The role of stress echocardiography in transcatheter aortic valve implantation and transcatheter edge-to-edge repair era: A systematic review

Objectives: In the last decade, percutaneous treatment of valve disease has changed the approach toward the treatment of aortic stenosis (AS) and mitral regurgitation (MR). The clinical usefulness of stress echocardiography (SE) in the candidates for transcatheter aortic valve implantation (TAVI) and transcatheter edge-to-edge repair (TEER) of MR remains to be established. Therefore, the key aim of this review is to assess the main applications of SE in patients undergoing TAVI or TEER. Methods: We searched for relevant studies to be included in the systematic review on PubMed (Medline), Cochrane library, Google Scholar, and Biomed Central databases. The literature search was conducted in February 2022. The inclusion criteria of the studies were: observational and clinical trials or meta-analysis involving patients with AS or MR evaluated with SE (excluding those in which SE was used only for screening of pseudo-severe stenosis) and treated with percutaneous procedures. Results: Thirteen studies published between 2013 and 2021 were included in the review: five regarding candidates for TEER and eight for TAVI. In TEER candidates, seeing an increase in MR grade, and stroke volume of > 40% during SE performed before treatment was, respectively, related to clinical benefits (p = 0.008) and an increased quality of life. Moreover, overall, 25% of patients with moderate secondary MR at rest before TEER had the worsening of MR during SE. At the same time, in SE performed after TEER, an increase in mean transvalvular diastolic gradient and in systolic pulmonary pressure is expected, but without sign and symptoms of heart failure. Regarding TAVI, several studies showed that contractile reserve (CR) is not predictive of post-TAVI ejection fraction recovery and mortality in low-flow low-gradient AS either at 30 days or at long-term. Conclusion: This systematic review shows in TEER candidates, SE has proved useful in the optimization of patient selection and treatment response, while its role in TAVI candidates is less defined. Therefore, larger trials are needed to test and confirm the utility of SE in candidates for percutaneous procedures of valve diseases

Klebsiella pneumoniae carrying multiple alleles of antigen 43-encoding gene of Escherichia coli associated with biofilm formation

A clinical strain of Klebsiella pneumoniae typed as sequence type 307 carrying three different alleles of the flu gene encoding the Escherichia coli virulence factor antigen 43 associated with biofilm formation was detected and characterized. The flu alleles are located in the chromosome inside putative integrative conjugative elements. The strain displays the phenotypes associated with Ag43, i.e. bi-phasic colony morphology and enhanced biofilm production. Furthermore, the strain produces low amount of capsule known to affect Ag43 function. Analysis of 1431 worldwide deposited genomes revealed that 3.7% Klebsiella pneumoniae carry one or two flu alleles

AVALIAÇÃO DE FLEXIBILIDADE, TENDER POINTS E NÍVEL DE ANSIEDADE E DEPRESSÃO EM PACIENTES COM SÍNDROME DA FIBROMIALGIA

A Síndrome da Fibromialgia (SFM) é uma síndrome complexa não inflamatória que acarreta prejuízos no desempenho profissional, social e pessoal. O projeto “Hidroterapia, exercícios aeróbios e alongamento no tratamento de fibromialgia” avalia, trata e orienta portadores de SFM. O objetivo deste estudo foi avaliar o quadro clínico por meio de comparação do antes e após intervenção de dois meses. Estudo de caráter qualitativo comparativo, com oito participantes do gênero feminino, com avaliação do questionário HADS, número de tender points e teste terceiro dedo-chão. A idade média da população foi de 47,25 ± 13,31 com Índice de Massa Corporal (IMC) de 27,91 ± 3,60, mostrando diminuição nos pontos dolorosos e no HADS domínio de depressão. Concluímos que a hidroterapia se mostrou efetiva nos quesitos diminuição do número de tender points e ressocialização, diminuindo quadro depressivo apresentado. Porém para maiores resultados é necessário um tratamento contínuo e assíduo

Stroke volume and myocardial contraction fraction in transthyretin amyloidosis cardiomyopathy: A systematic review

BackgroundCardiac amyloidosis (CA) is primarily a restrictive cardiomyopathy in which the impairment of diastolic function is dominant. Despite this, the left ventricular ejection fraction (LVEF) may be depressed in the late stage of the disease, but it poorly predicts prognosis in the earlier phases and does not represent well the pathophysiology of CA. Many echocardiographic parameters resulted important diagnostic and prognostic tools in patients with CA. Stroke volume (SV) and myocardial contraction fraction (MCF) may be obtained both with echocardiography and cardiac magnetic resonance (MRI). They reflect many factors intrinsically related to the pathophysiology of CA and are therefore potentially associated with symptoms and prognosis in CA.ObjectivesTo collect and summarize the current evidence on SV and MCF and their clinical and prognostic role in transthyretin (TTR-CA).Methods and resultsWe performed a systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We searched the literature database for studies focusing on SV and MCF in patients with TTR-CA. We analysed the following databases: PUBMED, Cochrane Library, EMBASE, and Web of Science database. Fourteen studies were included in the review. Both SV and MCF have important prognostic implications and are related to mortality. Furthermore, SV is more related to symptoms than LVEF and predicts tolerability of beta-blocker therapy in TTR-CA. Finally, SV showed to be an excellent measure to suggest the presence of TTR-CA in patients with severe aortic stenosis.ConclusionStroke volume and MCF are very informative parameters that should be routinely assessed during the standard echocardiographic examination of all patients with TTR-CA. They carry a prognostic role while being associated with patients’ symptoms.Systematic review registrationhttps://doi.org/10.17605/OSF.IO/ME7DS

AVALIAÇÃO DO DESEMPENHO FÍSICO DE IDOSOS PARTICIPANTES DE UM GRUPO DE ATIVIDADE FÍSICA DA ESTRATÉGIA DE SAÚDE DA FAMÍLIA NO MUNICÍPIO DE PRESIDENTE PRUDENTE/ SP

Com o aumento da expectativa de vida as incapacidades e a dependência, representam as maiores adversidades quando associada ao envelhecimento. Intervenções especializadas para o cuidado da saúde do idoso são necessárias para proporcionar um envelhecimento saudável. Participaram 16 idosos praticantes de atividade física, alocados em dois grupos: G1 < 60 anos (n=9) e G2 ≥ 60 anos (n=7), submetidos a uma avaliação do desempenho físico dos membros inferiores através do Short Physical Performance Battery – SPPB. O G1 apresentou maior pontuação para equilíbrio, maior tempo do teste de velocidade e menor tempo para a força dos membros inferiores quando comparados ao G2 e houve prevalência de desempenho moderado para ambos. O teste SPPB é um instrumento capaz de auxiliar os profissionais da saúde a identificar as incapacidades e dependências de idosos e através de programas de atividades físicas intervirem para um envelhecimento com maior qualidade de vida

AVALIAÇÃO DO DESEMPENHO FÍSICO DE IDOSOS PARTICIPANTES DE UM GRUPO DE ATIVIDADE FÍSICA DA ESTRATÉGIA DE SAÚDE DA FAMÍLIA NO MUNICÍPIO DE PRESIDENTE PRUDENTE/ SP

Com o aumento da expectativa de vida as incapacidades e a dependência, representam as maiores adversidades quando associada ao envelhecimento. Intervenções especializadas para o cuidado da saúde do idoso são necessárias para proporcionar um envelhecimento saudável. Participaram 16 idosos praticantes de atividade física, alocados em dois grupos: G1 < 60 anos (n=9) e G2 ≥ 60 anos (n=7), submetidos a uma avaliação do desempenho físico dos membros inferiores através do Short Physical Performance Battery – SPPB. O G1 apresentou maior pontuação para equilíbrio, maior tempo do teste de velocidade e menor tempo para a força dos membros inferiores quando comparados ao G2 e houve prevalência de desempenho moderado para ambos. O teste SPPB é um instrumento capaz de auxiliar os profissionais da saúde a identificar as incapacidades e dependências de idosos e através de programas de atividades físicas intervirem para um envelhecimento com maior qualidade de vida

Acute Delta Hepatitis in Italy spanning three decades (1991–2019): Evidence for the effectiveness of the hepatitis B vaccination campaign

Updated incidence data of acute Delta virus hepatitis (HDV) are lacking worldwide. Our aim was to evaluate incidence of and risk factors for acute HDV in Italy after the introduction of the compulsory vaccination against hepatitis B virus (HBV) in 1991. Data were obtained from the National Surveillance System of acute viral hepatitis (SEIEVA). Independent predictors of HDV were assessed by logistic-regression analysis. The incidence of acute HDV per 1-million population declined from 3.2 cases in 1987 to 0.04 in 2019, parallel to that of acute HBV per 100,000 from 10.0 to 0.39 cases during the same period. The median age of cases increased from 27 years in the decade 1991-1999 to 44 years in the decade 2010-2019 (p &lt; .001). Over the same period, the male/female ratio decreased from 3.8 to 2.1, the proportion of coinfections increased from 55% to 75% (p = .003) and that of HBsAg positive acute hepatitis tested for by IgM anti-HDV linearly decreased from 50.1% to 34.1% (p &lt; .001). People born abroad accounted for 24.6% of cases in 2004-2010 and 32.1% in 2011-2019. In the period 2010-2019, risky sexual behaviour (O.R. 4.2; 95%CI: 1.4-12.8) was the sole independent predictor of acute HDV; conversely intravenous drug use was no longer associated (O.R. 1.25; 95%CI: 0.15-10.22) with this. In conclusion, HBV vaccination was an effective measure to control acute HDV. Intravenous drug use is no longer an efficient mode of HDV spread. Testing for IgM-anti HDV is a grey area requiring alert. Acute HDV in foreigners should be monitored in the years to come

Physical performance status predicts mortality in aging patients undergoing pacemaker implantation

Background: Aging patients requiring pacemaker implantation are increasing worldwide. Frailty or reduced physical performance status may have an impact on clinical outcomes after pacemaker implantation. Methods: A prospective cohort of patients aged more than 70 years, admitted to the hospital for pacemaker implantation, was enrolled. Patients were evaluated with the Short Physical Performance Battery (SPPB) and Handgrip Strength Test at hospital discharge and at 1 year. Overall mortality was the primary study endpoint. Results: Out of the 119 patients, the majority (71%) of patients had reduced physical performance (defined by an SPPB score &lt;10 points). After a median follow-up of 46 months, the mortality was 31% of the population. SPPB value at discharge predicted death even after adjusting for pertinent confounders (adjusted hazard ratio 0.91, 95% confidence interval (CI) 0.84-0.99, P = 0.02). Patients with a poorer SPPB score at discharge (SPPB 0-3) had also an increased risk of death or rehospitalization at 1 year compared with patients with highest SPPB score (odds ratio OR 4.05, 95% CI 1-16.6). Conclusion: Reduced physical performance is associated with increased mortality in aging patients with bradyarrhythmia requiring pacemaker implantation. The identification of patients with poor SPPB may tailor specific interventions to improve physical performance and outcomes after pacemaker implantation

Physical performance status predicts mortality in aging patients undergoing pacemaker implantation

Background: Aging patients requiring pacemaker implantation are increasing worldwide. Frailty or reduced physical performance status may have an impact on clinical outcomes after pacemaker implantation. Methods: A prospective cohort of patients aged more than 70 years, admitted to the hospital for pacemaker implantation, was enrolled. Patients were evaluated with the Short Physical Performance Battery (SPPB) and Handgrip Strength Test at hospital discharge and at 1 year. Overall mortality was the primary study endpoint. Results: Out of the 119 patients, the majority (71%) of patients had reduced physical performance (defined by an SPPB score &lt;10 points). After a median follow-up of 46 months, the mortality was 31% of the population. SPPB value at discharge predicted death even after adjusting for pertinent confounders (adjusted hazard ratio 0.91, 95% confidence interval (CI) 0.84-0.99, P = 0.02). Patients with a poorer SPPB score at discharge (SPPB 0-3) had also an increased risk of death or rehospitalization at 1 year compared with patients with highest SPPB score (odds ratio OR 4.05, 95% CI 1-16.6). Conclusion: Reduced physical performance is associated with increased mortality in aging patients with bradyarrhythmia requiring pacemaker implantation. The identification of patients with poor SPPB may tailor specific interventions to improve physical performance and outcomes after pacemaker implantation

The occurrence of the psbS gene product in Chlamydomonas reinhardtii and in other photosynthetic organisms and its correlation with energy quenching

To avoid photodamage, photosynthetic organisms have developed mechanisms to evade or dissipate excess energy. Lumen overacidification caused by light-induced electron transport triggers quenching of excited chlorophylls and dissipation of excess energy into heat. In higher plants participation of the PsbS protein as the sensor of low lumenal pH was clearly demonstrated. Although light-dependent energy quenching is a property of all photosynthetic organisms, large differences in amplitude and kinetics can be observed thus raising the question whether a single common mechanism is in action. We performed a detailed study of PsbS expression/accumulation in Chlamydomonas reinhardtii and investigated its accumulation in other algae and plants. We showed that PsbS cannot be detected in Chlamydomonas under a wide range of growth conditions. Overexpression of the endogenous psbs gene showed that the corresponding protein could not be addressed to the thylakoid membranes. Survey of different unicellular green algae showed no accumulation of anti-PsbS reactive proteins differently from multicellular species. Nevertheless, some unicellular species exhibit high energy quenching activity, suggesting that a PsbS-independent mechanism is activated. By correlating growth habitat and PsbS accumulation in different species, we suggest that during the evolution the light environment has been a determinant factor for the conservation/loss of the PsbS function