Post-Hospital Syndrome: A New Challenge in Cardiovascular Practice

AbstractThe image of the hospital representing the modern medicine and its diagnostic and therapeutic advances becomes more evident in the face of an aging population and patients with multiple comorbidities requiring highly complex care. However, recent studies have shown a growing number of hospital readmissions within 30 days after discharge. The post-hospital syndrome is a new clinical entity associated with multiple vulnerabilities that contribute to hospital readmissions. During hospitalization, the patient is exposed to different stressors of physical, environmental, and psychosocial natures that trigger pathophysiological and multisystemic responses and increase the risk of complications after hospital discharge. Patients with a cardiac disease have high rates of readmission within 30 days. Therefore, it is important for cardiologists to recognize the post-hospital syndrome since it may impact their daily practice. This review aims at discussing the current scientific evidence regarding predictors and stressors involved in the post-hospital syndrome and the measures that are currently being taken to minimize their effects.

Dipyridamole stress myocardial perfusion by computed tomography in patients with left bundle branch block

Abstract Background: Functional tests have limited accuracy for identifying myocardial ischemia in patients with left bundle branch block (LBBB). Objective: To assess the diagnostic accuracy of dipyridamole-stress myocardial computed tomography perfusion (CTP) by 320-detector CT in patients with LBBB using invasive quantitative coronary angiography (QCA) (stenosis ≥ 70%) as reference; to investigate the advantage of adding CTP to coronary computed tomography angiography (CTA) and compare the results with those of single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy. Methods: Thirty patients with LBBB who had undergone SPECT for the investigation of coronary artery disease were referred for stress tomography. Independent examiners performed per-patient and per-coronary territory assessments. All patients gave written informed consent to participate in the study that was approved by the institution’s ethics committee. Results: The patients’ mean age was 62 ± 10 years. The mean dose of radiation for the tomography protocol was 9.3 ± 4.6 mSv. With regard to CTP, the per-patient values for sensitivity, specificity, positive and negative predictive values, and accuracy were 86%, 81%, 80%, 87%, and 83%, respectively (p = 0.001). The per-territory values were 63%, 86%, 65%, 84%, and 79%, respectively (p < 0.001). In both analyses, the addition of CTP to CTA achieved higher diagnostic accuracy for detecting myocardial ischemia than SPECT (p < 0.001). Conclusion: The use of the stress tomography protocol is feasible and has good diagnostic accuracy for assessing myocardial ischemia in patients with LBBB.

Rotenon-induzierte Komplex I-Inhibierung in primär kultivierten neokortikalen Neuronen : oxidativer Stress, Permeabilitätstransitionsdynamik und die protektive Rolle von Minozyklin

Magdeburg, Univ., Fak. für Naturwiss., Diss., 2010

Untersuchungen zur Rolle zellulärer Proteinasen bei der durch oxidativen Stress induzierten Schädigung von Rattenpankreas-Azinuszellen in vitro

Magdeburg, Univ., Medizin. Fakultät, Diss., 2005

Early life stress-induced histone acetylations correlate with activation of the synaptic plasticity genes Arc and Egr1 in the mouse brain

Magdeburg, Univ., Fak. für Naturwiss., Diss., 2013

Einfluss von "Stress inoculation" und "Resilience" auf die alters- und geschlechtsspezifische Entwicklung des Angst-, Lern- und Sozialverhaltens von Degus (Octodon degus) und Ratten (Rattus norvegicus)

Magdeburg, Univ., Fak. für Naturwiss., Diss., 2014

Untersuchungen molekularer Mechanismen und funktioneller Konsequenzen der DNA-Schädigung durch oxidativen Stress in Tumorzellen

Magdeburg, Univ., Fak. für Naturwiss., Diss., 2014

Resilienz bei Rehabilitanden der Orthopädie und Psychosomatik : Eine Querschnittstudie

Theoretical background: The construct of resilience is now used in many fields, such as in sports, corporate governance and in health care system. Against the backdrop of the unique system of rehabilitation in Germany, that empowers people to participate in a social and pro-fessional way, the concept of resilience is becoming increasingly important. Accordingly this cross-sectional study should explore the resilience of orthopedic and psychosomatic patients in more detail.Questions: Are there differences in the sample that lead to different sub-samples based on the RS-13? Are there differences between the sub-samples in terms of socio-demographic data, psychosocial problems, psychological stress, stress in the workplace and the experi-ence of stress? Do socio-demografic, employment, psycho-social and psychological varia-bles influence resilience?Method: For this investigation the data of n = 131 patients was used. The data was collected in an orthopedic clinic of rehabilitation and in a psychosomatic clinic of rehabilitation. On the basis of the results of the short Resiliencescale RS-13 the sample was split into two sub-samples of N1 = 51 patients with low resilience and N2 = 80 patients with higher resilience. The questions were examined by regarding the Brief Symptom Checklist (BSCL), the Ultra-Kurz-Screening (UKS), the Stressscale (from the DASS-Questionnaire) and the Employee Attitude Survey (BAuA). Additionally a literature research was done in databases like Psy-Content, Psyndex and Springerlink to acquire the theoretical background.Results: Within the sample, there were two sub-samples, one which included patients with low resilience while the other was characterized by high resilience. Patients with low resili-ence did not differ by considering the variables of age, sex, marital status, children, educa-tion, occupational status, industry and job stress. Patients with high resilience are older and rarer incap

Statistical analysis of stress and deformation state in polycrystalline aggregates with a large number of grains

Magdeburg, Univ., Fak. für Maschinenbau, Diss., 2015

Interneuron function in pathological memory processes : relevance for posttraumatic stress disorder

Otto-von-Guericke-Universität Magdeburg, Fakultät für Naturwissenschaften, Univ., Dissertation, 2015

Analysis of phenotypes altered by temperature stress and hipermutability in Drosophila willistoni

Drosophila willistoni (Sturtevant, 1916) is a species of the willistoni group of Drosophila having wide distribution from the South of USA (Florida) and Mexico to the North of Argentina. It has been subject of many evolutionary studies within the group, due to its considerable ability to successfully occupy a wide range of environments and also because of its great genetic variability expressed by different markers. The D. willistoni 17A2 strain was collected in 1991 in the state of Rio Grande do Sul, Brazil (30°05'S, 51°39'W), and has been maintained since then at the Drosophila laboratory of UFRGS. Different to the other D. willistoni strains maintained in the laboratory, the 17A2 strain spontaneously produced mutant males white-like (white eyes) and sepia-like (brown eyes) in stocks held at 17°C. In order to discover if this strain is potentially hypermutable, we submitted it to temperature stress tests. Eighteen isofemale strains were used in our tests and, after the first generation, all the individuals produced in each strain were maintained at 29°C. Different phenotype alterations were observed in subsequent generations, similar to mutations already well characterized in D. melanogaster (white, sepia, blistered and curly). In addition, an uncommon phenotype alteration with an apparent fusion of the antennae was observed, but only in the isofemale line nº 31. This last alteration has not been previously described as a mutation in the D. melanogaster species. Our results indicate that the D. willistoni 17A2 strain is a candidate for hypermutability, which presents considerable cryptic genetic variability. Different factors may be operating for the formation of this effect, such as the mobilization of transposable elements, effect of inbreeding and alteration of the heat-shock proteins functions.

Stress and warfare among the Kayenta Anasazi of the thirteenth century A.D. / Jonathan Haas, Winifred Creamer.

n.s. no.21(1993)

Perioperative stress in dogs underwent elective surgery: evaluation of the antioxidant activity

Projecte de recerca elaborat a partir d’una estada al Department of Biological Science a la University of Lincoln, a la Gran Bretanya, entre octubre i desembre del 2006. L'objectiu del present assaig va ser desciure les respostes antioxidants d'estrès en gossos sotmesos a cirurgia electiva, en condicions de pràctica clínica normals, durant les fases de preoperatori i postoperatori.Setze gossos van ser sotmesos a orquiectomia o ovariohisterectomia electives, utilitzant un protocol quirúrgic estàndard. Durant les fases preoperatoria i postoperatoria, cada animal va ser confinat a la Unitat de Cures Intensives, temps durant el qual es va estudiar la seva resposta antioxidant. Els valors obtinguts a diferents temps van ser comparats amb el valor basal, que s'havia obtingut del mateix animal estant aquest en el seu ambient habitual. No es van detectar variacions significants causades per l'estrès perioperatori. Els valors màxims es van observar durant la fase preoperatoria, just després que l'animal fós confinat a la Unitat de Cures Intensives, moment en el que l'estrès percebut era degut a les amenaces psicològiques de una àrea restringida i de la manipulació per persones desonegudes. L'abscència de variacions significants podrien ser degudes al sistema i el temps d'emmagatzement de les mostres. En humana s'han descrit les alteracions en l'activitat dels antioxidants sèrics després d'un mes d'emmagatzematent. Per definir l'estabilitat, després de la recollida de mostres, de l'activitat dels antioxidants en sèrum de gos és necessari realitzar més estudis.

Neuroendocrine, metabolic, and immune functions during the acute phase response of inflammatory stress in monosodium L-glutamate-damaged, hyperadipose male rat.

In rats, neonatal treatment with monosodium L-glutamate (MSG) induces several metabolic and neuroendocrine abnormalities, which result in hyperadiposity. No data exist, however, regarding neuroendocrine, immune and metabolic responses to acute endotoxemia in the MSG-damaged rat. We studied the consequences of MSG treatment during the acute phase response of inflammatory stress. Neonatal male rats were treated with MSG or vehicle (controls, CTR) and studied at age 90 days. Pituitary, adrenal, adipo-insular axis, immune, metabolic and gonadal functions were explored before and up to 5 h after single sub-lethal i.p. injection of bacterial lipopolysaccharide (LPS; 150 microg/kg). Our results showed that, during the acute phase response of inflammatory stress in MSG rats: (1) the corticotrope-adrenal, leptin, insulin and triglyceride responses were higher than in CTR rats, (2) pro-inflammatory (TNFalpha) cytokine response was impaired and anti-inflammatory (IL-10) cytokine response was normal, and (3) changes in peripheral estradiol and testosterone levels after LPS varied as in CTR rats. These data indicate that metabolic and neroendocrine-immune functions are altered in MSG-damaged rats. Our study also suggests that the enhanced corticotrope-corticoadrenal activity in MSG animals could be responsible, at least in part, for the immune and metabolic derangements characterizing hypothalamic obesity.