Telemedicine in the Era of a Pandemic: Usefulness of a Novel Three-Lead ECG.

The 12-lead electrocardiogram (ECG) is a first-line diagnostic tool for patients with cardiac symptoms. As observed during the COVID-19 pandemic, the ECG is essential to the initial patient evaluation. The novel KardioPal three-lead-based ECG reconstructive technology provides a potential alternative to a standard ECG, reducing the response time and cost of treatment and improving patient comfort. Our study aimed to evaluate the diagnostic accuracy of a reconstructed 12-lead ECG obtained by the KardioPal technology, comparing it with the standard 12-lead ECG, and to assess the feasibility and time required to obtain a reconstructed ECG in a real-life scenario. A prospective, nonrandomized, single-center, adjudicator-blinded trial was conducted on 102 patients during the COVID-19 pandemic at the Dedinje Cardiovascular Institute in Belgrade. The KardioPal system demonstrated a high feasibility rate (99%), with high specificity (96.3%), sensitivity (95.8%), and diagnostic accuracy (96.1%) for obtaining clinically relevant matching of reconstructed 12-lead compared to the standard 12-lead ECG recording. This novel technology provided a significant reduction in ECG acquisition time and the need for personnel and space for obtaining ECG recordings, thereby reducing the risk of viral transmission and the burden on an already overwhelmed healthcare system such as the one experienced during the COVID-19 pandemic.

Endothelial dysfunction of coronary arteries in subjects without diabetes: An association with both insulin resistance and impaired insulin secretion response.

AIMS: This study was aimed to compare insulin sensitivity and secretion response, lipoprotein and plasminogen activator inhibitor 1 (PAI-1) levels between the subjects with and without coronary artery endothelial dysfunction (ED). METHODS: ED was detected by intracoronary injection of acetylcholine (ACh) in 47 nondiabetes subjects without stenotic coronary arteries, selected from 316 consecutive patients with coronary angiography performed for suspected coronary artery disease. The subjects were divided into two groups: presence of ACh-induced coronary spasm (group ED+, N = 30) and absence of ACh-induced coronary spasm (group ED-, N = 17). Insulin sensitivity (Si) was evaluated by frequently sampled intravenous glucose tolerance test (FSIGTT) with minimal model analysis and by HOMA-IR, insulin secretion by acute insulin response (AIR) (calculated from the first 8 min of FSIGTT) and by disposition index (DI) (Si × AIR). Lipids and PAI-1 levels were determined enzymatically, and LDL particle size by gradient gel electrophoresis. RESULTS: Si was significantly lower (4.22 ±â€¯0.62 vs 6.98 ±â€¯1.47 min-1/mU/l × 104; p < 0.05) while HOMA-IR was significantly higher in ED + group vs ED- group (2.8 ±â€¯0.3 vs 1.7 ±â€¯0.2; p < 0.05). Simultaneously, AIR and DI was significantly lower in ED + vs ED- groups (p < 0.05 and p < 0.01, respectively). Investigated groups did not differ in fasting lipid levels but ED+ group had significantly smaller LDL particles (p < 0.01) and higher PAI-1 levels (p < 0.05). Regression analysis shown that DI was a strong independent predictor of appearance of ED, together with PAI-1 and LDL particle size. CONCLUSIONS: Both insulin resistance and impairment in insulin secretion response strongly correlate with coronary ED in subjects without diabetes.

The relationship between right ventricular deformation and heart rate variability in asymptomatic diabetic patients.

OBJECTIVE: To investigate heart rate variability (HRV) and right ventricular (RV) remodeling in asymptomatic diabetic patients, as well as the relationship between HRV indices and RV structure, function and deformation. METHOD: This cross-sectional study included 59 asymptomatic patients with type 2 diabetes and 45 healthy controls without cardiovascular risk factors. All study subjects underwent 24-h Holter monitoring, laboratory analyses and complete two-dimensional echocardiography examination (2DE). RESULTS: RV diastolic function and longitudinal deformation were significantly impaired in diabetic individuals comparing with controls. RV global longitudinal strain and layer-specific longitudinal strains were significantly decreased in diabetic group. The same trend of changes in RV deformation was observed for global RV and lateral wall. All parameters of time and frequency domain of HRV were reduced in diabetic subjects. RV endocardial longitudinal strain together with LV mass index, mitral E/e' ratio and HbA1c correlated with HRV parameters. However, multivariate linear regression analysis showed that only RV endocardial longitudinal strain and LV mass index are associated with HRV parameters independently of age, BMI, HbA1c, RV free wall thickness and pulmonary artery pressure. CONCLUSIONS: RV subendocardial strain is independently associated with HRV parameters in the whole study population. This reveals potentially important role of determination of layer-specific RV longitudinal function as important marker of preclinical cardiac damage, but also indirectly show the impairment of cardiac autonomic function in diabetic patients.

Improvement of Glycemic Control in Insulin-Dependent Diabetics with Depression by Concomitant Treatment with Antidepressants.

BACKGROUND It is still disputable whether negative effects of comorbid depression in diabetics can be diminished by successful treatment of depression. The primary aim of this study was to assess whether addition of antidepressants to existing insulin treatment would further improve glycemic control in these patients. A secondary objective was to assess whether such treatment impairs their lipid and inflammatory status. MATERIAL AND METHODS Total of 192 patients with poorly controlled diabetes (defined as HbA1c ≥8%) in the absence of any uncontrolled medical condition entered the 6-month run-in phase with optimization of diabetic therapy. Depression status was screened at the end of this phase by BDI-II depression testing. Patients with BDI-II ≥14 and psychiatric confirmation of depression (58 patients) entered the 6-month interventional phase with SSRI class antidepressants. RESULTS Fifty patients completed the study. During the run-in phase, HbA1c dropped from 10.0±1.8% to 8.5±1.2% (p<0.001), and during the interventional phase it dropped from 8.5±1.2% to 7.7±0.7% (p<0.001). BDI-II scores improved significantly from 30.4±13.2 to 23.5±11.0 (p=0.02) during the interventional phase. A positive linear correlation between improvement in depression scale and improvement in glycemic control was observed (R²=0.139, p=0.008). Lipid profile and inflammatory status did not change significantly during the interventional phase. CONCLUSIONS Patients with poorly controlled diabetes and comorbid depression might benefit from screening and treatment of depression with SSRI antidepressants by achieving an incremental effect on glycoregulation. This therapy did not have any adverse effects on lipid profile or inflammatory status.

120 YEARS SINCE THE DISCOVERY OF X-RAYS.

This paper is intended to celebrate the 120th anniversary of the discovery of X-rays. X-rays (Roentgen-rays) were discovered on the 8th ofNovember, 1895 by the German physicist Wilhelm Conrad Roentgen. Fifty days after the discovery of X-ray, on December 28, 1895. Wilhelm Conrad Roentgen published a paper about the discovery of X-rays - "On a new kind of rays" (Wilhelm Conrad Roentgen: Ober eine neue Art von Strahlen. In: Sitzungsberichte der Wurzburger Physik.-Medic.- Gesellschaft. 1895.). Therefore, the date of 28th ofDecember, 1895 was taken as the date of X-rays discovery. This paper describes the work of Wilhelm Conrad Roentgen, Nikola Tesla, Mihajlo Pupin and Maria Sklodowska-Curie about the nature of X-rays . The fantastic four - Wilhelm Conrad Roentgen, NikolaTesla, Mihajlo ldvorski Pupin and Maria Sklodowska-Curie set the foundation of radiology with their discovery and study of X-rays. Five years after the discovery of X-rays, in 1900, Dr Avram Vinaver had the first X-ray machine installed in abac, in Serbia at the time when many developed countries did not have an X-ray machine and thus set the foundation of radiology in Serbia.

Low On-Treatment Platelet Reactivity Predicts Long-Term Risk of Bleeding After Elective PCI.

BACKGROUND: Bleeding after percutaneous coronary interventions (PCI) is an important complication with impact on prognosis. AIM: To evaluate the predictive value of enhanced platelet responsiveness to dual antiplatelet therapy with aspirin and clopidogrel, for bleeding, after elective PCI. METHODS AND RESULTS: We performed multiple electrode aggregometry (MAE) platelet functional tests induced by arachidonic acid (ASPI) and adenosine-diphosphate (ADP) before PCI, and 24 hours after PCI, in 481 elective PCI patients who were followed-up for an average of 15.34 ± 7.19 months. Primary end point was the occurrence of any bleeding, while ischemic major adverse cardiovascular event (MACE) was a secondary endpoint. The incidence of total, BARC ≤ 2, and BARC ≥ 3 bleeding, according to BARC classification, was 19, 18, and 1%, respectively. Groups with any, and BARC ≤ 2 bleeding, had a lower average value of MAE ADP test after 24 hours, compared to the group without bleeding: 45.30 ± 18.63 U versus 50.99 ± 19.01 U; P = 0.005; and 45.75 ± 18.96 U versus 50.99 ± 18.99 U; P = 0.01; respectively. Female gender (HR 2.11; CI 1.37-3.25; P = 0.001), previous myocardial infarction (HR 0.56; CI 0.37-0.85; P = 0.006), lower body mass (HR 0.78; CI 0.62-0.98; P = 0.03), and MAE ADP test after 24 hours (HR 0.75; CI 0.61-0.93; P = 0.009) were the independent predictors for any bleeding by Cox univariate analysis. After adjustment, MAE ADP test after 24 hours, was the only independent predictor for any (HR 0.7; CI 0.56-0.87; P = 0.002), and BARC ≤ 2 (HR 0.71; CI 0.56-0.89; P = 0.003) bleeding, by Cox multivariate analysis. CONCLUSION: MAE ADP test before and after PCI, was associated with any, and BARC ≤ 2 bleeding after elective PCI.

DR AVRAM JOZEF VINAVER (1862-1915) - PIONEER OF RADIOLOGY IN SERBIA.

INTRODUCTION: Dr Abraham Joseph Vinaver (1862-1915), a Jew from Poland, was a pioneer of radiology in Serbia. He graduated from the Faculty of Medicine in Warsaw (1887), but lived and worked in abac (the Kingdom of Serbia) since 1890. Dr Abraham Joseph Vinarev - Career Development. He procured the first X-ray machine and developed radiological service in Sabac five years after the discovery of X-rays. These were the beginnings of radiology in Serbia. He introduced the application of artesian wells. Dr Abraham Joseph Vinarev - a Participant at the First Congress of Serbian Physicians and Naturalists, Belgrade 1904. "The diagnostic importance of X-rays in lung disease, especially in initial tuberculosis" and "Five Years of Treatment by X-Ray Machines" were the first works in the field of radiology in Serbia by this author. Dr Abraham Joseph Vinaver - Reserve Medical Officer in the Serbian Army. During the Balkan Wars, he was a volunteer with the rank of major engaged in military corps and he participated in the First World War as well. He died of malaria in 1915 in Gevgelija. "Dr Avram Vinaver"- Stanislav Vinarev. His dedication to work during the typhus epidemics was put into verses of a poem by his son Stanislav Vinarev. CONCLUSION: Dr Avram Vinaver Joseph was a noble man with a great heart, who selflessly sacrificed himself for the Serbian people and Serbia. He gave his contribution to the development of health services in Serbia, both in peacetime and wartime conditions. Dr Abraham Joseph Vinaver laid the foundations for today's radiology in Serbia.

Drug-eluting stents with biodegradable polymer for the treatment of patients with diabetes mellitus: clinical outcome at 2 years in a large population of patients.

OBJECTIVE: This study investigates the safety and efficacy of a third-generation drug-eluting stent (DES) with biodegradable polymer in the complex patient population of diabetes mellitus (DM). CLINICAL TRIAL REGISTRATION: ISRCTN81649913. BACKGROUND: Percutaneous coronary interventions in patients with DM are associated with a higher incidence of death, restenosis, and stent thrombosis as compared to non-diabetic patients. The use of a DES has been shown to improve outcomes in diabetic patients. METHODS: Out of 3,067 patients, enrolled in 126 centers worldwide in the NOBORI 2 registry, 888 patients suffered from DM, 213 of them (14%) being insulin-dependent DM (IDDM). Two years' follow-up has been completed in this study. RESULTS: At 1- and 2-year follow-up, 97% and 95% of the patients, respectively, were available. The reported target lesion failure (TLF) rates at 1- and 2-year follow-up were 6.0% and 7.2% in the DM group, respectively, and 3.0% and 4.2% in the non-DM group, respectively (P<0.001 for both years). Inside the DM group, the TLF rates of 9.9% and 11.7% at the 1- and 2-year follow-ups, respectively, in patients with IDDM were significantly higher than the TLF rates of 4.7% and 5.8%, respectively, in the non-IDDM subgroup (P<0.01 for both years). The rate of stent thrombosis at the 2-year follow-up was 1.0% in the DM group and 0.7% in non-DM patients. There were no cases of late, or very late stent thrombosis in IDDM patients. CONCLUSION: The Nobori DES performed well in patients with DM. As expected, patients with DM, particularly those with IDDM, had worse outcomes. However, the absence of late, and very late stent thrombosis in IDDM patients merits further investigation, as this finding might have significant clinical value.

The impact of anabolic androgenic steroids abuse and type of training on left ventricular remodeling and function in competitive athletes.

BACKGROUND/AIM: Long-term intensive training is associated with distinctive cardiac adaptations which are known as athlete's heart. The aim of this study was to determine whether the use of anabolic androgenic steroids (AAS) could affect echocardiographic parameters of left ventricular (LV) morphology and function in elite strength and endurance athletes. METHODS: A total of 20 elite strength athletes (10 AAS users and 10 non-users) were compared to 12 steroid-free endurance athletes. All the subjects underwent comprehensive standard echocardiography and tissue Doppler imaging. RESULTS: After being indexed for body surface area, both left atrium (LA) and LV end-diastolic diameter (LVEDD) were significantly higher in the endurance than strength athletes, regardless of AAS use (p < 0.05, for both). A significant correlation was found between LA diameter and LVEDD in the steroid-free endurance athletes, showing that 75% of LA size variability depends on variability of LVEDD (p < 0.001). No significant differences in ejection fraction and cardiac output were observed among the groups, although mildly reduced LV ejection fraction was seen only in the AAS users. The AAS-using strength athletes had higher A-peak velocity when compared to steroid-free athletes, regardless of training type (p < 0.05 for both). Both AAS-using and AAS-free strength athletes had lower e' peak velocity and higher E/e' ratio than endurance athletes (p < 0.05, for all). CONCLUSIONS: There is no evidence that LV ejection fraction in elite athletes is altered by either type of training or AAS misuse. Long-term endurance training is associated with preferable effects on LV diastolic function compared to strength training, particularly when the latter is combined with AAS abuse.

[Medicine in notafilia--Part III].

INTRODUCTION: Notafilia is the study of paper money. Only a few countries in the world have issued banknotes with portraits of well-known scientists who brought international fame to their own people and medicine. PORTRAITS OF SCIENTISTS ON THE BANKNOTES OF YUGOSLAVIA, SERBIA AND MONTENEGRO AND SERBIA. Nikola Tesla and Mihailo Pupin Idvorski were the ingenious inventors and scientists of our time who made special contributions to radiology. Nikola Tesla (1856-1943) pioneered the use of X-rays for medical purposes, thus effectively laying the foundations of radiology and radiography, and revealed the existence of harmful effects of X-rays on the human body. Mihailo Pupin Idvorski (1854-1935) was worldwide famous for applying physics in practice, as well as in the basis of telephone and telegraph transmissions. He also studied the nature of X-rays and contributed to establishing of radiology. PORTRAITS OF SCIENTISTS ON THE BANKNOTES OF THE WORLD: Maria Sklodowska Curie (1867-1934) was the first woman to gain the academic title of the Academy of Medicine, Paris. Together with her husband Pierre Curie (1859-1906) she gave an outstanding contribution to science and medicine. The discovery of the radioactive elements introduced the concept of "radioactivity" into physics and "radiotherapy" as a new discipline in medicine, thus creating the conditions for the development of nuclear medicine, oncology, and mobile diagnostic radiology. CONCLUSION: This paper presents the banknotes featuring the portraits of Nikola Tesla, Mihailo Pupin Idvorski, Maria Sklodowska Curie and Pierre Curie, the world renowned scientists, who made enormous contributions to medicine and laid the foundation for radiology.

[Medicine in notafilia--part II].

Only a few countries in the world have issued banknotes featuring portraits of doctors and health workers who have made their people and medicine world famous. The hereby presented banknotes are those issued in Germany featuring the portrait of Dr. Paul Ehrlich, a Nobel laureate; the Austrian banknotes with the portrait of a Nobel laureate Dr. Karl Landsteiner and of Dr. Sigmund Freud, the founder of modern psychoanalysis; the Greek one featuring the portrait of Georgios Nicholas Papanikolaou, who was a pioneer in early detection of pre-cancerous cervix lesions in women and who gave his name to the test "Papa test"; and, the one issued in Sweden featuring the portrait of Carl von Linnd, a court physician and the first President of the Royal Swedish Academy of Science.

Unilateral optic nerve aplasia associated with microphthalmos.

INTRODUCTION: Optic nerve aplasia is a rare developmental anomaly characterised by the congenital absence of the optic nerve, central retinal vessels and retinal ganglion cells that is seen most often in a unilaterally malformed eye. CASE REPORT: We reported a girl with a very rare anomaly of the eye, unilateral aplasia of the optic nerve and microphthalmia. We carried out a complete ophthalmological examination, A- and B-scan ultrasonography, magnetic resonance imaging (MRI) of the orbit and brain, pediatrician, neurological examinations and karyotype determination. The examined child was a third child from the third regular pregnancy, born at term (39 GS, BM 3100 g). Family ocular history was negative. The right corneal diameter was 7.5 mm and left 10 mm. On dilated fundus examination, the right eye showed the absence of op tic nerve and central retinal vessels. B-scan echography showed a small right globe (axial length 13.80 mm), normal size left globe (axial length 18.30 mm) and the absence of optic nerve on the right eye. Physical and neurological findings and karyotype was normal. MRI of the orbits and brain marked asymmetry of globe size and unilateral absence of the optic nerve. The patient is under the control of a competent ophthalmologist and prosthetic. CONCLUSION: Further aesthetic and functional development of a young person is the primary goal in tracking this rare congenital optic nerve anomalies in the malformed eye.

[Marie Curie, née Maria Sklodowska (1867-1934)--contribution to the development of radiology].

Marie Curie, née Maria Sklodowska, was born on November 7, 1867 in Warsaw (Poland). She suffered from leukaemia and died on June 4, 1934. She was buried with full honours at Pantheon. Marie Curie and her husband Pierre Curie discovered the radioactive elements Polonium (84Po210), Thorium (90Th232) and Radium (88Ra226). Marie Curie introduced the term radioactivity into science. She was the first woman who got Ph.D. in France, the first woman professor at Sorbonne, Paris and Medical Academy. Of all the women who have ever won the Nobel Prize, Marie Curie was the only who received it twice. During World War I Marie Curie designed a mobile x-ray room "radiologic car". Marie Curie had an x-ray machine installed into a car and demonstrated how to use its dynamo for electric power production necessary for the x-ray machine to work. She had 20 cars with moving radiological lab made and trained 150 people to work on them. She brought something radically new into military medicine--mobile x-ray diagnostics. With the discovery of radioactive elements a new medical branch, radiotherapy, was developed.

[Laza K. Lazarevic--doctor, lawyer, writer and warrior in three wars].

INTRODUCTION: Laza K. Lazarevic was born on the 13th of May, 1851 in Sabac. He died on the 11th of January, 1891 in Belgrade. Laza K. Lazarevic was a Serb, lawyer, warrior, doctor and writer. He spoke Russian, German and French. Laza Lazarevic's road to the title of doctor of medicine. He studied law in Belgrade and graduated in 1871 and he graduated from the Faculty of Medicine in Berlin on the 28th of January, 1879. He took his doctor's degree in Berlin on the 8th of March, 1879 at the same Faculty. His road to the title of doctor of medicine was thorny and complicated. LAZA K. LAZAREVIC AS A WARRIOR: He took part in the Serbian-Turkish war and the Serbian-Bulgarian war. During the Serbian-Bulgarian War (1885) he was first given the rank of reserve medical major and later the rank of active medical colonel and then he was appointed assistant chief of the Supreme Command of Health Care with the task to establish the Great reserve military hospital in Nis. PROFESSIONAL AND SCIENTIFIC WORK OF DR. LAZA K. LAZAREVIC: He had seventy two professional and scientific medical papers published, a great number of which referring to nervous diseases, such as paralysis agitans, sclerosis of medulla spinalis, aphasia and others. Therefore, it can be rightly said that Dr. Laza K. Lazarevic was the first Serbian neurologist. The very first operation of cataract in Serbia was performed by Dr. Laza K. Lazarevic in aseptic conditions, when cocaine was applied for anesthesia. He was the first doctor to be sent by the Ministry of Internal Affairs to Vienna in 1884 to learn how to prepare animal lymph. In 1879 he was appointed the physician of the Belgrade District and in 1881 he was promoted to the position of head doctor and Chief of Internal Department of the General State Hospital in Belgrade. He was the personal doctor of King Milan Obrenovic. LAZA K. LAZAREVIC AS A WRITER: Laza Lazarevic is considered to be the originator of psychological stories in Serbian realistic literature and had nine stories published, while eight remained unfinished. CONCLUSION: Thanks to his intelligence, hard work, determination and persistence and the financial help of Serbia Medical Colonel Dr Laza K. Lazarevic gained the best of knowledge across Europe, having studied at the most prestigious school in Europe - the fact that can be admired and envied even today.

[Medicine in the notaphily].

INTRODUCTION: Apart from literature, painting and philately, some of the greatest names of medicine found their place in the field of numismatics. They popularised their people and nations, as well as the medical science worldwide. The paper exhibits banknotes with the portraits of famous and world-wide recognised people in world and national history. MEDICINE IN THE NOTAPHILY IN FORMER YUGOSLAVIA, SERBIA AND MONTENEGRO AND SERBIA: Among these are the poet and pediatrician, Jovan Jovanovic Zmaj; the doctor and botanist, Josif Pancic; the academic painter, Nadezda Petrovic, as well as the motifs from our national history. MEDICINE IN THE NOTAPHILY IN THE WORLD: The banknotes from China with the image of the surgeon, Dr. Sun Yat Sen, from Spain with the portrait of the histologist Dr. Santiago Ramón y Cajal, from Austria with the face of the Nobel Prize winner and psychiatrist, Dr. Julius Wagner Jauregg and from France with the portrait of the great scientist, Louis Pasteur are also presented. CONCLUSION: These are some of the examples of great names of medicine, who brought world fame to their nations and medical science, and who were, apart from literature, painting, philately, interested in numismatics.