Time Is Life: Golden Ten Minutes on Scene-EuReCa_Serbia 2014-2023.

Background and Objectives: This study analyzed the frequency of factors influencing the course and outcomes of out-of-hospital cardiac arrest (OHCA) in Serbia and the prediction of pre-hospital outcomes and survival. Materials and Methods: Data were collected during the period from 1 October 2014, to 31 September 2023, according to the protocol of the EuReCa_One study (clinical trial ID number NCT02236819). Results: Overall 9303 OHCA events were registered with a median age of 71 (IQR 61-81) years and 59.7% of them being males. The annual OHCA incidence was 85.60 ± 20.73/100,000. Within all bystander-witnessed cases, bystander-initiated cardiopulmonary resuscitation in 15.3%. Within the resuscitation-initiated group, return-of-spontaneous circulation (ROSC) on scene (any ROSC) was present in 1037/4053 cases (25.6%) and ROSC on admission to the nearest hospital in 792/4053 cases (19.5%), while 201/4053 patients survived to hospital discharge (5.0%). Predictive potential on pre-hospital outcomes was shown by several factors. Also, of all patients having any ROSC, 89.2% were admitted to the hospital alive. The probability of any ROSC dropped below 50% after 17 min passed after the emergency call and 10 min after the EMS scene arrival. These time intervals were significantly associated with survival to hospital discharge (p < 0.001). Five-minute time intervals between both emergency calls and any ROSC and EMS scene arrival and any ROSC also had a significant predictive potential for survival to hospital discharge (p < 0.001, HR 1.573, 95% CI 1.303-1.899 and p = 0.017, HR 1.184, 95% CI 1.030-1.361, respectively). Conclusions: A 10-min time on scene to any ROSC is a crucial time-related factor for achieving any ROSC, and indirectly admission ROSC and survival to hospital discharge, and represents a golden time interval spent on scene in the management of OHCA patients. A similar effect has a time interval of 17 min from an emergency call. Further investigations should be focused on factors influencing these time intervals, especially time spent on scene.

Galectin-3 as a Prognostic Biomarker in Patients with First Acute Myocardial Infarction without Heart Failure.

BACKGROUND: Galectin-3 (Gal-3) is a biomarker involved in a wide range of diseases including cardiac remodeling following acute myocardial infarction (AMI). Identification of prognostic markers in patients with AMI can guide strategies towards improved survival and quality of life. METHODS: Our study included 59 patients with AMI and a preserved ejection fraction. We determined the Gal-3 plasma concentration within 24 h of chest pain onset from the aortic root, femoral/radial artery, coronary sinus and cubital vein. Major adverse cardiovascular events (MACEs) were evaluated at six months follow-up. RESULTS: MACE at six months post-AMI was recorded in 20 patients (34%). The Gal-3 plasma concentration from the aortic root and the femoral/radial artery were independent predictors of MACE at six months follow-up after the first AMI (OR 1.228; 95%CI: 1.011-1.491; p = 0.038; OR 3.438; 95%CI: 1.275-9.265; p = 0.015). ROC analysis identifies the Gal-3 plasma concentration from the aortic root as a better predictor of MACE or death (cut-off ≥ 10.86 ng/mL; AUC 0.858; 95%CI: 0.744-0.973; p < 0.001) than Gal-3 plasma concentration from the femoral/radial artery (cut-off ≥ 10.18 ng/mL; AUC 0.742; 95%CI: 0.596-0.888; p = 0.006). CONCLUSION: the Gal-3 plasma concentration in patients with AMI determined during coronary angiography, especially from the aortic root, within 24 h after chest pain onset is a valuable biomarker of prognosis at six months follow-up.

Multisystem inflammatory syndrome in a young adult successfully treated with plasmapheresis, immunoglobulins, and corticosteroids: a case report.

A novel condition named multisystem inflammatory syndrome has raised the alarm worldwide and is leading to severe illness and long-term effects in the post-COVID era. This condition includes infection with fever, abdominal symptoms, acute cardiac injury, and shock. It has similarities with severe forms of Kawasaki disease (KD). In this study, we present a case of a 20-year-old male patient with multisystem inflammatory syndrome associated with COVID-19 infection who was successfully treated with plasmapheresis, immunoglobulins, and steroids for 4 h/day without heparinization or ultrafiltration. Plasmapheresis represents a therapeutic option for KD in patients with all other therapeutic strategies that have failed. However, there is no evidence from controlled clinical trials confirming this option. In our case, plasmapheresis was beneficial in stabilizing and improving the patient's clinical condition. Given the pathophysiological and therapeutic similarities between KD and multisystem inflammatory syndrome, it could be considered a therapeutic option.

Association of coronary ischemia estimated by fractional flow reserve and psychological characteristics of patients.

INTRODUCTION: Psychological characteristics of patients, depression, stress and anxiety are recognized as important confounding risk factors for ischemic heart disease. However, the impact of psychological characteristics on coronary ischemia and vice versa remain poorly understood. AIM: To demonstrate the interplay of psychological characteristics, depression, stress and anxiety with coronary ischemia estimated with fractional flow reserve (FFR). MATERIAL AND METHODS: From 2014 to 2016, 147 patients who were planned for FFR measurement were included in this study. Psychological characteristics of patients were evaluated using the Depression, Anxiety and Stress Scale 21 items (DASS 21) self-report questionnaire. RESULTS: Comparing the FFR ischemic vs. FFR non-ischemic groups, a significant difference was observed regarding results achieved for the depression, anxiety and stress scales. Multivariate logistic regression analysis was used to model the correlation between FFR and the DAS scale. It was clear, when controlling for previous myocardial infarction, that FFR was significant in all analyses. However, when the Canadian Cardiovascular Society grading of angina pectoris (CCS) class was entered in the model, FFR was not a significant predictor of anxiety, but was significant in other analysis. CONCLUSIONS: Higher degrees of the psychological characteristics depression, stress and anxiety were observed in the group of patients with coronary ischemia, corresponding to lower fractional flow values.

Knuckle technique guided by intravascular ultrasound for in-stent restenosis occlusion treatment.

One of the rarest lesions is in-stent restenosis chronic total occlusion (CTO). Limited data suggest that the treatment success rate is dependent on the possibility to cross into the lumen of an occluded stent, and the decision about what technique to use varies by operator preference. The knuckle technique is used to create a deliberate dissection plane in various CTO techniques. A guide wire is pushed until a complex loop is formed and advanced through the lesion. In this report we present a case where a knuckle wire guided by intravascular ultrasound control is used to penetrate the distal cap in an in-stent restenosis CTO lesion.

Novel OCT flushing technique for complex scenarios: imaging during iatrogenic transient AV block induced by intracoronary adenosine.

We report the application of a novel optical coherence tomography (OCT) flushing technique where OCT run was performed during transient complete atrioventricular block induced by intracoronary bolus of adenosine. This technique may allow lower hydraulic force needed for contrast flush and reduce artifacts, with consequently improved OCT imaging in demanding clinical scenarios.

Coronary spasm that caused non-ST elevation myocardial infarction appeared in cath lab due to vasovagal reaction.

Coronary artery spasm is sometimes an unrecognized cause of myocardial ischemia. Myocardial ischemia is not always a product of fixed stenosis; it can also be induced by dynamic, transient stenosis. The angiogram represents the current state of vasculature at the time of examination and absence of stenosis does not mean disease absence. We present a case of right coronary artery spasm that caused non-ST elevation myocardial infarction and arrhythmias and was induced again in the cath lab due to vasovagal reaction.

Unusual suspect-coronary subclavian steal syndrome caused severe myocardial ischemia.

Coronary-subclavian steal syndrome represents a reversal of blood flow in left internal mammary artery. The most common cause of the syndrome is atherosclerotic disease in the ipsilateral, proximal subclavian artery. We present a case of 72 years old male, who developed severe anginal and neurological complaints three years after coronary artery bypass graft surgery(CABG).

Modulation of glucocorticoid receptor function and expression in adolescent moderate asthma.

BACKGROUND: Previous studies on adult asthmatics have shown that the disease is associated with alterations in glucocorticoid receptor (GR) function. OBJECTIVES: The aim of the present study was to examine GR functional properties in adolescent asthma of different severity. Therefore, we determined GR hormone binding parameters, e.g. the equilibrium dissociation constant (K(d)) and the number of binding sites (B(max)), as well as the level of receptor expression in mononuclear cells isolated from the peripheral blood of patients with mild/moderate persistent asthma. METHODS: The GR hormone binding activity was assessed by whole-cell binding assay, while receptor expression was evaluated by quantitative Western blotting. RESULTS: In peripheral blood mononuclear cells (PBMCs) of patients suffering from moderate asthma, the GR displayed higher K(d) and B(max) values (78.0 +/- 19.5 nM and 11,715 +/- 1,952 sites/cell, respectively; n = 17) in comparison to healthy subjects (23.8 +/- 7.7 nM and 6,124 +/- 1,369 sites/cell; n = 12) and mild asthmatics (22.4 +/- 8.0 nM and 4,840 +/- 776 sites/cell; n = 11). However, the GR protein level in PBMCs was found to be similar in the three study groups. CONCLUSION: The results provide data on GR expression and its functional status in inflammatory cells of pediatric asthmatic patients. In moderate asthma, functional characteristics of GR are altered, though the significance of these findings remains to be clarified.

An imbalance in antioxidant enzymes and stress proteins in childhood asthma.

OBJECTIVES: The study was undertaken to examine antioxidant status and level of the major intracellular heat shock proteins (Hsps) in healthy children and children with mild and moderate asthma. DESIGN AND METHODS: Native gel assays were performed to estimate activities of copper/zinc (CuZn) and manganese (Mn) superoxide dismutase (SOD), and catalase (CAT) in peripheral blood mononuclear cells (PBMC) of healthy and asthmatic children. Hsp70 and Hsp90 protein levels in PBMCs were assessed by Western blot analysis. RESULTS: Moderate asthmatics displayed higher CuZnSOD/CAT activity ratio compared to healthy children, and increased Hsp90 level compared to mild asthmatics and healthy children. CONCLUSIONS: With regard to the imbalance in the antioxidant enzyme activities children with moderate asthma differ from healthy children, while an increased Hsp90 expression could be associated with the disease severity, as well.

Comparison of the efficacy and safety of ciclesonide 160 microg once daily vs. budesonide 400 microg once daily in children with asthma.

Ciclesonide is an onsite-activated inhaled corticosteroid (ICS) for the treatment of asthma. This study compared the efficacy, safety and effect on quality of life (QOL) of ciclesonide 160 microg (ex-actuator; nominal dose 200 microg) vs. budesonide 400 microg (nominal dose) in children with asthma. Six hundred and twenty-one children (aged 6-11 yr) with asthma were randomized to receive ciclesonide 160 microg (ex-actuator) once daily (via hydrofluoroalkane metered-dose inhaler and AeroChamber Plus spacer) or budesonide 400 microg once daily (via Turbohaler) both given in the evening for 12 wk. The primary efficacy end-point was change in forced expiratory volume in 1 s (FEV1). Additional measurements included change in daily peak expiratory flow (PEF), change in asthma symptom score sum, change in use of rescue medication, paediatric and caregiver asthma QOL questionnaire [PAQLQ(S) and PACQLQ, respectively] scores, change in body height assessed by stadiometry, change in 24-h urinary cortisol adjusted for creatinine and adverse events. Both ciclesonide and budesonide increased FEV1, morning PEF and PAQLQ(S) and PACQLQ scores, and improved asthma symptom score sums and the need for rescue medication after 12 wk vs. baseline. The non-inferiority of ciclesonide vs. budesonide was demonstrated for the change in FEV1 (95% confidence interval: -75, 10 ml, p = 0.0009, one-sided non-inferiority, per-protocol). In addition, ciclesonide and budesonide showed similar efficacy in improving asthma symptoms, morning PEF, use of rescue medication and QOL. Ciclesonide was superior to budesonide with regard to increases in body height (p = 0.003, two-sided). The effect on the hypothalamic-pituitary-adrenal axis was significantly different in favor of ciclesonide treatment (p < 0.001, one-sided). Both ciclesonide and budesonide were well tolerated. Ciclesonide 160 microg once daily and budesonide 400 microg once daily were effective in children with asthma. In addition, in children treated with ciclesonide there was significantly less reduction in body height and suppression of 24-h urinary cortisol excretion compared with children treated with budesonide after 12 wk.