Physiotherapy Treatment of Obstetrics Brachial Plexus Palsy (OBPP) Erb - Duchenne by age group

Presentation: Obstetric Brachial Plexus Palsy is a damage of Brachial Plexus. The aim of Study: The importance of treatment Obstetric Brachial Plexus Palsy divided by age groups , Erb - Duchenne with the techniques of Bobath and Vojta. Material and methods:In the study were 30 cases in an 8-year timeframe. Wich 15 of these children have come within 3 months of birth. These entities are applied treatment techniques according to Bobath and Vojta. Result:Of the 30 cases in the study, 15 came within 3 months of their birth. Were treated with Bobath and Vojta techniques and have achieved 100%functional results and 90% aesthetic. 15 children come after this age, 8 arrivals within the first year of birth have reached 90% function and 80% aesthetic. 7 arrivals after 18 months have received 80% function and 70% aesthetics. In measuring the results have participated doctors orthopedic and neuro-pediatric of Q.S.U. "Mother Teresa" and Trauma. Conclusion:Determinant in the results:1. The degree of damage2. Time of arrival in treatment3. Treatment by age.Keywords: Obstetric Brachial Plexus Palsy, Erb-Duchenne, 30 cases, techniques Bobath and Vojta, Function, Aesthetics

Therapeutic Effect and Safety of Early Treatment of Patent Ductus Arteriosus with Oral Ibuprofen in Preterm Infants

Background: Patent ductus arteriosus (PDA) is a common problem encountered in premature infants, especially those with respiratory distress syndrome. PDA can lead to life-threatening complications. Intravenous ibuprofen was shown to be as effective and to cause fewer side effects. If ibuprofen is effective intravenously, it will probably be effective orally too. Aim: This study was designed to determine the effectiveness and safety of oral ibuprofen compared to IV ibuprofen or no intervention for closing a PDA in preterm infants with RDS. Material and methods: A prospective study, randomized, a blindfold was conducted in NICU, at UOGH "Koço Gliozheni", Tirana, from February 2010-August 2013. The study included a total of 128 preterm infants, 28-35 weeks, ≤2500gr birth weight, in the first 48-96 hours of life, with SDR and confirm the presence of DBA's (Ǿ≥1.5mm) by echocardiographic examination. Infants were treated with Ibuprofen oral, intravenous Ibuprofen, no medical interventions, in randomized order. The cycle of treatment: 10 + 5 + 5/mg/kg, every 24 hours. Were highlighted the basic characteristics of infants included in the study, the effectiveness of treatment (closure of DBA's), side effects, complications, and the effectiveness of treatment. For continuous variables were calculated the average and standard deviation. The p≤0.05 value was accepted as statistically significant. All tests are two-sided. RR and OR were presented with 95% CI. Results: 38 infants were treated with Ibuprofen oral, 35 infants with intravenous Ibuprofen and 37 infants underwent no medical intervention. The effectiveness of early treatment: DBA remained open, after early treatment, in 7foshnja (18.4%) in group oral Ibuprofen vs 20 infants (54%) in the group that did not undergo any medical intervention [RR = 0.34; 95% CI = 0.16-0.7; p = 0.04], vs 6 infants (17.1%) in the group of intravenous Ibuprofen [RR = 1.07; 95% CI = 0.4-2.8; p≥0.05]. There was observed no statistically significant change of direction of side effects and complications, p≥0.05. Conclusions: Oral Ibuprofen is an effective and safe alternative when used for the treatment of DBAs to babies born prematurely and with low birth weight.Keywords: DBA, preterm births, Ibuprofen, treatment of early/late, side effects, complication

Physiotherapy Treatment of Obstetrics Brachial Plexus Palsy (OBPP) Erb - Duchenne by age group

Presentation: Obstetric Brachial Plexus Palsy is a damage of Brachial Plexus. The aim of Study: The importance of treatment Obstetric Brachial Plexus Palsy divided by age groups, Erb - Duchenne with the techniques of Bobath and Vojta. Material and methods: In the study were 30 cases in an 8-year timeframe. Wich 15 of these children have come within 3 months of birth. These entities are applied treatment techniques according to Bobath and Vojta. Result: Of the 30 cases in the study, 15 came within 3 months of their birth. Were treated with Bobath and Vojta techniques and have achieved 100%functional results and 90% aesthetic. 15 children come after this age, 8 arrivals within the first year of birth have reached 90% function and 80% aesthetic. 7 arrivals after 18 months have received 80% function and 70% aesthetics. In measuring the results have participated doctors orthopedic and neuro pediatric of Q.S.U. "Mother Teresa" and Trauma. Conclusion: Determinant in the results: 1. The degree of damage2. Time of arrival in treatment3. Treatment by age

Impact of cavotricuspid isthmus ablation for typical atrial flutter and heart failure in the elderly—results of a retrospective multi-center study

IntroductionWhile in the CASTLE-AF trial, in patients with atrial fibrillation and heart failure with reduced ejection fraction, interventional therapy using pulmonary vein isolation was associated with outcome improvement, data on cavotricuspid isthmus ablation (CTIA) in atrial flutter (AFL) in the elderly is rare.MethodsWe included 96 patients between 60 and 85 years with typical AFL and heart failure with reduced or mildly reduced ejection fraction (HFrEF/HFmrEF) treated in two medical centers. 48 patients underwent an electrophysiological study with CTIA, whereas 48 patients received rate or rhythm control and guideline-compliant heart failure therapy. Patients were followed up for 2 years, with emphasis on left ventricular ejection fraction (LVEF) over time. Primary endpoints were cardiovascular mortality and hospitalization for cardiac causes.ResultsPatients with CTIA showed a significant increase in LVEF after 1 (p < 0.001) and 2 years (p < 0.001) in contrast to baseline LVEF. Improvement of LVEF in the CTIA group was associated with significantly lower 2-year mortality (p = 0.003). In the multivariate regression analysis, CTIA remained the relevant factor associated with LVEF improvement (HR: 2.845 CI:95% 1.044–7.755; p = 0.041). Elderly patients (≥ 70 years) further benefited from CTIA, since they showed a significantly reduced rehospitalization (p = 0.042) and mortality rate after 2 years (p = 0.013).ConclusionsCTIA in patients with typical AFL and HFrEF/HFmrEF was associated with significant improvement of LVEF and reduced mortality rates after 2 years. Patient age should not be a primary exclusion criterion for CTIA, since patients ≥70 years also seem to benefit from intervention in terms of mortality and hospitalization

Prophylactic rivaroxaban in the early post-discharge period reduces the rates of hospitalization for atrial fibrillation and incidence of sudden cardiac death during long-term follow-up in hospitalized COVID-19 survivors

Introduction: While acute Coronavirus disease 2019 (COVID-19) affects the cardiovascular (CV) system according to recent data, an increased CV risk has been reported also during long-term follow-up (FU). In addition to other CV pathologies in COVID-19 survivors, an enhanced risk for arrhythmic events and sudden cardiac death (SCD) has been observed. While recommendations on post-discharge thromboprophylaxis are conflicting in this population, prophylactic short-term rivaroxaban therapy after hospital discharge showed promising results. However, the impact of this regimen on the incidence of cardiac arrhythmias has not been evaluated to date.Methods: To investigate the efficacy of this therapy, we conducted a single center, retrospective analysis of 1804 consecutive, hospitalized COVID-19 survivors between April and December 2020. Patients received either a 30-day post-discharge thromboprophylaxis treatment regimen using rivaroxaban 10 mg every day (QD) (Rivaroxaban group (Riva); n = 996) or no thromboprophylaxis (Control group (Ctrl); n = 808). Hospitalization for new atrial fibrillation (AF), new higher-degree Atrioventricular-block (AVB) as well as incidence of SCD were investigated in 12-month FU [FU: 347 (310/449) days].Results: No differences in baseline characteristics (Ctrl vs Riva: age: 59.0 (48.9/66.8) vs 57 (46.5/64.9) years, p = n.s.; male: 41.5% vs 43.7%, p = n.s.) and in the history of relevant CV-disease were observed between the two groups. While hospitalizations for AVB were not reported in either group, relevant rates of hospitalizations for new AF (0.99%, n = 8/808) as well as a high rate of SCD events (2.35%, n = 19/808) were seen in the Ctrl. These cardiac events were attenuated by early post-discharge prophylactic rivaroxaban therapy (AF: n = 2/996, 0.20%, p = 0.026 and SCD: n = 3/996, 0.30%, p < 0.001) which was also observed after applying a logistic regression model for propensity score matching (AF: χ2-statistics = 6.45, p = 0.013 and SCD: χ2-statistics = 9.33, p = 0.002). Of note, no major bleeding complications were observed in either group.Conclusion: Atrial arrhythmic and SCD events are present during the first 12 months after hospitalization for COVID-19. Extended prophylactic Rivaroxaban therapy after hospital discharge could reduce new onset of AF and SCD in hospitalized COVID-19 survivors

Impact of Ivabradine on Inflammatory Markers in Chronic Heart Failure

Background. Inflammation plays a crucial role in the progression of chronic heart failure (CHF). Ivabradine is known to reduce the morbidity and mortality of patients with CHF under certain conditions. Beyond the reduction of heart rate, only limited knowledge exists about potential anti-inflammatory effects of ivabradine that might contribute to its benefit in CHF. Thus, the present study aimed to investigate the effect of ivabradine on systemic inflammation. Methods. In the present study, 33 patients with CHF due to dilated, ischemic, and hypertensive cardiomyopathy were treated with ivabradine according to the guidelines of the European Society of Cardiology (ESC). A number of circulating dendritic cells as well as inflammatory mediators were investigated using FACS analysis and ELISA, respectively, before and during ivabradine therapy. Results. Treatment with ivabradine resulted in a significant improvement of CHF symptoms as well as an increase in left ventricular ejection fraction. Moreover, ivabradine treatment led to a significant reduction of TNF-alpha (TNF-α) serum levels and a reconstitution of circulating dendritic cells which are known to be reduced in patients with CHF. Conclusion. We show that treatment with ivabradine in patients with CHF resulted in an improvement of HF symptoms and ejection fraction as well as a normalization of inflammatory mediators

Decrease in Circulating Dendritic Cell Precursors in Patients with Peripheral Artery Disease

Peripheral artery disease (PAD) is a common manifestation of atherosclerosis. Inflammation is important for initiation and progression of the disease. Dendritic cells (DCs) as antigen-presenting cells play an important role in the immune system. Therefore, we hypothesize that, in patients with PAD, DCPs might be reduced in blood due to their recruitment into the vascular wall and induce a proinflammatory response. The numbers of myeloid DCPs, plasmacytoid DCPs, and total DCPs were analyzed by flow cytometry in blood of patients with PAD (n=52) compared to controls (n=60). Femoralis plaques (n=12) of patients who underwent surgery were immunostained for CD209 and CD83 (mDCs) as well as CD304, CD123 (pDCs), and HLA-DR. In patients with PAD, a significant decrease in mDCPs, pDCPs, and tDCPs was observed. In immunostaining, markers indicative for mDCs (CD209: 16 versus 8 cells/0.1 mm2, P=0.02; CD83: 19 versus 5 cells/0.1 mm2, P=0.03) were significantly elevated in femoralis plaques compared to control vessels. We show for the first time that mDCPs, pDCPs, and tDCPs are significantly reduced in patients with PAD. Immunohistochemical analysis unraveled that the decrease in DCPs might be due to their recruitment into atherosclerotic plaques

Analysis of Metabolic Markers in Patients with Chronic Heart Failure before and after LVAD Implantation

Chronic heart failure (HF) is a clinical syndrome characterized by functional impairments of the myocardium. Metabolic and clinical changes develop with disease progression. In an advanced state, left ventricular assist devices (LVADs) are implanted for mechanical unloading. Our study aimed to assess the effects of LVAD implantation on the metabolic phenotypes and their potential to reverse the latter in patients with advanced HF. Plasma metabolites were analyzed by LC–MS/MS in 20 patients with ischemic cardiomyopathy (ICM), 20 patients with dilative cardiomyopathy (DCM), and 20 healthy controls. Samples were collected in HF patients before, 30 days after, and >100 days after LVAD implantation. Out of 188 measured metabolites, 63 were altered in HF. Only three metabolites returned to pre-LVAD concentrations 100 days after LVAD implantation. Pre-LVAD differences between DCM and ICM were mainly observed for amino acids and biogenic amines. This study shows a reversal of metabolite abnormalities in HF as a result of LVAD implantation. The etiology of the underlying disease plays an essential role in defining which specific metabolic parameter is altered in HF and reversed by LVAD implantation. Our findings provide a detailed insight into the disease pattern of ICM and DCM and the potential for reversibility of metabolic abnormalities in HF