Peripartum Cardiomyopathy: An Intriguing Challenge. Case Report with Literature Review

Peripartum cardiomyopathy is a relatively rare disease, which can have devasting consequences and should be promptly identified and correctly treated. Overall prognosis is good in majority of the cases, although some patients may progress to irreversible heart failure. Early diagnosis is important and effective treatment reduces mortality rates and increases the chance of complete recovery of ventricular systolic function

Copeptin for risk stratification in acute illness: beyond cardiological problems

Copeptin (Cop) has been recently proposed as a reliable marker for the diagnosis of acute coronary syndrome, altough its concentration was found to increase in a variety of other severe clinical conditions. The aim of the present study was to assess the utility of Cop to identify high-risk patients in the emergency room (ER). Eighty-five patients admitted to ER of the San Maurizio Regional Hospital of Bolzano between February to March 2010 with epigastric or chest pain and/or discomfort were included in the study. Blood was drawn at admission and sampled for Cop in standard laboratory tests. Cop levels were significantly higher in patients who died at the hospital or shortly afterwards as compared with survivors (median 61 vs 40.6 pmol/L; P=0.014). Cop levels were also higher in patients with severe health problems (62.9 vs 28.3 pmol/L; P<0.0001). The area under the receiver-operating characteristic curve of Cop was 0.70 for in-hospital death [95% confidence interval (CI) 0.53-0.86], 0.74 for acute and subacute death (95% CI 0.61-0.87) and 0.90 for prediction of severe acute illness (95% CI 0.84-0.97). Accordingly, a Cop level >33.1 pmol/L correctly identified in-hospital death with 71% sensitivity and 74% specificity. A Cop level >13.6 pmol/L was instead associated with 89% sensitivity and 80% specificity for identifying patients with acute and severe conditions. The results of our analysis would suggest that the use of Cop may be a valuable aid in the ER for identifying patients with life-threatening conditions

Ten years differences in recently onset atrial fibrillation and flutter incidence and management

Objects and background: Atrial fibrillation (AF) and atrial flutter (AFl) are the most common arrhythmias in day-life clinical practice. Purpose of our study was to verify differences occurred in the last ten years in AF and AFl incidence and treatment in the emergency room (ER). Methods: from the 17th January to the 15th February 2000 and from the 18th January to the 16th February 2010 all the consecutive patients with AF or AFl referring to the ER of our hospital were included in the study. Epidemiological data were collected along with information about treatment, admission to hospital wards, days of hospital stay and therapy. Data from the year 2000 were compared to these collected ten years later. Results: incidence of AF and AFl has increased in the years (50%), patients are older (73.5 vs. 65.2 years; p 0.029) and refer late to the ER (45.6% in 2010 and 23.7% in 2000 with a delay of > 48 hours from arrhythmias onset; p 0.054). In 2010 only a minority of these patients is directly discharged from the ER (15.8% vs 14.4%) and there is an increased admission rate due to AF or AFl (67.5%; p 0.026), if compared to the whole admissions of the hospital. The median duration of hospital stay decreased from 6 days to 4.5 days in the year 2010 (NS). Conclusion: AF and AFl incidence is still increasing and account for a high admission rate from the ER to the hospital wards. Costs are consequently continuously increasing

Colchicine for prevention of postpericardiotomy syndrome and postoperative atrial fibrillation : the COPPS-2 randomized clinical trial

IMPORTANCE: Postpericardiotomy syndrome, postoperative atrial fibrillation (AF), and postoperative effusions may be responsible for increased morbidity and health care costs after cardiac surgery. Postoperative use of colchicine prevented these complications in a single trial. OBJECTIVE: To determine the efficacy and safety of perioperative use of oral colchicine in reducing postpericardiotomy syndrome, postoperative AF, and postoperative pericardial or pleural effusions. DESIGN, SETTING, AND PARTICIPANTS: Investigator-initiated, double-blind, placebo-controlled, randomized clinical trial among 360 consecutive candidates for cardiac surgery enrolled in 11 Italian centers between March 2012 and March 2014. At enrollment, mean age of the trial participants was 67.5 years (SD, 10.6 years), 69% were men, and 36% had planned valvular surgery. Main exclusion criteria were absence of sinus rhythm at enrollment, cardiac transplantation, and contraindications to colchicine. INTERVENTIONS: Patients were randomized to receive placebo (n=180) or colchicine (0.5 mg twice daily in patients 6570 kg or 0.5 mg once daily in patients <70 kg; n=180) starting between 48 and 72 hours before surgery and continued for 1 month after surgery. MAIN OUTCOMES AND MEASURES: Occurrence of postpericardiotomy syndrome within 3 months; main secondary study end points were postoperative AF and pericardial or pleural effusion. RESULTS: The primary end point of postpericardiotomy syndrome occurred in 35 patients (19.4%) assigned to colchicine and in 53 (29.4%) assigned to placebo (absolute difference, 10.0%; 95% CI, 1.1%-18.7%; number needed to treat\u2009=\u200910). There were no significant differences between the colchicine and placebo groups for the secondary end points of postoperative AF (colchicine, 61 patients [33.9%]; placebo, 75 patients [41.7%]; absolute difference, 7.8%; 95% CI, -2.2% to 17.6%) or postoperative pericardial/pleural effusion (colchicine, 103 patients [57.2%]; placebo, 106 patients [58.9%]; absolute difference, 1.7%; 95% CI, -8.5% to 11.7%), although there was a reduction in postoperative AF in the prespecified on-treatment analysis (placebo, 61/148 patients [41.2%]; colchicine, 38/141 patients [27.0%]; absolute difference, 14.2%; 95% CI, 3.3%-24.7%). Adverse events occurred in 21 patients (11.7%) in the placebo group vs 36 (20.0%) in the colchicine group (absolute difference, 8.3%; 95% CI; 0.76%-15.9%; number needed to harm\u2009=\u200912), but discontinuation rates were similar. No serious adverse events were observed. CONCLUSIONS AND RELEVANCE: Among patients undergoing cardiac surgery, perioperative use of colchicine compared with placebo reduced the incidence of postpericardiotomy syndrome but not of postoperative AF or postoperative pericardial/pleural effusion. The increased risk of gastrointestinal adverse effects reduced the potential benefits of colchicine in this setting. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT0155218

Plataforma de medição de consumo para comparação entre software e hardware em projetos energeticamente eficientes

The large number of mobile devices increased the interest in low-power designs. Tools that allow the evaluation of alternative implementations give the designer actionable information to create energy-efficient designs. This paper presents a new power measurement platform able to compare the energy consumption of different algorithms implemented in software and in hardware. The proposed platform is able to measure the energy consumption of a specific process running in a general-purpose CPU with a standard operating system, and to compare the results with equivalent algorithms running in an FPGA. This allows the designer to choose the most energy-efficient software vs. hardware partitioning for a given application. Compared with the current state-of-the-art, the presented platform has four distinguishing features: (i) support for both software and hardware power measurements, (ii) measurement of individual code sections in the CPU, (iii) support for dynamic clock frequencies, and (iv) improvement of measurement precision. We also demonstrate how the developed platform has been used to analyze the energy consumption of network intrusion detection algorithms aimed at detecting probing attacks.A popularização dos dispositivos móveis impulsionou a pesquisa e o desenvolvimento de soluções de baixo consumo. A evolução destas aplicações demanda ferramentas que permitam avaliar diferentes alternativas de implementação, fornecendo, aos desenvolvedores, informações valiosas para a criação de soluções energeticamente eficientes. Este trabalho desenvolveu uma nova plataforma de medição de consumo que permite comparar a eficiência energética de diferentes algoritmos implementados em software e em hardware. A plataforma é capaz de medir o consumo energético de um processo específico em execução em um processador de propósito geral com um sistema operacional padrão, além de comparar o resultado obtido com algoritmos equivalentes implementados em uma FPGA. Isto permite ao desenvolvedor dividir o processamento da aplicação entre software e hardware de forma a obter a solução mais energeticamente eficiente. Comparada com o estado da arte, a plataforma de medição criada possui três característica inovadoras: suporte a medição de consumo de software e hardware; medição de trechos de código específicos executados pelo processador; e suporte a alteração dinâmica do clock. Também é mostrado neste trabalho como a plataforma desenvolvida tem sido utilizada para analisar o consumo energético de algoritmos de detecção de intrusão de rede para ataques do tipo probing