True bipolar or extended bipolar left ventricular pacing is associated with better survival in cardiac resynchronization therapy patients

BackgroundLimited studies are available on the clinical significance of left ventricular (LV) lead polarity in patients undergoing cardiac resynchronization therapy (CRT), with a recent study suggesting better outcomes with LV true bipolar pacing.ObjectiveWe aimed to determine whether true bipolar LV pacing is associated with reduced mortality in a large, real‐life CRT cohort, followed by remote monitoring.MethodsWe analyzed de‐identified device data from CRT patients followed by the Boston Scientific LATITUDE remote monitoring database system. Patients with LV bipolar leads paced between the LV ring and LV tip were identified as true bipolar and those with LV bipolar leads paced between LV tip or LV ring and right ventricular (RV) coil were identified as extended bipolar. Patients with unipolar leads were identified as unipolar.ResultsOf the 59 046 patients included in the study, 2927 had unipolar pacing, 34 390 had extended bipolar pacing, and 21 729 had true bipolar pacing. LV true bipolar pacing was associated with a significant 30% lower risk of all‐cause mortality as compared to unipolar pacing (hazards ratio [HR] = 0.70, 95% CI: 0.62‐0.79, P < .001), after adjustment for age, gender, LV lead impedance, LV pacing threshold, and BIV pacing percentage <95%. Extended bipolar LV pacing was also associated with 24% lower risk of all‐cause mortality when compared to unipolar LV pacing (HR = 0.76, 95% CI: 0.68‐0.85; P < .001). However, there were no differences in outcomes between true bipolar and extended bipolar LV pacing (HR = 0.97, 95% CI: 0.93‐1.01; P = .198).ConclusionTrue bipolar or extended bipolar LV pacing is associated with a lower risk of mortality in CRT patients as compared to unipolar LV pacing.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154901/1/pace13889_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154901/2/pace13889.pd

Hepatitis C virus: host, environmental and viral factors promoting spontaneous clearance

Hepatitis C virus (HCV) is a pathogenic entity which determines inflammation and liver damage through complex immune mechanisms. Although progress has been made in managing the disease course, chronic infection still remains a significant cause of morbidity and mortality to this day. Because both acute and chronic infection are often asymptomatic, chronic infection is frequently diagnosed when its complications have developed. In a small proportion of cases, the chronic infection does not develop, the immune system managing to cleanse the body from this silent pathogen in the absence of specific treatment, a process called spontaneous viral clearance, which occurs rarely, in about 20-30 % of cases. A competent immune response that manages to eliminate the virus from the organism was associated with IL-28B genetic polymorphism, female gender, young age, which often lead to clinical manifestations of acute hepatitis after initial exposure. Environmental factors such as limited viral exposure also play an important role. These factors and the mechanisms underlying spontaneous clearance are not fully understood but their action is complementary. In this paper, we review the concept of spontaneous clearance of HCV and assess the factors that have been associated with this clinical outcome of the infection

Regenerative medicine options in treating premature ovarian failure

Infertility is generally defined as the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. premature ovarian failure (POF) is a cause of female infertility, being estimated to affect 1% of the general population. This condition represents a loss of hormonal and germinative activity of the ovaries due to a lack in the number of active follicles in women under 40 years old. Regenerative medicine represents a complex therapeutic option and it consists of technologies such as the use of stem cells, tissue engineering, and gene therapy alone or in different combinations. Although the boundaries of regenerative medicine are not clearly outlined at present, this paper is aiming to review its possibility of treatment in the future in what concerns POF, focusing more on the use of stem cell therapy. Stem cell therapy could be a feasible therapeutic approach for POF as the cells can be easily obtained. However, additional clinical studies are needed because until now the majority of the literature focuses on animal models for the evaluation of the role of stem cells on treating POF. Additionally, the platelet-rich plasma (PRP) approach for POF should be kept in mind as it was shown to be useful in the regeneration of multiple types of tissue

The experience of Romanian physiotherapists in the management of postoperative rehabilitation of patients with total hip arthroplasty - content and criteria for completion of physiotherapy sessions

Background: Total hip arthroplasty (THA) is a procedure that removes damaged bone and car-tilage and replaces it with prosthetic components and is performed by orthopedics. Objective: management of post-operative rehabilitation of THA patients in terms of content and comple-tion criteria of physiotherapy sessions. The research aims to explore the experience of Romani-an physiotherapists about the content and completion criteria of physiotherapy sessions in-volved in the management of postoperative rehabilitation after THA. Methods: The method used in this study was a questionnaire-based survey, with 120 Romanian specialists in the field completing an online screening tool that contained, along with a socio-demographic question-naire, a series of questions about their professional experience. Results: One of the most im-portant results of the study is the identification of statistically significant associations between the completion criteria of physiotherapy sessions and three techniques included in the rehabil-itation program after THA: edema management, gait re-education exercises, and exercises to increase hip mobility. Conclusion: The the research revealed that the experience of Romanian specialists regarding postoperative rehabilitation after THA is concordant with the experience of specialists in the field, and can be used to develop and test an individualized therapeutic protocol and to design continuing professional training programs for physiotherapists in Romania

Scoliotic postural alignment in prepubertal children: somatoscopic analysis of anatomical landmarks and development of a working model to limit spinal changes

Background. The study aims to perform a somatoscopic analysis on a sample of 100 prepubertal children aged 10-14 years, girls and boys, who are diagnosed with scoliosis. Somatoscopic as-sessment is one of the most commonly used, therefore we thought that making a way of inter-preting the results could be useful to monitor postural attitude in children diagnosed with sco-liosis. Identifying the early onset of physical impairment in the spine with somatoscopy can be a key factor in maintaining optimal postural status. This approach may help in achieving a way of working that limits the negative effects of scoliosis on the subjects. Materials and methods. The selection of subjects is based on exclusion and inclusion criteria related to age, comorbidi-ties, therapeutic approach, and other criteria. Also, aspects that accompany the growth and de-velopment process of children in this prepubertal period and factors that may disturb this pro-cess are described in detail. Also in this context, we will present basic notions of body posture and etiopathogenesis of the onset of scoliotic deficiencies in children during this period of growth and development. Somatoscopic analysis is performed in the orthostatic position and is based on the identification of anatomical landmarks of the body concerning body posture. Re-sults. From the total analyzed scoliosis, n = 100, 74% are type „C” scoliosis and only 26% are type „S” and in terms of gender, 59% are girls and 41% boys; type „C1” (Cobb angle <100) scoliosis n = 60, with an angulation < 100 are 43.24% stabilized, therefore type „C1” scoliosis are more likely to be stabilized. „S”-type scoliosis with an angulation < 150 is only 3 cases repre-senting 11.53%, and those with an angulation from < 200 to < 400 are number 23 cases 88.64% which concludes that „S” type scoliosis is more aggressive and more difficult to manage. Con-clusions. Our study show that only 13% of the subjects had a regression of the angulation fol-lowing the kinetotherapy program, therefore the main objective remains to stabilize the scoli-osis attitude and limit the effects of this pathology. A regular assessment and somatotopic analysis resulting in a physiotherapy exercises program containing corrective postural postures and postural education is the most beneficial approach to stabilize the postural deficit

ERCP extraction of stones in situs inversus patients; state-of-the-art techniques

Situs inversus totalis (SIT) is a rare congenital disease that causes mirror transposition of the abdomino-thoracic structures. When such patients develop pathologies related to the bile duct, most commonly choledocholithiasis, the optimal diagnostic process can be hampered by the rarity of such a pathology and the lack of medical information on this topic. Once the diagnosis is established, through endoscopic ultrasound and MRCP, the patient is sent to perform ERCP, which requires tailored approaches for each case. We present the case of a 33-year-old patient who was previously documented with SIT. On admission she presented with abdominal pain and fever that started a week before presentation, so antibiotic therapy was initiated. Imaging investigations revealed intrahepatic gallstones, so she underwent ERCP the next day with the identification of an intrahepatic bile lake containing stones within. Naso-biliary drainage was placed and further 2 ERCP procedures followed, with the insertion of 3 plastic biliary stents. The evolution was favorable, until the complete removal of gallstones and remission of clinical symptoms. The patient was carefully monitored in the following two days and the stents were removed, being later discharged and monitored for a period of 6 months in which no biliary/digestive symptoms were noted

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin

Malnutrition as assessed by nutritional risk index is associated with worse outcome in patients admitted with acute decompensated heart failure: an ACAP-HF data analysis

Malnutrition is common at hospital admission and tends to worsen during hospitalization. This controlled population study aimed to determine if serum albumin or moderate and severe nutritional depletion by Nutritional Risk Index (NRI) at hospital admission are associated with increased length of hospital stay (LOS) in patients admitted with acute decompensated heart failure (ADHF). Serum albumin levels and lymphocyte counts were retrospectively determined at hospital admission in 1740 consecutive patients admitted with primary and secondary diagnosis of ADHF. The Nutrition Risk Score (NRI) developed originally in AIDS and cancer populations was derived from the serum albumin concentration and the ratio of actual to usual weight, as follows: NRI = (1.519 × serum albumin, g/dL) + {41.7 × present weight (kg)/ideal body weight(kg)}. Patients were classified into four groups as no, mild, moderate or severe risk by NRI. Multiple logistic regressions were used to determine the association between nutritional risk category and LOS

Standard comparison of local mental health care systems in eight European countries

Aims. There is a need of more quantitative standardised data to compare local Mental Health Systems (MHSs) across international jurisdictions. Problems related to terminological variability and commensurability in the evaluation of services hamper like-with-like comparisons and hinder the development of work in this area. This study was aimed to provide standard assessment and comparison of MHS in selected local areas in Europe, contributing to a better understanding of MHS and related allocation of resources at local level and to lessen the scarcity in standard service comparison in Europe. This study is part of the Seventh Framework programme REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care in Europe) project. Methods. A total of eight study areas from European countries with different systems of care (Austria, England, Finland, France, Italy, Norway, Romania, Spain) were analysed using a standard open-access classification system (Description and Evaluation of Services for Long Term Care in Europe, DESDE-LTC). All publicly funded services universally accessible to adults (>= 18 years) with a psychiatric disorder were coded. Care availability, diversity and capacity were compared across these eight local MHS. Results. The comparison of MHS revealed more community-oriented delivery systems in the areas of England (Hampshire) and Southern European countries (Verona - Italy and Girona - Spain). Community-oriented systems with a higher proportion of hospital care were identified in Austria (Industrieviertel) and Scandinavian countries (Sor-Trondelag in Norway and Helsinki-Uusimaa in Finland), while Loiret (France) was considered as a predominantly hospital-based system. The MHS in Suceava (Romania) was still in transition to community care. Conclusions. There is a significant variation in care availability and capacity across MHS of local areas in Europe. This information is relevant for understanding the process of implementation of community-oriented mental health care in local areas. Standard comparison of care provision in local areas is important for context analysis and policy planning.Peer reviewe

How much do Romanian medical students know about research ethics? A survey

Background: Although scientific research in Romania has continued to expand over the past 20 years, it is unclear how prepared the country’s students are to be involved in research and to publish the results of their work.Objectives: To assess Romanian medical students’ level of knowledge about research integrity and research ethics.Methods: A cross-sectional survey of 187 medical students (of which 70% were women) from Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, was performed between September 2017 and June 2018. The survey consisted of self-evaluation with respect to three aspects, namely knowledge of research in general, that of research integrity, and that of publication integrity. The self-evaluation was followed by a set of 17 questions that tested the respondent’s knowledge.Results: On average, the proportion of correct answers was 34% (range, 12%–65%). Whereas those who had assigned low grades to themselves (a score below 5) fared poorly (fewer correct answers) in the test that followed, those who rated themselves highly (a score of 5 or higher) did not fare as well as they were expected to. The majority of respondents (83%) were willing to learn more about research integrity through courses, workshops, training programmes, etc.Conclusion: The respondents showed a low level of knowledge related to both research integrity and current standards of reporting scientific research. This lacuna demonstrates the need to train students at the beginning of their academic life because more and more of them, both undergraduate and postgraduate, are likely to be involved in scientific research