Cardiac hypertrophy and heart failure: from the case to review of literature

In response to an increased workload due to physiological or pathological stimuli, the heart may undergo a process of growth with increased muscle mass called cardiac hypertrophy. It is a particular mechanism of long term compensation used by the heart to adapt permanently to a greater workload. Although, through its peculiar structural, molecular and metabolic characteristics, in early stage the hypertrophy allows to maintain an adequate cardiac function, after a variable period of time, the same characteristics promote the evolution to contractile dysfunction and heart failure. The latter represents an important cause of death and so the cardiac hypertrophy increases the cardiovascular morbidity and mortality. In this paper we report a rare case of extremely high degree of concentric cardiac hypertrophy, with a heart weight of 1050 g and longitudinal diameter of 16.5 cm, transverse diameter of 16 cm and antero-posterior diameter of 9 cm. The thickness of the left ventricle free wall was 4.2 cm, of the septum 4.3 cm and at the apex level 3.5 cm. These data, compared with those described in scientific literature, indicate the exceptional nature of our necropsy finding of a huge cardiac hypertrophy. The analysis of the pathogenetic mechanisms, which may determinate the fatal event in case of cardiac hypertrophy, shows that in the described case the death cause can be the onset of heart failure in presence of cardiomegaly

Work-related allergic rhinitis: a contemporary review of the literature

Adverse health effects have been reported in workers exposed to inhaled allergens. Allergic rhinitis is a heterogeneous disorder that significantly affects daily activity, work productivity, sleep, learning, and quality of life in all generations. Occupational-ly-related hazards which contribute to the development of allergic rhinitis represent an important avoidable cause of morbidity. The occupational exposure to chemicals or biological agents is the cause of high incidences of allergic rhinitis and this risk is high when the organization and preparation are inadequate and there is a lacking or insufficient information, education and communication. The prevalence of work-related rhinitis, which encompasses both occupational rhinitis and work-exacerbated rhinitis, is estimated to be 31-61%. Data on occupational rhinitis itself are scarce. Although work-related asthma and allergies are a huge burden for society, investigation of oc-cupational exposures in early work life using an unexposed reference group is rare. Occupational allergic diseases are likely to worsen or become intractable as a result of continuous exposure to high concentrations of causative antigens, and are socioeco-nomically important diseases with which the patients might sometimes lose jobs due to work interruptions. It is important to adequately assess, communicate and manage risks in occupational chemical exposure settings with the aim to protect workers and the necessity to introduce periodic health examinations programs focusing on workers to monitor health and well-being and improve working conditions and the working environment

Early diagnosis of cardiovascular diseases in workers: role of standard and advanced echocardiography

Cardiovascular disease (CVD) still remains the main cause of morbidity and mortality and consequently early diagnosis is of paramount importance. Working conditions can be regarded as an additional risk factor for CVD. Since different aspects of the job may affect vascular health differently, it is important to consider occupation from multiple perspectives to better assess occupational impacts on health. Standard echocardiography has several targets in the cardiac population, as the assessment of myocardial performance, valvular and/or congenital heart disease, and hemodynamics. Three-dimensional echocardiography gained attention recently as a viable clinical tool in assessing left ventricular (LV) and right ventricular (RV), volume, and shape. Two-dimensional (2DSTE) and, more recently, three-dimensional speckle tracking echocardiography (3DSTE) have also emerged as methods for detection of global and regional myocardial dysfunction in various cardiovascular diseases, and applied to the diagnosis of subtle LV and RV dysfunction. Although these novel echocardiographic imaging modalities have advanced our understanding of LV and RV mechanics, overlapping patterns often show challenges that limit their clinical utility. This review will describe the current state of standard and advanced echocardiography in early detection (secondary prevention) of CVD and address future directions for this potentially important diagnostic strategy

Human enhancement: questioni biogiuridiche

Human Enhancement is a modification aimed to improve human’s characteristics and capabilities through scientific or technological interventions in the human body, starting from an ‘integrity condition’ and not from a state of disease. Therefore, we need to value if the enhancement is harmful of the human dignity or if it’s an useful tool to improve the human life’s condition. Methods: At first we focused on the bibliographic research dedicated to the HE’s classification through the analysis of health’s and enhancement’s definitions, confronting with the bio-juridical perspective as for example the possible negative effects over a person’s dignity, identity, freedom, equality; and comparing scientific and humanistic theories. We later examined in detail the national and the supranational legal framework of the last ten years, from the Science and Technology Options Assessment’s Human Enhancement Study to the Comitato Nazionale per la Bioetica’s opinions. Starting from this classification we located and analyzed some typologies of enhancement, using a medical social methodological approach and deepening each subject matter from both doctrinaire and jurisprudential profile. Results: Doping, cosmetic surgery and prenatal genetic enhancement’s prohibition are techniques already disciplined. Smart drugs and deep brain stimulation are techniques already disciplined for therapeutic purpose, but sometimes their application lies outside the disease’s therapy. Military and biological enhancementare techniques in an experimental phase. We have represented the particular difficulties inidentifying the limits of lawfulness of each of these typologies of enhancement. Conclusions: We could hypothesize a ‘case by case’ law’s approach, because it’s ductile and able to adapt on the peculiar characteristics of every single form of enhancement, evaluating at the same time political, legal, ethical, social and safety impact, in a context of inhomogeneity of the Human Enhancement Technologies that it doesn’t allow an uniform normative framework able to fully satisfy individual and collective needs.Background: Il potenziamento umano consiste in una modifica volta a migliorare caratteristiche e capacità umane attraverso interventi scientifici o tecnologici sul corpo umano, partendo da una “condizione di integrità” e non da uno stato di malattia. Occorre pertanto valutare se il potenziamento sia lesivo della dignità umana oppure strumento utile a migliorare le condizioni di vita dell’uomo. Metodi: In un primo momento si è proceduto alla ricerca bibliografica dedicata all’inquadramento dello HE mediante l’analisi dei concetti di salute e potenziamento, affrontando gli aspetti di pertinenza biogiuridica come ad esempio i possibili impatti negativi su dignità, identità, libertà ed uguaglianza, e mettendo a confronto teorie scientifiche ed umanistiche. In un secondo momento si è proceduto all’analisi dettagliata del quadro normativo nazionale e sovranazionale degli ultimi dieci anni, dallo Human Enhancement Study dello Science and Technology Options Assessment ai pareri del Comitato Nazionale per la Bioetica. A partire da tale inquadramento sono state individuate e trattate alcune tipologie di potenziamento, utilizzando un approccio metodologico medico sociale ed approfondendo ciascuna tematica sotto il profilo sia dottrinario sia giurisprudenziale. Risultati: Doping, chirurgia estetica e divieto di selezione eugenetica sono tecniche già disciplinate. Smart drugs e deep brain stimulation sono tecniche già disciplinate per utilizzo a scopo terapeutico, ma talvolta il loro utilizzo esula dalla cura di patologie. Potenziamento militare e Potenziamento biologico sono tecniche in fase sperimentale. Di ciascuna di esse sono state rappresentate le peculiari difficoltà nell’identificazione dei limiti di liceità. Conclusioni: Sembrerebbe ipotizzabile un approccio “case by case” del diritto, poiché duttile ed in grado di adattarsi alle caratteristiche peculiari di ogni singola forma di potenziamento valutandone al contempo l’impatto politico, legale, etico, sociale e di sicurezza, in un quadro di disomogeneità delle Tecnologie di Potenziamento Umano che non permette una cornice normativa unitaria in grado di soddisfare pienamente i bisogni individuali e collettivi

Dataset on the use of 3D speckle tracking echocardiography in light-chain amyloidosis

The dataset presented in this article is related to the research article entitled “Biventricular assessment of light-chain amyloidosis using 3D speckle tracking echocardiography: Differentiation from other forms of myocardial hypertrophy” (Vitarelli et al.,2018) [1], which examined the potential utility of left ventricular (LV) and right ventricular (RV) deformation and rotational parameters derived from three-dimensional speckle-tracking echocardiography (3DSTE) to diagnose cardiac amyloidosis(CA) and differentiate this disease from other forms of myocardial hypertrophy. The combined assessment of LV basal longitudinal strain, LV basal rotation and RV basal longitudinal strain had a high discriminative power for detecting CA. The data of this study provides more understanding on the value of LV 3DSTE deformation parameters as well as RV parameters in this particular cardiomyopathy

Assessment of biventricular function by three-dimensional speckle tracking echocardiography in adolescents and young adults with human immunodeficiency virus infection. a pilot study.

Background. The purpose of the study was to assess biventricular parameters of wall deformation with three-dimensional speckle tracking echocardiography (3DSTE) in adolescents and young adults with human immunodeficiency virus infection (HIV) on antiretroviral therapy in order to detect a possible subclinical myocardial dysfunction. Methods. Twenty-one patients aged 12 to 39years with HIV, 21 normal controls of the same age and sex, and 21 patients with idiopathic non-ischemic dilated cardiomyopathy (DCM) were studied with 3DSTE. All HIV patients were stable in terms of HIV infection, with no history of heart disease or other chronic systemic disease except HIV infection, and were on highly active antiretroviral therapy (HAART) with good immunological control. Standard echocardiographic measures of LV-RV function were assessed. 3D LV global longitudinal strain (GLS), circumferential strain, radial strain and LV twist (TW) were calculated. Global area strain (GAS) was calculated by 3DSTE as percentage variation in surface area defined by the longitudinal and circumferential strain vectors. 3D right ventricular (RV) global and free-wall longitudinal strain were obtained. Results. LV GLS and GAS were lower in HIV patients compared to normal controls (p=0.002, and p=0.01, respectively). There were no significant differences in LV ejection fractions between the groups. There was a weak positive correlation between LV GLS and age (r=0.215, p=0.034) and a weak negative correlation between LV GLS and nadir-CD4 T-cells count (r=0.198, p=0.043). DCM patients had more marked and widespread reduction in LV GLS and GAS compared to controls (p<0.001), whereas in HIV patients LV strain impairment (p<0.05) was more localized in basal and apical regions. RV free-wall longitudinal strain was significantly reduced in HIV patients when compared with the control group (p=0.03). No patient had pulmonary systolic pressure higher than 35mmHg. Conclusions. Three-dimensional speckle tracking echocardiography may help to identify HIV patients at high cardiovascular risk allowing early detection of biventricular dysfunction in the presence of normal LV ejection fraction and in the absence of pulmonary hypertension. LV strain impairment in HIV patients is less prominent and widespread compared to DCM patients

Both COVID-19 infection and vaccination induce high-affinity cross-clade responses to SARS-CoV-2 variants

The B.1.1.529 (omicron) variant has rapidly supplanted most other SARS-CoV-2 variants. Using microfluidics-based antibody affinity profiling (MAAP), we have characterized affinity and IgG concentration in the plasma of 39 individuals with multiple trajectories of SARS-CoV-2 infection and/or vaccination. Antibody affinity was similar against the wild-type, delta, and omicron variants (KA ranges: 122 ± 155, 159 ± 148, 211 ± 307 μM-1, respectively), indicating a surprisingly broad and mature cross-clade immune response. Postinfectious and vaccinated subjects showed different IgG profiles, with IgG3 (p-value = 0.002) against spike being more prominent in the former group. Lastly, we found that the ELISA titers correlated linearly with measured concentrations (R = 0.72) but not with affinity (R = 0.29). These findings suggest that the wild-type and delta spike induce a polyclonal immune response capable of binding the omicron spike with similar affinity. Changes in titers were primarily driven by antibody concentration, suggesting that B-cell expansion, rather than affinity maturation, dominated the response after infection or vaccination

De-Intensification of Antidiabetic Treatment Using Canagliflozin in Patients with Heart Failure and Type 2 Diabetes: Cana-Switch-HF Study

Canagliflozin is a sodium-glucose co-transporter 2 inhibitor that reduces glycemia as well as the risk of cardiovascular events. Our main objective was to analyze antidiabetic treatment de-intensification and the glycemic efficacy of replacing antidiabetic agents (excluding metformin) with canagliflozin in patients with heart failure and type 2 diabetes with poor glycemic control. In this observational, retrospective, real-world study, we selected patients treated with metformin in combination with ≥2 non-insulin antidiabetic agents or metformin in combination with basal insulin plus ≥1 non-insulin antidiabetic agent. Non-insulin antidiabetic agents were replaced with canagliflozin. Patients were followed-up on at three, six, and 12 months after the switch and a wide range of clinical variables were recorded. A total of 121 patients were included. From baseline to 12 months, the number of antidiabetic agents (3.1 ± 1.0 vs. 2.1 ± 0.8, p < 0.05), basal insulin dose (20.1 ± 9.8 vs. 10.1 ± 6.5 units, p < 0.01), and percentage of patients who used basal insulin (47.9% vs. 31.3%, p < 0.01) decreased. The proportion of patients who used diuretics also declined significantly. In addition, we observed improvement in glycemic control, with an increase in the proportion of patients with glycated hemoglobin <7% from 16.8% at three months to 63.5% at 12 (p < 0.001). Canagliflozin use was also beneficial in terms of body weight, blood pressure, heart failure status, functional class, and cardiovascular-renal risk. There were also reductions in the number of emergency department visits and hospitalizations for heart failure. Moreover, canagliflozin was well-tolerated, with a low rate of drug-related discontinuation. Mounting evidence from randomized controlled trials and real-world studies point to the beneficial profile of sodium-glucose co-transporter type 2 inhibitors such as canagliflozin in patients with heart failure.This work was supported by PI15/00256 from the Institute of Health “Carlos III” (ISCIII), co-funded by the Fondo Europeo de Desarrollo Regional-FEDER. Maria Isabel Queipo-Ortuño was supported by the “Miguel Servet Type II” program (CPI18/00003, ISCIII, Spain, co-funded by the Fondo Europeo de Desarrollo Regional-FEDER) and by the “Nicolas Monardes” research program of the Consejería de Salud (C-0030-2018, Junta de Andalucía, Spain. Bruno Ramos Molina was supported by the “Miguel Servet Type I” program (CP19/00098, ISCIII, Spain, co-funded by the Fondo Europeo de Desarrollo Regional-FEDER). Lidia Sanchez-Alcoholado was the recipient of a predoctoral grant (PE-0106-2019) from the Consejería de Salud y Familia (co-funded by the Fondo Europeo de Desarrollo Regional-FEDER, Andalucia, Spain). Aurora Laborda-Illanes was the recipient of a predoctoral grant, PFIS-ISCIII (FI19-00112), co-funded by the Fondo Europeo de Desarrollo Regional-FEDER, Madrid, Spain.Ye