Postgraduate medical journal
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Acute myocarditis is an inflammatory disease of the heart muscle that may progress to dilated cardiomyopathy and chronic heart failure. A number of factors including the sex hormone testosterone, components of innate immunity, and profibrotic cytokines have been identified in animal models as important pathogenic mechanisms that increase inflammation and susceptibility to chronic dilated cardiomyopathy. ⋯ However, the diverse presentations of myocarditis and the lack of widely available, safe, and accurate non-invasive diagnostic tests remain major obstacles to early diagnosis and population based research. Recent advances in the understanding of disease pathogenesis described in this review should lead to more accurate diagnostic algorithms and non-invasive tests.
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Cardiac troponins are measured in acute coronary syndrome (ACS) and other conditions. The authors investigate the prognostic significance of cardiac troponin T (TnT) test and comorbid medical conditions. ⋯ Hospitalised patients with raised TnT levels from any cause predicted a higher mortality than normal TnT, with worst survival in those without an obvious ACS.
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To evaluate the views of clinicians and researchers on their use of outcome measures and which questions are most important in palliative and end-of-life care. ⋯ In palliative care, outcome measures often used in clinical practice are also often used in research. Questions relating to pain, symptoms, emotional needs and family concerns are consistently considered the most useful and important in palliative patient reported outcome measures (PROMs).
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To determine whether analysis of unsolicited healthcare complaints specifically focusing on unprofessional behaviour can provide additional information from the patients' perspective. ⋯ The vast majority of unprofessional behaviour identified related to non-cognitive, professionalism aspects of care. Complaints pertaining to unsatisfactory communication were especially noticeable. Incongruence is noted between the physicians' and the patients' perception of actual care.
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Multicenter Study
Muscle weakness, health status and frequency of exacerbations in chronic obstructive pulmonary disease.
Multiple factors contribute to muscle weakness and reduced muscle mass in chronic obstructive pulmonary disease (COPD) and this impacts patients' quality of life. One factor implicated in this process is systemic inflammation, an accompaniment of acute exacerbations. Recurrent exacerbations are associated with lower health status. This study examines the relationship between muscle weaknesses, health status and exacerbation frequency in a cohort of patients with COPD. ⋯ Our data clearly demonstrate that reduction in grip strength occurs more frequently and to a greater extent in patients with a history of frequent exacerbations and is associated with reduced health status.