Short term outcome of myocarditis and pericarditis following COVID-19 vaccines: a cardiac magnetic resonance imaging study

To evaluate clinical and cardiac magnetic resonance (CMR) short-term follow-up (FU) in patients with vaccine-associated myocarditis, pericarditis or myo-pericarditis (VAMP) following COVID-19 vaccination. We retrospectively analyzed 44 patients (2 women, mean age: 31.7 +/- 15.1 years) with clinical and CMR manifestations of VAMP, recruited from 13 large tertiary national centers. Inclusion criteria were troponin raise, interval between the last vaccination dose and onset of symptoms < 25 days and symptoms-to-CMR < 20 days. 29/44 patients underwent a short-term FU-CMR with a median time of 3.3 months. Ventricular volumes and CMR findings of cardiac injury were collected in all exams. Mean interval between the last vaccination dose and the onset of symptoms was 6.2 +/- 5.6 days. 30/44 patients received a vaccination with Comirnaty, 12/44 with Spikevax, 1/44 with Vaxzevria and 1/44 with Janssen (18 after the first dose of vaccine, 20 after the second and 6 after the "booster" dose). Chest pain was the most frequent symptom (41/44), followed by fever (29/44), myalgia (17/44), dyspnea (13/44) and palpitations (11/44). At baseline, left ventricular ejection fraction (LV-EF) was reduced in 7 patients; wall motion abnormalities have been detected in 10. Myocardial edema was found in 35 (79.5%) and LGE in 40 (90.9%) patients. Clinical FU revealed symptoms persistence in 8/44 patients. At FU-CMR, LV-EF was reduced only in 2 patients, myocardial edema was present in 8/29 patients and LGE in 26/29. VAMPs appear to have a mild clinical presentation, with self-limiting course and resolution of CMR signs of active inflammation at short-term follow-up in most of the cases

Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation : Data From ROCKET AF

M. Kaste on työryhmän ROCKET AF Steering Comm jäsen.Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS(2) score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P= 75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, approximate to 7 in 10 deaths were cardiovascular, whereasPeer reviewe

Alternativa ed elementi di socialismo nelle comunità locali

Introduzione (E. Bettinelli e E. Renzi) – Tendenze e prospettive dell’autogoverno e dell’autogestione a Pavia (E. Bettinelli) – Politica comunale alternativa (U. Dragone) – Aspetti problematici della partecipazione e dell’autogestione a livello comunale (F. C. Rampolla) – Autonomia tributaria e finanziaria dei comuni (F. Osculati) – Consigli tributari e decentramento urbano (G. Tremonti) – Enti locali, decentramento e strategia della sinistra (F. Borgoglio) – La partecipazione per un nuovo modello di sviluppo (E. Veltri) – Un ritorno socialista per gli enti locali: la politica del territorio (V. Spini) – Alternativa socialista: dagli enti locali al governo centrale (G. De Michelis-) – Contropotere locale e alternativa di sistema (A: Zanini) – Su alcune ipotesi alternative di amministrazione della giustizia (M. Taruffo) – Gli Enti locali nel settore scolastico (G. Luzzato) – Democrazia di base e democrazia rappresentativa per la costruzione della società socialista (L. Labor) – Autogestione e movimento operaio (J. P. Chevènement) – Le giunte dopo il 15 giugno (G. Martinetti) – Nota bibliografica (E. Bettinelli e E. Renzi) – Documento fondativo dell’A.R.A. (Associazione per la Ricerca dell’Alternativa)

MRI postoperative monitoring in patients surgically treated for aortic dissection

In most cases, surgery of aortic dissections repairs only the ascending portion of the aorta, leaving a residual dissection in the arch and descending aorta, We studied 17 patients operated upon for type A aortic dissection, A total of 42 magnetic resonance imaging (MRI) examinations were performed, with two to five studies per patient(mean 2.47), The studies were done between 5 weeks and 47 months (mean 17.5 months) after surgery, The patients were evaluated by MRI using gated spin-echo and gradient-echo sequences on axial and oblique sagittal views, and in selected cases, coronal views, A high incidence of abnormalities was observed. Pericardial hematoma was observed in 11% of cases, aortic and branch involvement in 41%, abdominal aortic branch involvement in 47%, dilatation of native aorta in 58%, and extension df dissection in 10%, New complications were detected during follow-up in 53% of patients, MRI was helpful in the follow-up of patients operated upon for aortic dissections, owing to its noninvasiveness and multiplanarity, By means of this technique, it was possible to obtain information about the natural history of the disease, as well as information useful for subsequent treatment. Copyright (C) 1996 Elsevier Science Inc