Association of stress induced hyperglycemia with angiographic findings and clinical outcomes in patients with ST-elevation myocardial infarction.

BACKGROUND: Stress induced hyperglycemia (SIH) is common among patients with ST-elevation myocardial infarction (STEMI), even in patients without diabetes mellitus. However, evidence regarding its role on the angiographic outcomes and the prognosis of patients presenting with STEMI is scarce. METHODS: This study included 309 consecutively enrolled STEMI patients undergoing primary percutaneous coronary intervention (pPCI). Patients were diagnosed with SIH if blood glucose on admission was > 140 mg/dl. Also, patients had to fast for at least 8 hours before blood sampling. The objective was to assess whether SIH was associated with major adverse cardiovascular and cerebrovascular (MACCE) events and explore its relationship with angiographic predictors of worse prognosis such as poor initial TIMI flow, intracoronary thrombus burden, distal embolization, and presence of residual thrombus after pPCI. RESULTS: SIH in diabetic and non-diabetic patients was associated with a higher incidence of LTB (aOR = 2.171, 95% CI 1.27-3.71), distal embolization (aOR = 2.71, 95% CI 1.51-4.86), and pre-procedural TIMI flow grade = 0 (aOR = 2.69, 95% CI 1.43-5.04) after adjusting for relevant clinical variables. Importantly, during a median follow-up of 1.7 years STEMI patients with SIH with or without diabetes experienced increased occurrence of MACCE both in univariate (HR = 1.92, 95% CI 1.19-3.01) and multivariate analysis (aHR = 1.802, 95% CI 1.01-3.21). CONCLUSIONS: SIH in STEMI patients with or without diabetes was independently associated with increased MACCE. This could be attributed to the fact that SIH was strongly correlated with poor pre-procedural TIMI flow, LTB, and distal embolization. Large clinical trials need to validate SIH as an independent predictor of adverse angiographic and clinical outcomes to provide optimal individualized care for patients with STEMI.

Prevalence of markers of atrial cardiomyopathy in embolic stroke of undetermined source: A systematic review.

BACKGROUND: Emerging evidence suggests the potential role of atrial cardiomyopathy (AC) as a direct thromboembolic determinant in embolic stroke of undetermined source (ESUS). OBJECTIVE: We aimed to quantify the prevalence of potential AC markers among ESUS, non-cardioembolic (NCE) and cardioembolic (CE) stroke patients. METHODS: PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for publications from inception to October 2021, with duplicate data extraction and risk of bias assessment. The Newcastle-Ottawa assessment scale was used to evaluate study quality. RESULTS: Among 398 screened studies, 11 observational studies with 2009 ESUS patients (mean age 66.5 years) fulfilled the inclusion criteria. Of electrocardiographic markers, increased P-wave terminal force in lead V1 was more prevalent in ESUS vs NCE (OR=2.26, 95%CI: 1.40-3.66). Of imaging markers, left atrial volume index (LAVI) and left atrial diameter (LAd) were higher in ESUS vs NCE (OR=1.04, 95%CI: 1.02-1.06 and OR=3.41, 95%CI: 1.35-8.61 respectively). Non-chicken wing morphology of the left atrial appendage was more frequent in ESUS compared to NCE patients in the majority of studies. Of serum biomarkers, the prevalence of NT-proBNP >250 pg/ml did not differ among ESUS vs NCE (OR=0.73, 95%CI: 0.39 -1.35). CONCLUSIONS: Electrocardiographic, echocardiographic markers and advanced imaging modalities able to assess the morphologic characteristics of left atrial appendage and left atrial function may be important tools to discriminate AC among ESUS vs NCE stroke patients. Prospective studies exploring the association of potential AC markers with ESUS occurrence are warranted to validate their clinical utility.

Variant distribution of the calf cutaneous nerves - case report and clinical impact

We report a cadaveric case of unusual innervation pattern of the right calf and ankle. During dissection of an 82 years-old, formalin-fixed, male cadaver, the posterior femoral cutaneous nerve was found providing sensory supply to the lateral knee region, while it terminated at the level of the ankle. Moreover, the medial sural cutaneous nerve did not anastomose with a peroneal communicating branch and it continued as the lateral dorsal cutaneous nerve of the foot. In cases that the peroneal communicating branch is absent, the medial sural cutaneous nerve is called sural nerve. Additionally, the lateral sural cutaneous nerve travelled over the calf crossing the sural nerve at its middle and thus, providing sensory supply to the upper lateral calf and the lower medial aspect of the calf and ankle. This peculiar sensory supply may cause diagnostic hazard in cases of nerve injury with neurological symptomatology, whereas due to the presented variability, nerves are prone to iatrogenic injury during procedures in the area

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Sternal foramina: incidence in Greek population, anatomy and clinical considerations.

PURPOSE: Sternal foramina represent developmental defects in the sternum, which occur due to incomplete fusion of the sternal ossification centers. Sternal foramina have been correlated with several clinical implications and constitute a subject of interest for the forensic practice. The aim of this study is to define their incidence in Greek population. METHODS: The presence of midline foramen was studied in 60 dried, adult sterna derived from the Anatomy Department of Medical School of Aristotle University of Thessaloniki. Measurements were made with a 0.01-mm accuracy caliber and photographic documentation was obtained. Additionally, computed tomography scanning of the sterna was performed. RESULTS: Sternal foramina were found in 11 subjects, resulting in an incidence of 18.3% over the total population. In 27.3% of the subjects with sternal foramen, a single sternal foramen was observed in the body of the sternum, while in 45.5% of the sterna presenting sternal foramina, multiple xiphoidal foramina were noticed. In two specimens, association of xiphoidal foramina with sternal cleft was documented. CONCLUSION: Sternal foramina are variant quite common in the population, with distinct imaging pattern and awareness of their existence is important for the physician.

Bony structures related to snapping scapula: correlation to gender, side and age.

PURPOSE: This study aimed at summarizing the non-pathologic bony structures which are involved in the pathogenesis of snapping scapula and evaluate their incidence, morphology and correlation to gender, side and age. METHODS: The angulation in the sagittal plane between the supraspinatus and infraspinatus portion of the medial border was measured in 140 dried scapulae. In 264 dried scapulae the medial scapular border morphology was classified into three types and the presence of the Luschka's tubercle and the teres major tubercle or process was recorded. Correlation to gender, side and age was examined using SPSS. RESULTS: The mean angulation between the supraspinatus and infraspinatus portion of the medial border was 154.6° ± 8.8°. Τhe medial scapular border was straight in 99 (37.5 %), convex in 135 (51.1 %) and concave in 30 bones (11.4 %). The Luschka's tubercle was present in eight bones (3 %), while teres major tubercle was found in 114 scapulae (43.2 %). A teres major process was present in 18 bones (6.8 %). The process was curved towards the chest wall in nine bones (3.4 %), while in the other nine scapulae (3.4 %) it had no curvature. CONCLUSIONS: The non-pathologic bony structures which predispose to snapping scapula are not rare and include the concave medial scapular border, the Luschka's tubercle and the teres major process curved towards the chest wall. Orthopaedic surgeons should bear in mind these non-pathologic bony structures in order not to be overlooked during the diagnostic procedure of a snapping scapula since they usually require surgical treatment.