Left atrial strain in patients with arterial hypertension

Background: Arterial hypertension (HTN) causes left ventricular (LV) cavity dysfunction even if ejection function (EF) remains preserved. Recent studies have shown that diastolic dysfunction and left atrial (LA) dilatation are also associated with myocardial dysfunction. The aim of the present study was to explore the nature of LA longitudinal function disturbances in hypertensive patients with normal LV and LA structure and conventional function parameters.Methods: Peak atrial longitudinal strain (PALS) was evaluated in 78 patients with systemic HTN and preserved EF (≥ 55%) divided in 41 patients with diastolic dysfunction but no hypertrophy (group HTNdd), and 37 patients with no diastolic dysfunction or hypertrophy (group eHTN). Results were compared with those from 38 age and gender-matched healthy controls.Results: Indexed LA area and indexed LA volume were within the normal range and not different between the two patient groups and controls. eHTN group had reduced global PALS (p &lt; 0.001) and four-and two-chamber average PALS (p &lt; 0.001 for both). Similar abnormalities were seen in HTNdd group but to a worse degree (P &lt; 0.01 for both). LV EF was not different between the eHTN and HTNdd groups compared to controls. LV E/e' ratio was the strongest predictor of reduced global PALS in both eHTN and HTNdd groups.Conclusion: Asymptomatic untreated HTN patients with preserved LVEF and normal diastolic function have compromised LA strain despite normal cavity size, consistent with preclinical LA myocardial dysfunction.</p

RV longitudinal deformation correlates with myocardial fibrosis in patients with end-stage heart failure

Objectives This study was performed to determine the accuracy of right ventricular (RV) longitudinal strain (LS) in predicting myocardial fibrosis in patients with severe heart failure (HF) undergoing heart transplantation. Background RVLS plays a key role in the evaluation of its systolic performance and clinical outcome in patients with refractory HF. Methods We studied 27 patients with severe systolic HF (ejection fraction 25% and New York Heart Association functional class III to IV, despite full medical therapy and cardiac resynchronization therapy) using echocardiography before heart transplantation. RV free wall LS, right atrial LS, sphericity index (SI), and tricuspid annular plane systolic excursion (TAPSE) were all measured. Upon removal of the heart, from the myocardial histologic analysis, the ratio of the fibrotic to the total sample area determined the extent of fibrosis (%). Results RV myocardial fibrosis correlated with RV free wall LS (r = 0.80; p < 0.0001), SI (r = 0.42; p = 0.01) and VO max (r = -0.41; p = 0.03), with a poor correlation with TAPSE (r = -0.34; p = 0.05) and right atrial LS (r = -0.37; p = 0.03). Stepwise multivariate analysis showed that RV free wall LS (β = 0.701, p < 0.0001) was independently associated with RV fibrosis (overall model R= 0.64, p < 0.0001). RV free wall LS was the main determinant of myocardial fibrosis. In the subgroup of patients with severe RV fibrosis, RV free wall LS had the highest diagnostic accuracy for detecting severe myocardial fibrosis (area under the curve = 0.87; 95% confidence interval: 0.80 to 0.94). Conclusions In late-stage HF patients, the right ventricle is enlarged, with reduced systolic function due to significant myocardial fibrosis. RV free wall myocardial deformation is the most accurate functional measure that correlates with the extent of RV myocardial fibrosis and functional capacity

Efficacy of SARS-CoV-2 Vaccination in Dialysis Patients: Epidemiological Analysis and Evaluation of the Clinical Progress

This study investigated the impact of the fourth COVID-19 pandemic wave on dialysis patients of Romagna territory, assessing the associations of vaccination status with infection risk, clinical severity and mortality. From November 2021 to February 2022, an epidemiological search was conducted on 829 patients under dialysis treatment for at least one month. The data were then analyzed with reference to the general population of the same area. A temporal comparison was also carried out with the previous pandemic waves (from March 2020 to October 2021). The epidemiological evolution over time in the dialysis population and in Romagna citizens replicated the global trend, as the peak of the fourth wave corresponded to the time of maximum diffusion of omicron variant (B.1.1.529). Of 771 prevalent dialysis patients at the beginning of the study, 109 (14.1%) contracted SARS-CoV-2 infection during the 4-month observation period. Vaccine adherence in the dialysis population of the reference area was above 95%. Compared to fully or partially vaccinated subjects, the unvaccinated ones showed a significantly higher proportion of infections (12.5% vs. 27.0% p = 0.0341), a more frequent need for hospitalization (22.2% vs. 50.0%) and a 3.3-fold increased mortality risk. These findings confirm the effectiveness of COVID-19 vaccines in keeping infectious risk under control and ameliorating clinical outcomes in immunocompromised patients

Novel echocardiographic techniques to assess left atrial size, anatomy and function

Three-dimensional echocardiography (3DE) and speckle tracking echocardiography (STE) have recently applied as imaging techniques to accurately evaluate left atrial (LA) size, anatomy and function. 3DE and off-line quantification softwares, have allowed, in comparison to magnetic resonance imaging, the most time-efficient and accurate method of LA volume quantification. STE provides a non-Doppler, angle-independent and objective quantification of LA myocardial deformation. Data regarding feasibility, accuracy and clinical applications of LA analysis by 3DE and STE are rapidly gathering. This review describes the fundamental concepts of LA 3DE and STE, illustrates how to obtain respective measurements and discuss their recognized and emerging clinical applications

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Right ventricular strain as a novel approach to analyze right ventricular performance in patients with heart failure

Speckle tracking echocardiography (STE) has recently applied as imaging technique to accurately evaluate right ventricular (RV) function. STE provides a non-Doppler, angle-independent and objective quantification of RV myocardial deformation. Data regarding feasibility, accuracy and clinical applications of RV strain are rapidly gathering, especially in the setting of heart failure patients. This review describes the fundamental concepts of RV-STE and discusses its emerging clinical applications, focusing on the useful of this technique in the clinical management of patients with advanced heart failure

Valutazione dell'idoneità a mansioni lavorative a rischio in base alla n.99/CU del 30.10.2007 (G.U. n. 266 del 15.11.2007). Esperienza della Sezione di Medicina Legale dell'Universtà di Ferrara

Studio retrospettivo su dati laboratoristici di dosaggio sostanze stupefacenti e/o psicotrope su matrice urinaria, relativi agli accertamenti di assenza di tossicodipendenza o di assunzione sporadica di tali sostanze, finalizzati al riconoscimento dell'idoneità a mansioni a rischio

Valutazione dell'efficacia dell'emoperfusione nell'avvelenamento da Paraquat

avvelenamento da Paraqua

Gaschromatography-mass spectrometry (GC-MS) determination of quetiapine in two non-fatal poisoning: diagnosis of intoxication and drug elimination monitoring

References Gaschromatography-mass spectrometry (GC-MS) determination of quetiapine in two non-fatal poisoning: diagnosis of intoxication and drug elimination monitoring Background Quetiapine is a benzazepinic derivate and part of the family of atypical antipsychotics. Is currently marketed to treat schizophrenia and prescribed in association with other drugs acting in the CNS. After oral administration and gastrointestinal absorption is exstensively metabolised by the liver, primarily by cytochrome P450, but the mayor plasma metabolites are inactive, and less than 1% of the dose is excreted as unchanged drug in the urine and feces. We report two cases of quetiapine's non-fatal intoxication: Case 1: woman, 59 years old, admitted to Emergency after ingestion of 1,4 gr of quetiapine (Seroquel 25 mg, 56 tablets). Case 2: woman, 54 years old, admitted to Emergency after ingestion of an unknown quantity of quetiapine. In both cases the time elapsed between assumption and hospitalization was unknown and each patient has taken quetiapine for suicidal purposes. Blood, urine and gastric lavage were collected for each patient and sent to our laboratory. The collection continues until quetiapine's elimination from blood.

CARDIAC “BALL OF WOOL”: A rare case of a solid interventricular hydatid cyst

A 49 years old Romanian lady was admitted to the department of infectious diseases because of dyspnoea, malaise and mild fever. Chest X-ray was normal. A 12 lead ECG demonstrated right bundle branch block, and a transthoracic echocardiography showed a mass in the mid inter-ventricular septum, measuring 40x25 mm, protruding into the right ventricular chamber. The mass had the appearance of a solid lesion iso-echoic with the myocardium with hypo-echoic zones inside, resembling a “ball of wool” (Figure 1), suggesting a myxoma. Otherwise, all echocardiographic parameters were normal, except a mild pulmonary hypertension (PAPs 35 mmHg). During laboratory investigations, serum antiechinococcus antibodies was positive. Various imaging investigations including CT scanning and echocardiography were undertaken, but no cysts were detected in the abdomen or chest, respectively. The cardiac mass was then studied in more detail: a three-dimensional echocardiography was performed to better appreciate the shape and the location of the mass for a cardio-surgical view (Figure 2). A cardiac magnetic resonance didn’t show specific features and indicated a probable tumour, such as echocardiography (Figure 3)