Effects of acute psychological stress on glucose metabolism and subclinical inflammation in patients with post-traumatic stress disorder.

During acute psychological stress, the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system are activated. The released stress hormones influence glucose metabolism, can activate immune cells, and modulate subclinical inflammation. The aim of our study was to analyze the effect of acute psychological stress on glucose metabolism and the inflammatory status in patients with post-traumatic stress disorder (PTSD). We included 15 overweight male Bosnian war refugees with PTSD into the study (mean age 44+/-11 years, BMI 29.3+/-4.3 kg/m (2)). All subjects underwent an oral glucose tolerance test (OGTT) with either acute stress (trauma script exposure) or a resting period in a cross-over design. Blood was drawn over 2.5 h and metabolic markers were measured. Systemic levels of immune markers were determined using high-sensitive ELISA or bead-based multiplex assay. Immune gene expression was quantified by RT-PCR. After being exposed to acute stress, cortisol levels and heart frequency tended to be increased. Higher blood glucose and insulin levels after stress exposure were observed (p<0.05). Systemic levels of the chemokines interferon-gamma-inducible protein-10 and macrophage chemoattractant protein-1 were decreased compared to the control day (both p<0.05) and the expression of the proinflammatory regulator IKK beta was significantly reduced after stress exposure (p<0.001). In conclusion, acute stress induces postprandial blood glucose peaks and elevated insulin levels and a selective decrease of systemic immune markers and the proinflammatory regulator of the NF kappaB cascade, which are associated with type 2 diabetes. This points towards an independent effect of acute psychological stress on glucose metabolism and inflammation.

Overcommitment predicts restenosis after coronary angioplasty in cardiac patients.

The objective of this study is to examine the role of a particular stress-enhancing psychosocial risk factor, termed overcommitment, in predicting restenosis after successful percutaneous transluminal coronary angioplasty (PTCA). Overcommitment defines a personal pattern of coping with demands characterized by excessive striving in combination with a strong desire of being approved and esteemed. One hundred six consecutive male patients with coronary artery disease who underwent PTCA were followed over a mean of 12 months. The restenosis rate as defined by quantitative angiography was 34%. Multivariate analysis revealed independent effects of high density lipoprotein cholesterol (odds ratio [OR] 3.19), age (OR 3.43), and overcommitment (OR 2.86) on risk of restenosis. In conclusion, a stress-enhancing psychosocial person characteristic termed overcommitment acts as an independent predictor of coronary restenosis after PTCA. As overcommitment is subject to cognitive-behavioral intervention, results have implications for a more comprehensive approach to secondary prevention in cardiac patients.

[Foreign bodies in the esophagus in children]. / Strana tela jednjaka kod dece.

The study describes 3 children with strange foreign bodies in the esophagus, one aged 14 the other two 8 and 13 months respectively. A metal hanger hook was found in the first one, a lollypop with a plastic stick 10 cm long in the second and a painting brush 21 cm long in the third one. Two of the foreign bodies were removed ambulatory, the third one hospitally. The interventions were not followed by complications.