Correlates of spinal deforming index (SDI) in HIV-positive patients naive and on treatment

Methods HIV-infected subjects naive or on stable HAART were included. Vertebral deformities were identified using SDI (according to semiquantitative method by Genant), calculated by summing the deformity grades of all vertebrae (T4 to L4); pathological deformities are defined as follow: grade 1 between 20–25%, grade 2 between 26–40%, and grade 3 > >40%. According to WHO criteria, osteopenia and osteoporosis were diagnosed in patients having spine BMD calculated as -1 << T-score << -2.5 and T-score ≤≤2.5, respectively. The correlation between SDI and spine BMD was evaluated by univariate and multivariate linear regression. [Other variables considered: gender, age, current CD4 count, CD4 nadir, BMI, lipid parameters, alcohol intake, smoking habit, physical activity, family history for bone fracture, months of ARV exposure, and co-infection with hepatitis viruses; only the variables with p <<0.2 in univariate analyses were included in the final model.

Prevención secundaria tras un síndrome coronario agudo. Resultados a medio plazo de un programa de rehabilitación cardiaca

Introducción Los Programas de Rehabilitación Cardiaca han adquirido gran relevancia como herramienta para mejorar el pronóstico y la calidad de vida de pacientes que han presentado un síndrome coronario agudo. Objetivo Evaluar los resultados de un programa de rehabilitación cardiaca a medio plazo. Materiales y métodos Estudio descriptivo retrospectivo de 121 pacientes que presentaron un síndrome coronario agudo y fueron incluidos en el programa de rehabilitación cardiaca. Se analizaron las características demográficas, antropométricas, analíticas y de capacidad funcional a la inclusión, tras finalizar el programa presencial y a los 12 meses. Resultados La edad media fue 54 ± 7 años. El factor de riesgo cardiovascular más prevalente fue el sobrepeso/obesidad (88, 4%). Tras la finalización del programa de rehabilitación cardiaca disminuyeron significativamente los valores de colesterol LDL (81, 1 ± 28, 7 vs. 76, 5 ± 31, 5 mg/dl; p 0, 03). Un porcentaje significativo de diabéticos alcanzaron objetivos de Hb A1c < 7% (50% vs. 68, 5%; p 0, 01). El perímetro abdominal mostró una disminución estadísticamente significativa (100, 8 ± 12, 8 vs. 99, 5 ± 12, 3 cm; p 0, 004). El 89, 3% de los pacientes mejoraron su capacidad funcional. En la revisión anual la mayoría de los parámetros estudiados mostraron una discreta tendencia negativa. Un 47, 36% de los fumadores a la inclusión mantenían el hábito tabáquico al año. Conclusiones Los programas de rehabilitación cardiaca mejoran el control de los factores de riesgo cardiovascular, cambios de estilo de vida y capacidad funcional en los pacientes que han sufrido un síndrome coronario agudo. Es preciso reforzar las estrategias de control para mantener estos beneficios a medio-largo plazo. Introduction: Cardiac rehabilitation programmes have become a very important tool for improving the prognosis and quality of life of patients that have suffered an acute coronary syndrome. Objective: To evaluate the medium-term results of a cardiac rehabilitation programme. Materials and methods: A descriptive study of 121 patients that presented with an acute coronary syndrome and were included in a cardiac rehabilitation programme. An analysis was performed on the demographic and anthropometric characteristics, as well as laboratory tests and functional capacity on inclusion, after finishing the programme, and at 12 months. Results: The mean age of the patients was 54 ± 7 years. The most prevalent cardiovascular risk factor was overweight / obesity (88.4%). After finishing the cardiac rehabilitation programmes, the LDL Cholesterol values significantly decreased (81.1 ± 28.7 vs. 76.5 ± 31.5 mg/dl; P =.03). A significant percentage of diabetics reached objectives of an Hb A1c < 7% (50% vs. 68.5%; P =.01). The abdominal circumference showed a statistically significant decrease (100.8 ± 12.8 vs. 99.5 ± 12.3 cm; P =.004). An improvement in functional capacity was observed in 89.3% of the patients. In the annual review, the majority of the parameters studied showed a slight negative trend. Just under half (47.36%) of smokers at inclusion maintained the tobacco habit at one year. Conclusions: Cardiac rehabilitation programmes improve the control of cardiovascular risk factors, changes in life style and functional capacity in patients that had suffered an acute coronary syndrome. Control strategies need to be enforced in order to maintain these benefits in the medium-long term

A multicentre roadmap to restart elective cardiac surgery after COVID-19 peak in an Italian epicenter

Background: During the Italian Phase-2 of the coronavirus pandemic, it was possible to restart elective surgeries. Because hospitals were still burdened with coronavirus disease 2019 (COVID-19) patients, it was focal to design a separate “clean path” for the surgical candidates and determine the possible effects of major surgery on previously infected patients. Methods: From May to July 2020 (postpandemic peak), 259 consecutive patients were scheduled for elective cardiac surgery in three different centers. Our original roadmap with four screening steps included: a short item questionnaire (STEP-1), nasopharyngeal swab (NP) (STEP-2), computed tomography (CT)-scan using COVID-19 reporting and data system (CO-RADS) scoring (STEP-3), and final NP swab before discharge (STEP-4). Results: Two patients (0.8%) resulted positive at STEP-2: one patient was discharged home for quarantine, the other performed a CT-scan (CO-RADS: 75 years: odds ratio [OR]: 2.6; 95% confidence interval [CI]: 1.25–5.57; p = 0.011; CPB >90 min. OR: 4.3; 95% CI: 1.84–10.16; p = 0.001). At 30 days, no periprocedural contagion and rehospitalization for COVID-19 infections were reported. Conclusions: Our structured roadmap supports the safe restarting of an elective cardiac surgery list after a peak of a still ongoing COVID-19 pandemic in an epicenter area. Mild to moderate CT residuals of coronavirus pneumonia do not justify elective cardiac surgery procrastination

Effect of partial inhibition of fatty acid oxidation by trimetazidine on whole body energy metabolism in patients with chronic heart failure

Objective: Trimetazidine may have beneficial effects on left ventricular (LV) function in patients with systolic heart failure. The authors assessed whether long-term addition of trimetazidine to conventional treatment could improve, along with LV function, resting whole body energy metabolism in patients with chronic systolic heart failure. Design: Single blind randomised study. Setting: University Hospital. Patients: 44 patients with systolic heart failure receiving full medical treatment. Interventions: Indirect calorimetry and two-dimensional echocardiography at baseline and after 3 months. Main outcome measures: Whole body resting energy expenditure (REE), percentage of predicted REE, LV ejection fraction (EF), NYHA class, quality of life. Results: Trimetazidine increased EF compared with conventional therapy alone (from 3568% to 42611% vs from 3567% to 36\ub16%; p=0.02, analysis of variance for repeated measures). NYHA class and quality of life also improved compared with conventional therapy (p<0.0001). REE (from 1677\ub1264 to 1580\ub1263 kcal/day) and percentage of predicted REE (based on the Harris-Benedict equation: from 114\ub110% to 108\ub19%) decreased in the trimetazidine group, but not in the control group (REE from 1679\ub1304 to 1690\ub1337 kcal/day and percentage of predicted REE from 113\ub112% to 115\ub114%). The variation was different between groups (p=0.03 and 0.023, respectively). Conclusions: In patients with systolic heart failure, improvement in functional class and LV function induced by middle-term trimetazidine therapy is paralleled by a reduction in whole body REE. The beneficial cardiac effects of trimetazidine may be also mediated by a peripheral metabolic effect

Atrial fibrillation detection using a novel three-vector cardiac implantable monitor: The atrial fibrillation detect study

Aims Continuous rhythm monitoring is valuable for adequate atrial fibrillation (AF) management in the clinical setting. Subcutaneous leadless implantable cardiac monitors (ICMs) yield an improved AF detection, overcoming the intrinsic limitations of the currently available external recording systems, thus resulting in a more accurate patient treatment. The study purpose was to assess the detection performance of a novel three-vector ICM device equipped with a dedicated AF algorithm. Methods and results Sixty-six patients (86.4% males; mean age 60.4 \ub1 9.4 years) at risk to present AF episodes, having undergone the novel ICM implant (BioMonitor, Biotronik SE&Co. KG, Berlin, Germany), were enrolled. External 48-h ECG Holter was performed 4 weeks after the device implantation. The automatic ICM AF classification was compared with the manual Holter arrhythmia recordings. Of the overall study population, 63/66 (95.5%) had analysable Holter data, 39/63 (62%) showed at least one true AF episode. All these patients had at least one AF episode stored in the ICM. On Holter monitoring, 24/63 (38%) patients did not show AF episodes, in 16 of them (16/24, 67%), the ICM confirmed the absence of AF. The AF detection sensitivity and positive predictive value for episodes' analysis were 95.4 and 76.3%, respectively. Conclusion Continuous monitoring using this novel device, equipped with a dedicated detection algorithm, yields an accurate and reliable detection of AF episodes. The ICM is a promising tool for tailoring individual AF patient management. Further long-term prospective studies are necessary to confirm these encouraging results