Recent Development: Hailes v. State: The State May Appeal a Trial Court\u27s Ruling Excluding a Dying Declaration; The Length of Time Between a Declarant\u27s Statement and Death is Irrelevant in a Dying Declaration Analysis; The Confrontation Clause is Inapplicable to Dying Declarations

The Court of Appeals of Maryland held that the State may appeal a trial court’s suppression of a victim’s dying declaration based on the legislative intent of Section 12-302(c)(4)(i) of the Maryland Code, Courts and Judicial Procedure Article (“section 12-302(c)(4)(i)”). Hailes v. State, 442 Md. 488, 497-98, 113 A.3d 608, 613-14 (2015). The court further held that a victim’s statement, made while on life support, was a dying declaration regardless of the fact that the victim died two years after making the statement. Id. at 506, 113 A.3d at 618. Finally, the court held that the Confrontation Clause of the Sixth Amendment to the United States Constitution does not apply to dying declarations

Medically unexplained symptoms and attachment theory: The BodyMind Approach

© 2019 Payne and Brooks. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.This article discusses how The BodyMind Approach ® (TBMA) addresses insecure attachment styles in medically unexplained symptoms (MUS). Insecure attachment styles are associated with adverse childhood experiences (ACEs) and MUS (Adshead and Guthrie, 2015) and affect sufferers' capacity to self-manage. The article goes on to make a new hypothesis to account for TBMA's effectiveness (Payne and Brooks, 2017), that is, it addresses insecure attachment styles, which may be present in some MUS sufferers, leading to their capacity to self-manage. Three insecure attachment styles (dismissive, pre-occupied and fearful) associated with MUS are discussed. TBMA is described and explanations provided of how TBMA has been specifically designed to support people's insecure attachment styles. Three key concepts to support insecure attachment styles involved in the content of TBMA are identified and debated: (a) emotional regulation; (b) safety; and (c) bodymindfulness. There is a rationale for the design of TBMA as opposed to psychological interventions for this population. The programme's structure, facilitation and content, takes account of the three insecure attachment styles above. Examples of how TBMA works with their specific characteristics are presented. TBMA has been tested and found to be effective during delivery in the United Kingdom National Health Service (NHS). Improved self-management has potential to reduce costs for the NHS and in General Practitioner time and resources.Peer reviewe

Impactul inflamaţiei în dezvoltarea restenozei intrastent

Procesul inflamator are un rol cheie în dezvoltarea restenozei după intervenţiile coronariene percutane, fiind un răspuns la leziunile tisulare şi determinând dezvoltarea hiperplaziei neointimei în urma inducerii răspunsurilor sistemice neuroendocrine şi metabolice. Intensitatea şi persistenţa inflamaţiei locale şi sistemice reprezintă un proces individual. Citokinele produse de celulele intimei de origine locală şi hematogenă pot avea un rol determinant în dezvoltarea restenozei. Citokinele şi proteinele fazei acute au o valoare prognostică independentă în estimarea dezvoltării restenozei şi pot fi o “ţintă” promiţătoare pentru utilizarea tratamentului medical individualizat

The role of systemic inflammation in cardiovascular disorders evolution

Department of Acquired Cardiac Malformations, Institute of Cardiology, Chisinau, the Republic of MoldovaBackground: Growing clinic-experimental evidences suggest notable systemic inflammation implication in the pathogenesis of multiple cardiovascular diseases. This article is aimed at underlying the most important referred to inflammation mechanisms causing circulatory disorders and proven predictors of their diagnosis and prognosis. It has been established that crucial triggering factor of inflammatory response is the nuclear transcription factorkappaB whose activation leads to increased quantity and expression of a lot of inflammation mediators, like C reactive protein, cytokines (TNF-alpha, interleukins), chemokines (MCP-1) and intercellular adhesion molecules (selectins, integrins) which basically guide the sequestration of circulatory leukocytes. These mediators are responsible for inflammation sustaining and dissemination. On the other hand IL-10 is defined as a cytokine having anti-inflammatory action. The common effects of inflammation are endothelial dysfunction associated with NO synthesis impairment, oxidative stress boosting, extracellular matrix reorganization resulted from metalloproteinase activation, cell migration proliferation and apoptosis, neointima hyperplasia and plaque destabilization. Conclusions: Recent studies indicate the inflammation pathogenic value in the major adverse cardiovascular events development in patients undergone primary coronary revascularization by angioplasty, inclusive in-stent restenosis. Diabetes mellitus, smoking, dislipidemia, metabolic syndrome, hyperhomocysteinemia, arterial hypertension are main cardiovascular risk factors leading to inflammatory response augmentation

Endothelial dysfunction and the pleiotropic effects of statins

Department of Acquired Cardiac Malformations, Institute of Cardiology, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: Growing clinic evidences indicate the role of endothelial dysfunction in pathogenesis of cardiovascular disorders, an evidence proven by use of many specific and reliable markers. More than that, endothelial dysfunction is viewed and promoted as an important therapeutic target in which regard statins occupy a special position due to their pleiotropic effects. This article is aimed at the evaluation of most important predictors of endothelial dysfunction and its mechanisms concerning coronary remodeling as well as the latest data of statin efficiency in patients with coronary lesion. Endothelial dysfunction facilitates smooth vascular cell migration to neointima due to activation of metalloproteinases and extracellular matrix degradation. It also leads to activation of oxidative stress and systemic inflammation resulting in oxi-LDL and mononuclear cells accumulation in neointimal zone contributing to atheromatous plaque destabilization and prothrombotic state. Endothelial dysfunction is a crucial factor of major cardiovascular events’ (MACE) risk after angioplasty. Most important predictors of endothelial dysfunction are: decreased nitric oxide, endothelial progenitor cells, tetrahydrobiopterin, flow mediated brachial artery dilation, and increased intima-media thickness and C reactive protein. Statins demonstrated in many randomized trials beneficial effect on ischemic heart disease and coronary remodeling. Statins, especially in high doze, improve endothelial markers, reduce the rate of MACE after angioplasty inclusive of in-stent restenosis, and mitigate the oxidative stress and inflammatory response. In the recent trial (IBIS-4, 2015) statins showed a capacity of atherosclerotic plaque regression in patient with ST-segment of elevation myocardial infarction assayed by intravascular ultrasonography. Conclusions: The endothelial dysfunction markers use can optimize the cardiovascular diagnostics and prognostics, and statins improve coronary remodelin

Sclerodermia sistemică și cardiomiopatia hipertrofică – afiliere cauzală sau stocastică

Background. Hypertrophic cardiomyopathy (HCM) is characterized by the presence of left ventricular hypertrophy, which cannot be explained only by ventricular filling abnormalities. HCM has been previously described in a small number of patients with systemic scleroderma (SDS). Objective of the study. Highlighting the importance of a multidisciplinary approach to the diagnostic approach in a patient with SDS. Material and Methods. Patient with paresthesia at low temperatures, discoloration of the fingers, dysphagia, arthralgia, thickening, and stiffness of the skin, fatigue, dyspnea on physical exertion. Results. Clinical and paraclinical parameters: BP-130/80mmHg, HR-74bpm; PCR - 22.9 mg/L, ESR - 21 mm/h, pro-BNP - 2461 ng/ml, positive Scl-70, ANA - 1/5120, HLA-DR3 was positive; ECG - sinus rhythm, LV myocardial hypertrophy. Trans-thoracic echocardiography: LV diastolic dysfunction, ejection fraction 61%, SIV – 17 mm, PPVS - 13 mm with severe obstruction of the LV ejection tract. HCM is an autosomal dominant genetic disorder associated with HLA-DR3 genes, acting with genetic and non-genetic factors, in which the link to SDS is perceived. Diffuse connective tissue disease can be considered a “natural experiment” in the interaction between inflammation and heart disease, which could elucidate the fundamental mechanisms by which inflammation accelerates the development of cardiovascular disease. Thus, in a patient with SDS, the vector of the investigation is redirected to a confluence that includes cardiac involvement. Conclusion. Diagnosis: systemic scleroderma and hypertrophic cardiomyopathy. This affiliation can be interpreted as two concomitant diseases or a causal association.Introducere. Cardiomiopatia hipertrofică (CMH) se caracterizează prin prezența hipertrofiei ventriculare stângi care nu poate fi explicată doar de anomaliile de umplere ventriculară. CMH a fost descrisă anterior la un număr mic de pacienți cu sclerodermie sistemică (SDS). Scopul lucrării. Evidențierea importanței abordării multidisciplinare a demersului diagnostic la un pacient cu SDS. Material și Metode. Pacientă cu acuze la parestezie la temperaturi joase, modificări de culoare a degetelor mâinilor, disfagie, artralgii, îngroșarea și rigiditatea pielii, fatigabilitate, dispnee la efort fizic. Rezultate. Parametrii clinici și paraclinici: TA 130/80mmHg, FCC 74 c/min; PCR - 22,9 mg/L, VSH - 21 mm/h, pro-BNP - 2461 ng/ml, Scl-70 pozitiv, ANA - 1/5120, HLA-DR3 pozitiv; ECG – ritm sinuzal, hipertrofie a miocardului VS. Ecocardiografia: disfuncție diastolică VS, fracția de ejecție 61%, SIV-17 mm, PPVS-13 mm cu obstrucția severă a tractului de ejecție a VS. CMH este o tulburare genetică cu transmitere autozomal dominantă, asociată cu genele HLADR3, acționând cu factori genetici și non-genetici, în care se percepe legătura cu SDS. Maladiile difuze ale țesutului conjunctiv pot fi considerate un „experiment natural” în interacțiunea dintre inflamație și bolile cardiace, care ar putea elucida mecanismele fundamentale prin care inflamația accelerează dezvoltarea maladiilor cardiovasculare. Astfel, la un pacient cu SDS se redirecționează vectorul investigației spre o confluență ce include implicarea cardiacă. Concluzii. Diagnostic: sclerodermie sistemică și cardiomiopatie hipertrofică. Această afiliere poate fi interpretată ca două boli concomitente sau asociere cauzală

Endocardită infecţioasă la pacienţii cu hemodializă cronică

În acest studiu retrospectiv s-a prezentat evoluția endocarditei infecțioase (EI) la 5 pacienți cu insuficiență renală cronică în stadiu terminal, aflați la tratament prin hemodializă cronică. S-au analizat principalii factori de risc implicați în declanșarea EI la pacienții cu hemodializă cronică, precum și cauzele incidenței, morbidității și mortalității mai înalte decât în populația generală. S-au evidențiat particularitățile în prezentarea clinică și dificultățile în stabilirea diagnosticului la acești pacienți. Constatările studiului subliniază importanța diagnosticării cât mai precoce a endocarditei în asociere cu un tratament rapid și agresiv, inclusiv cel chirurgical

Ateroscleroza şi procesul inflamator imun

Cercetările contemporane presupun că răspunsul imunitar la acţiunea antigenelor endogene (lipoproteidele cu densitate scăzută) şi extragene (adenoviruşii ş.a.) are o importanţă primordială în apariţia aterosclerozei arterelor. La etapa primară a aterogenezei în stratul subendotelial al intimei se depun lipoproteidele cu densitate joasă, care devin astfel de caracter autoantigen şi stimulează formarea moleculelor hemoadezive cu moleculele endoteliale. Acestea, la rândul lor, se leagă cu liganzii leucocitelor agranulate. Monocitele/macrofagele şi T-celulele activate, pătrunse în intimă, iniţiază procesul de infl amare a „fazei acute” la etapa primară a aterogenezei. Participarea celulelor intimei în procesele de infl amare (macrofagele, celulele musculare netede şi celulele endoteliale produc antigeni de gradul II) transformă procesul acut în unul cronic. Până nu demult se considera că ateroscleroza este legată numai de dezvoltarea hipercolesterinomiei şi de depunerea în surplus a lipoproteidelor pe pereţii vaselor sanguine, ceea ce cauzează formarea plăcilor aterosclerotice. Însă, răspunsul molecular al pereţilor vaselor determină evoluţia procesului, care poate regresa sau progresa spre formarea plăcilor aterosclerotice. Citokinele, produse din moleculele intimei locale sau de provenienţă hematogenă, pot avea un rol determinant în procesele patologice din pereţii vasculari, indiferent de nivelul lipidelor în sânge