Section Of Internal Medicine Research Articles

Inside the April 2024 Issue.

Dear Readers, We are thrilled to bring you the first issue of the ninth volume of POCUS Journal. Published since 2016, POCUS Journal is the only multi-disciplinary, peer-reviewed, POCUS-focused journal that is free for authors and readers alike. We are grateful for the vision of our founder Dr. Amer and for the support of CINQUILL Medical Publishers, Inc. as we enter our ninth year of publication. POCUS is an ever-changing field as clinicians seek out better and faster solutions for patient care at the bedside. We at POCUS Journal continue to evolve as well. Our editorial board is growing to meet the demands of our high volume and high-quality manuscript submissions. We welcome Dr. Andre Kumar of Stanford University and Dr. Manpreet Malik of Emory University to the Internal Medicine section. We also welcome Dr. Andrea of the University of Southern California to the Pediatrics section. Natalie joins us from Queen’s University as the Social media Editor. If you haven’t seen her high-yield on social media I highly encourage you to visit POCUS Journal on X and Instagram for summaries of research articles and other content published in our journal. A journal our size also needs help with statistics, and we are excited that Nicholas has joined our team from the University of Toronto as Statistical Editor. We also have a new Editorial Director of Artificial Intelligence, Dr. Bredon Crawford. We are the first journal to feature an AI bot on our website, which is thanks to Dr. Crawford. Its name is “PJ” and you can find it on the bottom right of our website: www.pocusjournal.com. And finally, we are excited to have had Kathryn Matsushita join our team as , helping us preserve our standard of high quality publishing as the volume of submitted articles and size of our issues continues to grow. With the addition of these new members, I also share the bittersweet news that our Managing Editor Braeden Hill will be leaving POCUS Journal to pursue MD/PhD studies at The University of Toronto. started at POCUS Journal in 2020 as Social Media Editor and his contributions these past few years have been remarkable. We welcome Laura Guzman of Queen’s University into the role of Managing Editor. Every issue I oversee at POCUS Journal strikes me as better than the last, with fascinating cases and important research that answers key questions related to point of care ultrasound. This issue is no exception. Please find our author guidelines here: https://pocusjournal.com/author-guidelines/ Sincerely, Benjamin T. Galen, MD Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY Editor-In-Chief POCUS Journal

MANAGEMENT OF HYPERPROLACTINEMIA CAUSED PITUITARY MICROADENOMA

Hyperprolactinemia is an increase in fasting levels of the hormone prolactin above 20 ng/ml in menand above 25 ng/ml in women. Hyperprolactinemia occurs more often in women of reproductive age,with a percentage of 9 – 17%. The etiology of hyperprolactinemia can occur due to abnormal pituitarysecretions, systemic disease, use of drugs, damage to the hypothalamus-pituitary axis. A 33-year oldfemale patient came to the FER Polyclinic at M. Djamil Hospital with complaints of not menstruatingfor the past 2 months. Irregular menstruation since 15 years ago, menstruation 2-3 times in 6 months,irregular cycle for 7-8 days. The patient also complained of a fluid like breast milk coming out of thebreast for 5 years, initially the fluid came out in a trickle and then gradually reduced and now the fluidcomes out occasionally if the breast is squeezed. From the supporting examinations carried out, it wasfound that the prolactin hormone level in this patient was 134.53, and the results of the MRIexamination showed a mass measuring 1.05x1.12x0.5 mm, which was diagnosed as secondaryamenorrhea, hyperprolactinemia, and suspected pituitary microadenoma. The patient will bemonitored for general condition and vital signs, as well as consultations with colleagues involved, suchas consultations to the Internal Medicine section, Endocrinology, Metabolic and Diabetes Subdivision.

Relationship between Albumin Levels and the Incidence of Ascites in Patients with Liver Cirrhosis

Background: Patients with cirrhosis often develop hypoalbuminemia. In conditions of hepatic dysfunction, albumin synthesis is decreased due to hepatic dysfunction and abnormal distribution of portal blood flow. Ascites is a major complication and an important sign in the course of cirrhosis and is associated with 50% mortality after two years. 75% of patients' ascites etiology is liver cirrhosis, 10% malignancy, 3% heart failure, 2% tuberculosis, 1% pancreatitis, and others.
 Methods: This cross-sectional study was conducted from the medical records of patients with liver cirrhosis who were treated at the internal medicine section of Dr. M Djamil General Hospital, Padang, in 2015-2020. Patients with heart defects, malignancy, tuberculosis, pancreatitis, kidney failure, and incomplete medical record data were excluded from the study. Patients were grouped according to the presence or absence of ascites and albumin levels. Analysis using the chi-square test in 2020.
 Results: From 225 cases, 103 cases were analyzed. 77 were men (74.8%), and 26 were women (25.2%). The age of the patient was in the range of 40-60 years. No ascites were found in 30 people (29.1%), and 73 people (70.9%) had ascites. From normal albumin levels, five were without ascites, and four were with ascites. On mild hypoalbumin, 13 had no ascites, and 38 people had ascites. On severe hypoalbumin, 12 people were without ascites and 31 with ascites. A chi-square test was analyzed, and it was found that there was no relationship between the incidence of ascites and albumin levels (p 0.182).
 Conclusion: The incidence of ascites is not related to blood albumin levels.

Profile of the Use of Type II Antidiabetic Drugs in RSUD Dr. Husni Thamrin Natal Medan, North Sumatra

The pancreas does not produce enough insulin or the body cannot use the insulin it produces effectively. Insulin is a hormone that regulates the balance of blood sugar levels. (hyperglycemia). This research was conducted with a non-experimental descriptive method with a cross-sectional design that was carried out every month. Sampling was carried out in the internal medicine section of RSUD by Dr. Husni Thamrin Natal. Samples were taken retrospectively every month using secondary data, namely medical records of patients using oral antidiabetics (drugs) in the period from January to June 2019. The data obtained was presented in the form of table proportions and graphs. The results showed that the largest percentage of use of antidiabetic drugs was male, as many as 67 people (57.26%), over 50 years old, as many as 97 people (82.91%), and the type of work was self-employed for as many as 47 people (40, 17%). The most widely used antidiabetic drug groups are the biguanide groups (75.17%), the combination type of drug with a combination of metformin and glimepiride (93.33%), and the frequency of use of the drug metformin (74.15%). Based on the results of the study, it can be concluded that the highest prevalence is in the male sex, and the average age is over 50 years. The pattern of prescribing antidiabetic drugs based on the most widely used drug class is the biguanide group, which is a combination of metformin and glimepiride types of drugs, and the frequency of drug use is metformin.

GAYA HIDUP DENGAN KEJADIAN HIPERTENSI DI RSUD LABUANG BAJI MAKASSAR

Objective: The purpose of this study was to see the lifestyle relationship of hypertension occurrence at RSUD Labuang Baji Makassar. Method: In this study used the research design used in this study is cross sectional that researchers do observation or measurement of variables at one time. The sample size in this study are 30 respondents who match the inclusion criteria. The data were collected by using questionnaires. Results: The results showed that there was a correlation between smoking and hypertension (p = 0.029), there was a correlation between alcohol consumption and hypertension (p = 0.014), there was a relationship between high sodium consumption and hypertension (p = 0,002) the relationship between high fat consumption and the incidence of hypertension (p = 0.007), and there is a relationship between exercise with the incidence of hypertension (p = 0.001). Conclusion: The conclusion of this study is that there is a hubuangan between smoking, drinking alcohol, drinking alcohol consumption, high sodium consumption, and exercise with the incidence of hypertension. Suggestions: The results of this study can be used as a development of knowledge, especially about lifestyle relationships with the incidence of hypertension in the Inpatient Room Section of internal medicine in RSUD Labuang Baji Makassar

Remdesivir, Renal Function and Short-Term Clinical Outcomes in Elderly COVID-19 Pneumonia Patients: A Single-Centre Study.

BackgroundRemdesivir, an antiviral agent able to reduce inflammatory cascade accompanying severe, life-threatening pneumonia, became the first drug approved by the Food and Drug Administration for the treatment of hospitalized patients with coronavirus 2 related severe acute respiratory syndrome (SARS CoV2). As from its previously known clinical indications, the use of remdesivir in the presence of severe renal impairment is contraindicated; however, the impact of remdesivir on renal function in aging patients has not been elucidated.Subjects and MethodsThis retrospective observational study involved 109 individuals consecutively admitted in internal medicine section, Azienda Ospedaliero Universitaria Pisana hospital, in November–December 2020 due to a confirmed diagnosis of SARS CoV2 and receiving remdesivir according to international inclusion criteria. Biochemical variables at admission were evaluated, together with slopes of estimated glomerular filtration rate (eGFR) built during remdesivir treatment. Participants were followed until discharge or exitus.ResultsPatients were stratified according to age (80 formed the study cohort and 29 served as controls); CKD stage III was present in 46% of them. No patients showed any sign of deteriorated renal function during remdesivir. Fourteen patients in the elderly cohort deceased; their eGFR at baseline was significantly lower. Recovered patients were characterized by a relevant eGFR gaining during remdesivir treatment.ConclusionWe show here for the first time as remdesivir does not influence eGFR in a cohort of elderly people hospitalized for SARS CoV2, and that eGFR gain during such treatment is coupled with a better prognosis.

Clinical and serological profile of systemic sclerosis in Tunisia: A retrospective observational study

The Prevalence of systemic sclerosis (SSc) and different clinical subsets varies across the world. Few data have been published on SSc patients in North Africa. Our objective was to describe a SSc cohort in south of Tunisia and to compare clinical findings, disease subsets and antibodies with other international SSc populations. In this retrospective observational study, Folders of patients with SSc seen in the internal medicine section of the Hedi Chaker Hospital between 2000 and 2013 were retrospectively analyzed. The diagnosis of SSc was retained according to ACR/EULAR 2013 criteria. Patients were classified into diffuse cutaneous SSc and limited cutaneous SSc subsets. Comparison with other cohorts was made based on published information. A higher female: male ratio (8:1) and a higher diffuse subset prevalence (82%) was found in this Tunisian cohort comparing with others. We also found a lower prevalence of calcinosis and anticentromere antibodies. Within each subset, diffuse cutaneous and limited cutaneous scleroderma clinical findings were similar with other systemic sclerosis populations except for a very low prevalence in renal crisis and pulmonary hypertension. Our results indicate overlap syndrome defined as scleroderma associated with others connective tissue disorder's is a relatively common condition. With slight variations, perhaps due to genetic, environmental or referral factors, SSc in this cohort appears to be similar to that described in other part of the world.

THE RELATIONSHIP BETWEEN NITRIC OXIDE AND GLYCEMIC CONTROL IN CONTROLLED AND UNCONTROLLED TYPE 2 DIABETES MELLITUS PATIENTS IN THE ADAM MALIK HOSPITAL MEDAN

Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia. Hyperglycemia and other metabolic changes can cause Nitric Oxide (NO) production disturbance. This study investigated the difference in the levels of NO and its'relationship with HbA1c in controlled and uncontrolled diabetes mellitus type 2 patients in the Adam Malik Hospital. This study was a cross-sectional study, conducted in Outpatient Clinic and Inpatient Ward of Internal Medicine Section of Endocrinology in the Adam Malik Hospital on June through October 2016, involving 70 patients type 2 Diabetes Mellitus (DM) consisting of 35 controlled type 2 diabetes patients and 35 uncontrolled type 2 diabetes patients that fulfill this study's criteria. Nitric Oxide examination conducted by using Chemwell analyzer with the principle of double-antibody sandwich using Enzyme-Linked Immunosorbent Assay (ELISA). There was no significant relationship between HbA1c and Nitric Oxide in patients with controlled (r = 0.264) (p = 0.125) and uncontrolled (r = 0.194) (p = 0.265) type 2 diabetes mellitus. But there was a significant relationship between HbA1c and NO in patients with type 2 DM (r = 0,636) (p = 0.0001). In this study, there was no significant association between HbA1c and Nitric Oxide levels in patients with controlled and uncontrolled type 2 diabetes mellitus. There is a statistically significant relationship between HbA1C and NO in patients with type 2 diabetes.

Origin and development of the book Medical Semiology

Semiotics and Semiology share a similar etymology and meaning: the study of signs. In Medicine, signs are objective manifestations of disease, as opposed to the subjective nature of symptoms. Medical semiology comprises the study of symptoms, somatic signs and laboratory signs, history taking and physical examination (in English-speaking countries is known as Bedside diagnostic examination or Physical diagnosis). The first edition of Medical Semiology dates from 1987, and new editions appeared in 1999, 2010, and 2017. The book is devoted to semiology proper with clinical orientation. Its origin, however, dates back to 1937, when the University of Chile appointed Dr. Hernán Alessandri (1900-1981), the eminent Chilean medical educator, Professor in Semiology at the Internal Medicine Section of the Hospital del Salvador in Santiago. The authors of the present book served as Dr. Alessandri's teaching assistants for decades. The two-semester course in semiology had a tutorial character: each teaching assistant was assigned five students whom engaged daily in practical activities in the hospital wards for a total of four hours, in addition to a 45- minute lecture on the theoretical aspects of the subject. The 720-page fourth edition of the book brings together teaching method and clinical experience of more than 50 years. The book consists of six Sections: "Cardinal manifestations of disease", "Major clinical syndromes", "History taking and Physical examination", "Clinical diagnosis and the patient-physician relationship", "Laboratory clinical tests and Instrumental exploration of the body," and "Glossary of diseases." In its forty Chapters, a total of 207 issues are described in detail.

Retrospective evaluation of treatment of horses with colic over a period of 15 years

Colic is a common reason for both veterinary consultation and death in horses and to help decision making in such cases recent data on the outcome of treatment and identification of prognostic indicators is important. Patient records of all horses with colic admitted to the internal medicine section of a veterinary teaching hospital (VTH) between November 2012 and October 2013 were reviewed. Age, heart rate (HR), blood lactate concentration (BLa), packed cell volume (PCV), white blood cell (WBC) count and blood pH at admission, treatment and outcome were recorded. Results were compared to those obtained at the same institution during 2006-2007 and 1999-2000. During the present study period 867 horses were admitted and 311 (36%) of these were admitted for colic, 207/311 (67%) of these horses were treated medically, 67/311 (22%) surgically and 37/311 (12%) were euthanized on admission. The short-term survival, defined as discharge from the hospital, for surgically treated colic cases was 60%, while the survival for medically treated cases was 86%. When all colic cases were analysed together HR (P 1.5 mmol/L), heart rate (>60bpm), PCV (>42%), acidosis (pH<7.35) and small intestinal lesions were associated with increased odds of death. The number of horses admitted to the VTH was considerably lower during 2006-2007 compared to 1999-2000, but remained more or less constant from 2006-2007 until 2012-2013, as did the percentage of colic horses. The percentage of colic cases treated surgically has decreased slightly and the percentage of horses euthanized on admission increased slightly. Increased blood lactate concentration, heart rate, PCV, acidosis and small intestinal lesions were associated with increased risk of non-survival.

Diferencias en pacientes oncológicos y no oncológicos ingresados en una unidad de cuidados paliativos de reciente creación en un hospital de tercer nivel en la Comunidad Valenciana (España)

ObjectiveTo evaluate patient differences between palliative cancer and non-cancer patients admitted to the Unit of Palliative Care. Material and methodsA retrospective and analytical study of the palliative patients treated in the Unit of Palliative Care under the Department of Internal Medicine, Hospital General Universitario of Alicante between 1 June 2013 and 31 June 2014. Variables included were epidemiological (age, sex), clinical symptoms (fever, cachexia / anorexia, asthenia, nausea / vomiting, drowsiness, psychological symptoms, pain and dyspnoea), outcome and need for palliative sedation. ResultsOne hundred and forty-three patients out of the 1,599 (8.9%) admitted to the Section of Internal Medicine were studied in the Unit of Palliative Care. The median age of the patients was 83 years (interquartile range: 75-89) and the male: female ratio was 1.4. Sixty-four (44.7%) were palliative cancer patients and 79 (65.3%) were non-cancer palliative. Out of 79 non-cancer palliative patients: 38 (48.1%) were patients with irreversible progression of comorbidities, 33 (41.8%) patients with end-stage chronic disease and 8 (10.1%) elderly patients in the final stage of life. With regard to symptoms, the non-cancer palliative patients were more likely to experience dyspnoea (odds ratio [OR]: 4.65, 95% confidence interval [CI]:, 1.7-10 7) and less likely to experience pain (OR: 0.23; 95% CI: 0.09 to 0.54) and nausea /vomiting (p=.025). Symptoms were better controlled in the non- non- cancer palliative patients (OR: 2.03; 95% CI 1.0 to 4.10). Palliative sedation was administered to 23% of the patients, similar in both types of patients. ConclusionThe symptoms of palliative care were different in the non-cancer and cancer patients.

Apolipoprotein C-III glycoforms correlate heterogeneously with plasma lipid profile in subjects with coronary artery disease

HETEROGENEOUSLY WITH PLASMA LIPID PROFILE IN SUBJECTS WITH CORONARY ARTERY DISEASE Carmela Chiarielloa, Annalisa Castagnaa, Nicola Martinellia, Patrizia Guarinia, Marcello Manfredib, Elia Ranzatoc, Simona Martinottic, Emilio Marengoc, Daniela Cecconid, Oliviero Olivieria. aDepartment of Medicine, Section of Internal Medicine B, University of Verona, Italy. bISALIT S.r.l., Novara, Italy. cDepartment of Sciences and Technological Innovation, University of Piemonte Orientale, Alessandria, Italy. dProteomics and Mass Spectrometry Laboratory, Department of Biotechnology, University of Verona, Verona, Italy.

Effect of family presence on pain and anxiety during invasive nursing procedures in an emergency department: A randomized controlled experimental study

BackgroundPatients generally prefer to have their family present during medical or nursing interventions. Family presence is assumed to reduce anxiety, especially during painful interventions. AimThis study employed a randomized controlled experimental design to determine the effects of family presence on pain and anxiety during invasive nursing procedures. MethodThe study population consisted of patients hospitalized in the observation unit of the internal medicine section in the emergency department of a university hospital. The sample comprised 138 patients assigned into the experimental and control groups by drawing lots. The invasive nursing procedure was carried out in the presence of family members, for members of the experimental group, and without family members, for members of the control group. Thus, the effects of family presence on pain and anxiety during the administration of an invasive nursing procedure to patients were analyzed. ResultsThe results showed that members of the experimental and control groups did not differ with respect to the pain and state anxiety scores during the intervention. ConclusionFamily presence does not influence the participants' pain and anxiety during an invasive nursing procedure. Thus, the decision regarding family presence during such procedures should be based on patient preference.

The response of patients to hospitalization

Introduction: It is very difficult to describe how the patient feels at first contact with the hospital environment, medical personnel and medical diagnostic and therapeutic procedures. He was usually upset at first contact since carries with it suspense and feers, due to illnes, but also because of the new situation. Will the first meeting to encourage patients and create confidence and sureness or, derogate and hurt his personality, depends on these first impressions. The aim: The aim is to exemine react to hospitalization, analyze what is to attitude of hospital personnel towards patients, and investigate which patients are proposals to improve the conditions and procedure for hospitalization. Methods: The study was conducted at University Hospital in Foca, period October-November, 2014. The study included 50patients who are being treated at the University Hospital in Foca, in the section of Internal Medicine. The research used an anonymous questionnaire, and the results are graphically presented. Results: Two-thirds of respondents reacted very well to the hospitalization. Asked about their impressions on the first meeting with the medical personnel, 94% of respondents expressed a positive opinion, while 6% of respondents characterized their first meeting as negative. Conclusion: Generally, this study yilded the following results which can be characterized as positive, but we must strive to be better and try to patients satisfaction with the services and attitude of health worker, made at the highest level.

New advances in precision medicine for hepatocellular carcinoma recurrence prediction and treatment

New advances in precision medicine for hepatocellular carcinoma recurrence prediction and treatment

Low grade systemic inflammation and insulin resistance, instead of metabolic syndrome, as predictors of 9-years mortality in older population

Department of Clinical and Experimental Medicine, Section of Internal Medicine, Gerontology and Clinical Nutrition, University of Ferrara, Ferrara, Italy Department of Internal Medicine and Biomedical Sciences, Section of Geriatrics, University of Parma, Parma, Italy Institute of Gerontology and Geriatrics, INNRCA, Ancona, Italy ASF Geriatric Rehabilitation, ASF, Florence, Italy Department of Gerontology, Geriatrics and Metabolic Diseases, Second University of Naples, Naples, Italy Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, United States Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, NIH, Baltimore, United States

Bone marrow endothelial cells of patients with multiple myeloma: antigen presenting functions and T cell regulation

Event Abstract Back to Event Bone marrow endothelial cells of patients with multiple myeloma: antigen presenting functions and T cell regulation ARIANNA FERRUCCI1, PATRIZIA LEONE1, ROBERTO RIA1, VITO RACANELLI1 and ANGELO VACCA1* 1 DEPARTMENT OF BIOMEDICAL SCIENCES AND HUMAN ONCOLGY - SECTION OF INTERNAL MEDICINE AND CLINICAL ONCOLOGY, Italy Immunity against cancer is hampered by local mechanisms promoting tumor evasion from T cell surveillance or tumor-specific T cell tolerance in the tumor microenvironment. We have analyzed the antigen presenting capacities of endothelial cells from bone marrow of patients with multiple myeloma (MM), an inexorably lethal plasma cell malignancy1. We have found that bone marrow endothelial cells basally express both class I and class II MHC molecules as well as the costimulatory molecules CD80 and CD86. The expression level of these molecules is slightly lower than that of professional antigen presenting cells, such as dendritic cells, from the same patients. Bone marrow endothelial cells also express the components of the MHC class I antigen processing machinery which include the constitutive proteasome subunits delta (beta1), MB1 (beta5) and zeta (beta2); the interferon-gamma (INF-gamma)-inducible proteasome (immunoproteasome) subunits LMP2 (beta1i), LMP7 (beta5i) and LMP10 (beta2i); the peptide transporters TAP1 and TAP2 and the endoplasmic reticulum chaperones calnexin, calreticulin, ERp57 and tapasin. When bone marrow endothelial cells are cultured, CD80 and CD86 expression decreases, class II MHC molecule largely disappears and class I MHC molecule does not significantly change2. Both class II MHC and costimulatory molecule expression are restored by bone marrow endothelial cell exposure to IFN-gamma and IL-6. Cultured bone marrow endothelial cells can activate purified allogeneic and autologous CD4 and CD8 T cells. Acknowledgements This work was supported by Associazione Italiana per la Ricerca sul Cancro (Italian Association for Cancer Research - AIRC), Investigator Grant and the 5 per thousand Molecular Clinical Oncology Special Program (grant n. 9965), Milan, to AV, the European Commission's Seventh Framework programme (EU FPT7) under grant agreement n° 278706 (OVER-MyR) to AV, and grants from MIUR PRIN 2009WCNS5C_004 to RR, and 2010NECHBX to AV.

276 LYSOPHOSPHATIDIC ACID RECEPTOR 6 (LPA6) IS A MASTER REGULATOR ORCHESTRATING AND PROMOTING TUMOR GROWTH DURING HCC PROGRESSION

276 LYSOPHOSPHATIDIC ACID RECEPTOR 6 (LPA6) IS A MASTER REGULATOR ORCHESTRATING AND PROMOTING TUMOR GROWTH DURING HCC PROGRESSION A. Mazzocca, F. Dituri, F. De Santis, S. Antonaci, G. Giannelli. Department of Emergency and Organ Transplantation, Section of Internal Medicine Allergology and Immunology, Internal Medicine, Immunology and Infectious Diseases, Section of Internal Medicine, University of Bari, Bari, Italy E-mail: g.giannelli@intmed.uniba.it

277 LY2109761-LOADED MICROCAPSULES AS DRUG DELIVERY SYSTEM TO INHIBIT THE TGF-B1 PATHWAY IN HEPATOCELLULAR CARCINOMA

276 LYSOPHOSPHATIDIC ACID RECEPTOR 6 (LPA6) IS A MASTER REGULATOR ORCHESTRATING AND PROMOTING TUMOR GROWTH DURING HCC PROGRESSION A. Mazzocca, F. Dituri, F. De Santis, S. Antonaci, G. Giannelli. Department of Emergency and Organ Transplantation, Section of Internal Medicine Allergology and Immunology, Internal Medicine, Immunology and Infectious Diseases, Section of Internal Medicine, University of Bari, Bari, Italy E-mail: g.giannelli@intmed.uniba.it

Ask the Experts: Cardiovascular complications in diabetic patients

Morris Mosseri trained at Hadassah University Hospital (Jerusalem, Israel) and was certificated as a Cardiologist in 1987. He worked as a Research Associate at the Division of Cardiology, St. Elizabeth’s Hospital (MA, USA) from 1989 to 1991, and in Washington Hospital Center (DC, USA) in 1998. Mosseri was appointed Director of Interventional Cardiology at Hadassah in 2000 and since 2006 he is the Head of Cardiology Division in Meir Medical Center (Kfar-Sava, Israel). Significant academic activities of Mosseri include appointment as Chair of the Internal Medicine Section in the Medical School of the Hebrew University and Hadassah in 2000–2003, the Editor of the Journal of the Israel Heart Society in 1997–2002 and the Chairman of the Israeli Working Group on Interventional Cardiology from 2005 to 2009. Clinical and research areas of interest include acute coronary syndrome, interventional cardiology, the diabetic heart and cardiology in the elderly. Deepak L Bhatt is Chief of Cardiology at VA Boston Healthc...