Mediterranean jellyfish sting-induced Tako-Tsubo cardiomyopathy.

We report a case of a 53-year-old woman swimming in the southern Mediterranean Sea on the Calabrian coast that was suddenly stung on her right forearm by a mauve-pink jellyfish. She got extremely scared and while swimming back to the shore, she accused fatigue and an intense itch sensation. She lost consciousness on the beach as a consequence of a condition of pulseless electrical activity

Migration of a stent from left main and its retrieval from femoral artery: A case report

Rationale:Embolization of a deployed stent is a rare complication and its mechanism remains unclear in most cases.Patient concerns:A 52-year-old man underwent coronary angiography for effort angina, revealing an 80% stenosis of the proximal left anterior descending (LAD) involving the distal left main (LM). After luminal sizing with intravascular ultrasound two drug-eluting stents were deployed (5.0 × 12 mm and 3.5 × 15 mm) to cover the LM-LAD lesion. After postdilatation, the proximal stent had disappeared from the LM.Diagnoses:The missing stent was found in the right deep femoral artery.Interventions:A new 5.0 × 15 mm stent was deployed onto the LM-LAD ostium, in overlapping with the previously implanted. Then, the stent migrated to the deep femoral artery was successfully retieved through the contralateral femoral artery.Outcomes:The patient was discharged 2 days later, after an uneventful hospital stay.Lessons:Stent deformation after postdilation is a possible causes of stent migration

Description and validation of TAVIApp: A novel mobile application for support of physicians in the management of aortic stenosis - Management of aortic stenosis with TAVIApp

Background. Aortic stenosis (AS) is the most common heart valve disease in developed countries. The advent of transcatheter aortic valve implantation (TAVI) significantly improved patients' outcome but made clinical management more complex. The aim of the present study was to describe TAVIApp, a mobile app we developed to guide the management of AS, and test its efficacy. Methods and Results. Clinical cases comprising 42 patients with AS were blindly evaluated by (A) an interventional cardiologist, assisted by the Heart Team (EXPERT), (B) young residents in cardiology, and (C) a young resident supported by TAVIApp. There was poor concordance between Group A and Group B with low performance by young residents (k=0.52; p<0.001). However, concordance increased to an optimal value when young residents were supported by TAVIApp (k=1.0; p<0.001) for the diagnosis of severe AS and eligibility assessment. Furthermore, regarding the selection of the most appropriate prosthesis size, concordance to Group A was poor without TAVIApp support (Group B) (k=0.78; p=0.430), but excellent with TAVIApp (k=1.0; p<0.001). Conclusions. This study is the first describing and validating a new mobile application to support the management of AS. TAVIApp supports cardiologists in the evaluation of stenosis severity, eligibility for TAVI or AVR, and selection of the most appropriate prosthesis size in individual patients

Clinical and procedural outcomes of 5-French versus 6-French sheaths in transradial coronary interventions

The radial artery has been increasingly used for its favorable safety profile. However, no conclusive data are available on the optimal sheath size. In particular, it is seemingly difficult to weight both advantages and disadvantages of narrower versus larger sheaths size. Despite several studies were performed to compare the use of 6-Fr to the smaller 5-Fr sheaths, these were mostly small, single center-studies, yielding various results. We performed a comprehensive meta-analysis of all available studies comparing the use of 5-Fr versus 6-Fr sheaths in coronary procedures through the TRA. Studies comparing a 5-Fr versus a 6-Fr sheaths were searched for in PubMed, the Cochrane Library, and ISI Web of Knowledge databases. Studies were deemed eligible if they only included patients undergoing transradial cardiac catheterization with 5-Fr or 6-Fr system and reported at least one of these parameters: contrast dye volume, procedural success, procedural time, access complications, radial artery occlusion, and bleedings. Odds ratio (OR) and the mean difference (MD) were respectively used for dichotomous and continuous variables as summary measures. Both the random-effects model and the fixed effect models were used for computation of meta-analyses. Heterogeneity was assessed by means of the Cochrane Q test. Metaregression was calculated using the unrestricted maximal likelihood random effects model. The use of a 5-Fr system is associated with a significant lower contrast medium administration (MD=-22.20 [-36.43 to-7.96], P<0.01) and significantly reduces bleedings (OR=0.58 [0.38- 0.90], P=0.02), without compromising procedural success (OR=0.95 [0.53-1.69], P=0.86) or procedure length (OR=0.55 [-2.58 to 3.69], P=0.73), compared to the 6-Fr system. Despite no significant difference was observed between the groups (OR=0.88 [0.50-1.56], P=0.67), at metaregression RAO incidence in the 5-Fr group was increasingly lower as the percentage of women included into the study increased (P=0.02). Some potentially interesting technical details, such as sheath length, hydrophilic coating, or periprocedural anticoagulation, were not homogeneously reported in individual studies. Results of the present meta-analysis confirm the excellent safety profile of transradial procedures both with 5-Fr and 6-Fr system. A 5-Fr system could be preferred in patients with a higher bleeding propensity or kidney injury

“It’s Making Memories”: A Qualitative Investigation of Family Mealtime Cognitions, Barriers and Strategies for Success of Parents and School-aged Kids

Objective: Family meals, particularly those occurring in calm environments, are associated with numerous health benefits for both children and parents. However, families often struggle to share meals, with the frequency declining as kids get older. This qualitative research study aimed to explore the factors influencing family meal behaviors. Methods: Parents (n=38) and school-age children (n=37) participated in focus group discussions guided by Social Cognitive Theory. Results: Content analysis results indicate that parents and children believed family meals were important, promoted communication, and strengthened family bonds. Parents and children reported that a calm, enjoyable, conflict-free mealtime environment bolstered mealtime enjoyment and increased the likelihood of regular family meals. Busy schedules were the greatest barrier to family meals identified by children and parents. Strategies for overcoming barriers to family meals identified by parents were similar to those shared by kids and included keeping mealtime conversations positive, altering schedules to accommodate family mealtime, planning ahead, using time saving strategies and recruiting kids to help with meal preparation. Conclusion: This qualitative research study provides novel insights into parents’ and school-age children’s cognitions (e.g., beliefs, attitudes), barriers, and facilitators related to family meals. Consideration of these insights during the development of nutrition education interventions has the potential to improve intervention effectiveness in increasing family meal frequency

Delayed sudden radial artery rupture after left transradial coronary catheterization a case report

Local complications at the radial access site are not frequent, hence its large diffusion as the preferred access route for endovascular procedures. However, in a time of fast widespreading, better comprehension of all potential complications becomes critical to facilitate their early recognition and the most appropriate treatment. In this case report, we present for the first time a case of sudden massive bleeding at the left wrist, due to spontaneous gross rupture of the left radial artery bleeding 15 days after an endovascular procedure through a left radial arterial access. The patient had been readmitted to the hospital after evidence of local infection at the left wrist with loss of substance. The radial artery was patent with no evidence of pseudoaneurysm. After sudden radial artery rupture, with massive bleeding and suspicion that the local infection could have reached the arterial wall, surgical hemostasis with artery ligation was obtained. Healing of the large wound was then efficiently speeded up using a negative pressure wound therapy. This is the first case of macroscopic radial artery rupture associated with local wrist infection after arterial catheterization. After prompt surgical hemostasis, negative pressure wound therapy was very helpful in favoring healing of the large and deep wound

Fast-track ruling in/out SARS-CoV-2 infection with rapid 0/1.5 h molecular test in patients with acute coronary syndromes

AIMS: Patients with acute coronary syndrome (ACS) often arrive in the catheterization (cath) lab directly from the field or an emergency department without an accurate triage for Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.Although in the pandemic period the treatment in the cath laboratory of high-risk ACS should not be delayed because the operators wear special protection systems, the subsequent risk of contagion in a non-Covid coronary care unit could be high in the case of patients positive for SARS-CoV-2. METHODS: We tested the possibility of a fast-track protocol in 51 consecutive patients (mean age 65 ± 12 years) transferred from spokes centres or from the field to our HUB centre and admitted to our coronary care unit (CCU). Once the patient had arrived in the cath lab, the nasopharyngeal swab was performed. The real-time PCR to extract RNA for SARS-CoV-2 detection was performed with an automated rapid molecular Xpert Xpress test. Meanwhile, coronary angiography or percutaneous coronary intervention was performed if necessary. RESULTS: In this fast-track protocol, the time to perform nasopharyngeal swab was 11 ± 11 min; time spent to transport nasopharyngeal swab to the laboratory was 29 ± 20 min; time to detect viral nucleic acid was 68 ± 16 min. The overall time from the execution of nasopharyngeal swab to the result was 109 ± 26 min. The results were immediately put into the hospital computer system and made readily available. Depending on the test result, patients were then transferred to the regular CCU or Covid area. CONCLUSION: This study demonstrates that 0-1.5 h fast-track triage for coronavirus disease 2019 (COVID 19) is feasible in patients with ACS. The execution of nasopharyngeal swab in the cath lab and its analysis with a rapid molecular test allows rapid stratification of SARS-CoV-2 infection