Volume 3 • Issue 3 • September 2016 – JCE – Journal of Cardiovascular Emergencies https://www.jce.ro Cardiology, Emergency Medicine and Intensive-Care Medicine, Radiology Mon, 26 Dec 2016 10:35:52 +0000 en-US hourly 1 https://wordpress.org/?v=6.1.1 Writing Clinical Papers. The Heart of the Matter https://www.jce.ro/article/writing-clinical-papers-heart-matter/ Fri, 30 Sep 2016 16:53:26 +0000 http://www.jce.ro/?post_type=article&p=766 Read More ...]]> Only through clear and meticulous writing can clinicians transfer the benefit of their research to patients and fellow researchers. It is through comprehensive written articles that clinicians appreciate the concepts being developed, and judge the extent to which results can be applied in their situation. Unfortunately, many submitted manu- scripts fall short of achieving the clarity of thought and standards of medical writing required of quality journals. This is partly due to the inappropriate emphasis on pub- lished papers as criteria governing, not only professional status, but the appropriateness of a clinician in obtaining academic advancement.

As a reviewer of several medical journals, I am aware of several common errors continually evidenced in submit- ted manuscripts. The following highlights these and of- fers guidance to increase the standard of presentation of a well-conducted study, so that it will not be rejected by a journal.

Poorly planned, poorly conducted and poorly presented research are the three commonplace shortfalls found in the submitted articles. A robust paper cannot be predicated on poor study design. A well thought-out, detailed proto- col must be completed at the conception stage of the study, and it is frequently apparent to this reviewer, that suffi- cient time has not been given to this phase of the study.

A writer must scrutinize every aspect of the text to en- sure that it conforms to the requirements of the journal to which it will be submitted. Ensure that your paper has a clear research question, and demonstrates an appropriate study design. Always seek statistical advice at the “proto- col” stage to ensure the study has sufficient power, and that proper statistical tests will be used.

Keep the title simple and use it to accurately describe the contents of your article. Avoid abbreviations, jargon, formulas and avoid words with little impact, such as “Ob- servations on…”, “Investigation into…”, “Study of…”. Use the title to report the subject of the paper, and not the results. The words in the title should accurately reflect the aims of the paper as stated in a null hypothesis.
Keywords must be chosen carefully; they heighten the visibility of an article, and like the title, will attract, or distract readers.

A common fault lies in composing the “Introduction” by cutting and pasting from a thesis. Do not try to impress the editor, either with the extent of your knowledge, or with superfluous issues. Keep the introduction concise and the contained knowledge relevant to the paper. End with a succinct statement of the aims of the study, and in most cases, a null hypothesis.

The “Material and Methods” section is often the most poorly written part of a paper. Provide sufficient detail, explaining each step of the study clearly and chronologi- cally. For clinical studies list inclusion and exclusion cri- teria. The notions embodied in the Declaration of Helsinki Publication Ethics should be adhered to by protecting pa- tients’ identities, listing any deviation from usual practice or inconvenience or risk imposed on participants, as well as any perceived benefits to participants, patients, and society in general. Specify how written informed consent was obtained and from which committee. Provide infor- mation on ethics clearance, and if this was not required, state the name of the committee which decided this. Keep a written letter of all correspondence and opinions of the Ethics Committee, whether this be positive or negative.

The “Results” section is the strength of the paper, pre- senting, as it does, new knowledge. A frequent error is to introduce discussion elements into the “Results” section. Report the data without discussion, remembering that negative data should be acknowledged to allow satisfac- tory interpretation of the results. Avoid repetition of data in tables and graphs. Use the SI system (Système Interna- tional d’Unités) for reporting measurements.

In the “Conclusion” section, state the outcome of the study and the possible clinical implications. Avoid indicat- ing that further research is required. Always declare any conflict of interest, real or perceived.

The journal’s instructions to contributors are likely to contain other requirements unique to that journal. Pay strict attention to the journal’s “instructions to authors”.

In spite of all these assistances, writing a journal article is a demanding exercise especially for those whose first language is not English. For those who fall into this cat- egory, consult a native English speaking colleague before submitting a paper. Additionally, be “open minded” and in your writing, demonstrate that you and your team had no preconceived end-points.

The following are the most common reasons for rejec- tion of a manuscript: poorly written papers; papers with excessive jargon; inadequate description of the study de- sign; confused and contradictory reasoning, indicating a lack of thought and concentration on the part of the au- thors; essential data omitted or other relevant studies ig- nored, possibly due to insufficient knowledge of the sub- ject or an inadequate in-depth literature review.1 Above all, avoid excessive zeal and self-promotion.

Authorship accreditation is a frequently encountered present day issue. Only those who make a substantial contribution to the study conception and design, analyze data, interpret or draft the article, or revise or rewrite it critically before the final version being ready for publish- ing, should be included. Solely acquiring funding or col- lecting data does not justify authorship. To avoid conflicts, decide on authorship at the protocol stage.

Avoiding plagiarism is primarily the responsibility of authors. The Council of Science Editors defines plagia- rism as “a form of piracy that involves the use of text or other items (figures, images, tables) without permission or acknowledgment of the source of these materials.” The editorial board of the Journal of Cardiovascular Emergen- cies participates in the CrossCheck System to ensure that published papers are original and trustworthy.

Attention to these issues should enable authors to sub- mit high-quality basic and clinical research, which will integrate clinical and pre-clinical studies, allowing clini- cians to transfer the benefit of their research to their pa- tients and to fellow researchers.2,3

]]> The Use of Biomarkers for the Early Detection of Vulnerable Atherosclerotic Plaques and Vulnerable Patients. A Review https://www.jce.ro/article/use-biomarkers-early-detection-vulnerable-atherosclerotic-plaques-vulnerable-patients-review/ Fri, 30 Sep 2016 16:50:35 +0000 http://www.jce.ro/?post_type=article&p=761 Read More ...]]>

ABSTRACT

Acute coronary syndromes represent the most severe consequences of atherosclerosis, most often triggered by the rupture of a coronary plaque, which, for various reasons, has become unstable. In many cases, these rupture-prone vulnerable plaques are difficult to diagnose, because they do not always cause significant obstruction noticeable by coronary angiogra- phy. Therefore, new methods and tools for the identification of vulnerable plaques have been proposed, many of which are currently under study. Various biomarkers have been suggested as predictors of a vulnerable plaque, as well as indicators of an increased inflammatory sta- tus associated with higher patient susceptibility for plaque rupture. Integration of such bio- markers into multiple biomarker platforms has been suggested to identify superior diagnos- tic algorithms for the early detection of the high-risk condition associated with an unstable plaque. The aim of this review is to summarize recent research related to biomarkers used for the early detection of vulnerable plaques and vulnerable patients.

]]> Integrated ST Segment Elevation Scores and In-hospital Mortality in STEMI Patients Undergoing Primary PCI https://www.jce.ro/article/integrated-st-segment-elevation-scores-hospital-mortality-stemi-patients-undergoing-primary-pci/ Fri, 30 Sep 2016 16:48:33 +0000 http://www.jce.ro/?post_type=article&p=758 Read More ...]]>

ABSTRACT

The objective of this study was to study the integrated score of ST-segment resolution (ISSTE) and in-hospital death in patients undergoing primary percutaneous intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI). Material and Methods: This prospective study included 586 consecutive patients admitted with STEMI to the Cardiol- ogy Clinic of the County Emergency Clinical Hospital of Tîrgu Mureș, between January 1st, 2013 and December 31, 2014, who underwent pPCI in less than twelve hours after the onset of symptoms. Clinical and demographic data were analyzed in 539 (91.9%) survivors (Group 1) and 47 (8.1%) nonsurvivors (Group 2). The Integrated Score of ST elevation (ISSTE) was calculated by summing the amplitude of the ST segment elevation in all the 12 leads, before and at 2 hours after revascularization. Results: The ISSTE score calculated at baseline, im- mediately before the primary percutaneous coronary intervention, was significantly higher in Group 2 as compared to Group 1 (13.9 ± 1.2 vs. 11.0 ± 0.2, p = 0.026). At the same time, the ISSTE score calculated at 2 hours after the coronary intervention was significantly higher for patients in Group 2 (7.36 ± 1.12 vs. 2.9 ± 0.1, p <0.0001). Analysis of the dynamics of the ISSTE score indicated that patients who survived presented a more expressed reduction in the ISSTE score following pPCI, as compared to those who subsequently died (73.5% reduction in Group 1 compared to 47.2% reduction in Group 2, p <0.0001). In-hospital mortality was significantly higher in the group of patients with >50% reduction in the ISSTE score. The in-hospital death rate was 5.4% in patients with >50% reduction in the ISSTE score, compared to 19.4% for those who presented less than 50% reduction in the ISSTE score following pPCI (p <0.0001). The rate of successful reperfusion rate, expressed by the reduction in ISSTE score, was 83.8% in Group 1, compared to 55.3% in Group 2 (p <0.0001), indicating that the absence of an effi- cient reperfusion after pPCI is associated with a higher mortality in STEMI patients, and could be evaluated using regression of the ISSTE score, which proved to be directly associated with mortality. Conclusion: The ISSTE score is shown to be an effective ECG-derived marker of myocardial damage in STEMI patients. A high ISSTE score is associated with higher mortal- ity, while a reduction in the ISSTE score after pPCI may indicate an efficient reperfusion and a decrease in mortality in the first days after infarction.

]]> Distance-related Differences in Critical Times, Protocol Activation and Mortality in a Regional STEMI Network https://www.jce.ro/article/distance-related-differences-critical-times-protocol-activation-mortality-regional-stemi-network/ Fri, 30 Sep 2016 16:45:31 +0000 http://www.jce.ro/?post_type=article&p=754 Read More ...]]>

ABSTRACT

Introduction: The aim of the study was to assess the differences in critical network times and mortality in STEMI patients presenting to hospitals in the same STEMI network, but located at different distances from the pPCI center. Methods: Four-hundreed sixteen patients with STEMI were studied. Group 1: 101 patients presenting to any of the six regional hospitals in the network located at less than 70 km from the pPCI center, with a maximum transport time of 30 minutes. Group 2: 81 patients presenting to any of the three territorial hospitals in the network located at 70–150 km from the pPCI center, with a transport time between 30 and 70 minutes. Group 3: 93 patients presenting to any of the four territorial hospitals in the network located at 150–250 km from the pPCI center, with a transport time between 70 and 150 minutes. Group 4: 141 patients presenting directly to the emergency room of the pPCI center. The following time intervals were recorded: presentation time (PT), from the onset of symptoms to arrival at the pPCI center; protocol initiation time (PIT), from arrival at the pPCI center to STEMI protocol initiation; isch- emic time (IT), from the onset of symptoms to repermeabilisation; door to balloon time (DTB), from arrival in the pPCI center to balloon. Results: PT showed no significant difference between the groups – 183.08 ± 25.2 minutes vs. 199.1 ± 32.4 minutes vs. 166.7 ± 42.5 minutes vs. 161.91 ± 36.8 minutes, respectively (p=0.4). PIT was significantly lower in Group 3 (61.66 ± 15.4 minutes in Group 3 vs. 92 ± 11.5 minutes in Group 2 vs. 107.4 ± 12.5 minutes in Group 1, p = 0.002). DTB time was significantly longer for patients presenting directly to the pPCI center compared to those arriving from Zone 1, 2 or 3 hospitals, 86.96 ± 11.6 minutes vs. 52.27 ± 11.2 minutes vs. 39.94 ± 10.3 minutes vs. 43.9 ± 5.3 minutes, p <0.001). Despite the differences in distance to the pPCI center, there was no significant difference in total IT between the groups (Group 1, 344.6 ± 53.4 minutes; Group 2, 369.3 ± 42.6 minutes; Group 3, 366.65 ± 36.4 minutes; and 340.2 ± 26.9 minutes in the pPCIcenter, p = 0.2), and this was reflected in similar rates of mortality (Group 1, 3.9%; Group 2, 3.7%; Group 3, 3.2%; and 3.5% in the pPCI center). Conclusion: A well organized STEMI network can shorten protocol initiation and DTB times, achieving similar ischemic times and resulting in similar mortality rates with the centers located closer to the pPCI center. Early activation of the STEMI protocol could lead to superior results even in areas situated at longer distances from the pPCI center.

]]> The Facilitation of Pericardiocentesis Using Imaging Techniques. A Case Report https://www.jce.ro/article/facilitation-pericardiocentesis-using-imaging-techniques-case-report/ Thu, 29 Sep 2016 05:32:40 +0000 http://www.jce.ro/?post_type=article&p=741 Read More ...]]>

ABSTRACT

Introduction: Pericardiocentesis is a procedure performed for diagnostic and therapeutic purposes, and it consists in draining the pericardial effusion liquid in sterile conditions. The accumulation of fluid in the pericardial space may be caused by several systemic conditions, including viral or bacterial infections, autoimmune disease, cancer, as well as thyroid mal- function. A rapidly growing pericardial effusion can lead to cardiac tamponade, and conse- quently to acute hypodiastolic heart failure. Case report: We report the case of a 79-year-old female, without previously known cardiovascular pathologies, who presented to the Emer- gency Room due to a gradual deterioration in her health status. Imaging procedures included a chest X-ray and an echocardiography that confirmed the diagnosis of pericardial effusion. Pericardiocentesis was performed using cardiac ultrasound guidance, resulting in the drain- ing of a small quantity of yellowish, partly haemorrhagic fluid. The patient’s general condi- tion did not improve, thus another pericardiocentesis was carried out, this time with fluo- roscopical and cardiac ultrasound guidance, and 1200 milliliters of sero-haemorrhagic fluid was drained. The laboratory analysis revealed that the patient had hypothyroidism, and the cytological analysis of the drained pericardial fluid excluded a neoplastic origin, tuberculosis, and other infectious etiologies. The particularity of the case consists in a pericardial effusion evolving into cardiac tamponade, for which the pericardiocentesis was guided using echocar- diographic, fluoroscopic and radiologic methods, because simple ultrasound-guided drainage was not efficient. Conclusion: The superiority of a combined imaging-guided approach in cases of pericardial effusion recommends it as an alternative to a surgical procedure, guided solely by echocardiography, which is often used in cases of unsuccessful drainage of pericar- dial effusion fluid.

]]> Pneumo-pyopericardium Mimicking an Acute Myocardial Infarction. A Rare Complication of an Incarcerated Hiatus Hernia and Gastro-pericardial Fistula https://www.jce.ro/article/pneumo-pyopericardium-mimicking-acute-myocardial-infarction-rare-complication-incarcerated-hiatus-hernia-gastro-pericardial-fistula/ Thu, 29 Sep 2016 05:28:45 +0000 http://www.jce.ro/?post_type=article&p=737 Read More ...]]>

ABSTRACT

Pyopericardium is an acquired disease associated with very high complication rates. Pyoperi- cardium is a very rare form of pneumopericardium. The nontraumatic causes of pneumoperi- cardium include gastro-pericardial fistula that can occur in refractory gastric ulcers, stomach or esophageal neoplasia, and in surgical interventions of the stomach, such as the Niessen fundoplication procedure. The case of life-threatening pneumopericardium associated with gastro-pericardial fistula resulting from the incarceration of a giant hiatal hernia is reported.

]]>