Presumptive myocarditis with ST-Elevation myocardial infarction presentation in young males as a new syndrome. Clinical significance and long term follow up

<p>Abstract</p> <p>Background</p> <p>Acute myocarditis may mimic myocardial infarction, since affected patients complain of "typical" chest pain, the ECG changes are identical to those observed in acute coronary syndromes, and serum markers are increased. We describe a case series of presumptive myocarditis with ST segment elevation on admission ECG.</p> <p>Methods and Results</p> <p>From 1998 to 2009, 21 patients (20 males; age 17-42 years) were admitted with chest pain, persistent ST segment elevation, serum enzyme and troponine release. All but one patients had fever and flu-like symptoms prior to admission. No abnormal Q wave appeared in any ECG tracing, and angiography did not show significant coronary artery disease. Patients remained asymptomatic at long term follow-up, except 2 who experienced a late relapse, with the same clinical, electrocardiographic and serum findings as in the first clinical presentation.</p> <p>Conclusion</p> <p>Presumptive myocarditis of possible viral origin characterized by ST elevation mimicking myocardial infarction, good short term prognosis and some risk for recurrence is relatively frequent in young males and appears as a distinct clinical condition.</p

Can an ECG help prevent sudden death in young people?

A wide spectrum of diseases or conditions (genetically based or acquired), in the presence of triggering elements, can lead to arrhythmic events, having sudden death as a common result. The substrate of fatal arrhythmia depends on age: over 35 years old it is mainly represented by the instability of coronary heart disease. Up to 35 years of age, the substrate consists mainly of electrical or structural alterations of the heart of a genetic nature the main of which are i) idiopathic hypertrophic cardiomyopathy ii) arrhythmogenic cardiomyopathy of the right ventricle iii) congenital syndrome of long QT iv) congenital syndrome of short QT; v) Brugada syndrome. Each of these proarrhythmic genetic conditions has the prerogative of being able to be highlighted by an electrocardiogram: a simple and economical gesture that can lead directly to an important diagnosis, or at least make it suspected, addressing the subsequent evaluations. Formulating a diagnosis of this kind can minimize the risk of sudden death, through careful use of lifestyle advice, drugs, devices, procedures. It has been scientifically proved that identifying genetic conditions at risk of malignant arrhythmias in the athlete leads to a dramatic reduction in the risk of sudden death: on this basis, an electrocardiographic screening has become peremptory in many countries in order to be able to perform competitive sports (in Italy, for some years, also to be able to carry out non-competitive sports). Electrocardiographic screening should be considered for the entire youth population, regardless of participation in an organized sports activity program, as this can potentially mean saving young lives from sudden death

Etiology of newly-diagnosed cases of chronic liver disease in Southern Italy: results of a prospective multicentric study

The pattern of liver diseases has radically changed in our country over the last few decades. We prospectively collected data on the newly-diagnosed cases of chronic liver diseases in a region of southern Italy after about a decade from the last epidemiological study. We conducted a multicentric prospective study that enrolled 631 patients from 21 Liver Centers of the Campania region (Southern Italy) at their first hospital admission or at their first outpatient visit. In our cohort of 631 patients (367 males, 263 females), 397 (62.9%) were hepatitis C virus (HCV) positive, 75 (11.9%) were hepatitis B virus (HBV) positive, 8 (1.3%) were co-infected by HBV and HCV, 73 (11.6%) had an alcoholic liver disease and 64 (10.1%) had a nonalcoholic fatty liver disease. HBV infection was present in young people with a higher-than-expected prevalence, despite the vaccination program which should have involved this population. HCV chronic hepatitis still remains the most common cause of liver disease in our region. HBV infection still continues to represent a health problem in young people, despite the vaccination program

Silicon sensors for the BaBar vertex tracker: design, electrical tests and production quality control

We report on design, fabrication and test of the double-sided strip detectors (DSSD) for the BaBar vertex tracker. The total number of required sensors is 340, subdivided into 6 different shapes (5 rectangular and one trapezoidal). The strip design is a standard one, with polysilicon bias resistors and integrated decoupling capacitors on both sides. On the n-side the n(+) implants, perpendicular to the p(+) strips on the p-side, are insulated by individual p-stops. We have minimized the insensitive region at the edge of the detectors, so that the cut line is only 700 mu m from the axis of the first strip. Special care was put in the design of the trapezoidal (wedge) detector, in order to make the testing of production of this special sensor as easy as for the rectangular ones. The design and the controls have been optimized to reach the goal value of an average efficiency of 99% for the readout channels, taking into account not only broken capacitors, but also other faulty strips (shorted to neighbouring ones or drawing a high-leakage current). We present the results of electrical tests on about 200 detectors, belonging to all six different shapes, on capacitance, bias resistance, leakage current and capacitor yield. All results are compatible with the specifications required for the BaBar experiment

Does Timing of Ventricular Tachycardia Ablation Affect Prognosis in Patients With an Implantable Cardioverter Defibrillator? Results From the Multicenter Randomized PARTITA Trial

Optimal timing for catheter ablation of ventricular tachycardia is an important unresolved issue. There are no randomized trials evaluating the benefit of ablation after the first implantable cardioverter defibrillator (ICD) shock

The Geriatrician: The Frontline Specialist in the Treatment of COVID-19 Patients

On February 20, 2020, a man living in the north of Italy was admitted to the emergency room with an atypical pneumonia that later proved to be COVID-19. This was the trigger of one of the most serious clusters of COVID-19 in the world, outside of China. Despite aggressive restraint and inhibition efforts, COVID-19 continues to increase, and the total number of infected patients in Italy is growing daily. After 6 weeks, the total number of patients reached 128,948 cases (April 5, 2020), with the higher case-fatality rate (15,887 deaths) dominated by old and very old patients.This sudden health emergency severely challenged the Italian Health System, in particular acute care hospitals and intensive care units. In 1 hospital, geriatric observation units were created, the experience of which can be extremely useful for European countries, the United States, and all countries that in the coming days will face a similar situation. (C) 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine

Residual respiratory impairment after COVID-19 pneumonia

Abstract Introduction: The novel coronavirus SARS-Cov-2 can infect the respiratory tract causing a spectrum of disease varying from mild to fatal pneumonia, and known as COVID-19. Ongoing clinical research is assessing the potential for long-term respiratory sequelae in these patients. We assessed the respiratory function in a cohort of patients after recovering from SARS-Cov-2 infection, stratified according to PaO2/FiO2 (p/F) values. Method: Approximately one month after hospital discharge, 86 COVID-19 patients underwent physical examination, arterial blood gas (ABG) analysis, pulmonary function tests (PFTs), and six-minute walk test (6MWT). Patients were also asked to quantify the severity of dyspnoea and cough before, during, and after hospitalization using a visual analogic scale (VAS). Seventy-six subjects with ABG during hospitalization were stratified in three groups according to their worst p/F values: above 300 (n = 38), between 200 and 300 (n = 30) and below 200 (n = 20). Results: On PFTs, lung volumes were overall preserved yet, mean percent predicted residual volume was slightly reduced (74.8 ± 18.1%). Percent predicted diffusing capacity for carbon monoxide (DLCO) was also mildly reduced (77.2 ± 16.5%). Patients reported residual breathlessness at the time of the visit (VAS 19.8, p &lt; 0.001). Patients with p/F below 200 during hospitalization had lower percent predicted forced vital capacity (p = 0.005), lower percent predicted total lung capacity (p = 0.012), lower DLCO (p &lt; 0.001) and shorter 6MWT distance (p = 0.004) than patients with higher p/F. Conclusion: Approximately one month after hospital discharge, patients with COVID-19 can have residual respiratory impairment, including lower exercise tolerance. The extent of this impairment seems to correlate with the severity of respiratory failure during hospitalization