Case Report Primary Amyloidosis Manifesting as Cholestatic Jaundice after Laparoscopic Cholecystectomy

A 71-year-old female patient with cholelithiasis who had undergone laparoscopic cholecystectomy was admitted with obstructive jaundice (total bilirubin ∼6 mg/dL) three months later. An ERCP was performed, in which a gallstone was found, followed by a sphincterotomy and cleansing of the bile duct. Due to deterioration of jaundice (>25 mg/dL), a new, unsuccessful ERCP and stent placement was carried out. Because of ongoing cardiac failure, she underwent an echocardiogram which revealed restrictive cardiomyopathy possibly due to amyloidosis. A liver biopsy was performed, which was positive for amyloid deposits in the liver, and the diagnosis was confirmed by the detection of monoclonal IgG protein in urine. The patient's jaundice gradually deteriorated and she died one week later from hepatic insufficiency

Investigation of the parameters affecting the thermosiphonic phenomenon in solar water heaters

Cyprus is currently the leading country in the world with respect to the application of solar water heaters for domestic applications, with more than 93% of the houses equipped with such a system. The great majority of these solar water heaters are of the thermosiphonic type. Thermosiphonic is a natural phenomenon where the flow of the solar heated water from the collector to the storage tank occurs from a small flow created due to the difference in density between hot and cold water. The main advantage of such systems is that they do not require a pump for circulating the water and circulation exists as long as there is sunshine. This reduces the maintenance requirements and the system is foolproof. In spite of the fact that extensive analyses of the performance of solar water heaters has been carried out by numerous researchers, almost all of them concerned forced circulation systems which use a circulating pump. Currently, the knowledge on the parameters affecting the ‘thermosiphonic phenomenon’ is rather poor while on an international level (ISO and CEN committees) there isn’t any standard to test thermosiphon solar collectors. The deeper understanding of the ‘thermosiphonic phenomenon’ and the identification of the key parameters affecting it, is the main aim of a research project currently in process in Cyprus. In this work the first preliminary results of the experimental procedure are presented. More specifically, a special test rig was set up and equipped with all sensors necessary to measure all parameters that are most likely to affect the ‘thermosiphonic phenomenon’. All tests were conducted according to ISO 9459- 2:1995(E). The system was able to operate in various weather and operating conditions and could accommodate the change of inclination of the collector. Initially, the solar collector was tested according to EN12975-2:2006 in order to determine the thermal performance at a flow and operation conditions specified by the standard. Subsequently, the efficiency of the collector operating thermosiphonically was calculated based on quasi-dynamic approach. Finally, a series of correlations were attempted using the data acquired when the collector is operating themosiphonically which are the following: (i) the temperature difference of the water at the outlet and the inlet of the collector (ΔΤ) with the solar global radiation, (ii) the water mass flow with the solar global radiation, (iii) the water mass flow with the temperature difference of the water at the outlet and the inlet of the collector (ΔΤ). The results of the data analysis showed that these parameters are very well correlated between them since the coefficient of determination (R2) is over 0.91 in all cases

Effects of High-Intensity Interval Training versus Continuous Training on Physical Fitness, Cardiovascular Function and Quality of Life in Heart Failure Patients

Introduction Physical fitness is an important prognostic factor in heart failure (HF). To improve fitness, different types of exercise have been explored, with recent focus on high-intensity interval training (HIT). We comprehensively compared effects of HIT versus continuous training (CT) in HF patients NYHA II-III on physical fitness, cardiovascular function and structure, and quality of life, and hypothesize that HIT leads to superior improvements compared to CT. Methods Twenty HF patients (male:female 19:1, 64±8 yrs, ejection fraction 38±6%) were allocated to 12-weeks of HIT (10*1-minute at 90% maximal workload—alternated by 2.5 minutes at 30% maximal workload) or CT (30 minutes at 60–75% of maximal workload). Before and after intervention, we examined physical fitness (incremental cycling test), cardiac function and structure (echocardiography), vascular function and structure (ultrasound) and quality of life (SF-36, Minnesota living with HF questionnaire (MLHFQ)). Results Training improved maximal workload, peak oxygen uptake (VO2peak) related to the predicted VO2peak, oxygen uptake at the anaerobic threshold, and maximal oxygen pulse (all P<0.05), whilst no differences were present between HIT and CT (N.S.). We found no major changes in resting cardiovascular function and structure. SF-36 physical function score improved after training (P<0.05), whilst SF-36 total score and MLHFQ did not change after training (N.S.). Conclusion Training induced significant improvements in parameters of physical fitness, although no evidence for superiority of HIT over CT was demonstrated. No major effect of training was found on cardiovascular structure and function or quality of life in HF patients NYHA II-III

Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Meta-analysis Evaluating the Effect of Sodium-Glucose Co-Transporter-2 Inhibitors on the Risk for New-Onset Obstructive Sleep Apnea in Patients With Type 2 Diabetes Mellitus Regardless of Cardiovascular Disease at Baseline

[No abstract available

Generation of a “typical meteorological year” for Nicosia, Cyprus

The present study is concerned with the generation of a Typical Meterological Year for Nicosia, Cyprus. The above tool will be useful for the prediction and comparison of the performance and cost effectiveness of passive and active solar systems in the island. The Typical Meteorological Year was generated from available hourly meteorological data recorded during the period 1986–1992, using the Filkenstein-Schafer statistical method

Impaired oxygen kinetics in beta-thalassaemia major patients

Aim: Beta-thalassaemia major (TM) affects oxygen flow and utilization and reduces patients&apos; exercise capacity. The aim of this study was to assess phase I and phase II oxygen kinetics during submaximal exercise test in thalassaemics and make possible considerations about the pathophysiology of the energy-producing mechanisms and their expected exercise limitation. Methods: Twelve TM patients with no clinical evidence of cardiac or respiratory disease and 10 healthy subjects performed incremental, symptom-limited cardiopulmonary exercise testing (CPET) and submaximal, constant workload CPET. Oxygen uptake (Vo2), carbon dioxide output and ventilation were measured breath-by-breath. Results: Peak Vo2 was reduced in TM patients (22.3 ± 7.4 vs. 28.8 ± 4.8 mL kg-1 min-1, P &amp;lt; 0.05) as was anaerobic threshold (13.1 ± 2.7 vs. 17.4 ± 2.6 mL kg-1 min-1, P = 0.002). There was no difference in oxygen cost of work at peak exercise (11.7 ± 1.9 vs. 12.6 ± 1.9 mL min-1 W-1 for patients and controls respectively, P = ns). Phase I duration was similar in TM patients and controls (24.6 ± 7.3 vs. 23.3 ± 6.6 s respectively, P = ns) whereas phase II time constant in patients was significantly prolonged (42.8 ± 12.0 vs. 32.0 ± 9.8 s, P &amp;lt; 0.05). Conclusion: TM patients present prolonged phase II on-transient oxygen kinetics during submaximal, constant workload exercise, compared with healthy controls, possibly suggesting a slower rate of high energy phosphate production and utilization and reduced oxidative capacity of myocytes; the latter could also account for their significantly limited exercise tolerance. © 2008 Scandinavian Physiological Society

Prolonged oxygen kinetics during constant workload submaximal exercise is associated with disease severity in adult subjects with cystic fibrosis

BACKGROUND: The goal of this study was to explore the relation between oxygen kinetics during constant work load submaximal cardiopulmonary exercise test (CPET) and disease severity in adult subjects with cystic fibrosis. METHODS: Fourteen adult subjects with cystic fibrosis (CF; 8 males, 22 ± 4 y old) and a mean Schwachman score of 73 ± 11 and 10 healthy individuals (5 males, 29 ± 4 y old) underwent pulmonary function tests at rest, maximal and constant work load submaximal CPET on a cycloergometer. Breath-by-breath analysis was used for measuring oxygen kinetic parameters and the time constant (tau), expressing phase 2 of submaximal CPET. RESULTS: Subjects with CF had a significantly prolonged tau compared with healthy subjects (42.3 ± 21.5 vs 29.3 ± 6.4, s, P &amp;lt;.05). The tau during phase 2 was inversely correlated with FEV1(% pred) (r=-0.77, P =.001), breathing reserve (r=-0.74, P =.003),VO2peak (r=-0.53, P =.049),VO2/t slope (r = -0.58, P =.03), and Schwachman score (r = -0.80, P =.001). In a multivariate regression model including all the above variables, the Schwachman score (β= -0.697, P =.002) emerged as independent predictor of tau (R2 = 0.719, P =.001). CONCLUSIONS: We conclude that adult subjects with CF present significant prolonged oxygen kinetics during constant work load submaximal exercise in relation to disease severity. Thus, submaximal exercise should be considered the preferable CPET choice in adult patients with severe CF. © 2015 Daedalus Enterprises