Cardiopulmonary functional evaluation and competitive sports eligibility in subjects with congenital heart diseases

openIntroduzione. Le cardiopatie congenite (CHD) includono varie malformazioni cardiache e colpiscono circa lo 0,5-1% della popolazione mondiale. Grazie ai progressi negli interventi medici e chirurgici, quasi il 90% dei pazienti con CHD ora sopravvive fino all'età adulta, soprattutto nei paesi sviluppati. Questo ha portato a un crescente interesse per la partecipazione sportiva, sia ricreativa che competitiva. Negli ultimi 15 anni, le raccomandazioni riguardanti l'attività sportiva sono evolute da linee guida focalizzate sulla patologia a un approccio clinico e funzionale personalizzato, come delineato dalle Società Europee di Cardiologia (ESC 2020). In Italia, la presenza di linee guida specifiche (COCIS 2017 e COCIS 2023) rappresenta uno strumento complementare per valutare al meglio il rilascio di idoneità sportiva agonistica nei pazienti con CHD. Scopo dello studio. L'obiettivo principale di questo studio è classificare l'idoneità per gli sport agonistici in una vasta popolazione di pazienti con cardiopatia congenita (CHD) utilizzando l'algoritmo valutativo delle raccomandazioni del 2020 delle Società Europee di Cardiologia. Inoltre, lo studio valuta la possibilità di concedere l'idoneità agli sport agonistici secondo le normative italiane vigenti e confronta le discipline consentite dai protocolli italiani (COCIS 2017 e COCIS 2023) con quelle permesse dalle raccomandazioni europee (linee guida ESC 2020). Materiali e metodi. Un'analisi retrospettiva è stata condotta su 493 pazienti sottoposti a correzione chirurgica per cardiopatie congenite (CHD) e successivamente monitorati presso l'Azienda Ospedale-Università di Padova. I parametri morfologici ed emodinamici a riposo sono stati valutati sulla base dei referti ecocardiografici e/o di risonanza magnetica cardiaca forniti dai pazienti. I parametri cardiovascolari e funzionali durante l'esercizio sono stati valutati tramite test cardiopolmonare. Risultati. L'età mediana (IQR) era di 17 (13; 22.5) anni; 321 pazienti (65,1%) erano maschi. Il 31% era in classe D, il 14,2% in classe B, il 26,1% in classe C e il 28,1% in classe A. 216 soggetti (46,0%) hanno svolto esercizio fisico strutturato nell'intera popolazione, corrispondenti al 59,4% dei soggetti in classe A, al 44,1% di quelli in classe B, al 39,4% di quelli in classe C e al 40,7% di quelli in classe D. La CRF e i principali parametri funzionali erano simili tra le classi A e B, ma significativamente diversi tra la classe A rispetto alle classi C e D (VO2/Kg) e VO2% del predetto A rispetto a C e D (p <.0001). Anche la compromissione funzionale è risultata significativamente più elevata nei pazienti nelle classi di idoneità più basse (C e D) rispetto a quelle più alte, con una prevalenza di CRF compromessa del 22,5% in classe A, del 42,5% in classe B, del 55,1% in classe C e del 57,0% in classe D (p <.0001). Il confronto tra soggetti allenati e non allenati ha mostrato differenze significative nella CRF (VO2/Kg) sia all'interno che tra le classi ESC 2020, mentre nessuna differenza è risultata significativa tra i gruppi di classi diverse, ma con lo stesso livello di attività fisica. Un modello di regressione multivariata ha mostrato che l'allenamento fisico strutturato è un determinante significativo indipendente della capacità funzionale nelle persone con CHD corretta chirurgicamente. Il confronto dell'idoneità sportiva ha mostrato che dal COCIS 2017 al COCIS 2023 circa il 17,7% in più di pazienti idonei solo per le discipline di destrezza potrebbe essere valutato per ottenere l'idoneità per tutti gli sport competitivi. Conclusione. L'applicazione delle linee guida ESC 2020 a una vasta popolazione di individui con cardiopatia congenita (CHD) rivela che solo circa un terzo dei soggetti dovrebbe evitare ogni tipo di sport agonistico.Introduction. Congenital heart disease (CHD) includes various cardiac malformations and affects approximately 0.5-1% of the global population. With the improvement of medical and surgical interventions, nearly 90% of CHD patients now survive into adulthood, particularly in developed nations. This has led to a growing interest in both recreational and competitive sports participation in this population. Over the last 15 years, recommendations regarding sports involvement changed significantly from pathology-focused guidelines to the more recent personalized clinical and functional approach outlined by the European Societies of Cardiology (ESC 2020). In Italy, the presence of specific guidelines (COCIS 2017 and COCIS 2023) represents a valuable tool for better assessing competitive sports eligibility in patients with CHD. Aim of the study. The primary aim of this study is to classify the eligibility for competitive sports in a large population of patients with congenital heart disease (CHD) using the evaluative algorithm from the 2020 European Society of Cardiology guidelines. Additionally, the study assesses the change in competitive sports eligibility according to current Italian protocols (COCIS) from the 2017 to the 2023 edition. Materials & methods. A retrospective analysis was conducted on 493 patients who underwent surgical correction for congenital heart disease (CHD) and were subsequently monitored at the University-Hospital of Padua. Resting morphological and hemodynamic parameters were evaluated based on echocardiographic and/or cardiac MRI reports provided by the patients. Cardiovascular and functional parameters during exercise were assessed through maximal cardiopulmonary exercise testing. Results. Median (IQR) age was 17 (13; 22.5) years; 321 patients (65,1%) were males. 31% were in class D, 14,2% in class B, 26,1% in class C and 28,1% in class A. 216 subjects (46,0%) performed structured physical training in the whole population, corresponding to the 59,4% of subjects in class A, 44,1% of those in class B, 39,4% of those in class C and 40,7% of those in class D. CRF and the main functional parameters were similar between class A and B, but significantly different between class A vs. classes C and D (VO2/Kg) and VO2% of predicted A vs. C and vs D p<.0001). Also functional impairment resulted significantly higher in patients in the lower class of sport eligibility (C and D) than in the higher ones with a prevalence of impaired CRF of 22.5% in class A, 42.5% in class B, 55.1% in class C and 57.0% in class D (p <.0001). Paired comparison showed significant differences in CRF (VO2/Kg) between trained and untrained subjects both within and across ESC 2020 classes, while no difference was significant among paired group of different classes, but with the same physical activity level. A multivariable stepwise regression model showed that structured exercise training is a significant independent determinant of functional capacity in people with surgically corrected CHD.Sports eligibility comparison showed that from COCIS 2017 to COCIS 2023 about the 17,7% more of patients eligible only for skill disciplines could be evaluate for all competitive sports. Conclusion. The application of the ESC 2020 guidelines to a large population of individuals with congenital heart disease (CHD) reveals that only about one-third of subjects should avoid all types of competitive sports. However, even those unable to participate in competitive sports can benefit from individualized exercise prescriptions aimed at preserving and improving functional capacity. The comparison with the COCIS 2023 guidelines, which include an additional level of recommendation, enhances the medical-sports evaluation for granting eligibility

A new UV-LED device for automatic disinfection of stethoscope membranes

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“Every cockroach is beautiful to his mother’s eyes”? A multicentric study on the perception of child’s health status according to the parent.

INTRODUCTION: Childhood obesity is a social health problem in the Western World and an important goal is to analyze and correct risk factors. However, part of the problem could be determined by a different perception of the weight. MATERIAL AND METHODS: In October 2019, we conducted a cross-sectional study in which a questionnaire was administered to the parents of primary and secondary school children in South-East Tuscany, Italy. The aim was to determine the association between children’s Body Mass Index (BMI) and the parent’s perception.RESULTS: Analysis was carried out on 1,405 complete questionnaires. We found that most parents wrongly perceive the weight of their children. 88.3% of parents with obese children believe that their children are of normal weight or only “a little overweight”. 67.6% of parents who have overweight children think that their children are of normal weight (p&lt;0.001). CONCLUSIONS: Our results show a misperception of the weight of the children in the parents eyes. The acquisition of healthy behaviour during childhood is extremely important for health in adulthood and for avoiding the onset of associated diseases. Therefore, food education becomes a crucial objective. Children and parents need to increase consciousness of the correct weight and diseases resulting from bad nutrition

BACTERIAL LYSATES (OM-85 BV): a cost-effective proposal in order to contrast antibiotic resistance

Background Chronic Obstructive Pulmonary Disease (COPD) is one of the most frequent pathologies in which antibiotics are used because 50% of the exacerbations are attributable to a bacterial infection. The aims of our study were: i)to perform a meta-analysis on the efficacy of the bacterial lysate OM-85 BV in preventing acute exacerbations in patients with COPD; ii) to evaluate whether this preventive treatment can lead to significant savings for the National Health Service (NHS). &nbsp; Methods A systematic research was conducted in the electronic database MEDLINE (PubMed) in June 2017-July 2020, collecting evidences without time restrictions. Only randomized controlled trials (RCTs) were included. The keywords used were "OM 85 BV AND chronic bronchitis" and "OM 85 BV AND COPD". We realized the cost-effectiveness analysis (CEA) considering the costs for a treatment with OM-8BV, the costs for the treatment of an acute exacerbation and the number of prevented exacerbations. &nbsp; Results 59 publications were found, but the meta-analysis was conducted on 13 studies conducted between 1981 and 2015.OM-85 BV is responsible of a statistically significant reduction in the mean number of COPD exacerbations (p &lt;0.01; WMD -0.86;CI 95% -1.38, -0.34) and in the days of antibiotic therapy (p &lt;0.01; WMD -9.49;CI 95% -11.93, -7.05). The cost-effectiveness ratio with a negative value is in favor to treatment. &nbsp; &nbsp;&nbsp; Conclusions OM-85 BV is effective in reducing exacerbations, and could lead to significant savings for the NHS. Moreover, reducing the number of exacerbations it avoids an over-use of antibiotics and the consequent antibiotic resistance

Effectiveness of near-UVA in SARS-CoV-2 inactivation

This experimental study aimed to determine the activity of a near-UVA (405 nm) LED ceiling system against the SARS-CoV-2 virus. The ceiling system comprised 17 near-UVA LED lights with a radiant power of 1.1 W/each centred at 405 nm wavelength. A 96-multiwell plate, fixed to a wooden base, was inoculated with suspensions of VERO E6 cell cultures infected with SARS-CoV-2 virus and irradiated at a distance of 40 cm with a dose of 20.2 J/cm(2) for 120 min. The collected suspensions were transferred to VERO cell culture plates and incubated for 3 days. The maximum measurable log reduction obtained, starting from a concentration of 10(7.2) TCID50/mL, was 3.0 log(10) and indicated inhibition of SARS-CoV-2 replication by the near-UVA LED ceiling system. Near-UVA light at a 405-nm wavelength is emerging as a potential alternative treatment for localised infections and environmental decontamination because it is far less harmful to living organisms' cells than UV-C irradiation

Dispositivo per l’igienizzazione di strumenti medici

La presente invenzione si riferisce ad un dispositivo per l’igienizzazione di strumenti medici, in particolare di stetoscopi. In particolare, la presente invenzione riguarda un dispositivo di igienizzazione o sterilizzazione (1) di uno stetoscopio (S) comprendente un involucro (2) che alloggia dei mezzi di igienizzazione o sterilizzazione (3, 3’, 3”), un’unità di comando e controllo (4) ed una batteria (5), detto dispositivo (1) comprendendo mezzi di aggancio allo stetoscopio (S) da igienizzare o sterilizzare, detti mezzi di aggancio essendo mezzi di aggancio magnetico o elettromagnetico (12), mezzi di aggancio meccanico (13) o una combinazione di essi, caratterizzato dal fatto che detto involucro (2) presenta verso l’esterno una rientranza che forma un cono (11) rovesciato, la cui base è aperta e sostanzialmente a livello della superficie esterna dell’involucro (2), detti mezzi di igienizzazione o sterilizzazione (3, 3’, 3”) essendo disposti in corrispondenza di detto cono (11). (FIGURA 1A

Can a UV-C box help the cinema industry by disinfecting video cameras?

UV-C has proven to be an effective virucide and microbicide, and its cost-effectiveness allowed it to spread as a disinfecting device in different environments. The study aims to determine the microbicide activity on S. Aureus, E. Coli and Sars-CoV-2 of the UV-C Boxer by Cartoni S.p.A. Three separate experiments were performed to assess the effectiveness of the UV-C disinfection by the box on different materials, on surfaces of a videocamera and on a specific carrier for Sars-CoV-2. In all three experiments, a significant abatement of bacterial and viral contamination was reached after 60 seconds on carriers and after 3 minutes on all examined surfaces of the video camera, with a higher reduction on glass carriers. UV-C devices may be a valuable tool to implement in the working routine to achieve a higher level of safety in work environments

Efficacy of violet–blue light to inactive microbial growth

The increase in health care-associated infections and antibiotic resistance has led to a growing interest in the search for innovative technologies to solve these problems. In recent years, the interest of the scientific community has focused on violet–blue light at 405 nm (VBL405). This study aimed to assess the VBL405 efficiency in reducing microbial growth on surfaces and air. This descriptive study run between July and October 2020. Petri dishes were contaminated with P. aeruginosa, E. coli, S. aureus, S. typhimurium, K. pneumoniae and were placed at 2 and 3 m from a LED light source having a wavelength peak at 405 nm and an irradiance respectively of 967 and 497 μW/cm2. Simultaneously, the air in the room was sampled for 5 days with two air samplers (SAS) before and after the exposition to the VBL405 source. The highest microbial reduction was reached 2 m directly under the light source: S. typhimurium (2.93 log10), K. pneumoniae (2.30 log10), S. aureus (3.98 log10), E. coli (3.83 log10), P. aeruginosa (3.86 log10). At a distance of 3 m from the light source, the greatest reduction was observed for S. aureus (3.49 log10), and P. aeruginosa (3.80 log10). An average percent microbial reduction of about 70% was found in the sampled air after 12 h of exposure to VBL405. VBL405 has proven to contrast microbial growth on the plates. Implementing this technology in the environment to provide continuous disinfection and to control microbial presence, even in the presence of people, may be an innovative solution