Clinical Utility of Cardiovascular Magnetic Resonance Imaging for Diagnosis of Acute Myocarditis

Cardiac magnetic resonance imaging (CMR) is a novel imaging technique that may help differentiate between myocarditis and acute coronary syndrome and compares favorably to other imaging techniques because it also provides information on tissue consistency and characteristics. We herein present a case, whereby CMR was most useful in providing such a differential diagnosis

Clinical Utility of Cardiovascular Magnetic Resonance Imaging for Diagnosis of Acute Myocarditis

A 49 year-old patient with past medical history significant for arterial hypertension (treated with telmisartan 80 mg daily), presented to the emergency department with 18-hour gastric discomfort and fatigue. Five days prior to this presentation the patient had an episode of febrile gastroenteritis. The evening prior to presentation the patient had blood chemistries performed at an outside institution, where an increase of myocardial enzymes (troponin and CPK-MB) were noted. On presentation the patient was uncomfortable due to abdominal pain, but the clinical examination was almost normal. Blood pressure was 150/80 mmHg and heart rate was 60 beats/min. Cardiac S1 and S2 sounds where audible, without additional cardiac tones, murmurs, pericardial or pleural friction. There was no jugular venous distention, rales or peripheral edema present. Admission 12-lead electrocardiogram (ECG) demonstrated normal sinus rhythm with a rate of 60 beats/min, and early repolarization pattern with a slight J-point elevation in the lateral leads (I, aVL, V5, V6)

The ARIA-MASK-air® approach

Funding Information: The authors thank Ms Véronique Pretschner for submitting the paper. MASK‐air has been supported by Charité Universitätsmedizin Berlin, EU grants (EU Structural and Development Funds Languedoc Roussillon and Region PACA; POLLAR: EIT Health; Twinning: EIP on AHA; Twinning DHE: H2020; Catalyse: Horizon Europe) and educational grants from Mylan‐Viatris, ALK, GSK, Novartis, Stallergènes‐Greer and Uriach. None for the study. ® Publisher Copyright: © 2023 The Authors. Clinical and Translational Allergy published by John Wiley & Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.MASK-air®, a validated mHealth app (Medical Device regulation Class IIa) has enabled large observational implementation studies in over 58,000 people with allergic rhinitis and/or asthma. It can help to address unmet patient needs in rhinitis and asthma care. MASK-air® is a Good Practice of DG Santé on digitally-enabled, patient-centred care. It is also a candidate Good Practice of OECD (Organisation for Economic Co-operation and Development). MASK-air® data has enabled novel phenotype discovery and characterisation, as well as novel insights into the management of allergic rhinitis. MASK-air® data show that most rhinitis patients (i) are not adherent and do not follow guidelines, (ii) use as-needed treatment, (iii) do not take medication when they are well, (iv) increase their treatment based on symptoms and (v) do not use the recommended treatment. The data also show that control (symptoms, work productivity, educational performance) is not always improved by medications. A combined symptom-medication score (ARIA-EAACI-CSMS) has been validated for clinical practice and trials. The implications of the novel MASK-air® results should lead to change management in rhinitis and asthma.publishersversionpublishe

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Percutaneous treatments of liver metastases

Περίληψη Η μεταστατική νόσος του ήπατος αποτελεί ενα σημαντικό κλινικό πρόβλημα το οποίο λόγω της πολυπλοκότητας του απαιτεί προσέγγιση απο πολυεπιστημονική ομάδα που περιλαμβάνει χειρουργούς, ογκολόγους και επεμβατικούς ακτινολόγους. Οι ηπατικές μεταστάσεις δύναται να προέρχονται απο διάφορες πρωτοπάθεις εστίες που μπορούν να κατηγοριοποιηθούν σε τρείς μεγάλες κατηγορίες : ορθοκολικός καρκίνος, νευροενδοκρινείς όγκοι και μη ορθοκολικοί μη νευροενδοκρινείς όγκοι. Οι ορθοκολικές ηπατικές μεταστάσεις όπως και οι γαστρο-εντερο-παγκρεατικές νευροενδοκρινείς ηπατικές μεταστάσεις προέρχονται απο διασπορά κυρίως μέσω της πυλαίας φλέβας και του ενδοκοιλιακού λεμφικού συστήματος, καθιστώντας έτσι την εφαρμογή διαδερμικών τεχνικών δυνατή με σκοπό την ανακούφιση απο τα συμπτώματα και την επιμήκυνση της επιβίωσης. Σε αντίθεση οι μη ορθοκολικές μη νευροενδοκρινείς ηπατικές μεταστάσεις αναπτύσονται μέσω συστηματικής κυκλοφορίας, με μεγάλη πιθανότητα εξωηπατικής νόσου, καθιστώντας τις διαδερμικές θεραπείες να παρουσιάζουν χαμηλή εφαρμογή σε αυτη την κατηγορία ασθενών. Ενθαρρυντικά αποτελέσματα εχουν αναφερθεί κυρίως για ορθοκολικές ηπατικές μεταστάσεις σε ασθενείς οχι κατάλληλους για χειρουργική εκτομή, με θεραπείες κατάλυσης όπως θερμοκαυτηρίαση με ραδιοσυχνότητες (RFA), κατάλυση με χρήση μικροκυμάτων (MWA), κατάλυση με χρήση ηλεκτροπόρωσης (IRE), κατάλυση με χρήση λέιζερ (LITT). Ικανοποιητικά αποτελέσματα έχουν αναφερθεί και για ενδο-αρτηριακές θεραπείες με μετατροπή αρχικώς μη υποψήφιων ασθενών για χειρουργείο σε ασθενείς κατάλληλους για χειρουργική εκτομή, ως θεραπεία πρώτης γραμμής σε συνδυασμό με συστηματική χημειοθεραπεία και σε ασθενείς με ανθεκτικό νόσο στη χημειοθεραπεία. Οι ενδο-αρτηριακές θεραπείες περιλαμβάνουν : Ισχαιμικό εμβολισμό (TAE), κλασικό χημειοεμβολισμό (TACE), χημειοεμβολισμό με σωματίδια που εκλύουν χημειοθεραπευτικά (DEBs-TACE) και ραδιοεμβολισμό (RE). Η εργασία αυτή περιγραφεί τις διάφορες τεχνικές που δύναται να εφαρμοσθούν, σε ασθενείς με ηπατικές μεταστάσεις, διαδερμικώς από επεμβατικούς ακτινολόγους και τα αποτελεσματα τους. Προκειμένου να αυξήσουμε την επίγνωση όσον αφορά τον χειρισμό ασθενών που υποφέρουν απο ηπατικές μεταστάσεις, με την εφαρμογή διαδερμικών θεραπειών, είναι σημαντική η διενέργεια τυχαιοποιημένων μελετών όλων των ως άνω μεθόδων.Abstract Liver metastatic disease is a significant clinical problem which due to its complexity requires an approach by a multidisciplinary team that involves surgical and medical oncologists as well as interventional radiologists. Liver metastases may originate from numerous primary sites categorized into three major groups as following, colorectal cancer (CRC), neuroendocrine tumors (NETs), and non-colorectal non-neuroendocrine tumors (NCNNETs). Due to the fact that liver metastases develops to patients suffering from CRC and gut-endocrine tumors (GEP-NETs) mainly through the portal venous drainage and intra-abdominal lymphatics, a number of liver-directed therapies may be implemented in order to relief symptoms and prolong survival. In contrast non-colorectal liver metastases have reached the liver via the systemic circulation, with high probability of extrahepatic tumor deposits, thus lowering the implementation rate of loco-regional treatments. Encouraging results have been obtained, regarding survival mainly for CRC liver metastases to patients not suitable for surgical resection, with ablation treatments such as radiofrequency ablation (RFA), microwave ablation (MWA), irreversible electroporation (IRE), laser interstitial thermotherapy (LITT), as well as intra-arterial treatments, in order to stage downsize patients for potential curable resection, as a salvage treatment to chemo-refractory patients, or as a first line treatment. Such treatments include bland embolization (TAE), chemoembolization (TACE), chemoembolization with drug-eluting beads (TACE-DEBs) and selective internal radiation therapy (SIRT). This review describes the various techniques available, in the armamentarium of interventional radiologists, for treating patients with liver metastases, and their results. In order to increase awareness, regarding optimal management for patients suffering from liver metastases and implementation of percutaneous treatments, randomized controlled studies of all the above methods are needed

Uncontrolled diabetes resulting in diabetic cardiomyopathy in a young male patient and eventually presenting with a stroke

Diabetic cardiomyopathy (DCP) is defined as the cardiovascular damage present in diabetes patients, which is characterized by myocardial dilatation and hypertrophy, as well as a decrease in the systolic and diastolic function of the left ventricle, and its presence is independent of the coexistence of ischemic heart disease or hypertension. As in the case of the patient that we present here, DCP may be subclinical for a long time, before the appearance of serious clinical symptoms, signs and complications. DCP is poorly recognized by most physicians. Currently, there is no specific treatment for this pathologic entity. However, proper treatment of diabetes and its metabolic abnormalities in the primary care setting reduces the rates of this serious metabolic complication of diabetes. As this high-risk diabetic population is constantly rising, increasing the awareness of physicians for the serious metabolic complications of diabetes, especially in the primary care setting, will help in taking appropriate and early action towards the prevention of full -blown disease and decreasing disability and mortality