment for ACS.

Arterial embolism in a patient with pulmonary embolism and patent foramen ovale.

Paradoxical embolization is an uncommon but devastating complication of pulmonary embolism and continues to be frequently missed. Although the prevalence of patent foramen ovale is 25% to 30%, the risk of paradoxical embolism is <2% of all arterial ischemia. Paradoxical embolism is infrequent but can involve almost any artery of the body. Here, we present a case of a 65-year-old woman with paradoxical systemic arterial embolism secondary to deep venous thrombosis and pulmonary embolism in the presence of patent foramen ovale. High suspicion for paradoxical embolism is needed in the event of unexplained arterial occlusion. Awareness of this complication with prompt recognition and treatment could serve to preclude significant disability and death.

Smoking behaviour and patterns among university students during the Syrian crisis.

BACKGROUND: The ongoing Syrian war has resulted in many changes in the social and economic life of Syrians. To date, no study has documented the relationship between smoking behaviour and the war. AIM: To determine the prevalence of cigarette smoking among university students during the crisis in Damascus, Syrian Arab Republic, and the impact of the war on smoking behaviour. METHODS: We conducted an anonymous online cross-sectional survey of 1027 undergraduate students from all years and colleges at Damascus University. RESULTS: The overall prevalence of tobacco smoking was 24.73% for cigarettes and 30.4% for waterpipe. Prevalence of cigarette smoking was significantly higher in men, non-health profession students, and in students living away from their families. There was no significant difference in prevalence of smoking cigarettes when comparing students according to their origin (urban vs rural), year of study, and change of residence due to war. War was associated with a significant increase in mean number of cigarettes smoked daily, and 53.1% of smokers reported that the number of cigarettes consumed per day had increased since the beginning of the war. CONCLUSIONS: Increased smoking is an additional health concern in areas of conflict and may require special consideration and efforts by public health authorities.

Smoking behaviour and patterns among university students during the Syrian crisis

الخلفية: أسفرت الحرب الدائرة في سوريا عن كثير من التغييرات في الحياة الاجتماعية والاقتصادية للسوريين. ولم توثّق، حتى تاريخه، أي دراسةللعلاقة بين سلوك التدخين والحرب.الهدف: تحديد مدى انتشار تدخين السجائر بين الطلاب الجامعيين خلال الأزمة في دمشق، الجمهورية العربية السورية ، وأثر الحرب على سلوكالتدخين.طرق البحث: أجرينا مسحاً مقطعياً مغْفل الأسماء على الإنترنت لما مجموعه 1027 طالباً في المرحلة الجامعية من جميع السنوات الدراسية والكلياتفي جامعة دمشق.النتائج: بلغ المستوى العام لانتشار تدخين التبغ 24.73 % بالنسبة لتدخين السجائر، و 30.4 % بالنسبة لتدخين الشيشة )الأرجيلة(. وتبيّ أنمستوى انتشار تدخين السجائر أعلى بكثير بين الرجال وطلاب غير المهن الطبية والطلاب المغتربين عن أسرهم. ولم تظهر أي اختلافات كبيرة فيمستوى انتشار تدخين السجائر عند مقارنة الطلاب وفقاً لمكان نشأتهم )ريفيين مقابل حضريين(، وسنة الدراسة، وتغيير محل الإقامة بسبب الحرب.وتبيّ ارتباط الحرب بزيادة كبيرة في متوسط عدد السجائر المدخّنة يومياً، وأفاد 53.1 % من المدخنين بزيادة عدد السجائر التي يستهلكونها يومياً منذاندلاع الحرب. وتمثل زيادة التدخين شاغلاً صحياً إضافياً في مناطق النزاع وقد تتطلب اهتماماً وجهوداً خاصة من جانب السلطات المعنية بالصحةالعمومية.الاستنتاجات: تمثل زيادة معدلات التدخين شاغلاً صحياً إضافياً في مناطق النزاع وقد تتطلب اهتماماً وجهوداً خاصةً من جانب السلطات المعنيةبالصحة العامة

Background: The ongoing Syrian war has resulted in many changes in the social and economic life of Syrians. To date, no study has documented the relationship between smoking behaviour and the war. Aim: To determine the prevalence of cigarette smoking among university students during the crisis in Damascus, Syrian Arab Republic, and the impact of the war on smoking behaviour. Methods: We conducted an anonymous online cross-sectional survey of 1027 undergraduate students from all years and colleges at Damascus University. Results: The overall prevalence of tobacco smoking was 24.73% for cigarettes and 30.4% for waterpipe. Prevalence of cigarette smoking was significantly higher in men, non-health profession students, and in students living away from their families. There was no significant difference in prevalence of smoking cigarettes when comparing students according to their origin [urban vs rural], year of study, and change of residence due to war. War was associated with a significant increase in mean number of cigarettes smoked daily, and 53.1% of smokers reported that the number of cigarettes consumed per day had increased since the beginning of the war. Conclusions: Increased smoking is an additional health concern in areas of conflict and may require special consideration and efforts by public health authorities

Contexte : La guerre qui sévit en République arabe syrienne a conduit à de nombreuses modifications dans la vie sociale et économique des Syriens. À ce jour, aucune étude ne documente la relation entre les comportements tabagiques et la guerre. Objectif : Déterminer la prévalence de la consommation de cigarettes parmi les étudiants à l'université pendant la crise à Damas, en République arabe syrienne, et l'impact de la guerre sur les comportements tabagiques. Méthodes : Nous avons organisé une enquête en ligne transversale et anonyme sur 1027 étudiants de premier cycle de toutes les années et dans toutes les facultés de l'Université de Damas. Résultats : La prévalence globale du tabagisme était de 24,73 % pour la cigarette, et de 30,4 % pour la pipe à eau. La prévalence de la consommation de cigarettes était significativement plus élevée chez les hommes, les étudiants d'autres filières que celle de la santé, et chez les étudiants ne vivant plus dans leurs familles. Aucune différence significative n'a été observée pour la prévalence de la consommation de cigarettes en fonction de l'origine des étudiants [urbaine ou rurale], de leur année d'étude, ou de leur changement de résidence du fait de la guerre. La guerre était associée à une augmentation significative du nombre moyen de cigarettes consommées quotidiennement, et 53,1 % des fumeurs rapportaient que le nombre de cigarettes qu'ils consommaient par jour avait augmenté depuis le début de la guerre. Conclusions : L'augmentation du tabagisme est une préoccupation sanitaire supplémentaire dans les zones de conflit, et requiert une attention spéciale ainsi que des actions de la part des autorités de santé publique

Self-reported study habits for enhancing medical students' performance in the National Medical Unified Examination.

BACKGROUND: The National Medical Unified Examination (NMUE) is currently required for graduation, joining postgraduate medical training, and practicing medicine in Syria. OBJECTIVE: To investigate self-reported study habits that correlate with high performance on the NMUE. METHODS: First through 3(rd) year residents at the three main hospitals in Damascus, Syria, were asked to complete a retrospective cross-sectional survey investigating their study habits and previous scores. RESULTS: Significantly higher score was associated with >15 study h/day and allocating 1-40% of study time for practicing questions. Mean NMUE score was not significantly different in relation to preparation months for examination or for those who reported spending all their time studying alone compared with spending any amount of time in a group setting. Scores of 231-240 on the Syrian scientific high school exam correlated with significantly higher NMUE performance compared with fewer scores, except scores of 221-230. For every 10 point increase in medical school cumulative grades, the NMUE score increased 3.6 (95% confidence interval 2.5-4.8). CONCLUSION: The NMUE score was significantly affected by hours spent studying per day, number of practice questions completed, percentage of study time allocated for doing questions, Syrian scientific high school exam scores, and the cumulative medical school class grades. It was not significantly affected by preparation months or studying in a group setting. More studies are needed to further describe and investigate the factors that might affect performance in the NMUE.