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Introduction The aim of this study was to determine the epidemiological characteristics of suicide attempt cases who were admitted to the emergency departments and to determine their level of social support and related factors by using multidimensional scale of perceived social support (MSPSS).Methods This study was conducted simultaneously in two different centres between February 23 and June 31, 2009. Totally 260 suicidal cases who were admitted to the emergency departments were included in the study after obtaining the consents. Related derived data were collected with a questionnaire. The questionnaire determined epidemiological characteristics of suicide attempters by using MSPSS derived data. The data were analysed with percentage, mean, t test, ANOVA, and Scheffe test.Results About 70% of all cases were female and 63.1% of them were between 16 and 25 years of age. The main causes leading to suicide attempts were family problems (41.9%), financial problems (11.2%), and peer suicide attempts (5.4%). Drug use was the most common suicide method both in males and females. The MSPSS score was 52.47±17.81 (mean±SD, range=12-84). While being a member of a broken family, being widow/divorced, previously diagnosed mental disorder affected social support scores negatively, being a student or having a high level of education affected scores positively.Conclusion Family problems, financial problems, 16-25 age group, female sex, being divorced/widowed, being a member of broken family, chronic physical and psychological problems, and lower level of perceived social support are main characteristics associated with suicide attempts. (Hong Kong j.emerg.med. 2011;18:412-420)

The aim of this study was to determine the epidemiological characteristics of suicide attempt cases who were admitted to the emergency departments and to determine their level of social support and related factors by using multidimensional scale of perceived social support (MSPSS). This study was conducted simultaneously in two different centres between February 23 and June 31, 2009. Totally 260 suicidal cases who were admitted to the emergency departments were included in the study after obtaining the consents. Related derived data were collected with a questionnaire. The questionnaire determined epidemiological characteristics of suicide attempters by using MSPSS derived data. The data were analysed with percentage, mean, t test, ANOVA, and Scheffe test. About 70% of all cases were female and 63.1% of them were between 16 and 25 years of age. The main causes leading to suicide attempts were family problems (41.9%), financial problems (11.2%), and peer suicide attempts (5.4%). Drug use was the most common suicide method both in males and females. The MSPSS score was 52.47±17.81 (mean±SD, range=12-84). While being a member of a broken family, being widow/divorced, previously diagnosed mental disorder affected social support scores negatively, being a student or having a high level of education affected scores positively. Family problems, financial problems, 16-25 age group, female sex, being divorced/widowed, being a member of broken family, chronic physical and psychological problems, and lower level of perceived social support are main characteristics associated with suicide attempts. (Hong Kong j.emerg.med. 2011;18:412-420)

Background: The hemodynamic factors contributing to the clinical symptomatology in patients with mitral stenosis (MS) have been under investigation. The objective of this study was to evaluate the use of the Valsalva maneuver in patients with MS and whether there is an association between the degree of the hemodynamic changes in transmitral gradient (TG) in response to Valsalva maneuver and functional status, systolic pulmonary artery pressure, and left atrial function in patients with MS in sinus rhythm. Methods: The study prospectively evaluated 42 patients (37 female, mean age 40 +/- 10 years) with a diagnosis of pure MS in sinus rhythm. Patients were divided into 3 groups according to their New York Heart Association (NYHA) functional class. In all, 12 patients were in NYHA functional class I, 17 patients in class II, and 13 patients in class III. TG, including the mitral peak, mean, and late filling gradients, were calculated by the modified Bernoulli equation at rest and during the strain phase of Valsalva maneuver. The percentage changes in all TG in response to Valsalva were calculated. Traditional echocardiographic parameters for atrial function were also measured. Results: We found that, in patients who were more symptomatic according to NYHA classification, a reduction in TG in response to Valsalva maneuver was blunted and associated with higher systolic pulmonary artery pressure compared with those who were asymptomatic or had mild symptoms. Patients in NYHA class III decreased mitral mean pressure gradient by only 13.5%, significantly less (P < .001) than those in classes I (53.9%) and II (41.7%). However, despite the fact that left atrial ejection fraction was low in all patients, it was not associated with functional status in patients with MS. Conclusion: This study, for the first time, suggests that echocardiographically determined changes in TG in response to the Valsalva maneuver may provide an objective, noninvasive means of evaluating patients with MS.

A 63-year-old man was admitted to our emergency department with the complaint of syncope. An electrocardiogram showed complete atrioventricular block with a low ventricular rate. He was hospitalized and a temporary transfemoral pacemaker was inserted under direct fluoroscopy urgently. Immediate postprocedural electrocardiogram in the paced mode showed right bundle branch block morphology that led to suggestion of abnormal lead location. A transthoracic echocardiogram revealed that the pacemaker lead was directly inserted from the right atrium into the left ventricle through the junction of the interatrial and interventricular septums. Because severe multivessel coronary artery disease was diagnosed angiographically in his subsequent hospital course, coronary artery bypass grafting and surgical extraction of the misplaced lead was performed at the same time. Clinical implications, diagnosis, and therapeutic options of left ventricular pacemaker lead malposition are discussed.

Background: Systemic sclerosis (SSc) is a rare connective tissue disease that can lead to severe heart complications, i.e. congestive heart failure, arrhythmia and sudden cardiac death. The latter are associated with poor prognosis in SSc. The aim of this study was to test whether infra-clinical myocardial dysfunction can be detected in patients with SSc free from cardiovascular symptoms. Methods: Global LV, and segmental right ventricular longitudinal strain (2D-speckle tracking strain) were quantified by transthoracic echocardiography to assess ventricular deformations in 48 patients suffering from SSc and 40 matched control subjects. Results: Despite normal LVEF, patients presenting SSc had significantly impaired LV GLS in compared to controls (17.9 +/- 3.04 % vs -19.4+/- 2.3 %; p= 0.01). By contrast, there was no significant difference on lateral and inferior RV strain between patients and controls. Decreased LV deformation was detected in patients regardless of pulmonary injury, i.e. restrictive syndrome and pulmonary arterial hypertension (PAH). Patients with diffuse cutaneous SSc had impaired (GLV?) LV and RV strains in 4 and 2 chamber views compared to those presenting a limited form of cutaneous SSc, with respectively, -18.9 +/- 3.47% vs -16.6+/- 3.70%, p=0.039 and -19.7+/- 2.93% versus -17.6+/- 3.40% p=0.047. Conclusion: Speckle-tracking strain analysis can detect infra-clinical impairment of LV myocardial function in patients with SSc who are free from any cardiovascular symptoms regardless of SSc impact on pulmonary function. Right and Left ventricular strain in Ssc